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Generate impression based on findings. | Status post left mastectomy for breast cancer in 2006, presents today for routine follow up. No current breast complaints. Two standard and three implant displaced views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Right retropectoral saline implant is unchanged in contour and positioning. Benign-appearing calcifications are also unchanged. Benign appearing lymph nodes are projected over the right axilla, unchanged. No new mass, suspicious microcalcifications, or areas of architectural distortion in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Lymphoma CHEST:LUNGS AND PLEURA: Interval improvement in previously noted tree in bud opacities bilaterally.Interval improvement in scarlike opacity within the right major fissure. Right middle lobe micronodule no longer measurable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference segment 7 low attenuation lesion best seen on image 75 of series 3 measures 1.1 x 0.9 cm not significantly changed from the prior study. The reference segment 6 peripheral lesion best seen on image 11 of series 3 has also remained relatively stable measuring 2.2 x 1.6 cm. Stable hepatic dome hemangioma.A new low-attenuation focus within segment 5 is seen on image 84 series 3 now measures 1.2 x 0.6 cm.SPLEEN: Stable low-attenuation splenic focus best seen on image 84 series 3 measuring 0.8 x 0.9 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant mesenteric mixed fatty and solid lesion best seen on image 139 of series 3 now measures 1.6 x 2.2 cm and demonstrates interval change consistent with evolution of inflammatory process.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New subcentimeter segment 5 low-attenuation hepatic focus; would pay special attention to this lesion on future surveillance scans.Interval near resolution of tree in bud inflammatory lung findings.Otherwise stable examination. |
Generate impression based on findings. | Female 33 years old Reason: evaluate for obstruction History: hx of roux en Y, vomiting, constipation x 1 month, was diagnosed with SBO on 1/1/14 OSH ABDOMEN:LUNG BASES: Respiratory motion limits evaluation of the lung bases.LIVER, BILIARY TRACT: The patient is status post cholecystectomy and there is mild prominence of the common duct. There is mild intrahepatic biliary ductal dilatation as well.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post Roux-en-Y gastric bypass. There is mild prominence of the biliary limb measuring up to 2.4 cm in maximal diameter, which is nonspecific but could reflect mild obstruction. The jejunojejunal and gastrojejunal anastomoses are intact. The remainder of the small bowel is collapsed. There is large stool burden distributed throughout the colon.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The patient is status post Roux-en-Y gastric bypass. There is mild prominence of the biliary limb measuring up to 2.4 cm in maximal diameter, which is nonspecific but could reflect mild obstruction. The jejunojejunal and gastrojejunal anastomoses are intact. The remainder of the small bowel is collapsed. There is a large stool burden distributed throughout the colon.BONES, SOFT TISSUES: No significant abnormality noted | 1.Postsurgical changes related to Roux-en-Y gastric bypass with mild prominence of the biliary limb, which could reflect mild obstruction. 2.Prominence of the common bile duct and intrahepatic biliary ducts most likely reflects postoperative sequelae from prior cholecystectomy. |
Generate impression based on findings. | 8-year-old female with supracondylar fracture, AVN.VIEWS: Right elbow AP/lateral (two views), 1/6/2015, 916 hours. Healed supracondylar fracture in anatomic alignment. Irregularity of the capitellum consistent with history of AVN. | Healed supracondylar fracture. |
Generate impression based on findings. | Female 59 years old Reason: intraabdominal abscess History: bacteremia ABDOMEN:LUNG BASES: A central venous catheter tip is seen at the cavoatrial junction.LIVER, BILIARY TRACT: Nodular hepatic contour, hepatomegaly and widening of the fissures suggests chronic liver disease. There is persistent prominence of the common duct now measuring 1.9 cm in maximal diameter, which is unchanged. No biliary duct stones are evident, suggesting a benign stricture as the etiology. Gastroesophageal varices suggest portal hypertension.SPLEEN: No significant abnormality notedPANCREAS: Anterior positioning of the pancreatic duct in relation to the common bile duct suggesting chronic divisum. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evaluation of the ascending colon is limited by underdistention; however, suggestion of wall thickening and possible fat density in the wall suggests chronic inflammation, and clinical correlation is recommended.BONES, SOFT TISSUES: Lucent lesion with sclerotic border in the right iliac bone has a benign appearance and was not hypermetabolic on the prior PET scan.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lucent lesion with sclerotic border in the right iliac bone has a benign appearance and was not hypermetabolic on the prior PET scan. | 1.No evidence of intraabdominal abscess or explanation for the patient's bacteremia evident.2.Unchanged dilatation of the common duct without evidence of choledocholithiasis, suggestive of a benign stricture as previously described on the M.R.C.P. examination from 12/30/2014.3.Findings consistent with chronic liver disease with suggestion of portal hypertension.4.Evaluation of the ascending colon is limited by underdistention; however, suggestion of wall thickening and possible fat density in the wall suggests chronic inflammation, and clinical correlation is recommended to exclude superimposed acute infection/inflammation. |
Generate impression based on findings. | Right lower quadrant pump is partially visualized on the scout view. Catheter is seen entering the spinal canal at the L2-L3 level. Catheter courses dorsally in the subdural space with tip at the T10-T11 level. Contrast injection demonstrates opacification of the subdural space.Vertebral body heights and alignment in the thoracic spine are normal. No significant spinal canal or neural foramina stenosis is seen at any level.Incidentally seen is enlargement of the left thyroid lobe with hypodense nodule measuring 1.7 cm. | 1. Spinal catheter tip is at the T10-T11 level and is subdural in location. 2. Incidentally seen is enlargement of the left thyroid lobe with hypodense nodule measuring 1.7 cm. Consider ultrasound for further evaluation as clinically indicated.Dr. Ali discussed findings with Dr. Malik at 1030 hrs on 1/6/2015. |
Generate impression based on findings. | Pain. Healing? Again seen is a plate and screw device affixing the first metatarsophalangeal joint in near-anatomic alignment. I see no hardware complications. The articulation is narrowed but remains visible at this time. Mild osteoarthritis affects the interphalangeal joints | Orthopedic fixation of the first metatarsophalangeal joint as described above. |
Generate impression based on findings. | Reason: metastatic lung CA to liver, pancreas, lung. followup scan History: weight loss CHEST:LUNGS AND PLEURA: Postsurgical scarring with volume loss and radiation reaction in the right hemithorax.Multiple bilateral pulmonary metastases, increased in size and number.Left upper lobe reference nodule (series 5/33): 13 x 14 mm, increased from 9 x 10 mm.Left lower lobe reference nodule (series 5/97): 15 x 11 mm, increased from 11 x 9 mm.Marked increase in a nodule in the left base (series 5/88) with new surrounding groundglass opacity which may represent hemorrhage.Minimal right pleural effusion, unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple upright metastases, increased from previous.The reference left lobe lesion measures 57 x 40 7 mm, increased from 53 x 33 mm previously (series 3/92), with associated biliary dilation in the left lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts.PANCREAS: Poorly defined mass in the body of the pancreas, compatible with a metastasis, measures 31 by 23 mm, increased from 22 x 16 mm previously (series 3/111).RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy with a conglomerate group of lymph nodes in the porta hepatis measuring approximately 17 mm, increased from 14 mm previously (series 3/102).BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval progression of disease in the lungs, liver, pancreas and gastrohepatic lymph nodes. |
Generate impression based on findings. | 50 year old female with nausea, vomiting, and abdominal pain. Evaluate for gastroparesis. The patient was unable to tolerate the exam and only immediate images were obtained which are nondiagnostic. | Nondiagnostic gastric emptying study. |
Generate impression based on findings. | 57 years old, Female, Reason: 57 yo female with history of jejunal mass seen on July 2014 MRI/MRE. Please evaluate for internal change. Per radiologist, please us Volumen as oral contrast. History: Intraabdominal mass, abnormal MRI abdomen ABDOMEN:LUNG BASES: Centrilobular emphysema.LIVER, BILIARY TRACT: Hepatic hypodensity in the left hepatic lobe is not significantly changed since 2012. Cholelithiasis without evidence of cholecystitisSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Bilobed, exophytic, heterogeneously enhancing mass in the proximal jejunum is again noted. It appears similar in size, accounting for differences in imaging modality, measuring 2.2 x 2.4 cm (series 4, image 56), measuring 2.6 x 2.5 cm on recent MRI. The mass appears to be in a slightly different orientation compared to the MRI and measures 3.3 x 2.3 cm in the coronal plane (series 80336, image 61). There is no evidence of associated obstruction or adjacent bowel wall thickening. This may represent a neurofibroma in a patient with known neurofibromatosis.Previously mentioned small nodular enhancing focus in the duodenum is not visualized on this exam.BONES, SOFT TISSUES: Questionable neurofibroma skin lesion in the anterior upper abdominal wall (series 4, image 25).PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus is present.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Exophytic mass of the proximal jejunum appears unchanged in size given differences in modality.2.Stable hepatic hypodensity, likely benign.3.Fibroid uterus. |
Generate impression based on findings. | Female 50 years old; ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 2.5 x 2.3 cm hepatic segment 8 lesion with hypoattenuated appearance relative to background liver on noncontrast imaging. Discontinuous peripheral nodular enhancement seen in arterial phase of postcontrast imaging. Progressive central filling in of lesion seen in venous phase with intralesional retention of contrast noted in delayed phase, image 13 series 9. There is no evidence of washout in the delayed phase. Constellation of findings compatible with a hepatic hemangioma. Additional 3-mm focus suggested more medially at level of hepatic dome, seen only in arterial phase, may be an additional small flashfilling hemangioma, image 11 series 5.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Scattered subcentimeter sclerotic foci, for example, in left femoral head, most likely bone islands. | Outside exam read:1. Findings compatible with a hepatic segment 8 hemangioma as described. Additional subcentimeter flashfilling hemangioma also suggested in region of hepatic dome. |
Generate impression based on findings. | Right knee pain status post quad rupture in 2014. Four views of the right knee are provided. The patella is low lying, and there is heterotopic ossification within the extensor mechanism anterior to the distal femoral metadiaphysis, compatible with the stated history of prior quadriceps tendon rupture. Lucencies within the patella likely reflect prior quadriceps tendon repair. Moderate osteoarthritis affects the knee. Small linear metallic densities are noted within the soft tissues along the lateral cortex of the proximal tibial metadiaphysis, perhaps representing small foreign bodies. Mild to moderate osteoarthritis affects the left knee as seen on the frontal views. | Findings compatible with prior quadriceps tendon rupture and osteoarthritis as described above. |
Generate impression based on findings. | 62 year-old female with hyperparathyroidism. Following injection, intraoperative probe localization was performed. No images were acquired. | Successful injection for intraoperative identification of parathyroid adenoma. |
Generate impression based on findings. | Evaluate ankle Fracture Three views of the left ankle reveal a nondisplaced spiral fracture of the distal fibula that extends down to the joint line. There is also a posterior malleolar fracture in anatomic alignment. The fracture lines are indistinct consistent with healing. No change in position from previous. | Healing ankle fractures in anatomic alignment |
Generate impression based on findings. | Ms. Turner is a 53 year old female who presents for short-term follow-up for a mass in the left breast. No family history of breast cancer. Three standard views of both breasts and two left Spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There has been an interval decrease in size of a previously described focal asymmetry in the left lateral breast, 3 o'clock position, compatible with a benign etiology such as an involuting cyst. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Interval decrease in size of left lateral breast asymmetry, probably due to involution of a benign cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Frontal sinus: There is mild mucosal thickening along the left frontal ethmoidal recess. The frontal sinus and right frontoethmoidal recess are clear. Anterior ethmoids: Trace mucosal thickening is present in scattered bilateral anterior ethmoid air cells.Maxillary sinuses: There is scattered trace mucosal thickening in the maxillary sinuses. The ostiomeatal units are clear, although there is narrowing of the left infundibulum secondary to mild mucosal thickening.Posterior ethmoids: There is trace mucosal thickening in posterior ethmoid air cells.Sphenoid sinus: There is trace mucosal thickening in both sphenoid sinuses. Bilateral sphenoethmoidal recesses are clear. There is minimal leftward nasal septal deviation with a 3-mm leftward directed bony spur. Bilateral concha bullosa are present. Aerated secretions are present in the right concha. The nasal turbinate morphology is otherwise within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.There are scattered dental caries as well as multiple areas of periradicular as well is periapical lucency suggestive of endodontal and periodontal disease. There is minimal fluid opacification of a few right mastoid air cells. Irregular opacities are noted in the external auditory canals bilaterally, which are nonspecific but likely dense cerumen. | 1. Very minimal scattered sinus inflammatory changes without CT evidence of acute sinusitis.2. Minimal leftward nasal septal deviation.3. Multiple dental caries with suggestion of periodontal and endodontal disease, for which correlation with dental exam is recommended. |
Generate impression based on findings. | Male 11 months old Reason: out toeing hip contracture History: outtoeing hip contractureVIEWS: Pelvis AP and frog leg 1/6/15 (two views) Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. | Normal examination. |
Generate impression based on findings. | Female 88 years old Reason: Patient came in with severe sepsis of unclear source, wish to examine for abscess/fluid collections. Has CKD so unable to receive IV contrast History: Severe sepsis with unclear source ABDOMEN:LUNG BASES: New small bilateral pleural effusions with associated compressive atelectasis. There is a large hiatal hernia, likely sliding type.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Lobulated exophytic fluid density lesion arising from the interpolar region of the left kidney suggestive of a minimally complex renal cyst.RETROPERITONEUM, LYMPH NODES: There mild atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. There is a large lateral hernia, likely sliding type.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: There is a Foley catheter in place, with a focus of gas in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. There is a large lateral hernia, likely sliding type.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine. | 1.No specific finding seen to account for the patient's sepsis.2.New small bilateral pleural effusions with associated compressive atelectasis.3.Large sliding type hiatal hernia. |
Generate impression based on findings. | Smoldering myeloma. Screening to rule out lytic lesions. SKULL: There are small lucencies within the calvarium that I suspect represent venous lakes rather than myelomatous deposits.CERVICAL SPINE: I see no discrete lytic lesions. Degenerative arthritic changes affect the cervical spine, particularly at the lower cervical levels. Calcifications in the soft tissues lateral to the cervical spine likely reside in the carotid vasculature.THORACIC SPINE: I see no discrete lytic lesions. Tiny anterior vertebral body osteophytes are noted. LUMBAR SPINE: I see no discrete lytic lesions. Mild degenerative disk disease affects the lumbar spine.RIBS: I see no discrete lytic lesions. Mild osteoarthritis affects the acromioclavicular joints bilaterally.PELVIS: I see no discrete lytic lesions. Moderate osteoarthritis affects both hip joints.UPPER EXTREMITY: Two views of the right humerus reveal no discrete lytic lesions.Two views of the left humerus reveal no discrete lytic lesions. There is mild spurring along the greater tuberosity of the humeral head.AP views of the forearms reveal no discrete lytic lesions. Mild osteoarthritis affects the elbows bilaterally.LOWER EXTREMITY: Two views of the right femur reveal no discrete lytic lesions. There is mild thickening of the cortex along the lateral aspect of the mid to distal femoral diaphysis which may represent an old healed stress fracture, but this is equivocal. There is chondrocalcinosis of the menisci and articular cartilage of the knee.Two views of the left femur reveal no discrete lytic lesions. There is chondrocalcinosis of the menisci and articular cartilage of the knee.AP view of the right tibia/fibula reveals no discrete lytic lesion. Deformity of the distal tibia may reflect old trauma. Well corticated ossicles distal to the lateral and medial malleoli may likewise reflect old trauma. The AP view of the left tibia/fibula reveals no discrete lytic lesions. | No definite lytic lesions. Small lucencies in the skull are favored to represent venous lakes. Degenerative arthritic changes as described above. |
Generate impression based on findings. | Female; 67 years old. Reason: missing lap sponge History: missing lap sponge Single AP oblique view of the skull demonstrates a bandlike radiopacity projecting over the left temporoparietal region, which after discussion with the surgical resident in the operating room (Dr. Fuller) likely represents a known surgical drain in this location. Otherwise, we see no evidence of retained surgical foreign body. There are multiple soft tissue clips in the left neck. Multiple plates with screws, a surgical mesh-like device, and a fibular allograft project over the left facial bones. Endotracheal and enteric tubes are seen. Dental hardware.Single AP view of the left femur demonstrates skin staples, clips, and tubing projecting over the soft tissues. No evidence of retained surgical foreign body.Single AP view of the left tibia/fibula demonstrates skin staples, clips, and tubing projecting over the soft tissues. Postsurgical changes of the left fibular allograft harvesting with resection of most of the fibular diaphysis. Mild soft tissue emphysema. No evidence of retained surgical foreign body. | No evidence of retained surgical foreign body. A bandlike opacity projecting over the left temporoparietal region is likely a drain, after discussing the finding with Dr. Fuller in the operating room. These findings were discussed with Dr. Fuller and the circulating nurse (Marvin Glenn) both in the operating room by telephone at approximately 9 a.m. on 1/6/2015. Though Dr. Lawrence Gottlieb, the attending surgeon, was not available for direct communication, the findings were discussed with Dr. Tezen, a surgical resident who was with Dr. Gottlieb, at approximately 9 a.m. on 1/6/2015. |
Generate impression based on findings. | Reason: target ventricles for surgery today History: hydrocephalus, aqueductal stenosis There are bilateral ventriculostomy tubes coursing through the frontal lobes into the lateral ventricles with tips near the region of the foramen of Monro. Additionally there is a right parietal entry ventriculostomy tube coursing into the trigone of the left right lateral ventricle with tip in the body of the right lateral ventricle. These are in stable position when compared to the previous exam.The biventricular diameter at the level of foramina of Monro and at the tip of the right frontal ventriculostomy catheter is currently 36 mm and previously was 46 mm. A third ventricular diameter was previously 11 mm and is currently 4 mm .There is redemonstration of colpocephaly.Small fluid fluid levels are present in the occipital horns of the lateral ventricles. A subependymal calcification is present at the trigone of the left lateral ventricle.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Since the previous exam the lateral ventricles and third ventricle have decreased in size.2.Hyperdense fluid within the lateral ventricles is suspected to represent a small amount of blood.3.A small calcification is present in the left lateral ventricle which is likely dystrophic or related residua from old congenital infection.4.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Male 69 years old Reason: HCC on observation, evaluate for disease progression CHEST:LUNGS AND PLEURA: Trace fluid again seen in the right major fissure.MEDIASTINUM AND HILA: Aortic valve replacement. Severe coronary arterial calcifications. Dense atherosclerotic calcifications of the thoracic aorta and its branches. Postoperative changes related to sternotomy and CABG. Stable appearance of the right hilum. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postoperative changes related to right hepatectomy with associated compensatory left lobe hypertrophy again seen.There is redemonstration of multiple foci with arterial enhancement, but without washout in the left lobe abutting and near the resection margin, increased in size, with the largest now measuring 2.4 x 2.5 cm (image 27, series 6), previously measuring 1.4 x 1.3 cm. Enhancement imaging characteristics of these lesions is similar to the primary lesion seen on the 6/23/2011 exam.Superior to the ablation zone, there is an arterially enhancing lesion without definite washout, which now measures 1.9 x 2.3 cm (image 21, series 6), previously 1.0 x 1.1 cm.There are multiple small nodules along the anterior peritoneum near the right hepatic lobe resection site, which enhance during arterial phase, some of which have increased in size since the prior exam. These lesions are suspicious for peritoneal HCC metastases. For reference purposes, a posterior peritoneal lesion now measures 0.7 x 0.8 cm (image 29, series 6), previously 0.2 x 0.6 cm.Portal veins and hepatic veins remain patent. No biliary ductal dilatation.SPLEEN: Numerous perisplenic varices again seen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating renal lesions most consistent with simple renal cysts.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and its branches. There are scattered retroperitoneal lymph nodes, which are not pathologically enlarged by size criteria.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Disease progression with interval increase in size of the index and non-index arterially enhancing hepatic lesions. Although these lesions do not meet strict criteria for an HCC and do not demonstrate washout, they have enhancement and washout characteristics similar to the primary lesion seen on the 6/23/2011 examination and remain suspicious for multifocal neoplastic disease. |
Generate impression based on findings. | Restaging recently diagnosed Hodgkin lymphoma on ABVD chemotherapy. HIV positive.RADIOPHARMACEUTICAL: 13.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 75 mg/dL. Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in the SVC. Multiple surgical clips are seen in both the right axilla and in the right upper abdomen. Multiple coronary arterial calcifications are seen most notably in the left anterior descending.Today's PET examination demonstrates complete interval resolution of hypermetabolic tumor activity previously seen in the neck, chest, abdomen and pelvis without FDG avid tumor currently. | 1.Complete interval resolution of previous hypermetabolic tumor activity without FDG avid tumor currently in the neck, chest, abdomen or pelvis.2.Extensive coronary calcifications, notably in the LAD. Please correlate clinically as to the need for further evaluation such as with myocardial perfusion scintigraphy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 79-year-old female, rule out fracture There is dextrolumbar scoliosis and multiple number vertebral body osteophytes. Degenerative changes also affect the SI joints. No fracture is evident. | Scoliosis with associated arthritic changes as detailed above. |
Generate impression based on findings. | 26-year-old male with pain Again seen is attempted fusion with screws through the base of the first metacarpal and medial cuneiform. A K wire extends across the first MTP joint in near-anatomic alignment with interval correction of hallux valgus deformity. | Postoperative changes as described above without evidence of complication. |
Generate impression based on findings. | Status post fracture. History of non-ossifying fibroma of the distal radius.VIEWS: Left wrist AP lateral and oblique 1/6/15 (3 views) There is a refracture of the non-ossifying fibroma of the distal metaphyses of the left radius. Alignment is near-anatomic. | Refracture of non-ossifying fibroma of the distal metaphysis of the left radius. |
Generate impression based on findings. | Female 64 years old; Reason: assess for metastatic disease History: right inguinal swelling CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change. Biapical pleural scarring, stable. Small scarring/tree in bud appearance in anteromedial aspects of lingula and right middle lobe without significant change, may reflect postinflammatory/infectious sequela. No pleural effusion.MEDIASTINUM AND HILA: Small calcified nodes, likely reflecting sequela of prior granulomatous disease.CHEST WALL: Right chest wall port with tip near cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post partial colon resection in left abdomen with associated postprocedural luminal dilatation at level of anastomosis. Appendix mildly prominent measuring up to 7 mm with mild wall enhancement, similar appearance to earlier study. At base of appendix is nonspecific loculated hypoattenuation, may be layering intracecal material, measures approximately 1.2 x 1.1 cm, image 156 series 3, not present on prior study. No significant periappendiceal stranding or inflammation.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right inguinal/groin lymphadenopathy with adjacent subcutaneous induration, nodes more conglomerate in appearance. For reference, 3.8 x 3 cm lymph node, image 193 series 3, previously measured 1.5 x 1.5 cm. Asymmetric enlargement of right pectineus muscle and additional mildly enhancing soft tissue foci seen along course of right femoral vessels, insinuating into adjacent pectineus musculature, image 217 series 3, not well seen on prior study. For reference, lesion measuring 2.5 x 1.7 cm on image 211 series 3, in retrospect may have been present on earlier study and measured 1.4 x 1 cm. Previously seen right common femoral vein thrombus not as well visualized.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance, decreased osseous mineralization. | 1.Worsening right inguinal adenopathy as described. Additionally, asymmetric enlargement of right pectineus muscle and mildly enhancing soft tissue foci seen along course of right femoral vessels, insinuating into adjacent pectineus musculature, suspicious for additional enlarging lymph nodes, underlying neoplastic muscle involvement a consideration.2.Appendix mildly prominent measuring up to 7 mm with mild wall enhancement, similar appearance to earlier study. At base of appendix is nonspecific loculated hypoattenuation, may be layering intracecal material, measures approximately 1.2 x 1.1 cm, not present on prior study. No significant periappendiceal stranding or inflammation. Correlation with patient's clinical history and attention on follow-up imaging recommended. |
Generate impression based on findings. | 75-year-old with history of ADH status-post lumpectomy. A mass is seen near lumpectomy bed on follow-up imaging. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 6 x 3 mm at the 12 o’clock position without increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. Initial attempts were made to aspirate the lesion, however this was unsuccessful and core biopsy was then performed. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral posterior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe and van Beek. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Reason: Pt with known lung cancer and ?rml infiltratte overlying known cavitary lesion on cxr. please clarify if pna is present. History: sob, fever, known lung ca CHEST:LUNGS AND PLEURA: Right lower lobe cavitating mass (image 50 mass demonstrates interval increase in size now measuring 4.6 cm x 3.3 cm previously measuring 4.6 cm x 2.6 cm.There is an associated small pleural effusion.Adjacent right hilar mass (image 45 series 3) with effacement of the right intrapulmonary vein and interval cavitation and necrosis has increased in size now measuring 2.3 cm x 3.1 cm. Comparable measurement on the prior exam (image 43 series 3) measures 1.5 cm x 2.8 cm. Pleural based opacity with surrounding groundglass noted posterior in the right upper lobe. A loose may represent an area of infection the differential diagnosis would include an area of infarction. No obvious pulmonary embolus can be identified.Mild subsegmental atelectasis in the right middle lobe and right lung base..MEDIASTINUM AND HILA: Necrotic right paratracheal lymph node (image 29 series 3 now measures 17 mm in short axis previously measuring 12 mm.Additional enlarged mediastinal lymph nodes demonstrate interval increase in size.Cardiac size is normal upon evidence of a pericardial effusion.CHEST WALL: Multiple vertebral osteolytic metastases without significant interval change.No axillary lymphadenopathy. Right posterior eighth rib osteolytic lesion redemonstrated.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Anterior wall subcutaneous nodule (image 66 series 3) is stable. Redemonstration of multiple lumbar and pelvic metastases.OTHER: No significant abnormality noted. | 1.Increasing size of cavitating right lower lobe mass and adjacent right hilar mass.2.New peripheral wedge-shaped opacity posterior in the right upper lobe with surrounding groundglass compatible with either infection or infarction.3.Increasing mediastinal and right hilar lymphadenopathy.4.New right pleural effusion.5.Stable numerous osseous metastases. 6.New right pleural effusion. |
Generate impression based on findings. | 7 month old female, replaced feeding tube.VIEW: Chest and abdomen AP, 12/30/2014, 14:12 hours. Enteric tube with weighted tip is at the pylorus/duodenal bulb. A second enteric tube tip is in the gastric body. Central line terminates at the right atrium. IVC stents and right lower extremity central line again noted. Abdominal drain and surgical sutures unchanged. A urinary bladder catheter is noted.Low lung volumes. Retrocardiac atelectasis. Normal cardiac silhouette size.Nonspecific, mildly disorganized bowel gas pattern. No evidence of pneumatosis, portal venous gas, or intraperitoneal free air. | Feeding tube tip at the pylorus/duodenal bulb. |
Generate impression based on findings. | Female; 48 years old. Reason: humerus fx, ongoing pain History: humerus fx, ongoing pain Three views of the right humerus demonstrate a comminuted fracture of the mid humeral diaphysis with approximately 30 degrees of posterior angulation of the distal fracture fragment. The fracture also demonstrates slight varus alignment. | Comminuted humerus fracture as described above. |
Generate impression based on findings. | 7 month old female with replaced feeding tube.VIEW: Chest and abdomen AP (two view) 12/30/2014, 1400 hrs. Enteric tube with weighted tip is coiled in the stomach with tip in the mid gastric body. A second enteric tube tip is in the distal gastric body. Central line terminates at the right atrium. IVC stents and right lower extremity central line again noted. Abdominal drain and surgical sutures unchanged. A urinary bladder catheter is noted.Low lung volumes. Retrocardiac atelectasis. Normal cardiac silhouette size.Nonspecific, mildly disorganized bowel gas pattern. No evidence of pneumatosis, portal venous gas, or intraperitoneal free air. | Feeding tube tip in the stomach. |
Generate impression based on findings. | Ms. Corley is a 62 year old female with a personal history of right breast lumpectomy in June 2014 for IDC with neuroendocrine features. She has no current breast related complaints. Three standard views of both breasts, two right spot magnification views and two left magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There are new postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also identified in the right axilla. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Numerous benign calcifications are noted. Spot magnification views of the left upper outer breast were obtained to further evaluate calcifications. These calcifications have a benign appearance on the additional views and are stable from the prior exam. There is no new mass or areas of architectural distortion identified in the left breast. | Expected postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 83-year-old female who presents for short-term follow-up for high probability benign calcifications in the left breast. Personal history of rheumatoid arthritis. History of breast cancer in half sister diagnosed in her 40s. No current breast complaints. Three standard views of both breasts and two magnified views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Two groups of high probability benign calcifications are present in the central left breast, unchanged from the prior two studies.No new masses or areas of architectural distortion are present. Other bilateral benign calcifications are present. | Stable high probability benign calcifications in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 12 months, given the lack of change over the past year. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | There are post-operative findings related to a subtotal cranial vault reconstruction. There are biparietal surgical osteotomies and focal defect at the superior convex margin of the sagittal suture. There is slight focal convexity at the apex. Additional scattered small osseous defects of the calvarium likely represent osteotomy sites with interval surrounding healing. There is interval improvement in the scaphocephalic configuration of the calvarium with decreased elongation and proportionate increased transverse diameter. There is fusion of the remaining portions of the sagittal suture. There is interval fusion of the metopic suture, which is normal for age. The lambdoid suture is patent. The anterior aspect of the left squamosal suture is fused, but this can be normal for age. The imaged brain is grossly unremarkable. There is mild mucosal thickening of the bilateral ethmoid sinuses and near complete opacification of the bilateral maxillary sinuses. | Post-operative findings related to a subtotal cranial vault reconstruction with improvement in the previous scaphocephalic configuration of the calvarium. |
Generate impression based on findings. | Female; 48 years old. Reason: post reduction History: post reduction Two views of the right humerus demonstrate interval placement of overlying cast material, which limits evaluation of fine bone detail. Again seen is a comminuted fracture of the mid humeral diaphysis, which has been slightly reduced when compared to prior exam. There is slight varus alignment of the fracture fragments. | Comminuted fracture of the humerus as described above. |
Generate impression based on findings. | Male 50 years old; Reason: 50 yo male with hx of appendiceal cancer; please do CT scan and evaluate for abnormalities and or recurrence History: appendiceal cancer CHEST:LUNGS AND PLEURA: Mild right basilar atelectasis. Left basilar opacity has the appearance of rounded atelectasis.MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes measure less than 1 cm short axis dimension.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcapsular hypoattenuating lesion in the posterior right hepatic lobe measures 1.1 x 0.8 cm (series 3, image 79), previously 1.2 x 0.9 cm. Exophytic nodularity arising from the more inferior posterior right hepatic lobe measures 1.8 x 1.3 cm (series 3, image 92), previously 2.2 x 1.5 cm. These are suspicious for peritoneal implants. Hypoattenuating rim enhancing fluid extending along the inferior aspect of the right hepatic lobe measures 4.8 x 2.0 cm (series 3, image 117), previously 2.2 x 1.0 cm. This may represent lesion enlargement versus postsurgical changes. Correlation for resection at this site is recommended. SPLEEN: Hypoattenuating peri-splenic abnormality is suspicious for additional neoplastic disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a 1.0-cm nonobstructing renal calculus in the lower left kidney, increased in size compared to prior study. Exophytic hypoattenuating lesion arising from the lower pole of the left kidney is too small to characterize but likely represents a renal cyst.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic lymph node measures 1.8 x 2.8 cm (series 3, image 95), previously 1.5 x 2.3 cm. Multiple additional prominent retroperitoneal and mesenteric lymph nodes are not significantly changed.BOWEL, MESENTERY: Status post right hemicolectomy. There is tethering of bowel to the anterior abdominal wall, likely secondary to omentectomy.BONES, SOFT TISSUES: Postsurgical changes along the anterior abdominal wall.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is thickwalled. This may relate to underdistention however correlation for evidence of cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post right hemicolectomy. There is tethering of bowel to the anterior abdominal wall, likely secondary to omentectomy.BONES, SOFT TISSUES: No significant abnormality noted | 1. Status post exploratory laparotomy and biopsies. Two subcapsular posterior right hepatic lobe implants are stable/mildly decreased compared to prior study. Hypoattenuating rim enhancing fluid extending along the inferior aspect of the right hepatic lobe has increased compared to prior study. This may represent enlargement of the previous lesion in this location versus postsurgical changes. Correlation with resection site is recommended. 2. Hypoattenuating perisplenic abnormality is suspicious for additional disease.3. The previously described enlarged gastrohepatic lymph node is mildly enlarged compared to prior study. |
Generate impression based on findings. | Female 64 years old Reason: Persistent nausea, vomiting, increased NG output after surgery. Previous imaging suggestive of partial SBO. History: As above ABDOMEN:LUNG BASES: Trace bibasilar dependent atelectasis. Previous described pulmonary embolus not seen on today's examination.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: Atrophic appearing pancreas with dense intraparenchymal calcifications suggests sequelae of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There has been interval removal of the bilateral nephroureteral stents. There is now mild left hydronephrosis. There is bilateral renal cortical scarring. The patient status post cystectomy with Indiana pouch formation.RETROPERITONEUM, LYMPH NODES: There are moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There has been interval increase in the patient's diffusely dilated small bowel, measuring up to at least 6.1 cm in diameter, with bilateral transition points evident within the pelvis. These are best seen on coronal images 73 and 72, consistent with small bowel obstruction, most likely due to adhesive disease. There are postsurgical findings related to right hemicolectomy with ileal conduit formation. The distal and terminal ileum is collapsed. There has been interval development of interloop fluid within the pelvic small bowel loops.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The patient is status post cystectomy and ileal conduit formation. There is a JP drain within the surgical bed, with fluid and air adjacent, which has decreased in volume since the prior examination.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Small bowel obstruction with two transition points seen within the pelvis as detailed above, likely due to adhesive disease and with associated development of interloop fluid.2.Postsurgical changes related to cystectomy and Indiana pouch formation with interval removal of the nephroureteral stents.3.New mild left-sided hydronephrosis. |
Generate impression based on findings. | Male; 41 years old. Reason: eval for fx History: severe pain Three views of the left humerus demonstrate mild expansion with underlying ground-glass matrix of the left humerus diffusely and an appearance typical for fibrous dysplasia. There is an acute transverse fracture of the distal diaphysis of the left humerus with fracture fragments in near anatomic alignment. The left scapula also appears to be affected by fibrous dysplasia, as are the proximal left radius and ulna. There is poor visualization of one of the upper left ribs, which may also be affected by fibrous dysplasia.Two views of the left elbow demonstrate the aforementioned distal left humerus pathologic fracture and findings of fibrous dysplasia. No additional acute fracture is evident. | Pathologic fracture of the distal left humerus through fibrous dysplasia. |
Generate impression based on findings. | Reason: 65M with AML acutely altered and unresponse, plts 8 History: AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the right ethmoid air cells. A nasal trumpet is in place. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Male; 41 years old. Reason: r/o compression fx History: acute on chronic lumbar back pain s/p hitting back on toilet today Five views of the lumbar spine demonstrate no acute fracture. There is moderate degenerative disk disease affecting L5-S1. The remaining disk spaces are within normal limits. Alignment of the lumbar spine is within normal limits. | Degenerative disk disease at L5-S1. No acute fracture is evident. |
Generate impression based on findings. | Status post left patellar fracture Again seen is a comminuted fracture of the patella with fracture fragments in near anatomic alignment. The fracture line extends to the articular surface of the patella, and there is a moderate-sized joint effusion. The bones appear slightly demineralized. Mild osteoarthritis affects the knee. | Patellar fracture appearing similar to that seen on the prior study. |
Generate impression based on findings. | 69-year-old female with history of no cancer. Malignant neoplasm of the submandibular gland. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules, with measurements as follows:Reference left upper lobe pulmonary nodule (4/25) measures 8 x 10 mm, unchanged.In the right upper lobe anterior nodule which abuts the pleura (4/28) has increased in size to approximately 11 x 11 mm, previously 7 x 7.Other previously seen pulmonary nodules have also slightly increased in size over the interval.MEDIASTINUM AND HILA: The heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.Mild coronary artery calcifications.CHEST WALL: Degenerative changes affect the spine. T10 vertebral body hemangioma, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Right hepatic lobe hypoattenuating focus, unchanged from prior and likely a benign cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts and punctate renal pelvis arterial calcifications bilaterally, unchanged. No hydronephrosis or hydroureter.PANCREAS: Mild pancreatic fatty atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Multiple bilateral pulmonary nodules, most of which have slightly increased in size of the interval, consistent with progression of disease. |
Generate impression based on findings. | Male; 75 years old. Reason: r/o fracture History: knee pain Three views of the left foot demonstrate soft tissue swelling along the dorsum of the foot. There is deformity of the proximal phalanx of the fifth toe, most likely due to old healed fracture. Severe osteoarthritis affects the first MTP joint. No acute fracture or malalignment is evident. Arterial calcifications are seen in the soft tissues.Four views of the left knee demonstrate soft tissue swelling anteriorly. There is a moderate knee joint effusion. Mild osteoarthritis affects the knee. No acute fracture or malalignment is evident. | Soft tissue swelling and osteoarthritic changes as described above. We see no acute fractures. |
Generate impression based on findings. | 65 years old, Female, Reason: 65 y/o woman with recurrent ovarian cancer receiving chemotherapy. Evaluate for treatment response and extent of disease. History: Recurrent ascites. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary micronodules, pleural-based right middle lobe nodule, and likely a lymph node within the right major fissure are unchanged. No evidence of pleural effusion or consolidation.MEDIASTINUM AND HILA: Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Marked improvement of perihepatic ascites with persistent fluid causing scalloping of the right edge of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged hypoattenuating renal lesions, some of which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Surgical clips noted in the retroperitoneum. Persistent nodularity of the peritoneum particularly in the left upper quadrant suggestive of carcinomatosis. Reference peritoneal nodule appears smaller in size measuring 1.0 x 0.6 cm (series 4, image 115), previously measuring 1.7 x 1.2 cm.BOWEL, MESENTERY: Improvement in ascites exerting mass effect on the small bowel which is centrally located within the abdomen concerning for malignant ascites. Improved bowel wall thickening and dilatation.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Tarlov cysts are present bilaterally. Mild degenerative changes of the spine.OTHER: No significant abnormality noted. | 1.Improvement in volume of malignant ascites.2.Decrease in size of reference peritoneal nodule.3.Improved bowel wall thickening and dilatation. |
Generate impression based on findings. | Female 74 years old; Reason: 74 yo female with hx of schwannoma and right retroperitoneal mass ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable well-circumscribed hepatic segment 8/5 hyperattenuating lesion, most likely a cyst, image 33 series 3. Mild intrahepatic and extrahepatic biliary duct prominence (common bile duct measures up to 7 mm) without significant change. No radiopaque choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES, BONES, SOFT TISSUES: Mild interval enlargement of right retroperitoneal mass, measuring 5.9 x 5.5 cm x 7.6 cm in craniocaudal dimension, image 90 series 3, previously measured 5.2 x 4.7 by 7.6 cm in craniocaudal dimension cm, located posterior to psoas muscle. Associated heterogeneous enhancement and gentle scalloping of underlying bone seen.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: New from prior exam is left-sided gonadal vein thrombus, image 75 series 3. Left adnexal enhancing nodularity again visualized, while may reflect exophytic/subserosal uterine fibroid, confirmation with dedicated pelvic sonography recommended to exclude underlying neoplasm. Region not significantly changed in size, previously seen central hypoattenuation now more increased in attenuation, may reflect leiomyomatous changes.BLADDER: No significant abnormality noted. | 1. Mild interval enlargement of right retroperitoneal mass, biopsy-proven schwannoma.2. New left gonadal vein thrombus. 3. Left adnexal enhancing nodularity again visualized and without significant change in size, while may reflect exophytic/subserosal uterine fibroid, confirmation with dedicated pelvic sonography recommended to exclude underlying neoplasm.Findings discussed with RN Alisha Wilson at 11:25 a.m. on 1/6/15. |
Generate impression based on findings. | Pain. Healed? A plate and screws affix a fracture of the medial malleolus in near anatomic alignment. The fracture line is less distinct on the current study than on the prior study suggesting some interval healing. I see no hardware complications. Ossification along the anterior aspect of the tibial plafond may represent a healing avulsion fracture fragment or simply an osteophyte. | Orthopedic fixation of healing medial malleolar fracture. |
Generate impression based on findings. | 15-year-old male with pyuria, no urine output for 24 hours. Evaluate for hydronephrosis, stones, bladder anatomic abnormality. BLADDER Wall Thickness: Not assessed. Contents: Foley catheter present in a decompressed bladder. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 10.0 cm Left: 10.9 cm Mean for age: 10.3 cm Range for age: 9.1 - 11.6 cmADDITIONAL OBSERVATIONS: Two nonobstructing left renal stones are identified, larger measuring approximately 8 mm. | Two nonobstructing left renal stones, the larger measuring 8 mm.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Severe pain and tenderness right big toe. Assess for fracture/dislocation. Although these are nonweightbearing views, there is a mild to moderate hallux valgus deformity. I see no fracture or dislocation. There are small enthesophytes at the Achilles insertion on the calcaneus which are not necessarily of any current clinical significance. | Hallux valgus deformity without fracture or dislocation. |
Generate impression based on findings. | Postop images, cervicalgia Again seen is a plate with screws entering the C5, C6, and C7 vertebral bodies. I see no hardware complications. There is interposed bone graft at C5/6 and C6/7 that appears similar to that seen on the prior study accounting for slight positional differences. Small osteophytes project from the anterior aspects of C3 and C4. The fracture suspected on the prior study is not clearly evident on the current study. | Postoperative changes of ACDF appearing similar to those seen on the prior study. |
Generate impression based on findings. | Male 58 years old Reason: 58M with portal hypertension, lymphoma, recurrent rectal cancer. eval for metastatic disease History: rectal cancer, eval for metastatic disease CHEST:LUNGS AND PLEURA: There are a few scattered pulmonary nodules. The dominant nodule is located in the left lower lobe measuring 1.1 x 0.9 cm (image 72/series 4). The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are mediastinal mildly enlarged lymph nodes.A right chest wall port terminates at the cavoatrial junction.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology. Right portal vein is poorly defined. Status post cholecystectomy.No definite hepatic lesions.SPLEEN: Status post splenectomyPANCREAS: Multiple collaterals through the head of the pancreas from thrombosis of the superior mesenteric vein. The pancreas is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged retroperitoneal lymph nodes. The largest in the left para-aortic measuring 2.0 x 1.9 cm (image 119/series 3). BOWEL, MESENTERY: Small bowel is normal in caliber and course. Postsurgical changes in the upper abdomen.BONES, SOFT TISSUES: Nodular thickening in the right rectus muscle in the upper abdomen of unclear etiology.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left common iliac lymph node measures 1.1 x 1.1 cm (image 146/series 3). BOWEL, MESENTERY: Diffuse rectal wall thickening representing the primary neoplasm. infiltration of the surrounding fat planes possibly due to radiation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Rectal mass with retroperitoneal lymph nodes and left lower lobe pulmonary nodule.2.Cirrhosis with thrombosis of the superior mesenteric vein and possibly the right portal vein. Dedicated liver imaging with liver MRI is suggested to detect HCCI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Follow-up Again seen is a side plate and screws affixing a fracture of the distal fibula in near anatomic alignment. The majority of the fracture line is indistinct, suggesting healing, appearing similar to the prior study accounting for slight positional differences. There is soft tissue swelling along the lateral aspect of ankle. I see no hardware complications. | Orthopedic fixation of healing distal fibular fracture. |
Generate impression based on findings. | 63-year-old male with aggressive prostate cancer, bone METs and refractory constipation. Assess narcotic-induced constipation after conservative measures; indication for Relistor? Nonobstructive bowel gas pattern. No visible stool. Diffuse sclerotic osseous metastases again seen. | No visible stool. |
Generate impression based on findings. | 64 years old, Male, Reason: hx of bladder cancer s/p cystectomy w/ neobladder urinary diversion, evaluate for mets with delayed imaging ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver is again seen. No focal liver lesion identified.SPLEEN: No significant abnormality notedPANCREAS: Coarse calcifications are noted in the pancreatic head most often associated chronic pancreatitis. There is mild proximal pancreatic ductal dilatation, increased from prior exam which could be related to changes of chronic pancreatitis. However, if there is clinical suspicion for pancreatic mass, ERCP or MRCP is recommended to further evaluate.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No focal lesion detected. No hydronephrosis or perinephric fluid collection. Mild perinephric fat stranding appears similar to prior study. There is opacification of the ureters bilaterally with subsequent opacification of the neobladder. No definite filling defects or mass to suggest local recurrence.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine most severe at the level of L4-L5 and L5-S1.PELVIS:PROSTATE, SEMINAL VESICLES: Patient is status post cystoprostatectomy with neobladder formation. BLADDER: No evidence of mass or filling defect to suggest local recurrence.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.No evidence of recurrent or metastatic disease.2.Mild pancreatic ductal dilatation, increased from prior exam. This may be related to changes of chronic pancreatitis; however, if there is clinical suspicion for pancreatic head mass, MRCP or ERCP is recommended to further evaluate.3.Hepatic steatosis. |
Generate impression based on findings. | 70 year-old female with right breast mass identified on screening mammography. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a mixed echogenicity mass measuring 14 mm at the 9 o’clock position without increased vascularity, 3 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral inferior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. van Beek and Abe. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Knee pain There is moderate osteoarthritis of the knee, with tricompartment osteophytes and mild narrowing of the medial tibiofemoral compartment. I suspect that there is also a small joint effusion. | Osteoarthritis. |
Generate impression based on findings. | 85 year old female with dysphasia. Evaluate for esophageal pathology vs motility disorder. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Exam limited by patient immobility. Within these limits, single contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. No masses or strictures.Fluoroscopic evaluation of esophageal peristalsis demonstrated breakup of the primary wave with stasis.During the exam, spontaneous reflux was observed. TOTAL FLUOROSCOPY TIME: 2 minutes and 28 seconds | 1.Findings compatible with gastroesophageal reflux were observed.2.Breakup of the primary wave with stasis indicating moderate motility disorder. |
Generate impression based on findings. | Reason: lung CA, metastatic, on systemic therapy. FOllowup scan to assess disease History: none CHEST:LUNGS AND PLEURA: Right lower lobe infrahilar mass (image 69 series 5) slightly decreased in size now measuring 4.5 cm x 2.1 cm previously measuring 4.8 cm x 2.5 cm.Stable subpleural right middle nodule (image 82 series 5) measuring 7 mm x 7 mm.Scattered micronodules and areas of scarring/discoid atelectasis unchanged. No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Stable right hilar lymph node (image 49 series 3 measuring 8 mm.Cardiac size is normal with stable small pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mild interval decrease in the right lower lobe mass.2.No new suspicious pulmonary nodules or masses. |
Generate impression based on findings. | Female 69 years old Reason: evaluate for abscess, hernia, mass, bowel ischemia History: severe RUQ tenderness in pt with hx CHF, ESRD, GI bleed, hernia ABDOMEN:LUNG BASES: Calcified and noncalcified pulmonary micronodules suggest prior granulomatous disease. The heart is enlarged. There are annular calcifications of the mitral valve.LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Moderate perihepatic ascites. Status post cholecystectomy. Nonspecific prominence of the common duct, may relate to prior cholecystectomy.SPLEEN: Nonspecific hypoattenuating lesions scattered throughout the splenic parenchyma are unchanged dating back to 2009 and likely benign in etiology.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys, with cystic lesions scattered throughout the renal parenchyma consistent with end-stage renal disease.RETROPERITONEUM, LYMPH NODES: Enlarged porta hepatis lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 17 x 12 x 7 cm heterogeneous collection in the left rectus sheath, which demonstrates internal foci of hyperattenuation consistent with a rectus sheath hematoma with active hemorrhage. Chronic fractures of the left superior and inferior pubic rami as well as the right inferior pubic ramus. There is moderate body wall edema.OTHER: Moderate volume ascites.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a 17 x 12 x 7 cm heterogeneous collection in the left rectus sheath, which demonstrates internal foci of hyperattenuation consistent with a rectus sheath hematoma with active hemorrhage. Chronic fractures of the left superior and inferior pubic rami as well as the right inferior pubic ramus. There is moderate body wall edema.OTHER: Moderate volume ascites. | 1.Left rectus sheath hematoma with active hemorrhage as detailed above.2.Cirrhotic liver morphology and associated ascites.3.Chronic fractures of the superior and inferior left pubic rami as well as the right inferior pubic ramus.4.Cardiomegaly. |
Generate impression based on findings. | 52-year-old with history of left mastectomy for breast cancer in 2002. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Stable benign morphology mass in the right lower outer breast. Stable focal asymmetry in the right upper outer quadrant. A few scattered benign calcifications are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 39-year-old male with a history of an undescended left testis. The patient reports that he had corrective surgery at 5. RIGHT TESTIS: The right testicle is normal in morphology, echogenicity, and size, measuring 3.2 x 1.9 x 4.5 cm. Color and spectral Doppler evaluation demonstrates normal blood flow.LEFT TESTIS: The left testis is not visualized in the scrotum or inguinal region.RIGHT EPIDIDYMIS: The right epididymis is normal in morphology, echogenicity and size.LEFT EPIDIDYMIS: Not clearly visualized.OTHER: No significant abnormalities noted. | The left testis is not visualized in the scrotum or inguinal region. |
Generate impression based on findings. | Female, 38 years old. Reason: Assess for SMA (Superior mesenteric artery syndrome) History: nausea and vomiting, abdominal pain relieved only by lying down flat. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no significant gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.The stomach was normal in size, shape, and position. The gastric mucosal surface was normal. Spontaneous emptying of contrast into the duodenal sweep was observed. The duodenal bulb and sweep were within normal limits. There was no evidence of SMA syndrome (fluro capture series 13). Transit time to the colon was one hour. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 5:37 minutes | Normal examination of the esophagus, stomach, duodenum, small bowel and proximal colon. No evidence of SMA syndrome. No signs of proximal dilatation or adhesions to explain the patient's symptoms. |
Generate impression based on findings. | Postoperative changes are seen from previous posterior surgical fusion of L3 through L5, with bilateral pedicle screws at these levels as well as bilateral connecting rods. Instrumentation results in extensive streak artifact which limits evaluation. There is bone graft material which appears confluently fused along the posterior elements bilaterally. No interbody spacers are present. There is no evidence of instrumentation complication. There is no acute fracture.The scout lateral view and the sagittal reformatted images demonstrate minimal grade 1 anterolisthesis of L3 on L4 which measures 5 mm. There is also trace grade 1 anterolisthesis of L4 on L5. There is slight straightening of the normal lower lumbar lordosis. The vertebral body heights are well-maintained. There is mild disk space narrowing at L2-L3 and mild-moderate disk space narrowing at L3-L4. Vacuum phenomena are present at L2-L3 and L5-S1, and to a lesser degree at L1-L2. Small scattered ventral osteophytes are noted.At T11-T12, there is left greater than right facet arthropathy and ligamentum flavum thickening, with mild-moderate spinal canal stenosis suggested. There is also mild right and moderate left foraminal narrowing.At T12-L1, there is bilateral facet arthropathy.At L1-L2, there is a diffuse disk bulge with right greater than left paracentral prominence. There is also bilateral facet arthropathy and ligamentum flavum thickening with resultant at least moderate central spinal stenosis. There is moderate to severe right and mild-moderate left foraminal narrowing.At L2-L3, there is a mild disk bulge with right paramedian osteophyte versus mineralized disk. There is bilateral facet arthropathy and ligamentum flavum thickening with likely moderate-severe central spinal stenosis as well as narrowing of the lateral recesses. There is moderate-severe right and severe left foraminal narrowing.At L3-L4, there is uncovering of the disk with bilateral facet arthropathy. There is perhaps mild central spinal stenosis and mild left foraminal narrowing. There is also lateral recess narrowing.At L4-L5, there is uncovering of the disk and the central spinal canal is decompressed secondary to a laminectomy. There is suggestion of moderate bilateral foraminal narrowing. There is bilateral facet arthropathy.At L5-S1, there is a diffuse disk bulge with minimal bilateral facet arthropathy. There is no significant central spinal canal stenosis although likely at least moderate bilateral foraminal narrowing.Limited views through the retroperitoneum demonstrate no gross abnormalities. There is mild thickening of the bladder wall, although this may be due to underdistention. There are multiple colonic diverticuli. There are minimal scattered aortoiliac atherosclerotic calcifications. | 1. Postoperative changes from previous L3 through L5 posterior surgical fusion. Minimal grade 1 anterolisthesis of L3 on L4 and trace retrolisthesis of L4 on L5. No evidence of acute fracture or instrumentation complication.2. Spondylotic changes as detailed above, most prominent at L2-L3 where there is likely moderate-severe central spinal stenosis due to diffuse disk bulge and facet arthropathy, with moderate to severe right as well severe left foraminal narrowing at this level. Additional findings at L1-L2 where there is at least moderate central spinal canal and moderate to severe right foraminal narrowing. |
Generate impression based on findings. | 45-year-old with known right breast cancer receiving neoadjuvant chemotherapy. Please check size. A targeted right ultrasound was performed for the known malignancy. The right breast mass at 9 o'clock now measures 0.8 x 0.7 x 0.8 cm. Previously this measured 1.1 x 1.0 x 0.7 cm on 12/1/2014, and 2.5 x 1.2 x 1.6 cm before therapy. Internal artifact from the Hydromark biopsy clip was seen within the mass. | Continued interval decrease in size of known right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 62 year old female. Reason: 61 y/o F with dysphagia to solids and liquids, history of gastric bypass surgery 2012, rule out stricture or other etiology History: as above Double contrast visualization of the esophagus showed Mild broad impression on the right aspect of the esophagus above the level of the thoracic outlet. No other morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Barium passed readily from the esophagus through the anastomosis into the small bowel. A very small gastric pouch with an end-to-side patent (8-14 mm wide) gastrojejunal anastomosis with a short jejunal afferent limb. The gastric mucosal surface was normal. Mild dilation of the afferent limb with suggestion of mild transient intussusception (series 21).During the exam, spontaneous gastroesophageal reflux was observed to the level of the upper thoracic esophagus. The reflux cleared slowly in the supine position.A swallowed pill passed readily into the proximal small bowel.TOTAL FLUOROSCOPY TIME: 4:54 minutes | 1. Postsurgical changes of a roux-en-Y gastric bypass, with a small gastric pouch and mild dilation of the afferent limb. The anastomosis is patent measuring 8-14 mm.2. Gastroesophageal reflux with slow clearing.3. No esophageal stricture. Mild broad impression on the right aspect of the esophagus above the level of the thoracic outlet; may be normal anatomic variant, correlate with thyroid enlargement. |
Generate impression based on findings. | Postop Again seen is a plate and screw device affixing a fracture of the distal fibular diaphysis in near anatomic alignment. There has been progression of callus formation along the fracture, indicating some interval healing. There is also a transsyndesmotic screw affixing the distal tibia and fibula in near-anatomic alignment. There is slight widening of the syndesmosis that appears similar to that seen on the prior study. There has been some maturation of ossification across the syndesmosis. Two screws also affix a fracture of the medial malleolus in near-anatomic alignment. The fracture line is indistinct suggesting some healing. | Orthopedic fixation of ankle fractures as above. |
Generate impression based on findings. | 10-year-old male with pain after fall. Rule out fracture.VIEWS: Left ankle AP/lateral/oblique (3 views) 1/6/2015, 1130 hrs. No joint effusion, fracture, or malalignment is evident. | No evidence of fracture or malalignment. |
Generate impression based on findings. | ALL for intrathecal chemotherapy. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues.Using fluoroscopic guidance, a 22 gauge x 3-1/2 inch spinal needle was localized into the thecal sac at the L3-4 level. There was immediate return of approximately 3 mL of clear cerebrospinal fluid, which was collected into two tubes. Subsequently, intrathecal chemo was administered by the primary service over 3 minutes. The stylet was replaced and the needle was removed by the primary service. Hemostasis was achieved with manual compression. The patient tolerated the procedure well with no immediate complications. Fluoroscopy time: 0.5 minutes | Successful fluoroscopically guided lumbar puncture and intrathecal chemotherapy injection without immediate complication. |
Generate impression based on findings. | Three months status post C7 -- T1 ACDF. Assess implants. Again seen is an anterior fixation device with screws entering the C7 and T1 vertebrae. There is also an intervertebral spacer at C7 -- T1. I see no frank bony bridging at this level at this time. There is also an anterior plate with screws entering the C6 and C7 vertebral bodies with an intervertebral spacer device at this level. Bony bridging across the disk space appears similar to that seen on the prior study. Small osteophytes project from the anterior aspects of C4 and C5. There is straightening of the cervical spine which appears similar to that seen on the prior study. | Postoperative changes of ACDF appearing similar to those seen on the prior study. |
Generate impression based on findings. | Female, 67 years old. Reason: s/p Dobbhoff tube please eval placement History: - Dobbhoff tube with tip overlying the proximal gastric body.Nonobstructive bowel gas pattern. | Dobbhoff tube with tip overlying the proximal gastric body. Recommend to advance 3-4 cm. |
Generate impression based on findings. | Left wrist pain Three views of left wrist are provided. The bones appear slightly demineralized, and there is perhaps mild soft tissue swelling along the ulnar aspect of the wrist, but otherwise I see no specific findings to account for the patient's pain.Three views of the left hand are provided. The bones are perhaps slightly demineralized, but otherwise appear normal. | Possible mild soft tissue swelling along the ulnar aspect of the wrist. I otherwise see no findings to account for the patient's pain. |
Generate impression based on findings. | Reason: R sided weakness, AMS History: coumadin The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. Is also present on the prior examPunctate hypodense foci are present in the thalami and right caudate nucleus. These were not present on the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.3.Punctate lesions in the thalami and right caudate nucleus could represent lacunar infarcts of indeterminate age.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | There is levoscoliosis of the thoracolumbar spine with apex at the at the T10-T11 level as seen on prior radiographs. The most inferior well-defined disc space is L5-S1.There is a butterfly vertebral body involving the T12 vertebral body. There is associated focal convexity involving the inferior and superior endplates of T11 and L1.Craniocervical junction is unremarkable without evidence of Chiari malformation. CSF flow sequence demonstrates good biphasic flow at the craniocervical junction.No abnormal signal is seen in the spinal cord. Conus is low-lying at the mid L3 level. No anterior displacement of the conus is seen on prone T2 sequence. No masses are seen along the cauda equina and filum terminale.Abnormal appearance of the left T9 and T10 pedicle, lamina, and transverse process is also noted.Spinous processes are unfused at L4 and L5 without abnormal neural, dural, or lipomatous tissue within posterior fossa defect. Upper lumbar lamina and spinous process appear broad/slightly dysplastic in appearance. Sacrum is incompletely visualized.No significant spinal canal stenosis seen at any level. Distended urinary bladder and duplicated collecting system on the left are noted. There appears to be dilatation of the collecting system draining the lower pole.Correlate with prior ultrasound studies. | 1. Butterfly vertebra at T12. There is associated mild focal convexities of inferior T11 and superior L1 endplates. 2. Low-lying conus at the mid L3 level, which does not demonstrate anterior displacement on the prone sequence. Imaging findings are suggestive of tethered cord and can be correlated with clinical findings. 3. Spinous processes are unfused at L4 and L5 without abnormal neural, dural, or lipomatous tissue within posterior fossa defect. Upper lumbar lamina and spinous process appear broad/slightly dysplastic in appearance. Abnormal dysplastic appearance of the left T9 and T10 pedicle, lamina, and transverse process is also noted. CT can be considered to better assess extent of osseous abnormalities if clinically indicated. 4. No Chiari malformation or cord signal abnormality.5. Distended urinary bladder and duplicated collecting system on the left are noted. There is dilatation of the collecting system draining the lower pole. Correlate with prior ultrasound studies. |
Generate impression based on findings. | Reason: h/o oropharyngeal ca and CRT, compare to previous, measurements pls History: none There continues to be effacement of fat planes adjacent to left carotid space. This is suspected to be related to posttreatment change.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent. The left vocal cord is deviated towards the right.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact. There is effacement of fat planes adjacent to the submandibular glands bilaterally.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations. There is medial deviation of the carotid arteries bilaterally.The cervical vertebral bodies in general are intact. There are endplate and uncovertebral osteophytes present at see 34 C4-5 C5-6 and C6-7 with encroachment of the neural foramina at these levels and narrowing of the spinal canal at C4-5. This is stable when compared to the prior exam. | 1.No convincing evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy. Please note, however, that a contrast-enhanced CT soft tissues neck study is more sensitive in the detection of lymphadenopathy and than a noncontrast study.2.Deviation of the vocal cord may imply vocal cord paresis. Please correlate with clinical exam. |
Generate impression based on findings. | Postoperative changes from prior total thyroidectomy, neck dissection, and tracheostomy are again noted. There remains irregular soft tissue in the subcutaneous fat just adjacent to the left inferolateral aspect of the tracheotomy stoma. This has a somewhat persistent rounded appearance on 6/63 but has not changed significantly in overall size or configuration, appearing slightly more heterogeneous on the current exam which may be related to differences in technique as well as slight increase in beam hardening artifact from the adjacent tracheostomy tube. Again noted is a rind of soft tissue along the left posterior lateral subglottic larynx deep to the cricoid again measuring up to 5 mm, likely representing granulation tissue. No definite mass lesions are identified in the region of the thyroidectomy bed or elsewhere in the neck. PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The postcontrast appearance of the salivary glands is stable.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: The right internal jugular vein is again not contrast opacified. There is persistent mild scarring at the anterior lung apices. Cervical spondylotic changes are present, most notably at C4-C5 where there is a prominent central disk protrusion with mild to moderate narrowing of the central spinal canal. There is mild mucosal thickening in the maxillary sinuses.There is significant irregularity proximal to mid left clavicle which has been progressive since the October 2009 exam, where the clavicular head was surgically resected. There is chronic deformity and callous formation of the medial left clavicle, which relates to a healed fracture. This appears stable compared back to 1/8/2013. The left clavicular head was noted to be likely surgically resected in October 2009, with suggestion of perhaps a more distal fracture deformity. The irregularity of the residual medial left clavicle has progressed since more remote exams but is felt to be posttreatment related. | 1. Stable post treatment changes without evidence of locoregional tumor recurrence or cervical lymphadenopathy.2. Chronic deformity and irregularity of the residual medial left clavicle which is felt to be due to a combination of postsurgical and posttreatment changes as well as healed fracture, with progressive changes compared to more remote exams. |
Generate impression based on findings. | Female 30 years old; Reason: eval for stone History: abdominal pain ABDOMEN:LUNG BASES: Micronodule in the right lung base.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The calcifications in the right kidney likely represent small nonobstructive calculi.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel malrotation without obstruction. Postsurgical changes in the cecum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Punctate calcification adjacent to right wall of the bladder may represent either a small distal ureter calculus or pelvic phlebolith. No bladder calculi are evident.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Nonobstructive right renal calculi.2.Punctate calcification adjacent to the right wall of the bladder may represent either a small distal ureter calculus or small phlebolith. |
Generate impression based on findings. | Male 49 years old; Reason: Stage IV pancreas cancer, please compare to previous scan and provide index lesion as required per RECIST CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change. Scattered calcified and noncalcified pulmonary micronodules stable.MEDIASTINUM AND HILA: Small residual soft tissue attenuation in anterior mediastinal area similar to earlier study, may reflect small residual thymic tissue. Calcified left hilar lymph nodes, likely reflecting sequela of prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hypoattenuation of liver, suggestive of underlying fatty infiltration. Stable reference left liver lesion measuring 1.1 x 0.9 cm, image 91 series 3. Calcified hepatic granulomata. Common bile duct stent present with associated small pneumobilia, small air in gallbladder. Unchanged mild intrahepatic biliary duct prominence. SPLEEN: Multiple splenic calcified granulomata.PANCREAS: Mild interval increase in prominence of pancreatic duct at level of head, measuring 8 mm, previously measured 4 mm. Accounting for differences in technique, no significant change with respect to ill-defined hypoattenuating pancreatic head mass, measuring approximately 3 cm by 2.4 cm, image 109 series 3, previously measured 2.9 x 2.4 cm. Remainder of pancreas atrophic. Associated hepatic arterial encasement again visualized and pancreatic mass abuts portal vein near confluence. Prominent peripancreatic and portacaval lymph nodes. Reference portacaval lymph node mildly increased in size, measuring 2.8 x 2.1 cm, image 100 series 3, previously measured 2.6 x 1.8 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left extrarenal pelvis. Hypoattenuating subcentimeter renal lesions, too small to characterize (including exophytic posteriorly located left renal hypoattenuating focus that does not measure simple fluid with associated Hounsfield units of approximately 22), but stable.RETROPERITONEUM, LYMPH NODES: Reference left paraaortic lymph node measures 0.8 x 0.8 cm, image 133 series 3, previously measured 1 x 0.6 cm. Unchanged peri celiac lymph node, measuring 1 x 0.5 cm, image 96 series 3, previously measured 1 x 0.5 cm.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Small prostatic calcification.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structure stable in appearance, mild multilevel degenerative changes of spine. | 1. Mild interval increase in prominence of pancreatic duct at level of head, measuring 8 mm, previously measured 4 mm. Accounting for differences in technique, no significant change with respect to ill-defined hypoattenuating pancreatic head mass. 2. Reference portacaval lymph node mildly increased in size, additional reference lymph nodes stable to showing mild interval decrease in size, see above.3. Stable reference left liver lesion. |
Generate impression based on findings. | Ms. Rodriguez is a 56 year old female recalled from screening mammogram for an asymmetry in the right breast. Family history of breast cancer in maternal aunt. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Spot compression views of the right lateral breast demonstrate persistence of a subcentimeter ovoid, circumscribed asymmetry on the CC view. In retrospect, this is likely present on a mammogram from 2008. There are no new suspicious microcalcifications or areas of architectural distortion identified in the right breast.RIGHT UNILATERAL ULTRASOUND | Simple benign right breast cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 12 months. If that exam is stable, she could then probably return to routine screening in subsequent years. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 58 years old; Reason: GIST please assess and evaluate and compare to previous scan for RECIST as required per study History: As above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypodense lesion at the dome of the liver measures 0.9 x 0.9 cm (image 16/series 3) previously, 1.1 x 0.9 cm. A second right hepatic lobe hypodense lesion is not significantly changed.The smaller subcentimeter hypodensities are unchanged.SPLEEN: Hypodense lesion in the spleen is unchanged. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cortical cysts without change. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Post surgical changes in the small bowel in the left upper abdomen without bowel obstruction or focal mass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the small bowel without obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable exam with near stable size measurements of the reference liver lesion. |
Generate impression based on findings. | Status post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | PHARYNX/LARYNX: There are again post treatment changes in the neck, including mild supraglottic mucosal edema with slightly improved mild narrowing of the airway. There is improved aeration of the piriform sinuses. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable except for a somewhat diminutive left lobe which is unchanged. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is mild mucosal thickening in the maxillary sinuses. Multilevel cervical spondylotic changes are again noted, with scattered moderate to severe foraminal narrowing | Continued stable post treatment appearance of the neck without evidence of tumor recurrence or cervical lymphadenopathy. |
Generate impression based on findings. | Follow-up Two views of the left knee are provided. Again seen are sideplates and screws affixing a proximal tibial fracture in near-anatomic alignment. The fracture lines are less distinct on the current study than on the prior study, with callous formation noted along the posterior aspect of the fracture, indicating some interval healing. I see no hardware complications, although the distal extent of the hardware is not included on the field of view of the knee radiographs. There is also a healing fracture of the fibular neck. Round lucencies within the distal femur presumably reflect prior external fixation.Mild osteoarthritis affects the right knee as seen on the frontal view. | Orthopedic fixation of healing proximal tibial fracture as above. |
Generate impression based on findings. | 48-year-old with history of left lumpectomy for breast cancer in 2011. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. There are stable postsurgical changes in the left breast with increased density, architectural distortion, volume loss and surgical clips in the lumpectomy bed. Stable asymmetries in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 56 years old; Reason: restating for colon cancer s/p hemi colectomy; prior to starting treatment History: none CHEST:LUNGS AND PLEURA: Few scattered pulmonary micronodules. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is enlarged. No pericardial effusion. No mediastinal lymphadenopathy.Right chest wall port terminates at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No solid hepatic lesion has developed. The hepatic and portal veins are patent. The gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Non obstructing left lower pole renal calculi and scattered left renal parenchymal calcifications. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Post surgical changes from a partial colectomy. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is heterogeneous and enlarged possibly due to fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post partial colectomy without evident metastatic disease. |
Generate impression based on findings. | Pain, swelling status post fall. Rule out dislocation/fracture. There is dorsal dislocation of the middle phalanx with respect to the proximal phalanx. There is also slight ulnar angulation of the middle phalanx with respect to the proximal phalanx. I see no fracture on this study, although postreduction radiographs may be considered for further evaluation. | PIP joint dislocation as above. |
Generate impression based on findings. | Redemonstrated is a left lateral occipital lobe enhancing lesion measuring 6 x 7 mm, previously 6 x 7 mm, consistent with known metastatic lesion. Apparent curvilinear high signal in the left cerebellar hemisphere on series 1701, not reproduced on sagittal images, is likely artifactual. There are no new lesions detected. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild to moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. There are scattered punctate foci of susceptibility artifact, consistent with hemosiderin deposition from chronic microhemorrhage.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | No significant interval change in left lateral occipital lobe lesion. No new lesions are detected. |
Generate impression based on findings. | 60 year-old male with a history of pancreatic cancer. Presents for restaging. CHEST:LUNGS AND PLEURA: No significant pulmonary parenchymal or pleural abnormality. Minimal right basilar subsegmental atelectasis. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal cardiac size without pericardial effusion. No significant coronary calcifications. Note is made of a right thyroid lobe nodule, unchanged.CHEST WALL: Right-sided chest port with the catheter tip at the cavoatrial junction. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a prior Whipple procedure including hepaticojejunostomy and pneumobilia, unchanged. The patient is status-post cholecystectomy. The hepatic vasculature is patent. The reference of left hepatic lobe subcapsular hypoattenuating lesion is poorly delineated and measures approximately 1.9 x 1.3 cm (series 4/95) compared to 1.9 x 1.3 cm previously. Poorly defined caudate lobe attenuating lesion is also unchanged. No new hepatic lesions are identified.SPLEEN: Mildly enlarged spleen. A small splenule is noted.PANCREAS: Postsurgical changes from Whipple procedure. Stable main pancreatic duct dilatation up to 9 mm. Stable soft tissue infiltration within the resection bed.ADRENAL GLANDS: Stable right adrenal nodule measuring 2.3 x 2.0 cm (series 4/99), compared to 2.2 x 1.8 cm previouslyKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disease of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged, heterogeneous prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative disease of the spine.OTHER: No significant abnormality noted | No significant interval change in the post-operative findings, hepatic lesions and right adrenal nodule. No new sites of disease are identified. |
Generate impression based on findings. | Male 42 years old; Reason: metastatic colon cancer off chemotherapy since June 2014 History: colon cancer CHEST:LUNGS AND PLEURA: There are multiple bilateral pulmonary nodules compatible with metastatic disease. Index lesion in the right lower lobe measures 10 millimeters (image 79/series 5) previously, 6 millimetersReference lesion in the left lobe measures 1.4 x 1.3 cm (image 82/series 5) previously, 0.8 x 0.9 cm.There are new metastatic deposits in both lungs with growth of existing lesions.The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Interval development of several hepatic lesions. The reference left hepatic lobe lesion has increased in size and now measures 4.0 x 3.5 cm (image 100/series 3) previously, 2.4 x 2.2 cm.The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Delayed right nephrogram due to mild right hydronephrosis. The obstruction of the right ureter is due to a retro-peritoneal/mesenteric pelvic mass.RETROPERITONEUM, LYMPH NODES: New mesenteric mass that extends to the retroperitoneum about the aortic bifurcation measuring 2.1 x 2.3 cm (image 154/series 3). BOWEL, MESENTERY: Postsurgical changes in the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small mesenteric mass in the pelvis (image 173/series 3) that partially occludes the right ureter is new.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Multiple new pulmonary lesions and increase in the size of existing lesions.2.New liver lesions and increase in size of existing lesions.3.Retroperitoneal/mesenteric nodal mass that partially occludes the right ureter. |
Generate impression based on findings. | 44 years old, Male, Reason: hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: At least 3 liver hypodensities which peripherally fill with discontinuous nodular enhancement and appears to fill in on delayed imaging, consistent with multiple hemangiomas. The largest of these lesions, in hepatic segment 8, measures 4.9 x 4.9 cm (series 7, image 46).Two other subcentimeter hypoattenuating lesions which likely represent hepatic cysts. Focal fatty infiltration adjacent to the ligamentum teres.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis. No evidence of renal stone. The ureters are opacified bilaterally on delayed imaging and empty into the bladder. The distal portions of the ureters bilaterally are not well opacified. There is no evidence of filling defect to suggest a mass in the opacified portions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis. The appendix is normal appearance. No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes of the sacroiliac joints bilaterally most pronounced on the right.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Multiple hemangiomas in the liver.2. No specific findings to explain patient's hematuria. |
Generate impression based on findings. | Testicular carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter right hepatic lobe low attenuation foci.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable negative examination. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Male 6 years old Reason: fracture VIEWS: Left forearm AP and lateral 1/6/15 (two views) Cast material obscures fine bone details. Healing fractures of both forearm bones are in anatomic alignment. | Healing fractures , in anatomic alignment. |
Generate impression based on findings. | Right upper extremity lymphedema.RADIOPHARMACEUTICAL: The right upper extremity was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected subcutaneously. Following injection, intraoperative probe localization was performed. No images were acquired. | Successful injection for intraoperative identification of lymph nodes for lymph node transfer. |
Generate impression based on findings. | 68-year-old female, follow-up exam Again seen is a transverse fracture of the base of the fifth metacarpal with fragments in near anatomic alignment. Increased callus formation along the fracture suggests some interval healing. | Healing fifth metacarpal fracture. |
Generate impression based on findings. | 75-year-old male status post fall, evaluate for shoulder dislocation The bones are demineralized. Small glenohumeral osteophytes indicate mild osteoarthritis. Glenohumeral alignment is within normal limits. No fracture is evident. Mild degenerative arthritic changes affect the visualized spine. | Mild degenerative arthritic changes without fracture or dislocation. |
Generate impression based on findings. | 57-year-old male with shortness of breath and a history of cystic fibrosis. Evaluate for gastric emptying for lung transplant evaluation. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 60.4 % of peak activity (normal >70 %)1 hour: 37.4 % of peak activity (normal 30-90 %) 2 hours: 13.6 % of peak activity (normal <60 %) 3 hours: 0.6 % of peak activity (normal <10 % by 4 hours) | Gastric emptying within normal limits. |
Generate impression based on findings. | Female; 68 years old. Reason: pre-op for MAKO stryker protocol / left tha History: pain Marked osteoarthritis affects the left hip. Right total hip arthroplasty situated in near-anatomic alignment without evidence of complication. Degenerative arthritic changes of the partially visualized lumbar spine. Mild osteoarthritis affects the left knee.Postsurgical changes from ventral hernia repair, partially visualized. Status post hysterectomy. A round soft tissue nodule in the right superior pelvis measuring up to 3.3-cm is presumably the normal right ovary, similar to prior CT. Arterial vascular calcifications are seen. | Marked osteoarthritis of the left hip and other findings as described above. |
Generate impression based on findings. | Female 67 years old Reason: Pt is a 67 y/o female with urothelial cancer, s/p radical cystectomy, evaluate for recurrence, CT urogram, delayed views, 3D reconstruction History: urothelial cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy on the basis of size criteria. There are severe coronary arterial calcifications. The main pulmonary artery measures 3.2 cm in maximal diameter, which is greater than the upper limit of normal. Also a nonspecific finding, this finding may be seen in the setting of pulmonary arterial hypertension.CHEST WALL: Mild degenerative changes of the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The ureters are well opacified during the excretory phase and there are no filling defects to suggest metachronous urothelial lesion. There is mild prominence of the right ureter, presumably postoperative in etiology. The ileal conduit is normal in appearance.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. There are severe atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Postsurgical changes related to cystectomy and ileal conduit formation. There is a wide mouth fat containing ventral hernia, unchanged.BONES, SOFT TISSUES: Nonspecific heterotopic ossification in the bilateral subcutaneous gluteal fat. There are degenerative changes of the symphysis pubis and thoracolumbar spine. Irregularity of the right sacrum is again seen, unchanged.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Status post cystectomy. There is no evidence of enhancing soft tissue within the surgical bed to suggest local disease recurrence.LYMPH NODES: There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BONES, SOFT TISSUES: Nonspecific heterotopic ossification in the bilateral subcutaneous gluteal fat. There are degenerative changes of the symphysis pubis and thoracolumbar spine. Irregularity of the right sacrum is again seen, unchanged. | Postoperative changes related to cystectomy and ileal conduit formation, without evidence of locoregional recurrence or metastatic disease. |
Generate impression based on findings. | Status post fracture.VIEWS: Left wrist AP and lateral 1/6/15 (two views) Cast material obscures fine bone details. Healing fracture of the distal metaphyses of the left radius is in anatomic alignment. | Healing fracture in anatomic alignment. |
Generate impression based on findings. | 28-year-old male with a growing right sided groin mass which recently "popped" and is bleeding. RIGHT TESTIS: The right testicle is normal in morphology, echogenicity and size, measuring 3.1 x 2.0 x 3.9 cm. Spectral Doppler evaluation demonstrates arterial blood flow.LEFT TESTIS: The left testicle is normal in morphology, echogenicity and size, measuring 2.2 x 2.2 x 4.3 cm. Spectral Doppler evaluation demonstrates arterial blood flow.RIGHT EPIDIDYMIS: The right epididymis is normal in appearance.LEFT EPIDIDYMIS: There is a 10-mm left epididymal cyst. Otherwise, the left epididymis is normal in appearance. OTHER: There is marked thickening of the right scrotal area at the level of the patient's reported palpable abnormality and overlying skin bleeding. The subcutaneous soft tissues are hypoechoic with ill-defined margins with no drainable fluid collection, most compatible with an inflammatory collection.Small bilateral varicoceles. | 1. Inflammatory/phlegmonous collection corresponding to the patient's palpable abnormality and bleeding in the right scrotal area without a drainable fluid collection.2. Normal testes.3. Small bilateral varicoceles. |
Generate impression based on findings. | 65-year-old female with hip and groin pain Hip: Severe osteoarthritis affects the left hip.Pelvis: There is also severe osteoarthritis affecting the right hip although to a lesser degree than the left. The remainder of the pelvis is unremarkable. Degenerative arthritic changes affect the lumbar spine. | Osteoarthritis. |
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