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Generate impression based on findings. | Reason: r/o PE History: SOB, CP, hx DVTs PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolism. The main pulmonary artery is prominent suggesting pulmonary arterial hypertension.LUNGS AND PLEURA: Mild left pleural thickening/scarring.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. No visible coronary artery calcifications.No significant hilar/mediastinal lymphadenopathy.Ill-defined soft tissue density in the prevascular space, may represent residual thymic tissue, which is somewhat atypical for patient's age.CHEST WALL: No significant axillary lymphadenopathy.Mild degenerative disease of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism. No specific findings to account for patient's symptoms.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 3 years old Reason: rule out intra-abdominal process History: abdominal massVIEW: Abdomen AP (one view) 1/6/50 Normal abdominal gas pattern. No evidence of obstruction or free air. No displaced bowel loops suspicious for abdominal mass. | Normal examination. |
Generate impression based on findings. | 65-year-old female with a history of lupus, diabetes, and recent surgical repair of paraesophageal hernia. Now with recurrent vomiting hours after meals. Please assess for gastroparesis. Visually there was significantly delayed gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 84.2 % of peak activity (normal >70 %)1 hour: 82.9 % of peak activity (normal 30-90 %) 2 hours: 80.9 % of peak activity (normal <60 %) 4 hours: 79.1 % of peak activity (normal <10 %) | Severely delayed gastric emptying. |
Generate impression based on findings. | 90-year-old female with weakness and pain The bones are demineralized suggesting osteoporosis. Mild osteoarthritis affects the the glenohumeral joint. There is spurring of the acromion process and greater tuberosity. The humeral head is slightly high riding, which may reflect rotator cuff atrophy or tearing. Again noted are multiple old healed right rib fractures and degenerative arthritic changes affecting the visualized spine. | Degenerative arthritic changes and other findings as described above. |
Generate impression based on findings. | Reason: hx LVAD, pulm fibrosis, repeat CT History: Repeat CT LUNGS AND PLEURA: Significant interval improvement in the diffuse groundglass opacities and interlobular septal thickening which is compatible with edema.Interval clearing of a small bilateral pleural effusions.Severe underlying centrilobular emphysema redemonstrated.No new pulmonary opacities noted.MEDIASTINUM AND HILA: Nonspecific mild enlargement of multiple mediastinal lymph nodes unchanged.LVAD and ICD leads unchanged.Sphere cardiac enlargement without evidence of a pericardial effusion.Severe coronary artery calcification.CHEST WALL: Status post median sternotomy with nonunion of the sternotomy.ICD generator in the left anterior chest wall.Abandoned pacemaker leads in the right anterior chest wall.Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild perihepatic ascites redemonstrated. | Significant interval improvement in the pulmonary edema and clearing of small bilateral pleural effusions. |
Generate impression based on findings. | 50 year-old female 6 months status post a ALIF and PSF Three views of the lumbar spine show posterior stabilization rods with screws entering L4 and L5 with no evidence of hardware complication. A disk spacer device is present at the L4/L5 with no frank interbody fusion. Severe degenerative disk disease affects L5/S1. There is slight leftward curvature of the lumbar spine. | Orthopedic fixation of the lower lumbar spine and degenerative disk disease, as described above. |
Generate impression based on findings. | 82 year old with new bilateral breast masses presents for ultrasound guided biopsy. Biopsy for right breast mass is performed. Biopsy for left breast mass will be performed later today, and it will be reported separately. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 10 x 9 mm at the 10 o’clock position without increased vascularity, 5 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, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial 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 Hydromark 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 CC and ML views for both breasts were performed after the right and left breast biopsy. Images of right breast revealed the percutaneously placed clip to be in the expected location in the peripheral anterior aspect of the lesion. No evidence of hematoma or other complication. (Findings of the left breast images are reported in the separate report of left breast biopsy.)A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Subsequently, ultrasound guided biopsy for left breast is performed. (Please see the separate report).The procedure was performed by Dr. Abe. | 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. | Staging squamous cell carcinoma of the lung.RADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates right cerebellar porencephaly. Emphysema is seen bilaterally most notably in the upper lungs. An approximately 3.5-cm right upper lobe spiculated mass is present within a 1 cm satellite nodule just superiorly. Enlarged right hilar as well as pre-and subcarinal lymph nodes are noted. Atherosclerotic including coronary arterial calcifications are seen. A large hypodense left renal lesion is likely a cyst.Today's PET examination demonstrates a medium sized markedly hypermetabolic pulmonary mass in the right upper lobe which has increased in size and metabolic activity from previous (SUV max = 8.8 previously, = 17.4 currently), and is compatible with the patient's diagnosis of lung cancer. There is a new small satellite hypermetabolic nodule immediately superior to this mass, also in the right upper lobe, consistent with an additional tumor focus.A large markedly hypermetabolic right hilar lymph node has increased significantly in size and metabolic activity from previous (SUV max = 3.5 previously, = 13.8 currently), compatible with a regional lymph node metastasis. Several additional hypermetabolic mediastinal lymph nodes elsewhere in the right hilum as well as at the pre-and subcarinal stations are new and indicated additional regional lymph node metastases.No suspicious contralateral thoracic FDG avid lesion is identified.Within the pelvis, however, a medium sized markedly hypermetabolic colonic lesion in the region of the sigmoid (SUV max = 31.0) has increased in size from previous and is highly suspicious for a primary colonic malignancy.There are two much smaller but abnormally FDG avid foci involving colonic wall both more superiorly within the sigmoid (SUV max = 5.9) and more inferiorly along the right rectal wall (also SUV max = 5.9), which are stable and suspicious for small additional colonic polyps (benign or malignant).Hypermetabolic soft tissue foci between adjacent spinous processes in the upper lumbar spine are consistent with benign inflammation.Decreased right cerebellar activity again seen at the skull base is suggestive of a chronic cerebellar infarct although is incompletely visualized on this exam. | 1.Markedly hypermetabolic right upper lobe pulmonary mass with an adjacent satellite nodule is compatible with the patient's diagnosis of lung cancer and has progressed from previous PET.2.Enlarged markedly hypermetabolic right hilar, precarinal, and subcarinal lymph nodes are compatible with regional lymph node metastases, also progressed from previous.3.No contralateral thoracic or extrathoracic FDG avid metastatic disease.4.Increasing markedly hypermetabolic sigmoid colon mass, highly suspicious for synchronous primary colon cancer. Two smaller stable hypermetabolic colonic wall foci are suspicious for additional small colonic polyps (which may be benign or malignant). |
Generate impression based on findings. | Female, 69 years old, status post C7 fracture, assess healing. Concavity and sclerosis along the superior endplate of C7 is again seen compatible with the known fracture at this location. The fractured fragment continues to protrude slightly towards the ventral epidural space which, along with bulging disk material and/or ligamentous thickening, mildly narrows the spinal canal and indents the ventral spinal cord. At least partial healing of this fracture is seen with no significant interval change.An associated fracture through the right C7 transverse process shows evidence of interval healing in that the lucent fracture line is no longer clearly visible.No other fractures are suspected. Spinal alignment is anatomic. Mild disk osteophyte formation is again seen through the cervical spine, unchanged. No high-grade spinal canal or neuroforaminal stenoses are seen. | A fracture through the superior endplate of C7 shows findings compatible with at least partial healing and no significant interval change.Associated fracture through the right C7 transverse process has healed in the interval. |
Generate impression based on findings. | Ms. Springer is a 58 year old female with a personal history of left breast lumpectomy in March 2012 for IDC treated with chemotherapy and Herceptin. She also has a biopsy proven fibroadenoma in the left inferior breast. She has no current breast related complaints. Three standard views of both breasts, a left laterally exaggerated CC view, and two left spot 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. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Surgical clips are also seen in the left axilla. A biopsy marker clip with associated focal asymmetry is again identified in the left inferior breast, 6 o'clock position, compatible with prior benign biopsy. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes in the left 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. | 82 year old with new bilateral breast masses presents for ultrasound guided biopsy. Biopsy for left breast mass is performed. Biopsy for right breast mass was performed earlier today (please see the separate report). Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 20 x 12 mm at the 7 o’clock position without increased vascularity, 5 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, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 12-gauge core needle (Celero) 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 Hydromark 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 CC and ML views for both breasts were performed after the right and left breast biopsy. Images of left breast revealed the percutaneously placed clip to be in the expected location in the central portion 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. | Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 74 years old Reason: hx of bladder cancer, evaluate for mets with delayed imaging History: see above ABDOMEN:LUNG BASES: Pulmonary micronodules without significant change. However, there is a 1.0 cm right lower lobe pulmonary nodule (image 2, series 5), which was not included in the previous field of view. The etiology of this nodule is unclear, but continued surveillance is recommended.LIVER, BILIARY TRACT: Unchanged hypoattenuating hepatic lesions incompletely characterized, but most likely benign in etiology. Hyperattenuating hepatic dome lesion is unchanged and most likely reflects a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple left-sided renal cysts. Hypoattenuating lesion in the right renal cortex is consistent with a simple renal cyst.The ureters are well opacified during the excretory phase and there are no filling defects to suggest metachronous urothelial lesion. The patient is status post cystoprostatectomy with ileal conduit formation.RETROPERITONEUM, LYMPH NODES: There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: Postsurgical changes related to ileal conduit formation.BONES, SOFT TISSUES: Heterogeneous lucency of the bilateral sacrum, which is unchanged and presumably benign in etiology.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy. There is no enhancing soft tissue seen within the surgical bed to suggest locoregional disease recurrence.LYMPH NODES: Postsurgical changes related to prior lymph node dissection. There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: Postsurgical changes related to ileal conduit formation.BONES, SOFT TISSUES: Heterogeneous lucency of the bilateral sacrum, which is unchanged and presumably benign in etiology.OTHER: No significant abnormality noted | 1.No definite evidence of locoregional disease recurrence or distant metastatic disease.2.1.0 cm left lower lobe pulmonary nodule not included in the field of view on the prior examinations. The etiology of this nodule is uncertain, but attention at follow up is recommended. |
Generate impression based on findings. | 12-year-old female with pain, history of stone. Rule out cholecystitis. LIVER: The liver is normal in echotexture and size, measuring 13 cm in length.GALLBLADDER, BILIARY TRACT: No intra-or extrahepatic biliary ductal dilatation. Common duct measures 4 mm. Cholelithiasis is noted. No pericholecystic fluid or gallbladder wall thickening is present. Negative sonographic Murphy's sign. PANCREAS: The body and tail of the pancreas is obscured by overlying bowel gas.SPLEEN: Normal in size, measuring 9.4 cm.KIDNEYS: The kidneys are normal in size, measuring 9.6 cm on the right and 9.6 cm on the left, without evidence of hydronephrosis, stone, or renal mass.OTHER: No significant abnormality noted. | Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | Reason: recurring pneumonia History: recurring pneumonia LUNGS AND PLEURA: Scattered nonspecific micronodules. Peripheral bilateral lower lobe and right middle lobe tree in bud opacities compatible with aspiration bronchiolitis.No focal areas of consolidation.No pleural effusions.MEDIASTINUM AND HILA: Hypoattenuating bilateral thyroid nodules readno hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Degenerative changes in the thoracic spine with Schmorl's node at T11.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | Scattered peripheral areas of tree in bud opacities in both lungs compatible with aspiration/ bronchiolitis. No evidence of pneumonia. |
Generate impression based on findings. | Metastatic carcinoid CHEST:LUNGS AND PLEURA: Stable biapical scarring. Stable left basilar scarring.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Accounting for differences in technique, there has probably been no significant change in the overall size of the previously noted numerous bilobar hepatic metastases. Reference segment 8 lesion best seen on image 95 now measures 4.7 x 4.1 cm. Nodular thickening along the posterior aspect of the liver is again seen and unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Stable reference pancreaticoduodenal lymph node best seen on image 103 measuring 2 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination. |
Generate impression based on findings. | Reason: NSCLC in need of re-imaging please compare to prior History: NSCLC CHEST:LUNGS AND PLEURA: Comparable measurements are not possible, as the margins of the mass are obscured by radiation reaction.New multifocal centrilobular and subpleural ground-glass/solid opacities, bronchial wall thickening, and associated volume loss/traction bronchiectasis is suggestive of post radiation changes.Unchanged appearance of focal bronchiectasis and clustered small nodules in the right middle lobe, likely postinflammatory.Focal scarring in the right lower lobe is unchanged when compared to prior.Apical-predominant centrilobular emphysema.MEDIASTINUM AND HILA: No significant hilar/mediastinal lymphadenopathy.The heart size is within normal limits, no significant pericardial effusion. Severe coronary artery calcifications.CHEST WALL: No significant axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Biliary ductal dilatation status post cholecystectomy, unchanged. Multiple hepatic cysts are grossly stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable appearance of enlarged left adrenal gland, likely benign based on the appearance on previous PET/CT.KIDNEYS, URETERS: Multiple bilateral renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate to severe degenerative disease of the spine.OTHER: No significant abnormality noted. | Interval development of multifocal, patchy, air space opacities, which obscure the margins of the reference left perihilar mass; appearance is compatible with radiation reaction. No new suspicious nodule/mass. |
Generate impression based on findings. | Male; 69 years old. Reason: eval for oa History: hip pain Mild to moderate osteoarthritis affects both hip joints. No acute fracture or malalignment is evident. | Mild to moderate osteoarthritis of both hips. |
Generate impression based on findings. | Female, 67 years old. Reason: DHT advanced, nausea. Eval gastric bubble/DHT placement History: nausea Interval adjustment of Dobbhoff tube with tip overlying the gastric body.Nonobstructive bowel gas pattern. | Dobbhoff tube tip overlying the gastric body. |
Generate impression based on findings. | Reason: Patient is participating in research study. Evaluate for lung disease History: History of rheumatoid arthritis LUNGS AND PLEURA: Scattered centrilobular opacities are seen, as well as a mild mosaic attenuation pattern worse on expiratory series consistent with air trapping.While there is no significant bronchiectasis except for a region in the right middle lobe, there is mild diffuse bronchial wall thickening especially in the right upper lobe.No reticular or groundglass opacities.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.There are no visible coronary calcifications, and the heart and pericardium appear normal.Mediastinal lipomatosis is present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild pulmonary abnormalities consisting of centrilobular opacities, mosaic attenuation/air trapping, and bronchial wall thickening are nonspecific but could in part be related to rheumatoid disease. |
Generate impression based on findings. | Male 54 years old Reason: evaluate EC fistula ABDOMEN:LUNG BASES: Right basilar atelectasis.LIVER, BILIARY TRACT: The patient is status post cholecystectomy.SPLEEN: Findings consistent with splenosis.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided renal cyst. Symmetric nephrograms.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications and mural plaque affecting the abdominal aorta and its branches.BOWEL, MESENTERY: There are postsurgical changes related to gastrojejunostomy, although the anastomosis is not clearly seen. There is a fistulous tract between what appears to be greater curvature of the stomach and the ventral abdominal wall defect with fluid seen pooling within the defect. These findings are most compatible with a gastrocutaneous fistula. There is matted small bowel in the region of the gastric body, although no definite fistulous communication is evident between the small bowel and skin.There are postsurgical changes related to prior esophagogastric fundoplasty.BONES, SOFT TISSUES: Wide mouth ventral abdominal wall defect with associated diastases of the rectus abdominis musculature. Posterior pedicle rod and screw fixation of multiple lumbar vertebrae. There is exuberant heterotopic ossification about the iliac wings bilaterally.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: Wide mouth ventral abdominal wall defect with associated diastases of the rectus abdominis musculature. Posterior pedicle rod and screw fixation of multiple lumbar vertebrae. There is exuberant heterotopic ossification about the iliac wings bilaterally.OTHER: No significant abnormality noted | 1.Ventral abdominal wall defect with findings most compatible with a gastrocutaneous fistula near/at the presumed level of the prior gastrojejunal anastomosis, although the anastomosis is not definitely seen.2.Postsurgical changes related to multiple intra-abdominal surgeries including gastrojejunostomy, cholecystectomy and esophagogastric fundoplication as well as attempted ventral hernia repair.3.Splenosis. |
Generate impression based on findings. | Reason: evaluate for metastasis. History: mesenchymal chondrosarcoma. LUNGS AND PLEURA: No postsurgical changes in right lower lobe related to a prior wedge resection.Left basilar subpleural semisolid nodule (image 80 series 7) demonstrates continued decrease in size now measuring 10 mm x 60 mm imaging 13 x 16 mm and most likely represents resolving atelectasis/inflammation related to prior rib resection.Left upper lobe subpleural nodule (image 43 series 7) is stable measuring 8 mm x 6 mm.No new pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal adenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: No axillary lymphadenopathy.Partial resection of the posterior aspect of the left 11th rib.No evidence of recurrent tumor.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable hepatic hypodensities. Cholelithiasis. Partially visualized retroperitoneal surgical clips. | 1.No interval change without evidence of metastatic disease. Stable left upper lobe subpleural nodule.2.No evidence of recurrent disease in the region of the resected left 11th rib and left transverse process of T11. |
Generate impression based on findings. | 60 years old, Female, Reason: met colon cancer on chemotherapy, evaluate for disease progression History: colon cancer CHEST:LUNGS AND PLEURA: Multiple pulmonary lesions. Reference left lower lobe lung lesion measures 1.1 x 0.7 cm (image 60, series 4), previously measuring 0.9 x 0.8 cm.MEDIASTINUM AND HILA: Stable mild prominence of the ascending aorta measuring 3.2 centimeters.CHEST WALL: Right chest wall port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastases are again seen and do not appear significantly changed in size. Reference segment 4 lesion measures 4.0 x 3.0 cm (series 3, image 88), previously measuring 4 x 3 cm. Reference left lateral segment lesion measures 1.9 x 3.2 cm (series 3, image 100), previously measuring 3.3 x 2.0 cm.No biliary ductal dilatation. Cholelithiasis without evidence of acute cholecystitis.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: Mild thickening of the rectosigmoid colon, please correlate with site of malignancy. Small cystlike hypodensity in region of the sigmoid colon is nonspecific and unchanged since prior study. No evidence of obstruction. No evidence of pneumatosis or free air.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: See abdomen sectionBONES, SOFT TISSUES: Sequela of anterior abdominal wall injections.OTHER: No significant abnormality noted. | 1. No significant change in size of pulmonary nodules2. No significant change in size of hepatic metastases.3. Rectosigmoid colon similar in appearance as above. |
Generate impression based on findings. | 61-year-old male status post LVAD placement. Drainage around the tract line. Evaluate for drainable fluid collection. Targeted ultrasound was performed of the left upper and lower quadrants along the LVAD drive line. There is no discrete drainable fluid collection. The subcutaneous soft tissues are edematous. | No drainable fluid collection. Edematous subcutaneous soft tissues; correlate for clinical signs and symptoms of cellulitis. |
Generate impression based on findings. | 65-year-old male with history of gout, PsA, bilateral hand synovitis Hand: Severe osteoarthritis affects the fifth PIP joint. Relatively mild osteoarthritis affects additional scattered interphalangeal joints. There are no specific radiographic features of psoriatic arthritis or gout. Left hand: Mild osteoarthritis affects scattered interphalangeal joints, the first metacarpophalangeal joint and the basilar joint. There are no specific radiographic features of gout or psoriatic arthritis. | Osteoarthritis without specific radiographic features of psoriatic arthritis or gout. |
Generate impression based on findings. | Female 40 years old; Reason: 40 y/o met colon ca. on chemo. compare to prior scan. History: met colon ca CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Central venous catheter with tip in right atrium. Status post sternotomy and postoperative changes related to pulmonic valve replacement. Stable cardiomegaly. Visualized lung fields without significant change, stable subcentimeter right apical calcified granuloma.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatic lobe resection. Several left hepatic lesions seen, not as well visualized, may be related to interval improvement in disease or differences in timing of IV contrast bolus as current exam was performed in earlier arterial phase. Reference segment 2 lesion not significantly altered in size, measuring approximately 1.7 x 1.6 cm, image 67 series 3, previously measured 1.8 x 1.6 cm. Hypoattenuation seen near postsurgical resection site unchanged in appearance.SPLEEN: Splenomegaly, may be mildly improved.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged extrarenal pelvises, more pronounced on the right than the left.RETROPERITONEUM, LYMPH NODES: Again seen suprarenal intraluminal hypoattenuation in the IVC adjacent to/below hepatic resection site, may reflect underlying IVC stenosis. Collateral vessel formation and dilatation of hemiazygos system again suggested. Superficial small collateral vessel formation seen, similar to prior study. Multiple small retroperitoneal lymph nodes. Reference aortocaval lymph node stable to mildly smaller in size, measuring 1 x 0.9 cm, image 118 series 3, previously measured 1.2 x 1 cm.BOWEL, MESENTERY: Postsurgical changes relating to partial colectomy. PELVIS:UTERUS, ADNEXA: Follicles seen in both ovaries, may be physiologic.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Multilevel degenerative changes of spine. Ventral abdominal soft tissues scarring. | 1. Hepatic metastatic disease, not as well seen but grossly stable in size as above.2. Subocclusive IVC thrombus again seen, may be secondary to underlying intrahepatic IVC stenosis, associated collateral vessel formation seen. |
Generate impression based on findings. | 63 year old female with history of neck cancer. Chemoradiation therapy. CHEST:LUNGS AND PLEURA: Stable scattered pulmonary micronodules, some which are calcified. No pleural effusion, no consolidation and no pneumothorax. Minimal basilar scarring, unchanged. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Tracheostomy tube tip approximately 2 cm above the carina. Heart size within normal limits, and there is no pericardial effusion. Mild coronary artery calcifications. Pulmonary trunk diameter is enlarged, similar to prior. Small mediastinal lymph nodes are similar in size to prior.CHEST WALL: Prominent left axillary lymph nodes, unchanged. Left sternoclavicular deformity, unchanged. 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: Mild anterior listhesis of L4 on L5, stable and postoperative findings of hemilaminectomy. Degenerative changes appear similar to prior.OTHER: Small hiatal hernia. | Stable exam, without evidence of metastatic disease. |
Generate impression based on findings. | Reason: h/o oropharyngeal ca and CRT, compare to previous, measurements pls History: none LUNGS AND PLEURA: Ground-glass opacity in the right apex is unchanged.Posterior left upper lobe ground glass nodule measures 7 mm, unchanged (series 5, image 33), which may relate to atypical adenomatous hyperplasia or adenocarcinoma in situ.Unchanged, flat, right upper lobe lesion measures 8 x 6 mm (series 5, image 34), likely representing a scar.Stable appearance of calcified granuloma in the right lung.No new nodule/mass.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. Mild coronary artery calcifications.No significant hilar/mediastinal lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. Superficial calcifications in the right axilla.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No definitive evidence of metastatic disease.2. Unchanged solid and ground glass nodules. Continued surveillance is recommended. |
Generate impression based on findings. | Female 40 years old Reason: Colon cancer follow up History: Abdominal pain CHEST:LUNGS AND PLEURA: Biapical pleural parenchymal scarring unchanged. Multifocal patchy airspace opacities, with tree in bud opacities seen in the right lower lobe, may reflect chronic aspiration. More focal area of consolidation seen in the perihilar right lower lobe may be related to superimposed infection.MEDIASTINUM AND HILA: Interval increase in size of multiple scattered mediastinal lymph nodes as well as a right hilar lymph node. This is nonspecific and may be reactive in etiology, although metastatic disease is also possible. For reference purposes, a right hilar node measures 1.2 x 1.4 cm (image 48, series 3).CHEST WALL: Right chest wall Port-A-Cath tip terminating at the cavoatrial junction. Nonspecific slight interval increase in size of a left axillary lymph node.ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation, which is slightly increased from the prior examination. There is increased prominence of the pancreatic duct to the level of the ampulla suggesting an ampullary stricture as the etiology. Hypoattenuating lesion in hepatic segment 5/6 is unchanged in the prior exam.SPLEEN: No significant abnormality notedPANCREAS: Prominence of the pancreatic duct appears slightly increased from the prior examination, extending to the level of the ampulla suggesting an ampullary strictureADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: Postsurgical changes related to sigmoidectomy. There are multiple enlarged perirectal lymph nodes, which have increased in size since prior examination. The index perirectal lymph node now measuring 0.7 x 0.8 cm (image 170, series 3), previously 0.7 x 1.0 cm. However, new lymph nodes along the perirectal fascia have significantly increased in size. A new reference perirectal lymph node now measures 1.1 x 1.2 cm (image 170, series 3). There is extensive mucosal hyperenhancement affecting the distal transverse colon to the level of the rectum with associated loss of haustral markings and mild submucosal edema. Given the long segment of the affected bowel, inflammatory/infectious etiology is considered most likely, although neoplasm is not excluded.BONES, SOFT TISSUES: There are no definite lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple prominent pelvic lymph nodes are again seen, not pathologically enlarged by size criteria. | 1.Interval increase in size of the perirectal lymphadenopathy.2.Long segment mucosal hyperenhancement and submucosal edema affecting the transverse and left colon, suggesting an inflammatory or infectious etiology. However, neoplasm is not excluded.3.Findings above may reflect aspiration, with possible superimposed consolidation/infection.4.New mediastinal and hilar lymphadenopathy, which may be reactive in etiology, although metastatic disease is not excluded and attention at follow-up is recommended. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Moderate coronary calcifications are present, but the heart and pericardium are otherwise unremarkable.CHEST WALL: Degenerative abnormalities affect the thoracic spine.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. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Reason: Hx of COPD transferred here with new AML History: Fevers LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema and basilar predominant bronchial wall thickening.Calcification the left lower lobe most likely representing calcified granuloma.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes compatible with prior granulomatous disease.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a paracardial effusion.CHEST WALL: Degenerative changes of the thoracic spine with mild anterior wedging of several midthoracic vertebrae of indeterminate age.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild centrilobular emphysema and bronchial wall thickening compatible with COPD. No evidence of acute infection. |
Generate impression based on findings. | Status post scapholunate ligament reconstruction with scapholunate screw fixation. Assess healing. An orthopedic screw affixes the proximal pole of the scaphoid to the lunate in near-anatomic alignment. There is minimal widening of the scapholunate interval relative to the remaining intercarpal intervals. Lucency about the screw may represent loosening, but the true clinical significance of this finding is uncertain. A lucent defect in the scaphoid more distally likely represents previous orthopedic intervention. Mild osteoarthritis affects the trapezioscaphoid articulation. | Orthopedic fixation of the scapholunate interval as described above. |
Generate impression based on findings. | Status post fracture.VIEWS: Left ankle AP, lateral and oblique 1/6/15 (3 views) Cast material obscures fine bone details. Three K wires are affixing a medial malleolus fracture and two screws are doing this same with the distal fibular fracture. Alignment is anatomic. | Healing fractures in anatomic alignment after instrumentation as described. |
Generate impression based on findings. | 56 your old male with history of the neck cancer. Chemoradiation therapy. CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule (6/28) measures 14 x 4 mm, unchanged. Additional pulmonary nodules are unchanged in size.Biapical radiation fibrosis. Small left apical pneumothorax is new. Bronchiolar and bronchial wall thickening, which may represent reactive airway disease.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged in size. Heart size within normal limits. No pericardial effusion. Moderate calcifications. Atherosclerosis affects the aorta and its branches.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. No biliary dilatation or findings of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney, similar to prior.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.Multiple bilateral pulmonary nodules, unchanged in size, with no new sites of metastatic disease.2.Bronchiolar/bronchial wall thickening which may represents reactive airway disease.3.New small left apical pneumothorax.Clinical service has been notified of small apical pneumothorax. |
Generate impression based on findings. | Female; 56 years old. Reason: back pain s/p fall History: back pain Five views of the lumbar spine demonstrate mild degenerative disk disease L3-4, L4-5, and L5-S1. Vertebral body heights are maintained without evidence of fracture. Normal alignment.Single AP view of the pelvis demonstrates severe osteoarthritis of the hips, right greater than left. No acute fracture or malalignment. Two views of the right femur demonstrate the aforementioned osteoarthritis of the right hip. No acute fracture or malalignment. Mild osteoarthritis of the right knee.Two views of the right tibia/fibula demonstrate the aforementioned osteoarthritis of the right knee. No acute fracture or malalignment. | Degenerative arthritic changes without evidence of acute fracture or malalignment. |
Generate impression based on findings. | Status post fracture.VIEWS: Right ankle AP, lateral and oblique 1/6/15 (3 views) Cast material obscures fine bone details. Compression plates and screws are affixing a distal fibular fracture. Salter-Harris two fracture of the distal tibia is in anatomic alignment. | Interval instrumentation of distal fibular fracture as described. |
Generate impression based on findings. | Status post fracture.VIEWS: Right forearm AP and lateral 1/6/15 (two views) Cast material obscures fine bone details. Healing fracture of the right ulna is in anatomic alignment. | Right ulnar healing fracture in anatomic alignment. |
Generate impression based on findings. | Female 7 years old Reason: Evaluate degree of stool burden History: Hx cloaca and constipationVIEW: Abdomen AP (one view) 1/6/15 I1429 hours. Sacrum agenesis is again noted. Interval decreasing in fecal accumulation. Noted is obstruction or free air. | Interval improvement in fecal loading. |
Generate impression based on findings. | 40 year-old female with right breast mass detected on screening mammography. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 10 mm at the 2 o’clock position with increased vascularity, 2 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. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen partially sank. 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 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. | Status post fall. Evaluate for fracture. I see no fracture or dislocation. Tubing overlies the left hip. | No fracture evident. |
Generate impression based on findings. | 15-year-old female status post appendectomy 7/2014, delayed bowel function. Evaluate for IBD, fistula.EXAMINATION: MR enterography without and with IV contrast 1/6/2015, 1310 hrs. ABDOMEN:LIVER, BILIARY TRACT: Homogeneous liver parenchyma without focal lesion. No intra-or extrahepatic biliary ductal dilatation. Normal appearing gallbladder.SPLEEN: No focal splenic lesion.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The terminal ileum is identified and is normal in appearance without definite wall thickening. Postsurgical changes are present in the right lower quadrant. No loculated fluid collection/abscess or specific evidence of inflammatory bowel disease is present.BONES, SOFT TISSUES: No focal osseous lesion is identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal appearance of the uterus and adnexa.BLADDER: No filling defects, evidence of fistula, or bladder wall thickening is identified.LYMPH NODES: No pelvic, inguinal, or iliac chain lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of abscess, fistula, or inflammatory bowel disease. |
Generate impression based on findings. | Lumbar pain The bones appear demineralized, suggesting osteopenia/osteoporosis. There is a mild levoscoliosis of the lumbar spine. Severe degenerative disk disease affects L2/3 and L3/4. Vertebral body heights are preserved. | Degenerative disk disease. |
Generate impression based on findings. | Reason: left upper lung mass; had several CTs and a recent PET; need super D protocol History: cough LUNGS AND PLEURA: Left upper lobe mixed groundglass opacity with associated nodules are ((images 63 through 78, series 7) is unchanged from the prior exam and compatible with minimally invasive adenocarcinoma. Associated nodules were not present on the exam dated 7/30/13 but were present on the exam dated 2/4/14.No new pulmonary nodules or pulmonary opacities.Moderate upper lobe predominant centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.There is cardiac enlargement without evidence of pericardial effusion.Mild coronary calcifications.ICD leads identified within the heart.CHEST WALL: Old rib fracture deformities in the right hemithorax.Degenerative changes of the thoracic spine.ICD generator in the left and chest wall.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Stable hepatic hypodensities most likely representing cysts.Partially imaged abdominal aortic stent.Hyperdense exophytic left renal cyst. | Stable left upper lobe groundglass mass with solid components suspicious of a minimally invasive adenocarcinoma. |
Generate impression based on findings. | Female; 72 years old. Reason: ? OA History: Back pain Five views of the lumbar spine demonstrate severe degenerative disk disease at T12-L1, moderate degenerative disk disease of L1-L2, and mild degenerative disk disease of the remainder of the lumbar spine. Moderate degenerative arthritic changes of the facet joints of the lower lumbar spine. Vertebral body heights are maintained without evidence of acute fracture. Alignment is within normal limits. Pelvic surgical clips. | Degenerative arthritic changes as described above. |
Generate impression based on findings. | 82 years old, Female, Reason: 82 yo female with recurrent ovarian cancer and clinically worsening left groin metastasis History: Left groin pain, swelling and drainage CHEST:LUNGS AND PLEURA: New and enlarging bilateral pulmonary nodules. Left lower lobe pulmonary nodule appears larger in size measuring 6 mm (series 6, image 34), previously measuring 3 mm.MEDIASTINUM AND HILA: Newly right hilar adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified splenic granuloma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index left paraaortic lymph node is larger in size measuring 2.1 x 2.7 cm (series 4 image 103), previously measuring 1.3 x 1.6 cm. Multiple other scattered retroperitoneal lymph nodes appear larger in size and may be invading the psoas muscle. Ill-defined soft tissue attenuation posterior and adjacent to the IVC.The inferiormost IVC and common iliac vessels are not well visualized with adjacent tumor concerning for chronic thrombosis of these vessels with multiple collateral vessels and varicosities seen.BOWEL, MESENTERY: Multiple mesenteric lymph nodes appear larger in size. No evidence of obstruction. Colonic diverticulosis is present.BONES, SOFT TISSUES: See pelvis sectionOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualizedBLADDER: Conglomerate left adnexal lymph nodes may be invading the bladder.LYMPH NODES: Left obturator lymph node is larger in size now measuring 4.0 by 2.5 cm (series 4, image 17), previously measuring 2.3 x 3.1 cm. Multiple other pelvic lymph nodes appear larger in size. Conglomerate of left sided pelvic lymph nodes appear to invade the pelvic sidewall. There are also enlarged right pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: In the left inguinal area there is marked interval growth of metastases. There is now a large multilobulated heterogeneously enhancing mass with central areas of calcification which measures approximately 8.1 x 4.8 cm (series 4 image 180).Decreased osseous mineralization.OTHER: No significant abnormality noted. | 1.Marked interval growth of left inguinal mass.2.Interval growth of multiple retroperitoneal lymph nodes with questionable thrombosis of the common iliac vessels.3.Interval growth of pelvic lymph nodes with possible invasion of adjacent structures including the bladder.4.Enlarging and new pulmonary metastases. |
Generate impression based on findings. | 48-year-old female with history of salivary gland malignancy. LUNGS AND PLEURA: Right lower lobe peripheral 3-mm nodule (6/29) is unchanged in size compared with the most recent exams. Additional scattered micronodules are unchanged. No pleural effusion or new suspicious nodules.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Small calcified mediastinal lymph nodes are unchanged. No appreciable port or artery calcifications.CHEST WALL: Minimal degenerative changes affect the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hepatic hypodensities are unchanged comment two small characterize but likely benign cysts. | Unchanged right lower lobe peripheral nodule, likely benign. No evidence of metastatic disease. |
Generate impression based on findings. | 82 year male with history of T2 N0 squamous cell carcinoma of the floor of mouth and ventral tongue, treated in 2013 with surgery. Evaluate for recurrence. Again seen are postsurgical changes of resection involving the anterior tongue and floor of mouth with graft. Evidence of bilateral neck dissection is also seen. No masses or abnormal enhancement is seen to suggest tumor recurrence. Small scattered neck lymph nodes are again seen. No pathologic adenopathy is detected by size criteria.This partial effacement of the bilateral vallecular and piriform sinus likely related to secretions. Airway is patent. The parotid glands are within normal limits. The submandibular glands appear to have been resected. The thyroid is unremarkable.The cervical vessels are patent with evidence of atherosclerotic calcification of the carotid bifurcations. Lung apices are clear. Please see separate report for findings in the chest.No suspicious bony lesions are seen. Degenerative changes are seen in the cervical spine including multilevel neural foramina stenosis, particularly severe right C3-C4 and moderate right at C4-C5.A low density subcutaneous lesion in the left posterior neck is stable and may represent a sebaceous cyst. | 1. Postsurgical changes involving the anterior tongue and floor of mouth as well as of bilateral neck dissections. No findings to suggest tumor recurrence.2. No pathologic lymphadenopathy in the neck. |
Generate impression based on findings. | Ms. Brody is a 69 year old female with a personal history of right partial mastectomy in November 2013 for multicentric right breast IDC. She had a post-operative mammogram that demonstrated new calcifications at the lumpectomy site. Recent MRI performed in June 2014 was read as negative. She now presents for a short-term follow-up for these calcifications. Three standard views of the right breast and three spot 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. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also seen in the right axilla.Faint powdery calcifications are re-identified posterior to the lumpectomy site in the 12 o'clock radian of the right breast. These appear similar in size and appearance when compared to prior exam. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | Stable postsurgical changes with probably benign calcifications in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient. BIRADS:3 - Probably benign finding. RECOMMENDATION:3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Reason: r/u upper respiratory infection- needs CT non infused History: coughing LUNGS AND PLEURA: No specific evidence of infection.Mild compression atelectasis is present adjacent to the mediastinum primarily on the left.Mosaic attenuation is consistent with known pulmonary arterial hypertension.Prominent subpleural vessels may be small AVMs is associated with PAH.MEDIASTINUM AND HILA: Massive pulmonary artery dilation, the main pulmonary artery at least 5.1 cm.The heart chamber sizes cannot be evaluated as there is no contrast administered.Moderate pericardial effusion.CHEST WALL: Degenerative abnormalities affect the thoracic spine, with two vertebra fused in the midthoracic region.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Massive pulmonary arterial hypertension, with associated mosaic lung attenuation and possible small subpleural AVMs.2. Moderate pericardial effusion.3. No specific evidence of infection. |
Generate impression based on findings. | Female; 66 years old. Reason: healed fx? History: none Three views of the right wrist demonstrate volar plate and screw device affixing a comminuted fracture of the distal radius in near anatomic alignment. No evidence of hardware loosening. Increased sclerosis along the fracture lines, compatible with some interval healing. Mild soft tissue swelling about the wrist. | Fixated distal radius fracture without complication. |
Generate impression based on findings. | Low back pain. Multiple myeloma. 3 views of the thoracic spine are provided. Evaluation of the upper thoracic spine is limited due to overlying anatomy. The bones are demineralized, likely reflecting widespread multiple myeloma. Again seen is a compression fracture of T12 that was present on the May 2013 study. There is also slight loss of height of T11 that I believe is unchanged from the prior study. I see no new compression fractures. Degenerative disk disk disease affects the visualized cervical spine.Three views of the lumbar spine are provided. The bones are demineralized, likely reflecting myelomatous involvement. Mild compression fractures of L1, L3, and L5 appear similar to the prior study. Orthopedic hardware within the left proximal femur is incompletely imaged on this study. | Findings compatible with myeloma with compression fractures appearing similar to those seen on the prior study. |
Generate impression based on findings. | 64-year-old male with history of right lower facial droop. Evaluate for hemorrhage. There is no evidence of acute intracranial hemorrhage. There are foci of hypoattenuation within bilateral basal ganglia and thalami. There is mild confluent areas of periventricular and white matter hypoattenuation compatible with progressive small vessel ischemic disease. There is mild prominence of the ventricles and sulci which is out of proportion to age. There is no mass effect, midline shift, or herniation. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium and scalp soft tissues are unremarkable. The orbits are normal. | 1.No acute intracranial hemorrhage.2.Progressive small vessel ischemic disease with interval left basal ganglia and thalamic lacunar infarcts which are age indeterminate. MRI can be obtained if there remains concern for an acute ischemic event.3.Advanced cerebral volume loss somewhat out of proportion to age. |
Generate impression based on findings. | Male; 19 years old. Reason: fractured radius History: tenderness over distal radius, pain with pronation, suppination, extension s/p FOOSH Normal appearance of the bones without evidence of fracture. Alignment is normal. | No acute fracture or malalignment. |
Generate impression based on findings. | Left-sided weakness, confusion. Evaluate for any interval increase in right thalamic hemorrhage. Redemonstration an area of hemorrhage within the right thalamus measuring approximately 20 x 10 mm with surrounding edema and local mass effect on the third ventricle, which appears similar to the prior study. There is no evidence of intraventricular extension of the hemorrhage or any new areas of hemorrhage.There is sequela of remote left thalamic hemorrhage with ex-vacuo dilatation of the left lateral ventricle. There is subtle gyriform hyperattenuation of the right occipital lobe, likely reflecting laminar necrosis, and less likely blood. There is extensive periventricular white matter and scattered foci of subcortical white matter hypoattenuation consistent with age-indeterminant small vessel ischemic disease. The imaged paranasal sinuses and mastoid air cells are clear except for a small right sphenoid sinus retention cyst. The skull and scalp soft tissues are unremarkable. | No significant change of size of hemorrhage centered in the right thalamus or locoregional mass effect. |
Generate impression based on findings. | 72 year old with history of mesothelioma. CHEST:LUNGS AND PLEURA: Postoperative findings of right pleurectomy and decortication are again seen, and there has been interval resolution of the previously seen right pneumothorax. No significant pleural effusion. Scattered pulmonary micronodules are unchanged, with one new focus of pleural based nodularity (5/62). The right major fissure soft tissue density lesion (5/51) has decreased in size to 22 x 23 mm, previously 36 x 33 mm. Reference measurements are as follows:1.Level of the left main pulmonary artery (3/45) at the 1 o'clock position is subtle pleural thickening measuring approximately 3 mm, unchanged from prior.2.At the level of the right atrial appendage there is no appreciable pleural thickening at the 9 o'clock position, an approximately 3 mm of thickening at the 4 o'clock position.3.At the level of the tricuspid valve, no appreciable pleural thickening is seen.MEDIASTINUM AND HILA: Previously seen pretracheal lymph node (3/33) is similar in size, now measuring 8 mm, previously 9 mm. Decreased minimal residual pleural thickening adjacent to the esophagus (3/80).CHEST WALL: Minimal degenerative changes affect the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Hypodensity in the tail of the pancreas (3/106) is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable postoperative changes of right pleurectomy and decortication, with resolution of previously seen pneumothorax.2.Reference measurements of pleural thickening have decreased in size over the interval, however one new pleural-based nodule is seen for which appropriate follow-up is recommended.3.Right major fissure soft tissue density lesion has decreased in size. |
Generate impression based on findings. | Recurrent mucoepidermoid cancer of the buccal and parotid area with possible lung mets. Please measure any lesions using recist criteria. Pre-chemotherapy. There is no evidence of an enhancing parenchymal mass in the brain. The grey-white matter differentiation appears to be intact. The ventricles are stable in size and configuration. There is no midline shift or herniation. There is asymmetric thickening of the left frontal scalp soft tissues which is unchanged.There are extensive postsurgical changes of a partial left maxillectomy which extends into the hard palate, a left partial mastoidectomy, and a left parotidectomy. There is redemonstration of an heterogeneously enhancing soft tissue mass which is occupying the left infratemporal fossa. Given differences in the scan plane and contrast enhancement, the mass is grossly similar in size measuring approximately 2.0 x 2.0 cm in the coronal plane (images 38 and 39, series 1404). The mass measures approximately 5.2 x 2.2 cm (image 30, series 301) in the axial plane. There is an additional soft tissue nodule deep to the left zygomatic arch which measures 11 mm (image 29, series 301), unchanged in size. Small enhancing nodule involving the anterior left masseter muscle also again seen. There is bony destruction the adjacent skull base to the mass. There is redemonstration of asymmetric enlargement of the left foramen rotundum from the infratemporal fossa lesion extending into the left middle cranial fossa. There is sclerosis involving the left mandible, left maxillary alveolar process, sphenoid wing, zygoma and left temporal bone compatible with post-radiation sclerosis. The orbits are unremarkable. Unchanged postsurgical changes of partial left mastoidectomy and partial opacification of left mastoid air cells.There is an enlarged right level IIa lymph node which measures 13 mm in the short axis, which is unchanged given differences in the scan plane and technique. A prominent submental node measures 8 mm in the short axis, previously 9 mm. The left submandibular gland is atrophic. The right submandibular gland is not appreciably changed in size. The thyroid gland is unremarkable. The major cervical vessels are patent. The airways are patent. There is a right upper lobe pulmonary micronodule which appears similar in size to the prior study; please refer to separate CT chest report for additional details. | 1. Compared to outside CT neck 9/13/2014, grossly similar size of heterogeneously enhancing soft tissue mass at the left infratemporal fossa and enhancing nodules deep to the zygomatic arch and anterior aspect of the left masseter muscle, given differences in scan plane and contrast timing.2. No significant change in size of borderline prominent right level IIa lymph node and left level Ia lymph node. 3. Erosive changes of the skull base, enlarged left foramen rotundum, and post-radiation sclerosis is unchanged. If clinically indicated MRI can evaluate extent of perineural tumor spread. |
Generate impression based on findings. | 67 years old, Male, Reason: evaluate for stone History: left flank pain, h/o urolithiasis, recurrent UTI, renal transplant pt Lack of IV contrast limits evaluation of abdominal parenchyma. Within these limitations the following observations are made:ABDOMEN:LUNG BASES: Small right and trace left pleural effusion with associated underlying atelectasis. Patchy air space opacities, cannot exclude infection.LIVER, BILIARY TRACT: Hypoattenuating left hepatic lobe lesion likely represents a cyst and is unchanged from prior exam. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophy of native kidneys. Bilateral nonobstructing nephrolithiasis, present on prior study, without evidence of calculi within the ureters. No evidence of hydronephrosis. Right iliac fossa transplant kidney is unremarkable without evidence of nephrolithiasis or hydronephrosis.A small amount of fluid within the right paracolic gutter and extending down to the level of the transplanted kidney, cannot exclude pyelonephritis without IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid colon is underdistended, ventral abdominal subcutaneous induration and skin thickening, please correlate with physical exam for cellulitis.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine. Orthopedic hardware in the hips bilaterally.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.New bilateral pleural effusions.2.New ascites with fluid within the right paracolic gutter, adjacent to the transplanted kidney.3.No specific findings to account for the patient's flank pain. |
Generate impression based on findings. | Male, 56 years old, with history of pyriform sinus / supraglottic laryngeal cancer, status post CRT. Treatment related findings are again seen including volume loss on both sides of the neck, scarring along the fascial planes, and diffuse supraglottic mucosal hyperemia and thickening. No evidence of any nodular tissue is seen to suggest locally recurrent tumor. No pathologic adenopathy is detected in the neck by size criteria.The salivary glands demonstrate a normal posttreatment appearance. The thyroid is free of focal lesions. Atherosclerotic calcification is redemonstrated at the carotid bifurcations. A new small pneumothorax is evident at the left lung apex measuring about 1 cm in thickness. Biapical scarring is redemonstrated along with scattered nodular opacities. No concerning osseous lesions are seen. | 1.Stable posttreatment findings in the neck with no evidence of local recurrence or nodal metastasis.2.New small pneumothorax at the left lung apex. Discussed with Dr. Villaflor at 3:30 PM on 1/6/15. |
Generate impression based on findings. | Ms. Wolf is a 77 year old female presenting for routine imaging. She has no current breast related complaints. Three standard views of both breasts (total of 6 images) 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 is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. There is a stable benign appearing mass in the left outer breast. | 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. | 82-year-old male status post right total hip arthroplasty Status post right total hip arthroplasty in near-anatomic alignment without evidence of fracture or dislocation. Surgical drain and gas in the soft tissues reflects recent surgery. | Status post right total hip arthroplasty without evidence of complication. |
Generate impression based on findings. | Reason: history of metastatic renal and prostate cancer, on androgen ablation, assess for progression History: none CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules redemonstrated. Reference right upper lobe nodule (image 34 series 4 entering 12 mm.Reference left lower lobe nodule is unchanged measuring 9 mm.Reference right lower lobe subpleural nodule (image 66 series 4) is unchanged measuring 6 mm.There are however nodules that have significantly decreased in size or totally resolved since the prior exam. For example (image 63 series 4) 6.3 nodule with mild surrounding groundglass previously measured 14 mm.In addition cavitating left lower lobe superior segment nodule present on the prior exam demonstrates almost complete resolution (image 39 series 4).MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy identified.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary calcifications.CHEST WALL: Degenerative changes throughout the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Peripheral hypodensity laterally in the right hepatic lobe (image 101 series 3) suspicious for metastatic focus without significant interval change. Cholelithiasis.SPLEEN: Splenic granuloma. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable prominent retrocrural lymph node. Extensive atherosclerotic disease of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive degenerative changes of the thoracolumbar spineOTHER: No significant abnormality noted. | 1.Redemonstration of is a innumerable pulmonary nodules. For the most part these are stable however there has been interval decrease in size or resolution of several of the pulmonary nodules.2.Stable retrocrural lymphadenopathy.3.Stable hepatic lesion can better be evaluated with use of intravenous contrast and dedicated hepatic imaging. |
Generate impression based on findings. | Male 42 years old; Reason: Patient with a history of distal aorta dissection CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Main pulmonary trunk borderline in size, may be seen in setting of pulmonary arterial hypertension.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged indeterminant mild left adrenal nodularity.KIDNEYS, URETERS: Bilateral extrarenal pelvises. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Similar in appearance to prior January 2014 exam is infrarenal focal aortic dissection, located above the inferior mesenteric artery, somewhat oblique course makes evaluation and exact length measurement difficult but measures approximately 4 cm in length, unchanged. Abdominal aorta is stable in appearance and non-aneurysmal, measuring approximately 1.6 cm by 1.8 cm. IVC filter present.BOWEL, MESENTERY: Tiny hiatal hernia suggested.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter in collapsed bladder. Although bladder underdistended, circumferential wall thickening and mucosal enhancement seen, raising possibility for underlying cystitis.BONES, SOFT TISSUES: Incompletely imaged deformity of pelvic osseous structures, similar in appearance to prior study. Multilevel degenerative changes of spine with severe changes seen at T11/12 level and deformity of T11 vertebral body. Severe inflammation and dystrophic calcifications seen in bilateral hip regions and absence of right femoral head present, may be due in part to prior procedure. Ankylosis of sacroiliac joints. Dystrophic calcifications seen deep to the sacrum with associated small subcutaneous fluid and induration, similar in appearance to earlier exam. | 1. Stable focal infrarenal aortic dissection.2. Foley catheter in collapsed bladder. Although bladder underdistended, circumferential wall thickening and mucosal enhancement seen, raising possibility for underlying cystitis. Correlation with patient's clinical history and urinalysis recommended. |
Generate impression based on findings. | Male 70 years old Reason: Follow up residual dissection, s/p tissue AVR/root replacement History: as above ANGIOGRAM: There has been interval replacement of the aortic valve as well as placement of vascular stent graft material within the ascending aorta. There is persistent aneurysmal dilatation of the ascending aorta with extensive hematoma that may be intramural in location extending from the ascending aorta into the descending thoracic aorta. The ascending aorta measures 5.3 cm (image 52, series 9) at the level of the proximal arch, 4.0 cm (image 39, series 9) at the level of the mid arch and 4.1 cm (image 64, series 9) at the level of hiatus. Overall, the aortic dilatation appears improved from the prior CT chest examination.There is an aortic dissection flap arising in the mid ascending aorta and extending to the level of the aortic bifurcation. The true lumen gives rise to the great vessels of the head and neck, the right renal artery as well as the bilateral common iliac arteries. The false lumen gives rise to the celiac axis, left renal artery as well as the IMA. The dissection flap extends into the SMA, with the majority of blood flow arising from the false lumen. There is appropriate peripheral contrast opacification consistent with preserved blood flow. Two vessel arch.The main pulmonary artery measures 3.6 cm in maximal diameter, which is greater than the upper limit of normal. This finding is nonspecific, but may be seen in setting of pulmonary arterial hypertension.CHEST:LUNGS AND PLEURA: Scattered pulmonary nodules, many of which are calcified and likely benign in etiology. Resolution of the previously seen pleural effusion.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes are not pathologically enlarged by size criteria. Nodular thyroid gland.CHEST WALL: No significant abnormality notedABDOMEN: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: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis. The patient is status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are not pathologically enlarged by size criteria. Cluster of subcentimeter gastrohepatic node appears slightly larger from the prior examination. Although nonspecific, attention on follow-up imaging is recommended.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postoperative changes related to aortic valve replacement and placement of endograft material within the ascending aorta.2.Hematoma extending from the ascending aorta into the distal thoracic aorta as described.3.Type A aortic dissection and associated aneurysmal dilatation of the aorta as detailed above.4.Cluster of prominent gastrohepatic ligament nodes, not pathologically enlarged by size criteria, although attention at follow-up is recommended. |
Generate impression based on findings. | 62-year-old male with history of substance abuse. Evaluate for pathology. There is no acute intracranial hemorrhage. Mild periventricular and subcortical white matter hypoattenuation most conspicuous in the left periatrial region compatible with age indeterminate ischemic small vessel disease. The gray white differentiation is preserved. There is no midline shift or mass-effect. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | No acute intracranial hemorrhage. Mild age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | 72-year-old male with history of new weakness. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage or mass. There is mild periventricular and subcortical white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is a chronic deformity of the right lamina papyracea containing orbital fat compatible with chronic trauma. The remaining visualized paranasal sinuses are unremarkable. The mastoid air cells are clear. The orbits are normal. The calvarium and soft tissues of the scalp are unremarkable. | 1.No evidence of acute intracranial hemorrhage. Mild age indeterminate ischemic small vessel disease.2.Deformity of the right lamina papyracea secondary to chronic trauma. |
Generate impression based on findings. | Male, 21 years old, with epilepsy. Axial imaging was acquired portably with a stereotactic frame in place. Preoperative imaging shows no significant abnormality. Imaging obtained during/after the procedure demonstrates newly placed left frontal, left temporal, and bilateral occipital burr holes. Through these holes traverse 2 left frontal, 3 lateral left temporal, 1 medial left temporal and 1 medial right temporal electrode arrays. Pneumocephalus is compatible with recent instrumentation. | Expected findings status post placement of multiple intracranial electrode arrays. |
Generate impression based on findings. | 42 year-old female with history of prior trauma. Evaluate for orbital wall fracture. There is a concave deformity of the right lamina papyracea containing orbital fat, likely chronic in etiology. There is no associated significant medial rectus deformity. There are no acute fractures. The frontal sinuses are under pneumatized. The remaining paranasal sinuses and mastoid air cells are clear. No air-fluid levels are present. There is a mild rightward deviation of the nasal septum. The ostiomeatal complexes and sphenoethmoidal recesses are patent. | Deformity of the right lamina papyracea secondary to chronic trauma. No acute fractures. |
Generate impression based on findings. | 52 year old with history of dense breasts and benign left breast calcifications. Three standard views of both breasts with repeat right MLO view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable left upper outer quadrant benign calcifications. No change in bilateral areas of parenchymal asymmetry. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Tomosynthesis may be of benefit, especially given the patient's breast density. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 82-year-old male with history of squamous cell carcinoma of the floor of the mouth LUNGS AND PLEURA: Scattered pulmonary micronodules and basilar atelectasis/scarring are unchanged. No significant pleural effusion.MEDIASTINUM AND HILA: Severe coronary artery ossifications. Heart size upper normal, unchanged, and there is no pericardial effusion. Scattered small lymph nodes are seen in the mediastinum and hila, some of which are calcified.CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Atherosclerotic calcifications of the aorta and its branches. Minimal fatty atrophy of the pancreas. | Minimal basilar scarring/atelectasis, without evidence of metastatic disease. |
Generate impression based on findings. | Male 49 years old Reason: evaluate vasculature to support kidney transplant History: left toes amputated ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Dense splenic arterial calcifications.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are atrophic and there is symmetric prominent perinephric fat stranding bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: There are dense atherosclerotic calcifications of the vas deferens.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There are mild atherosclerotic calcifications of the proximal right common iliac artery. There are no significant atherosclerotic calcifications of the bilateral external iliac arteries seen. There are dense atherosclerotic calcifications of the bilateral internal iliac arteries bilaterally. | There are mild atherosclerotic calcifications of the proximal right common iliac artery. There are no significant atherosclerotic calcifications of the bilateral external iliac arteries seen. There are dense atherosclerotic calcifications of the bilateral internal iliac arteries bilaterally. |
Generate impression based on findings. | Female 65 years old; Reason: anal cancer follow up CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change with scattered micronodules, for example, peripheral 2 mm right upper lobe lung nodule, image 21 series 80353.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided chest wall port with tip near cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Again visualized is subcentimeter lesion with overlying capsular retraction in region of hepatic segment 7, image 85 series 4. As on prior CT imaging, measurements difficult due to small size and subtle appearance. Status post cholecystectomy. Stable mild intrahepatic biliary duct as well as extrahepatic biliary duct dilatation, measuring up to 1.5 cm. No radiopaque cholelithiasis.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: Aortobiiliac calcified atherosclerotic disease.BOWEL, MESENTERY: Thickening of rectal wall again seen in right lateral area. Index soft tissue density at this level without significant change accounting for differences in technique, measuring approximately 2.2 x 1.3 cm, previously measured 1.9 x 1.5 cm. Descending and sigmoid colon diverticulosis without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarging inguinal adenopathy with reference node measuring 4.1 x 2.7 cm, image 195 series 80312, previously measured approximately 2.8 x 1.7 cm. Smaller adjacent lymph nodes also seen, majority without significant change.BONES, SOFT TISSUES: Visualized osseous structures without significant change including subcentimeter sclerotic focus in left ilium, image 150 series 80312. Decreased osseous mineralization and heterogeneity also seen. Trace pelvic free fluid. | 1. Enlarging right inguinal adenopathy. New trace pelvic free fluid.2. Remainder of exam without significant change as described. |
Generate impression based on findings. | 69-year-old male with history of left-sided weakness. Evaluate for ischemia or hemorrhage. There is a large area of encephalomalacia in the territory of the right MCA involving much of the the frontal and temporal lobes as well as the right basal ganglia compatible with chronic infarction. There is associated ex vacuo dilatation of the right lateral ventricle. Additionally, the left cerebellum and right cerebellar peduncle are atrophic compatible with crossed cerebellar diaschisis and Wallerian degeneration, respectively. There are patchy areas of hypoattenuation within the remaining periventricular and subcortical white matter compatible with age indeterminate ischemic small vessel disease. There is no evidence of intracranial hemorrhage. There is minimal ex-vacuo midline shift with no evidence of herniation. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. Lack of dentition is only partially imaged. The calvarium and soft tissues of the scalp are normal. | 1.Large chronic infarct in the territory of the right MCA. No evidence of acute intracranial hemorrhage.2.Mild age indeterminate ischemic small vessel disease of the remaining brain parenchyma. |
Generate impression based on findings. | Female 53 years old Reason: Stage IV pancreas cancer, please compare to previous scan and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules again identified, which overall are slightly increased in size from the prior examination. For reference purposes, a left upper lobe perihilar nodule measures 0.5 x 0.9 cm (image 42, series 5), previously 0.5 x 0.6 cm. When compared to the first study of record, these nodules have markedly increased in size, and are most consistent with metastases.MEDIASTINUM AND HILA: The heart size is normal as is the caliber the great vessels. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: Right chest wall Port-A-Cath with tip terminating in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Subtle hypoattenuating lesion in the dome of the liver, measuring 0.8 x 0.9 cm, is new from the prior examination (image 77, series 3). This lesion is incompletely characterized, but worrisome for a metastasis. The peritoneal deposit alongside the right hepatic lobe again measures 3 mm (image 20, series 3).SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance of the ill-defined residual pancreatic mass, now measuring 0.8 x 1.4 cm (image 97, series 3), unchanged. Atrophy of the upstream pancreatic parenchyma is unchanged.There is persistent lymph node encasement of the proximal celiac axis as previously described. The splenic vein is narrowed as it passes posterior to pancreatic mass, but without complete occlusion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Cluster of left paraaortic lymph nodes has increased in size, now measuring 3.1 x 3.4 cm (image 114, series 3), previously 2.5 x 2.7 cm. Additional nonreference retroperitoneal lymph nodes have also increased in size from the prior exam.BOWEL, MESENTERY: Submucosal fat deposition in the ascending and transverse colon may reflect chronic inflammatory change. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are severe degenerative changes of the left hip. There are no definite lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Submucosal fat deposition in the ascending and transverse colon may reflect chronic inflammatory change. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are severe degenerative changes of the left hip. There are no definite lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality noted. | 1.Disease progression with interval increase in size of the patient's extensive retroperitoneal lymphadenopathy.2.Interval increase in size of the numerous pulmonary nodules, most consistent with metastatic disease.3.Subtle hypoattenuating lesion in the dome of the liver is worrisome for metastasis, although incompletely characterized on this examination.4.Pancreatic head mass unchanged.5.Submucosal fat deposition in the ascending and transverse colon suggestive of chronic inflammatory change. |
Generate impression based on findings. | Ms. Williams is a 66 year old female recalled from screening mammogram for calcifications in the left medial breast. She has a family history of breast cancer in her sister. An ML view and three spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Regionally distributed calcifications in the medial left breast are again identified. Magnification views of this area demonstrate calcifications of a benign appearance. They appear similar in size and appearance when compared to prior exam, and likely are very similar when compared to exams dating back to 2010. Multiple calcified and noncalcified masses are stable from prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | Stable calcifications of the left breast, considered benign largely based on long term stability. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 12 months, after which the patient may be a candidate for a return to screening. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 52-year-old male with history of DVT off anticoagulation, with tachypnea and tachycardia, evaluate for pulmonary embolism The comparison chest radiograph performed on 1/6/2015 demonstrates bibasilar opacities with pleural effusions.Single breath ventilation images show decreased activity in bilateral lung bases with subsequent wash in on equilibrium images. There is slight abnormal Xe-133 retention in the right lower lobe during the wash-out phase. The perfusion images show a perfusion abnormality throughout the the majority of the left lower lobe. There is also a perfusion abnormality involving multiple segments at the right lung base. | Intermediate probability for pulmonary embolism due to triple match perfusion defect in the left lower lobe. |
Generate impression based on findings. | Right cheek squamous cell carcinoma with parotid invasion, post resection with positive margins. Compared to 11/13/2014, interval postsurgical changes of lesion involving the right cheek, near total right parotidectomy, and right-sided neck dissection are seen. There is soft tissue thickening at the level of the previously seen right cheek lesion which extends to the level of the parotid tail/accessory parotid tissue lateral to the masseter muscle. Findings are compatible with postsurgical change.Previously seen right parotid mass has been resected including the necrotic component, extending in its deep aspect to the level of the sternocleidomastoid muscle. There is a small fluid collection in the surgical bed, likely representing a small seroma. Area of hyperdensity surrounding the seroma is favored to represent postsurgical change, although small component of tumor can not be excluded. Again seen is extensive bilateral cervical lymphadenopathy neck including bilateral levels one through 5. For reference a right level Va lymph node measures 13 x 17 x 15 mm and similar to prior.The airway remains patent. The thyroid, left parotid, and bilateral submandibular glands are unremarkable. The major cervical vessels are patent. No suspicion osseous lesions are seen. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. Prominence of the mediastinal lymph nodes appears similar to prior as well. Right chest wall port is in place. | 1. Interval postsurgical changes of resection involving the right cheek lesion, near total right parotidectomy, and right neck dissection. There appears to be gross total resection. Area of hyperdensity surrounding the small seroma in the right parotid surgical bed favored to represent postsurgical change, although small component of tumor can not be excluded. This study can serve as a postoperative baseline.2. Extensive bilateral cervical lymphadenopathy throughout the bilateral neck as seen on prior. Given history, these may be related to patient's leukemia. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild to moderate global volume loss greater than expected for the patient's stated age. The basal cisterns remain patent. There is no midline shift or mass effect. There is redemonstration of gyral thickening and T2/FLAIR hyperintensity involving the cortex of bilateral insula, hippocampi, mesial temporal lobes, and anterior cingulate gyri demonstrate no significant interval change. There is no associated diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The right cerebellar tonsil is slightly more low lying than the left, although remaining within normal limits at 4 mm below the level of the foramen magnum and retaining a rounded configuration.There has been interval development of moderate left and mild right mucosal thickening in the maxillary sinuses. There is an air-fluid level in both maxillary sinuses, much greater on the left side. There is moderate patchy opacification of bilateral anterior and posterior ethmoid air cells. There is a small T2 hyperintense rounded left paramedian mucous retention cyst within the posterior nasopharynx. | 1. No significant interval change with no acute abnormality. Stable chronic findings of abnormal signal and mild gyral expansion involving cortex of bilateral insula, mesial temporal lobes/hippocampi, and anterior cingulate gyri.2. Mild-moderate global volume loss greater than expected for the patient's stated age, likely due to the history of seizure disorder.3. Interval development of significant maxillary and ethmoid sinus opacification with air-fluid levels in the maxillary sinuses. Please correlate clinically for acute sinusitis. |
Generate impression based on findings. | Ms. Cade is a 60 year old female with biopsy proven malignancy in the right breast status post neoadjuvant therapy. She now presents for reimaging to assess for response to chemotherapy. 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. There has been an interval decrease in size of the biopsy proven malignancy within the right lower aspect of the proximal. Biopsy marker clip remains within the malignancy. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. RIGHT ULTRASOUND | Mild decrease in size of known malignancy within the right lower inner breast with continued extension towards the nipple. Surgical correlation is recommended as clinically warranted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 75-year-old male with history of prostate cancer, rising PSA, evaluate for metastatic disease No abnormal osseous foci are identified to indicate metastatic disease. Faint soft tissue activity adjacent to the right 10th rib posteriorly corresponds with old retroperitoneal hematoma with peripheral calcification. Foci of increased radiotracer activity, left greater than right, adjacent to bilateral hips corresponds to calcification/heterotopic heterotopic calcification/ossification. Degenerative changes are seen in the cervical spine. Degenerative and postsurgical changes are seen in the lumbar spine. There is a healed right fifth rib fracture. | No evidence of bone metastases. |
Generate impression based on findings. | 48-year-old female with history of recurrent mucoepidermoid cancer of the buccal and parotid area. Preclinical trial.RADIOPHARMACEUTICAL: 8.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion of the abdomen and pelvis demonstrates multiple small hypoattenuating hepatic lesions that are too small to further characterize but most likely represent cysts. Please see diagnostic CT reports for details of the head, neck, and chest.Today's PET examination demonstrates irregular curvilinear areas of marked hypermetabolic activity in the left infratemporal fossa corresponding with enhancing lesions on CT that appear similar but slightly progressed in activity from prior exam. For reference, the anterior portion of the hypermetabolic lesion measures SUV max 9.2, previously 8.6. The more posterior portion has increased slightly from SUV max of 6.2 to 7.8. Additional hypermetabolic tumor focus corresponding to the left superficial muscles of mastication is not significantly changed, SUV max 5.2.The previous identified small hypermetabolic bilateral jugular lymph nodes inferiorly have essentially resolved. Additional curvilinear hypermetabolic foci involving the right lateral tongue and pharyngeal mucosa are most likely benign inflammatory uptake given their appearance. There is increased hypermetabolic activity within the right parotid and submandibular glands, likely benign/inflammatory in etiology. | 1.Mixed metabolic response to therapy. The left neck tumor activity in the infratemporal fossa and within superficial masticator muscles remain markedly hypermetabolic and appear slightly progressed compared to previous exam. Previously identified bilateral hypermetabolic neck lymph node metastasis have resolved, however.2.No additional FDG avid tumor and remainder of the chest, abdomen and pelvis.Diagnostic CTs of the head, neck, and chest also performed at today's visit will be reported separately. |
Generate impression based on findings. | 2-year-old male with hip subluxation.EXAMINATION: Pelvis AP and frog leg (two views), 1/6/2015, 1141 hrs. Ossification of femoral heads is symmetric. There is bilateral coxa valga deformity, right greater than left, with no significant femoral head uncovering. No evidence of acute fracture or malalignment. | Bilateral coxa valga deformity. |
Generate impression based on findings. | 37 year-old female status post Lisfranc reduction A cast obscures underlying osseous detail. There is a Lisfranc fracture with lateral dislocation of the first and second metatarsals. | Lisfranc fracture-dislocation. |
Generate impression based on findings. | 50 year-old female with trismus, right facial pain Somewhat limited examination due to technique, which demonstrates expected anterior translocation of the mandibular condyles with open mouth views. There is no frank dislocation or fracture. | Limited examination demonstrating no frank dislocation although further evaluation with dedicated MRI may be considered if clinically warranted as evaluation of the TMJ by radiography is limited. |
Generate impression based on findings. | 2-year-old male with hip subluxation.EXAMINATION: Pelvis AP and frog leg (two views), 1/6/2015, 1216 hrs. Femoral heads are well-directed into normally formed acetabula bilaterally. No evidence of fracture or malalignment. | Normal examination. |
Generate impression based on findings. | Male 15 years old Reason: fracture VIEWS: Right tibia-fibula AP and lateral 1/6/15 (two views) Two screws traversing the right distal metaphyses of the tibia and fibula is again noted, alignment is anatomic. No evidence of hardware complications. Proximal fibular healing fracture is in anatomic alignment as well. | Healing fractures, unchanged in alignment. No evidence of hardware complications. |
Generate impression based on findings. | Two-year old male with hip subluxation.EXAMINATION: Pelvis AP and frog leg (two views), 1/6/2015 1150 hrs. Ossification of the femoral heads is symmetric. Bilateral coxa valga deformity without significant femoral head uncovering. No evidence of acute fracture or malalignment in the pelvis. | Bilateral coxa valga deformity. |
Generate impression based on findings. | 5-year-old male with hip subluxation.EXAMINATION: Pelvis AP and frog leg (two views), 1/6/2015, 1236 hrs. Coxa valga deformities are again noted bilaterally with approximately 30% femoral head uncovering on the right, well-covered on the frog leg view. No evidence of acute fracture or malalignment. Copious stool is again noted in the rectosigmoid colon. | Bilateral coxa valga deformities. |
Generate impression based on findings. | Male, 84 years old. Reason: assess dobhoff placement position History: see above The lower pelvis is excluded from the field-of-view.Dobbhoff tube is not visualized in the field of view on this exam.Nonobstructive bowel gas pattern. | Dobbhoff tube is not visualized in the field of view on this exam. |
Generate impression based on findings. | 4-year-old male with hip subluxation.EXAMINATION: Pelvis AP and frog leg (two views), 1/6/2015, 1311 hrs. Bilateral coxa valga deformities are again noted with approximately 20% femoral head uncovering bilaterally. With frog leg positioning the left femoral head is well-covered by the acetabulum, however 20% uncovering persists on the right. No evidence of acute fracture or malalignment. | Bilateral coxa valga deformities. |
Generate impression based on findings. | Female 47 days old Reason: CT placement History: s/p new CTVIEW: Chest AP (one view) 1/6/15 at 1612 hrs. ET tube tip is below thoracic inlet. Soft tissue edema again noted. Central line tip is at the left innominate vein. NG tube terminates at the stomach. Right-sided chest tube is again noted. Cardiac silhouette size is normal. Interval improvement in left-sided pleural effusion with persistent right upper lobe atelectases. No pneumothorax. | Interval improvement in left-sided pleural effusion after chest tube exchanged. |
Generate impression based on findings. | 72-year-old male status post Dobbhoff tube placement. Note that the pelvis was not included in the exam. The Dobbhoff tube has been pulled back and terminates in the intrathoracic stomach. Cholecystectomy clips are again seen. Nonobstructive bowel gas pattern with contrast within the small bowel. | Dobbhoff tube tip in the intrathoracic stomach. |
Generate impression based on findings. | Male, 84 years old. Reason: Where is Dobbhoff? History: Dobbhoff The lower pelvis is excluded from the field of view.A Dobbhoff tube is not clearly identified.Nonobstructive bowel gas pattern. | Dobbhoff tube is not seen within the field of view on this exam. |
Generate impression based on findings. | 51-year-old male with lung nodule and concern for malignancy. RADIOPHARMACEUTICAL: 8.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 115 mg/dL. Today's CT portion grossly demonstrates multiple enlarged bilateral cervical lymph nodes. There are also multiple enlarged anterior and middle mediastinal lymph nodes. Scattered pulmonary opacities are present most confluent in the posterior right upper lobe. The spleen appears mildly enlarged. There are borderline enlarged celiac, portacaval and retroperitoneal lymph nodes. Bilateral enlarged iliac and inguinal lymph nodes are also visualized. Destructive lesions of the anterior vertebral bodies of T3 through T5 are seen. Extensive atherosclerotic disease, including coronary artery calcifications, is present. Today's PET examination demonstrates markedly hypermetabolic lesions in the anterior vertebral bodies of T3 through T5 which correlate with destructive lesions seen on CT. For reference, the maximal SUV measures 7.7. The findings are highly suspicious for tumor involvement.Multiple enlarged but only mildly hypermetabolic lymph nodes (SUV max = 3.1) in the bilateral neck, anterior and middle mediastinum, and the bilateral inguinal region are present. Given the size but only mild avidity, these may represent a lymphoproliferative process / low-grade lymphoma versus inflammatory changes.Mildly enlarged spleen, which is hypermetabolic relative to the liver, is visualized which can be seen with a lymphoproliferative process / lymphoma as well as anemia.Scattered mildly hypermetabolic pulmonary foci most conspicuous in the posterior right upper lobe are seen. These are likely inflammatory in nature although tumor involvement cannot be entirely excluded. | 1.Markedly hypermetabolic destructive lesions in the T3 through T5 anterior vertebral bodies highly suspicious for tumor activity.2.Mildly hypermetabolic activity in numerous enlarged lymph nodes in the neck, chest, and pelvis with an associated enlarged and mildly hypermetabolic spleen. The findings are suspicious for lymphoproliferative disease / low-grade lymphoma. However, these lymph nodes abnormalities can also be seen with systemic inflammation.3.Mild to moderate hypermetabolic posterior right upper lobe pulmonary focus which is most likely inflammatory in nature, however, tumor cannot be entirely excluded. |
Generate impression based on findings. | 53-year-old female with AML and fevers There are numerous missing and broken teeth with multiple caries. No specific evidence of osteomyelitis. | Poor dentition, as detailed above. |
Generate impression based on findings. | Abdominal pain. History of lymphoma and stem cell transplant ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatation.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 | Negative for acute, inflammatory, or neoplastic process. |
Generate impression based on findings. | 57 year old female with hypoxia and increased a gradient. Evaluate for lung disease. LUNGS AND PLEURA: Scattered pulmonary micronodules, unchanged. No pleural effusion, no consolidation and no fibrosis.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no significant pericardial effusion. No mediastinal or hilar lymphadenopathy. No appreciable coronary artery calcifications.CHEST WALL: Multiple old rib fractures, unchanged. Diffuse vertebral endplate depression, possibly related to known renal disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atrophic kidneys, unchanged. | Stable scattered pulmonary micronodules. No findings to suggest interstitial lung disease or other abnormality to explain the patient's hypoxia. |
Generate impression based on findings. | Female 46 years old Reason: 46 yr F with autoimmune enterocolitis History: Asses for small bowel thickening lesion or ulceration ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypoattenuating lesion in hepatic segment 2 is consistent with a simple hepatic cyst. Hypoattenuating lesion in hepatic segment 6, which demonstrates peripheral nodular enhancement, consistent with a hemangioma. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesion in the left renal parenchyma to characterize.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: There is an approximately 3.7 cm segment of collapsed terminal ileum without evidence of upstream dilatation of the small bowel, may reflect peristalsis. Similarly, there is poor contrast opacification of the sigmoid and rectum giving the appearance of mucosal enhancement, but which is more likely related to underdistention rather than inflammation. There is suggestion of perirectal fat hypertrophy. High-density foci within the small bowel nonspecific and may be ingested material (image 60, series 3).PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Poor intraluminal contrast filling of the terminal ileum and rectosigmoid colon, giving the appearance of mild mucosal enhancement, nonspecific and may be due in part to underdistention.2.High-density foci within the small bowel, possibly ingested material. |
Generate impression based on findings. | Female 63 years old; Reason: Pt with hx of stage IV colon cancer now with NED, evaluate for progression. History: colon cancer. CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Enlarged thyroid nodules and gland.ABDOMEN:LIVER, BILIARY TRACT: Scattered calcifications within the liver. No new lesions have developed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis in either kidney.RETROPERITONEUM, LYMPH NODES: Post surgical changes with multiple clips in the upper abdomen.BOWEL, MESENTERY: Post changes may partial colectomy. Multiple clips in the upper abdomen. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is enlarged likely due to fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small hypodense focus in the left ilium with coarsened trabeculae may represent a small hemangioma and is unchanged.OTHER: No significant abnormality noted. | 1.Stable exam without evident metastatic disease. |
Generate impression based on findings. | 73 years old, Male, Reason: HNSCC. Compare to previous. History: as above CHEST:LUNGS AND PLEURA: Small right and trace left pleural effusions.Multiple new and enlarging pulmonary nodules suspicious for metastasis. Largest new pulmonary nodule in the right base measuring 8 mm (series 5, image 85). Patchy groundglass opacities in the left base may be infectious or inflammatory in etiology. Necrotic lymph node at the left lung base.MEDIASTINUM AND HILA: Left chest port with tip in SVC. Reference right paratracheal lymph node measures 5 cm (series 3, image 34), previously measuring 6 mm. Right hilar lymph node is larger in size measuring 1.9 cm (series 3, image 54), previously measuring 1.4 cm. Bilateral hilar lymphadenopathy appears worse. Diffuse tumor in the neck which appears to encase multiple vessels. Tumor in the neck is better characterized on dedicated study.CHEST WALL: Marked right axillary lymphadenopathy with reference axillary lymph node measuring 1.9 cm (series 3, image 20), previously measuring 1.8 cm.ABDOMEN:LIVER, BILIARY TRACT: Nodule in the tip of the gallbladder is indeterminate although may represent metastasis and was present on prior study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.New and enlarging pulmonary metastases.2.Worsening bilateral hilar lymphadenopathy.3.Mildly enlarged axillary lymphadenopathy.4.Diffuse tumor in the neck is better evaluated on dedicated neck CT. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with minimal age-related volume loss, with mild nonspecific prominence of the lateral ventricles which is unchanged. Exuberant calcifications are incidentally noted along bilateral choroid plexus cysts in the atria. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are minimal of any scattered punctate areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable minimal chronic small vessel ischemic changes. There is no extraaxial fluid collection. There is scattered tree cycles of thickening in the paranasal sinuses. The visualized portions of the mastoids/middle ears are grossly clear. | No acute intracranial abnormality. Stable mild chronic small vessel ischemic changes. |
Generate impression based on findings. | 35-year-old female with relapsed Hodgkin lymphoma status post two cycles of ICE in need of restaging.RADIOPHARMACEUTICAL: 9.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates multiple surgical clips in the right neck. Left chest Port-A-Cath with tip in the SVC. Superior mediastinal soft tissue mass is noted.Today's PET examination demonstrates a several punctate subcentimeter mild to moderately hypermetabolic foci in the right inferior neck and right mediastinum (SUV max = 3.4). Reviewing the prior CT with the much larger soft tissue masses and lymph nodes in these locations, today's activity is most likely inflammatory or slight residual tumor metabolism. However, if there has been a baseline outside PET, this would be useful for comparison.Crescentic activity corresponding to the thymus is most likely benign. Uterine cavity activity is also most likely benign in a premenopausal female. | Several punctate subcentimeter mild to moderately hypermetabolic foci in the right inferior neck and right mediastinum are most likely inflammatory or minimal residual tumor metabolism. However, if there has been outside baseline PET, this would be useful for comparison. |
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