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Generate impression based on findings. | Reason: persistant sinus tachy, r/o PE History: sinus tachy PULMONARY ARTERIES: Demonstration of acute pulmonary emboli within the right descending pulmonary artery and segmental branches of the right lower lobe.There is no evidence of right heart strain.LUNGS AND PLEURA: Right posterior paramediastinal postsurgical changes without evidence of a recurrent or residual neoplasm.No focal air space opacities or evidence of ulnar infarction/hemorrhage.Mild bronchial wall thickening similar to the prior exam.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Multiple acute pulmonary emboli within the right descending pulmonary artery and segmental branches the right lower lobe. No evidence of pulmonary infarction.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Negative. |
Generate impression based on findings. | Right distal femur giant cell tumor. Evaluate for hardware failure/recurrence. Again seen is a plate and screw device affixing cement at the site of the distal femoral giant cell tumor curettage in near-anatomic alignment without evidence of hardware complication. Expansile remodeling of the medial aspect of the medial femoral condyle appears similar to that seen on the prior study, although over the course of the last year, appears to have increased slightly in width (by a couple of millimeters). | Postoperative changes of giant cell cell tumor curettage and distal femoral reconstruction as described above. Expansile remodeling of the medial aspect of medial femoral condyle appears similar to that seen on the prior study, although over the course of the last year appears to have increase slightly in width. While I suspect that this reflects postoperative remodeling rather than tumor recurrence, continued surveillance is recommended. If the patient is currently symptomatic, MRI may be considered. |
Generate impression based on findings. | History of left lumpectomy for invasive ductal carcinoma status post chemotherapy and radiation. No current breast related complaints. Three standard views of both breasts were performed along with 2 repeat right CC views, a repeat right MLO view, repeat left MLO view, repeat right mediolateral view, two CC spot mag views of the left breast, and 2 ML spot mag views of the left breast (15 views total) 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. Redemonstrated postsurgical change in the left breast with surgical clips, volume loss, and architectural distortion. In the anterior aspect of the lumpectomy bed there are multiple partly calcified oil cysts. Additional scattered benign calcifications are present in the left breast. No suspicious microcalcifications or dominant mass lesion. No dominant mass, suspicious calcifications, or architectural distortion in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign bilateral breast biopsies. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. S-shaped clip at the 3 o'clock position of the right breast is unchanged in position. A new group of linear calcifications is present in the left lower inner quadrant for which spot magnification imaging is recommended. Additional calcifications in both breasts are unchanged.No suspicious masses or areas of architectural distortion are present. | New group of calcifications in the left breast. Spot magnification imaging is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 55-year-old male with history of right upper lung nodule. Status post stem cell transplant. LUNGS AND PLEURA: Right upper lobe centrilobular nodular opacities have resolved over the interval, with minimal persistent centrilobular nodules/bronchial wall thickening in this area. Minimal right lower lobe centrilobular nodules. No pleural effusion or consolidation. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size within normal limits. No pericardial effusion. Right IJ venous catheter tip at the superior cavoatrial junction. No appreciable coronary artery calcifications.CHEST WALL: Mixed lytic and sclerotic skeletal lesions are again seen diffusely, grossly unchanged. Subcutaneous emphysema presumably from recent central line placement.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenomegaly, similar to prior. | 1.Near complete interval resolution of right upper lung predominant centrilobular nodules, most consistent with infection.2.Diffuse skeletal sclerotic/lytic lesions, similar to prior.3.Unchanged severe splenomegaly. |
Generate impression based on findings. | Right shoulder pain. Evaluate for fracture. There is a transverse fracture through the surgical neck of the humerus with slight impaction and posterior angulation of the distal fracture fragment. The bones appear demineralized, suggesting osteopenia. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. | Proximal humerus fracture as above. |
Generate impression based on findings. | Seizures.VIEW: Chest AP (one view) 1/7/15 at 843 hours. ET tube tip is below the thoracic inlet. Feeding tube terminates at the antropyloric region. Central line tip is at the RA/SVC junction. Cardiac silhouette size is normal. Persistent bibasilar opacities likely atelectasis, with no effusions or pneumothorax. | Persistent bibasilar opacities. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal cousin and paternal grandmother. Two standard digital views and tomosynthesis of both breasts were performed 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 suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Unknown 16 days old Reason: is there digitation of bowel? History: abdominal distentionVIEW: Abdomen AP (one view) 1/7/15 at 903 hours. Proximal side port of NG tube is above GE junction. A central line tip is at the right atrium. Generalized , nonspecific bowel distention. No evidence of pneumatosis intestinalis, portal venous gas, obstruction or free air. No ascites. | Misplaced NG tube.Generalized, nonspecific bowel distention. |
Generate impression based on findings. | Pain Three views of the left knee are provided. Mild osteoarthritis affects the knee. I see no fracture or joint effusion.Mild osteoarthritis also affects the right knee as seen on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | Female 23 years old Reason: r/o colitis vs appendicitis History: abd pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 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: There are persistent inflammatory changes about the cecum including mesenteric fat stranding, thickening of the adjacent peritoneum and associated prominent lymph nodes. The visualized portions of the appendix are normal in appearance. Although nonspecific, these findings may reflect focal colitis or possibly diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There are persistent inflammatory changes about the cecum including mesenteric fat stranding, thickening of the adjacent peritoneum and associated prominent lymph nodes. The visualized portions of the appendix are normal in appearance. Although nonspecific, these findings may reflect focal colitis or possibly diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Persistent inflammatory changes about the cecum, appearing similar to the prior examination. Although nonspecific, this could reflect focal colitis or possibly diverticulitis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast cyst aspiration. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density , unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 58 year-old male with history of leukocytosis and concern for infection. CML. LUNGS AND PLEURA: Minimal bibasilar atelectasis/scarring. No consolidation or pleural effusion. Approximately 8mm well circumscribed left lower lobe solid nodule. An additional right middle lobe medial segment fat containing lenticular shaped subpleural nodule is most likely a lymph node (subpleural location confirmed on source images).MEDIASTINUM AND HILA: Heart size within normal limits. Mild coronary artery calcifications. No pericardial effusion. 14-mm left interlobar lymphadenopathy (3/53) containing amorphous calcifications, somewhat atypical in appearance for granulomatous disease though it remains statistically the most likely possibility. Otherwise, no significant mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes affect the visualized spine, including degenerative appearing endplate changes at several midthoracic vertebral bodies. No significant wedging/loss of height to suggest fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenomegaly and hepatomegaly. Hypoattenuating foci within the liver measure the density of simple fluid, nonspecific but most likely represent cysts. No granulomas are identified in either the liver or spleen. | 1.Minimal basilar atelectasis/scarring, without consolidation or other findings to suggest infection.2. 8mm left lower lobe solid nodule, of unclear etiology but possibly a noncalcified granuloma. Intrapulmonary chloromas have been reported in the literature but are extremely rare. Follow-up in 6 months with noncontrast chest CT suggested to ensure stability. Alternatively, if the referring clinical service can obtain and submit remote outside prior examinations to prove stability, an addendum to this report can be provided if formally requested.3. Hepatosplenomegaly. Hepatic lesions incompletely assessed but most likely reflect cysts. |
Generate impression based on findings. | Female 4 years old Reason: increased WOB, tachypnea VIEW: Chest AP (one view) 1/7/15 at 949 hours Left upper extremity PICC terminates at the RA/SVC junction. Upper abdominal surgical clips unchanged. Bibasilar opacities again noted. No evidence of pleural effusions or pneumothorax. | Stable bibasilar opacities. |
Generate impression based on findings. | 16 year old female. Toe injury after ballet practice.EXAMINATION: Left second toe AP/oblique/lateral (3 views) 1/6/15 No fracture or malalignment is present. No soft tissue swelling is evident. | Normal examination of the left 2nd toe |
Generate impression based on findings. | Female 12 years old Reason: eval for healing fracture distal 4th mt History: foot pain 3 days s/p fall on gymnasticsVIEWS: Right foot AP, lateral and oblique 1/7/15 (3 views) Cast material obscures fine bone details. Salter-Harris 3 healing fracture of the distal fourth metatarsal is in near anatomic alignment. | Healing fracture in near-anatomic alignment. |
Generate impression based on findings. | Fecal impactionEXAMINATION: Abdomen AP (one view) 1/6/15 Large rectosigmoid stool burden, with a moderate amount of stool throughout the rest of the colon. The rectum measures at least 10 cm in width. No pneumatosis, portal venous gas, or pneumoperitoneum. | Large rectosigmoid stool burden. |
Generate impression based on findings. | esoph ca, s/p chemo and RT and esophagectomy. Pls c/w previous study and evaluate dz status. CHEST:LUNGS AND PLEURA: No change in scattered nonspecific pulmonary micronodules. No suspicious pulmonary nodule or mass is seen. No pleural effusion or consolidation is present.MEDIASTINUM AND HILA: Status post total esophagectomy with gastric pull up. No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there are mild coronary artery calcifications. No pericardial effusion is present.CHEST WALL: Degenerative changes throughout the thoracic spine appears similar to the prior study.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: Previously noted right hydronephrosis has resolved.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. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 44-year-old male with history of tachycardia and shortness of breath. Evaluate for PE. Motion artifact slightly limits this exam.PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Patchy consolidation in the left lower lobe, most consistent with infection. Minimal patchy opacities in the right lower lobe are also noted. No significant pleural effusion.MEDIASTINUM AND HILA: Heart size upper limits of normal, with no significant pericardial effusion. Prominent subcarinal lymph nodes. No hilar lymphadenopathy. No visible coronary artery calcifications.CHEST WALL: Degenerative changes of the visualized spine, including endplate irregularity of two mid thoracic vertebral bodies with the appearance of small Schmorl's nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. | No pulmonary embolus. Predominantly left lower lobe patchy consolidation most consistent with infection. Follow-up PA and lateral chest radiographs in 6 weeks recommended to ensure resolution.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: mets lung cancer. s/p chemo. Pls c/w previous study and evaluate dz status. History: lung cancer CHEST:LUNGS AND PLEURA: Status post bilateral upper lobectomies. Fibrosis is again seen along the right superior hilum. The previously right lower lobe micronodule again measures 4 mm (image 77, series 4). Ground glass nodule adjacent to the fissure in the right lower lobe again measures 6-mm (image 88, series 4). Groundglass nodule in the right lower lobe again measures 7 mm (image 183, series 4).Additional non-referenced pulmonary micronodules and ground glass nodules are unchanged. No new suspicious pulmonary nodule or mass. No consolidation or pleural effusion.MEDIASTINUM AND HILA: No change in hypodense thyroid lesions. The left thyroid lesion again contains calcifications. No mediastinal or hilar lymphadenopathy is seen. The previously referenced right paratracheal lymph node now measures 4 mm in short axis (image 19, series 3). The heart is normal in size and there are no coronary artery calcifications. Pericardial fluid is again seen in the superior pericardial recess.CHEST WALL: No axillary lymphadenopathy. Healed right rib fractures are again noted. Moderate to severe degenerative changes of the spine are unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific liver hypodensities are unchanged and likely benign. No suspicious liver lesion is identified.SPLEEN: Accessory spleens are seen medial and superior to the spleen.ADRENAL GLANDS: Status post left adrenalectomy. No right adrenal lesion is identified.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: Severe degenerative changes throughout the lumbar spine appears similar to the prior study. | 1.No evidence of recurrent or metastatic disease.2.No change in indeterminate pulmonary nodules, however continued follow-up is recommended to exclude indolent primary adenocarcinoma. |
Generate impression based on findings. | Male 47 years old; Reason: rectal cancer restaging History: rectal cancer restaging CHEST:LUNGS AND PLEURA: 5-mm nodule along the minor fissure (image 51; series 5) is unchanged. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions are present in the liver. Index segment 2 lesion measures 1.2 x 1.2 cm (image 90; series 3), unchanged. Reference segment 5 lesion measures 1.8 x 1.4 cm (image 100; series 3) unchanged. Lesions remain well marginated hypoattenuating most suggestive of cysts.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: Nonobstructive ventral hernia containing fat.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Post operative changes in the perirectal space with subcentimeter lymph nodes as noted previously.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine with degenerative disease centered at L5-S1.OTHER: No significant abnormality noted | Stable exam with reference measurements given above. |
Generate impression based on findings. | 33-year-old female with a history of roux-en-y gastric bypass c/b anastomotic strictures s/p dilatation at OSH now with persistent abdominal pain and intermittent vomiting/intolerance to po intake. Scout radiograph showed a nonobstructive bowel gas pattern. Surgical clips are visualized in the right upper quadrant from a prior cholecystectomy as well as postoperative material in the left upper quadrant from the gastric bypass procedure.Single contrast oral barium administration revealed prompt transit of contrast from the esophagus and gastric pouch into the intestines past the gastrojejunal anastomosis. There was no evidence of stricture or narrowing at the site of the gastrojejunal anastomosis. Although contrast passed into the distal small bowel beyond the expected region of the jejunojejunal anastomosis, the small bowel was mildly dilated up to 3.1 cm proximal to this level (anastomotic surgical material seen in area). Amorphous areas of contrast were visualized in the left mid-abdomen and, on subsequent imaging, appeared to be located within small bowel, possibly in the common channel, as opposed to located in the biliopancreatic limb. Contrast did not reach the colon during the exam. The constellation of findings suggest the presence of a partial obstruction at the enteroenteric anastomosis. TOTAL FLUOROSCOPY TIME: 8 minutes and 34 seconds FT. | 1.Post-surgical changes related to a Roux-en Y gastric bypass procedure. 2.Findings suspicious for partial small bowel obstruction at the jejunojejunal anastomosis.3.Patent gastrojejunal anastomosis. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or depressed calvarial fracture.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 44 years old Reason: r/o obstruction History: metastatic colon cancer, not tolerating PO, emesis, no BM since yesterday ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hepatic metastases again seen without significant interval change in size. Hepatic segment 8 lesion now measures 2.2 .5 cm (image 26, series 3), previously 2.7 x 2.5 cm. Segment 3 lesion now measures 3.9 x 2.4 cm (image 40, series 3), previously two .by 2.4 cm. Additional non-referenced lesions are not significant size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is been interval development of mild right sided hydronephrosis and hydroureter, with an associated diminished right-sided nephrogram, consistent with a physiologically significant obstruction. There are bilateral nephroureteral stents in place and a percutaneous left nephrostomy tube in place. The right nephroureteral stent is likely malfunctioning. There is soft tissue encasing the distal ureters, likely the initial cause of obstruction. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is persistent but increased dilatation of small bowel measuring up to 4.4 cm in maximal diameter with multifocal transition points seen in the left hemipelvis where the bowel is encased by tumor. These findings are consistent with a small bowel obstruction, related to tumoral infiltration. There are postoperative changes related to right hemicolectomy. There is colonic diverticulosis without evidence of diverticulitis.Peritoneal carcinomatosis again identified, without significant change.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Tubular soft tissue density extending to the bladder to the umbilicus, be postoperative in etiology or peritoneal carcinomatosis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Physiologically significant right-sided renal obstruction, with the associated nephroureteral stent likely malfunctioning.2.Small bowel obstruction with multifocal transition points seen in the left hemipelvis, secondary to tumoral infiltration.3.Peritoneal carcinomatosis and liver metastases without significant interval change. |
Generate impression based on findings. | 53-year-old with atypical lobular hyperplasia in the left breast status post lumpectomy and follow-up biopsy with additional foci of ALH. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Surgical changes are present in the retroareolar region of the left breast with associated volume loss, architectural distortion and surgical clips. X-shaped biopsy clip is located in the 12 o'clock radian of the left breast, unchanged in position. Scattered benign appearing calcifications in the left breast are unchanged. Within the central medial right breast anterior depth there is an asymmetry that appears unchanged compared to the exam from 1/7/13. No dominant mass or suspicious microcalcifications. Benign appearing lymph nodes are projected over the left axilla. | 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. | Male 79 years old Reason: 79 yo male with recently diagnosed colon cancer by colonoscopy History: colon cancer CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: The heart size is enlarged. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: Moderate bilateral gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are atrophic, with much of the parenchyma replaced by cysts, compatible with end-stage renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is masslike enlargement of the sigmoid colon (image 140, series 3) with associated inflammatory change in the mesentery and peritoneal nodularity. There is a prominent pericecal lymph node, which measures 0.6 x 0.9 cm (image 146, series 3). These findings most consistent with colon cancer with possible regional lymph node metastasis and adjacent peritoneal carcinomatosis.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: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Cecal mass compatible with the reported history of colon cancer, with findings worrisome for regional lymph node metastasis and possible adjacent peritoneal carcinomatosis. |
Generate impression based on findings. | Reason: postoperative scans for right cheek SCC with parotid invasion and positive margins History: s/p resection for SCC of right cheek. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodule or mass. No pleural effusion or consolidation.MEDIASTINUM AND HILA: Several mildly enlarged lower cervical lymph nodes are partially visualized. Please see dedicated CT neck report for further details. Several mildly enlarged upper mediastinal lymph nodes are present. The heart is normal in size and there is no pericardial effusion. Mild coronary artery calcifications are present.Right port catheter is seen in place with its tip in the SVC.CHEST WALL: Mild axillary lymphadenopathy is present. Healed left rib fracture is noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific liver hypodensities are too small to characterize, however unchanged from the prior study and likely benign.SPLEEN: The spleen is enlarged measuring up to 14.8 cm in length.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense renal lesions are unchanged and likely represent simple cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild retroperitoneal lymphadenopathy is present.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small hiatal hernia is noted.BONES, SOFT TISSUES: L4 vertebral body hemangioma is present. | 1.Splenomegaly and mild mediastinal, axillary, and retroperitoneal lymphadenopathy is likely related to the patient's leukemia.2.No evidence of metastatic disease from the patient's right cheek SCC.3.Please see CT neck report for further details. |
Generate impression based on findings. | 78-year-old male with swelling and tenderness to palpation over the fourth metacarpal after fall There is swelling along the dorsal aspect of the hand. No fracture is evident. Mild osteoarthritis affects the interphalangeal joints. We also see narrowing of the metacarpophalangeal joints with osteophyte formation and faint chondrocalcinosis along the third metacarpophalangeal joint and wrist. | Arthritic changes likely representing a combination of osteoarthritis and perhaps CPPD arthropathy. |
Generate impression based on findings. | 50 year-old female with pain, evaluate for fracture There is mild soft tissue swelling about the PIP joint as well as a cortical step off seen on the PA and lateral views along the radial and dorsal aspects (respectively) of the base of the middle phalanx consistent with a nondisplaced fracture. | Nondisplaced fracture of the middle phalanx. |
Generate impression based on findings. | 54-year-old female with radiculopathy Moderate to severe degenerative disk disease affects C4/5 with moderate degenerative disk disease affecting C5/6 and C6/7. There are anterior and posterior vertebral body osteophytes at these levels. The cervical spine is kyphotic. There is narrowing of bilateral neuroforamina at C4/5, C5/6 and C6/7. Calcifications project over the region of the left carotid.Note is made of multiple dental fillings and possibly caries involving the mandibular molars. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | 67-year-old female with pain, evaluate for progression of AVN Left hip: Again seen is bandlike sclerosis consistent with AVN. Best seen on the frog leg view is curvilinear subchondral lucency indicating subchondral fracture with collapse of the overlying superior and medial articular surface, progressed from the prior exam. There is also progression of hip joint narrowing. Right hip: Patchy sclerosis is again noted within the femoral head, consistent with AVN without subchondral collapse.Pelvis: Bilateral AVN involving the femoral heads is again noted. Degenerative arthritic changes affect the lower lumbar spine. Surgical suture material projects over the pelvis. | Progression of avascular necrosis involving the left femoral head. |
Generate impression based on findings. | 64 year old woman with history of multiple myeloma. SKULL: Multiple lucent lesions are seen in the cranial apex, although with poorly defined margins.CERVICAL SPINE: Cervical spine alignment is within normal limits and the vertebral body and intervertebral disc heights are preserved. No myelomatous lesions are identified.THORACIC SPINE: Vertebral body and intervertebral disc heights are preserved. No myelomatous lesions are identified. LUMBAR SPINE: Vertebral body and intervertebral disc heights are preserved. No myelomatous lesions are identified. Small anterior osteophytes and joint space narrowing indicate degenerative disc disease.RIBS: No myelomatous lesions are identified.PELVIS: Minimal osteoarthritis affects both hips. No myelomatous lesions are identified.UPPER EXTREMITY: No myelomatous lesions are identified.LOWER EXTREMITY: Mild osteoarthritis affects both knees. No myelomatous lesions are identified. | Questionable lucent lesions of the calvaria, otherwise no myelomatous lesions identified. |
Generate impression based on findings. | 62 year-old female status post right total hip arthroplasty Hip: Hardware components of a total hip arthroplasty are situated in near-anatomic alignment without evidence of complication.Pelvis: The bones are demineralized, suggesting osteopenia. Mild osteoarthritis affects the left hip. | Total hip arthoplasty in near-anatomic alignment. |
Generate impression based on findings. | 10-year-old female with PICC manipulated/moved.VIEW: Chest AP (one view) 1/7/2015, 0832 hours. Right upper extremity PICC tip in the right axilla and does appear slightly retracted from the previous exam accounting for differences in technique. NG tube tip is beyond the field of view.No focal pulmonary opacity, pleural effusion, or pneumothorax. Cardiac silhouette size upper limits of normal. | PICC tip in the right axilla. |
Generate impression based on findings. | 77-year-old female with sickle crisis, evaluate for erosive OA or rheumatoid arthritis Right hand: Moderate osteoarthritis affects the basilar joint. Mild osteoarthritis affects the interphalangeal joints of the fingers. There is also mild narrowing of the metacarpophalangeal joints with tiny osteophytes, but no erosions or other specific radiographic features of rheumatoid arthritis.Left hand: Moderate osteoarthritis affects the interphalangeal joint of the thumb. Mild osteoarthritis affects the interphalangeal joints of the fingers as well as the first, second and third metacarpophalangeal joints. There is focal soft tissue swelling along the dorsal base of the metacarpals, which is nonspecific, but could represent a ganglion. There is mild radiocarpal joint narrowing, but no erosions or other specific radiographic features of rheumatoid arthritis. | Osteoarthritis of both hands. Mild degenerative osteoarthritic changes of the metacarpophalangeal joints may reflect an extension of the patient's primary osteoarthritis or perhaps CPPD arthropathy, although we see no definite chondrocalcinosis to support this. There is slight narrowing of the left radiocarpal joint, but we see no erosions or additional features of rheumatoid arthritis. |
Generate impression based on findings. | 78-year-old male with history of altered mental status. Evaluate for subdural hematoma. There is no evidence of acute intracranial hemorrhage. There is unchanged extensive cerebral white matter hypoattenuation. There is no midline shift or mass-effect. There is diffuse cerebral volume loss. There is unchanged tortuosity and prominent of the vertebrobasilar system. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | 1. No evidence of subdural hematoma. 2. Unchanged extensive chronic small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 48-year-old female status post fourth ray resection with transposition of the fifth to fourth ray A plate and screw device affixes the transplanted bones of the fifth ray to the fourth metacarpal. The lateral aspect of the osteotomy remains visible, but there is perhaps some bony bridging across the center of the osteotomy as seen on the oblique view. There is no evidence of hardware complication or of tumor recurrence. | Postoperative changes of fourth ray resection and fifth ray transposition as described above. |
Generate impression based on findings. | h/o met ACC, s/p chemo and palliative RT, compare to previous, measurements pls CHEST:LUNGS AND PLEURA: Innumerable pulmonary and pleural nodules are again seen, increased in size and number from the prior study. Reference measurements are as follows:1.Left lower lobe nodule now measures 15 mm (image 55, series 6), previously 9 mm.2.Right lower lobe nodule now measures 19 mm (image 66, series 6), previously 9 mm.3.Left lower lobe nodule now measures 12 x 9 mm (image 73, series 6), previously 10 x 8 mm.Bilateral pleural effusions have increased in size, right greater than left. New right upper lobe ground glass opacity and bilateral lower lobe bronchial wall thickening is likely related to lymphatic obstruction.MEDIASTINUM AND HILA: Mediastinal, cardiophrenic, and hilar adenopathy appears similar to the prior study. The previously referenced low right paratracheal lymph node now measures 16 mm in short axis (image 37, series 4), previously 15 mm.Right porta catheter tip lies within the right atrium. Small hiatal hernia is again noted. The heart is normal in size without pericardial effusion. No coronary artery calcifications are seen.CHEST WALL: Mixed sclerotic/lytic lesion in the manubrium with pathologic fracture is present. Sclerotic foci in the T7, T11, and T12 vertebral bodies are unchanged. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodense liver lesions have increased in size from the prior study. For reference, a segment 8 liver lesion now measures 2.4 x 2.5 cm (image 92, series 4), previously 1.3 x 1.1 cm.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several hypodense renal lesions are present, also likely representing metastases. Previously described wedge-shaped hypoattenuation in the superior right kidney now appears more mass like and likely represents a metastasis.Nonobstructing renal stones are seen in the inferior collecting systems. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy is again seen, unchanged from the prior study. IVC filter is seen in place.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Subtle lytic lesions in the superior aspect of the left iliac wing are new from the prior study dated 9/22/2014 and suspicious for metastases. | 1.Increase in size and number of pulmonary and pleural metastases. Increase in bilateral pleural effusions.2.Increase in size and number of hepatic metastases.3.New bilateral renal metastases.4.New subtle lytic lesions in the left iliac wing and may represent additional osseous metastases.5.No change in mediastinal/hilar/cardiophrenic/gastrohepatic lymphadenopathy. |
Generate impression based on findings. | 74 year-old woman with history of pain. Left knee: Hardware components of a left total knee arthroplasty device are seen in near anatomic alignment. There is no evidence of hardware complication.Right hip: Hardware components of a right total hip arthroplasty device are seen in near anatomic alignment. There is no evidence of hardware complication.Pelvis: Bilateral total hip arthroplasty devices are seen in near anatomic alignment. The distal stem of the left total hip arthroplasty is not visualized. There is heterotopic bone formation along the proximal aspects of the prostheses, but there is no other evidence of complication. Lumbar fixation rods and screws are noted. | Hip and knee arthroplasties as described above without evidence of complication. |
Generate impression based on findings. | There are post-treatment findings in the right frontal lobe related to tumor resection. There is minimal curvilinear enhancement along the posterior margin of the right frontal surgical cavity best seen on the sagittal sequence. The T2/FLAIR hyperintense nodular components of tumor along the anterior margin and posterosuperior margin of the resection cavity and in the right cingulate gyrus are grossly unchanged in size. An enhancing lesion along the lateral ependymal surface of the right frontal horn, at the level of the caudate head, has increased in size, now measuring13 x 10 mm (AP x TR), previously 11 x 6 mm. There is also a small T2/FLAIR hyperintense nodule along the posteromedial margin of the resection cavity which is also unchanged. There is unchanged patchy intrinsic T1 hyperintensity, enhancement, and T2 hyperintensity in the left cingulate gyrus. There is T2/FLAIR signal abnormality along the right lateral aspect of the 4th ventricle, unchanged in size compared to recent prior, but increased in size compared to remote prior study.There is no evidence of acute ischemia. 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. | 1. Interval increase in size of an enhancing ependymal lesion along the lateral aspect of the right frontal horn, suspicious for a growing tumor deposit.2. Gradual increase in size of abnormal T2/FLAIR hyperintense signal along the right aspect of the fourth ventricle, of uncertain significance.3. Otherwise, no significant interval change in residual tumor along the anterior, medial and posterior aspect of the surgical bed, and in the right anterior cingulate gyrus. Nonspecific abnormalities in the left cingulate gyrus and paracentral lobule are not significantly changed. |
Generate impression based on findings. | 49-year-old woman with history of pain. The hand is normal in appearance without acute fracture, malalignment, or significant degenerative changes. | No finding to explain the patient's pain. |
Generate impression based on findings. | 62 year-old woman with history of shooting pains along the talocalcaneal joint. There are small osteophytes at the navicular cuneiform articulation indicating mild to moderate osteoarthritis. The subtalar joint appears normal. There is no acute fracture or malalignment. | Degenerative changes of the navicular cuneiform articulation. |
Generate impression based on findings. | 77-year-old woman with history of bilateral knee pain and locking of the left knee. Left knee: Moderate to severe osteoarthritis affects the left knee with predominately lateral joint space narrowing to near bone-on-bone apposition and tricompartmental osteophyte formation. Multiple surgical clips are noted in the medial soft tissues.Right knee: Moderate to severe osteoarthritis affects the right knee with predominately lateral joint space narrowing and tricompartmental osteophyte formation. Additionally, there is a 14-mm calcific loose body in the right knee joint. | Degenerative changes of the knees bilaterally with loose body in the right knee joint. |
Generate impression based on findings. | 57 year-old female with elbow pain and hand paresthesias Wrist: No fracture or other specific findings are identified to account for the patient's pain.Elbow: No fracture, effusion, or malalignment evident.Lumbar spine: There is slight straightening of the lumbar spine. Vertebral body heights and disk spaces are maintained. Surgical clips are noted in the right upper quadrant, presumably from prior cholecystectomy. | No fracture or other specific findings to account for the patient's pain. |
Generate impression based on findings. | Trauma. Evaluate for clavicular fracture.VIEWS: Left clavicle AP and axial 1/7/15 (two views) There is a transverse fracture with inferior angulation of the mid shaft of the left clavicle. | Transverse fracture of the left clavicle as described. |
Generate impression based on findings. | Male 4 months old Reason: bilious emesis, eval obstruction VIEW: Abdomen AP (one view) 1/7/15 at 943 hours. Giant of velocities again noted. A second NG tube has been placed into the stomach. A single dilated loop in the right upper abdominal quadrant is again noted. Obstruction cannot be excluded. | Interval placement of a second NG tube.The bowel distention concerning for obstruction. |
Generate impression based on findings. | 62-year-old with history of IDC in the right breast status post lumpectomy, radiation, and hormonal therapy. Patient states the right breast is still tender, but otherwise has no complaints. No family history of breast cancer. Three standard views of the right breast along with two CC mag views and one mediolateral spot mag view 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 scar marker overlies the upper medial breast. Surgical clips and architectural distortion are present in the lumpectomy site as well as surgical clips in the right axilla. Focal asymmetry within the lumpectomy site compatible with postoperative hematoma/seroma. No suspicious microcalcifications. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in July 2015 (to get back on a bilateral annual schedule). Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: vocal cord paralysis, recurrent laryngeal nerve involvement History: hoarse Motion artifact limits evaluation of the lower lobes.LUNGS AND PLEURA: Small left pleural effusion is noted. No consolidation, pulmonary nodule, or mass.MEDIASTINUM AND HILA: Right central venous catheter tip is seen in place with its tip within the right atrium. Residual thymic tissue is noted. No mediastinal or hilar lymphadenopathy is seen. The heart is normal size and there is no pericardial effusion. No coronary artery calcifications are seen.No mass lesion is seen along the course of the recurrent laryngeal nerves.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right internal/external biliary drain is seen in place with expected pneumobilia. A moderate amount of ascites is present. Splenomegaly is partially visualized. Dilated/tortuous splenic vessels are again noted. Body wall edema seen predominantly in the upper abdomen. | No mass lesion is seen along the course of the recurrent laryngeal nerves.Small left pleural effusion. |
Generate impression based on findings. | 4-month-old male with a bradycardic episodes associated with feeding.EXAMINATION: Oropharyngeal motility study 1/7/2015, 1015 hrs. Beth Harrison, speech and language therapist, supervised the examination.99 seconds of fluoroscopy was used.Thin liquids and half strength nectar were administered via a slow flow nipple. Full strength nectar was administered via slow-flow and medium-flow nipples.Oral deficits included decreased rate of expression, delayed transit, premature loss of bolus, and decreased expression/efficiency of semi-thick and think consistency fluids.Pharyngeal deficits included delayed swallow and decreased laryngeal closure. Penetration was observed with thin liquids and with half strength nectar, with inconsistent cough. Silent aspiration was observed with half strength nectar. The patient tolerated nectar thick liquids via slow-flow and medium-flow nipples. | Penetration and aspiration, as above.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Recto-urinary fistula KIDNEYS Cortical Echogenicity: Normal. The cortex is minimally thinned in the left kidney due to hydronephrosis. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 3/4 Length*** Right: 4.3 cm Left: 4.4 cm Mean for age: 4 cm Range for age: 3.5 - 5.5 cmADDITIONAL OBSERVATIONS: The rectum is distended with meconium. The palpable perineal/anal bulge contains homogenous substance likely representing meconium within the anorectum. | 1. Grade 3/4 left hydronephrosis2. Palpable perineal/anal bulge likely representing anorectum with meconium. *SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Female 11 years old. Reason: follow-up scan. History: neurogenic bladder with history of renal stones. BLADDER Wall Thickness: Slightly thickened. Contents: Fluid distended with a small amount of layering debris. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 8.3 cm Left: 10.4 cm Mean for age: 9 cm Range for age: 8 - 10.5 cmADDITIONAL OBSERVATIONS: A 9 mm shadowing non-obstructive stone is noted in the right kidney inferior pole, similar to that seen on 9/8/14. | Non-obstructing right renal stone.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Prostate carcinoma CHEST:LUNGS AND PLEURA: Interval increase in size of small bilateral pleural effusions.MEDIASTINUM AND HILA: Stable thyroid nodules. Stable reference right paratracheal lymph node best seen on image 40 of series 3 measuring 1.1 x 2 cm. Stable bilateral hilar adenopathy.CHEST WALL: No significant change in widespread sclerotic bony metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: 0.6 x 0.6 cm low-attenuation focus within segment 5 of the right lobe of the liver best seen on image 135 of series 3 not clearly identified on prior study.Stable cholelithiasis without acute inflammation or ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy. Reference left periaortic lymph node best seen on image 117 of series 3 measures 1.7 x 1.5 cm.BOWEL, MESENTERY: Trace ascites.BONES, SOFT TISSUES: Stable widespread sclerotic bony metastases.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 change in widespread sclerotic bony metastasis.OTHER: No significant abnormality noted | Subcentimeter low attenuation focus within the right lobe of liver not appreciated on prior studies; would pay special attention to this lesion on future surveillance scans.Widespread sclerotic bony metastasis again noted and unchanged.Interval increase in small bilateral pleural effusions and new trace ascites. |
Generate impression based on findings. | Female 77 years old Reason: hx of urothelial cancer of the left kidney s/p left nephroureterectomy and bladder cancer, evaluate for metastatic disease History: see above ABDOMEN: Within the limits of a non IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small bilateral adrenal nodules without significant interval change.KIDNEYS, URETERS: Status post left nephrectomy. There is no soft tissue within the nephrectomy bed to suggest local recurrence.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. Stable slight prominent gastrohepatic ligament nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen fat stranding about the umbilicus has improved since the prior examination.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previously seen fat stranding about the umbilicus has improved since the prior examination.OTHER: No significant abnormality noted | 1.Post surgical changes related to left nephrectomy without evidence of locoregional disease recurrence or metastatic disease.2.Unchanged from the gastric hepatic ligament lymph nodes. Although nonspecific, attention at follow-up is recommended.3.Resolution of the previous seen fat stranding about the umbilicus. |
Generate impression based on findings. | There is an unchanged left posterior parafalcine extra-axial partially calcified mass with mildly worsened vasogenic edema in the adjacent left frontal and parietal lobes. There is unchanged erosion of the left parietal calvarium inner table with heterogeneous appearance. There is mild mass effect on the left lateral ventricle atrium which appears slightly worsened. There is periventricular and subcortical white matter hypoattenuation which is nonspecific and unchanged, likely representing chronic microvascular ischemic changes. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is marked nasal septal deviation to the left with osseous spur. | No acute intracranial hemorrhage. Mild interval worsening of vasogenic edema associated with the unchanged left posterior parafalcine meningioma. |
Generate impression based on findings. | Twisted knee. Pain.VIEWS: Left knee AP/lateral/oblique (3 views) 01/07/15 A joint effusion is not present. No fracture is seen. The bones are normal in appearance. | Normal examination. |
Generate impression based on findings. | 6-year-old female with fever, hypoxia, work of breathing.VIEW: Chest AP (one view) 1/7/2015, 1115 hrs. Low lung volumes.Retrocardiac opacity suggestive of atelectasis, less likely consolidation. No evidence of pleural effusion or pneumothorax. Normal cardiothymic silhouette.Dilated colon seen in the upper abdomen. Dedicated abdominal radiographs may be considered if clinically indicated.Scoliosis and gastrostomy tube again noted. | Retrocardiac opacity may represent atelectasis, less likely consolidation. |
Generate impression based on findings. | 65-year-old male status post orogastric tube placement. Paucity of bowel gas in the abdomen without evidence of obstruction. The orogastric enteric tube loops in the body of the stomach with the tip in the fundus. Note that the lower pelvis was not included in the exam. | Orogastric tube with the tip in the fundus. |
Generate impression based on findings. | 74 years old, Male, Reason: 73M with h/o acute pancreatitis c/b pancreatic necrosis and pancreatic pseudocsyst s/p drainage. 1 drain recently pulled. History: Pancreatic pseudocyst ABDOMEN:LUNG BASES: Moderate calcifications of the coronary arteries.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Persistent mild prominence of the intra-and extrahepatic bile ducts. The portal vessels are patent.SPLEEN: Scattered calcified granulomas.PANCREAS: Interval removal of a cystogastrostomy tube. There is interval decrease of a fluid collection adjacent to the wall of the body of the stomach and measuring 2.6 x 3.0 cm (series 10 image 30), previously measuring 5.7 x 5.5 cm. there is a stent entering this fluid collection. No significant residual fluid collection about the head of the pancreas. No evidence of pancreatic necrosis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal stone and multiple bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Extensive calcification of the abdominal aorta and its branches. Stable 3-cm aneurysmal is dilatation of the infrarenal abdominal aorta. 6.5 cm right common iliac aneurysm is unchanged. 2.7-cm aneurysmal dilatation of the left common iliac artery is unchanged.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 | 1.Interval decrease in size of perigastric fluid collection with drain in place.2.Interval removal of cyst gastrostomy drain without residual fluid collection in the area of the pancreatic head.3.Splenic vein and SMV well opacified and appear patent on this study. 4.Stable abdominal aortic and iliac aneurysms. |
Generate impression based on findings. | 65-year-old male with increasing abdominal distention and postoperative day one from an LVAD. Note that the pelvis was not included in the exam. Post-surgical changes, support devices, and tubes are again seen and appear similar to same day thoracoabdominal radiography. Nonobstructive bowel gas pattern. Surgical clips are noted throughout the abdomen and pelvis. Small oval density projecting over the midline pelvis could reflect ballistic material. | Nonobstructive bowel gas pattern, essentially stable exam. |
Generate impression based on findings. | 53-year-old female with defecatory dysfunction. On exam seems to have rectocele that extends to right ischiorectal fossa in area of prior episiotomy. History: Describes bulge that tracks R laterally with associated symptoms, chronic constipation. There was prompt opacification of the rectum and sigmoid of normal static morphology. The anorectal angle was normal at rest. With Valsalva maneuver/straining and with evacuation, rectal descent was seen, appearance compatible with rectal prolapse (series 11 and 17). There was evidence of a right-sided lateral rectocele and a possible smaller left-sided lateral rectocele, the former most apparent during straining (this maneuver reproduced the patient's symptoms, with sensation of rectum descending into right leg area) and the latter during defecation, in the AP view. The right-sided rectocele measures approximately 2 x 1.8 cm (series 10), while the possible left-sided rectocele measures approximately 0.8 x 0.7 cm (series 23). Voluntary anal sphincter contraction demonstrated expected perineal elevation. Formal straining and evacuation in both AP and lateral views (video series 17 and 23) showed passage of rectal contents. Following evacuation, small to moderate amount of residual contrast present. | 1. Small right-sided lateral rectocele and possible smaller left-sided lateral rectocele. 2. Rectal prolapse present. |
Generate impression based on findings. | Female 69 years old Reason: mets lung cancer. s/p 12 cycles of MPDL3280A. pls c/w previous study to evaluate tx response. History: lung ca ABDOMEN:LUNG BASES: Please see chest CT report from the same day for full evaluation of the thoracic findings.LIVER, BILIARY TRACT: Multiple hepatic hypodensities unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst is unchanged. Additional renal hypodensities are too small to characterize but unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia.BONES, SOFT TISSUES: Degenerative changes with compression fracture at T10 again seen. Partially imaged left sixth rib fracture.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes with compression fracture at T10 again seen. Partially imaged left sixth rib fracture.OTHER: No significant abnormality noted | 1.Stable examination, no evidence of metastatic disease as clinically indicated.2.Please see chest CT report from the same day for full evaluation of the thoracic findings. |
Generate impression based on findings. | Pain. Evaluate fracture. The nondisplaced medial malleolar fracture seen on the prior study is barely visible on the current study, likely due to some interval healing combined with slight differences in patient positioning between two examinations. | Medial malleolar fracture as described above. |
Generate impression based on findings. | Chronic back pain with paresthesias in left leg. Pain in right leg with radiation to foot. Severe degenerative disk disease affects L5/S1. Mild to moderate facet joint osteoarthritis affects the lower lumbar spine. There are minimal anterolistheses of L3 and L4 with slight posterior bulging of the calcified periphery of the disk at L3/4. Vertebral body heights are preserved. A calcified mass in the pelvis presumably represents a uterine fibroid, measuring 10 cm. | Degenerative disk disease/osteoarthritis as described above. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild periventricular and subcortical white matter hypoattenuation, especially adjacent to the left frontal horn and atrium of the left lateral ventricle which is nonspecific in this age group. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.No acute intracranial hemorrhage or mass effect. CT is insensitive for detection of early nonhemorrhagic stroke.2.Mild periventricular and subcortical white matter hypoattenuation, especially focally adjacent to the left frontal horn and atrium of the left lateral ventricle, nonspecific in this age group. Differential diagnosis includes age indeterminate small vessel ischemia, demyelination, and inflammatory etiologies. This can be further evaluated on MRI if clinically indicated. |
Generate impression based on findings. | Rule out shoulder dislocation. Shoulder pain. Hip pain. History of hip replacement. Rule out fracture. The Velpeau view of the shoulder again shows the fracture through the surgical neck of the humerus with fracture fragments in near-anatomic alignment. Glenohumeral joint alignment is within normal limits.Two views of the right hip show components of a total hip arthroplasty device situated in near anatomic alignment without fracture or radiographic evidence of hardware complication.The AP view of the pelvis shows the aforementioned right total hip arthroplasty device. Mild osteoarthritis affects the left hip. I see no fracture. Degenerative arthritic changes affect the pubic symphysis and lower lumbar spine. Linear metallic densities projecting between the right ischium and the arthroplasty likely represent needle tips in the overlying right buttock; these were present on the prior study. | Right humeral neck fracture, right total hip arthroplasty, and other findings as above. |
Generate impression based on findings. | Cough and S.O.B.. Evaluate ILD for changes. Pain in joint, shortness of breath, anemia, muscle weakness. LUNGS AND PLEURA: Significant interval improvement in pulmonary opacity since the previous examination, now with fairly symmetric residual areas of anterior and upper lung linear scarring. Mild cylindrical bronchiectasis in the right middle lobe and lingula. No pleural fluid or pneumothorax.No air trapping on the expiration sequence. No honeycombing.MEDIASTINUM AND HILA: Interval development of hazy soft tissue infiltration within the anterior mediastinal fat containing several small lymph nodes. Normal heart size. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy clips. Hypoattenuation in the right hepatic lobe suggestive of fatty infiltration. | Near complete resolution of pulmonary opacities with residual scarring and mild bronchiectasis. Interval development of anterior mediastinal fat stranding with numerous small lymph nodes; correlate for inflammatory process as it is more nodular than typically seen with reactive thymic hyperplasia. |
Generate impression based on findings. | 46 year old with left breast mass at the two o'clock position presents for ultrasound guided biopsy. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 6 x 4 mm at the 2 o’clock position without increased vascularity, 6 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 left 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 (Achieve) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at posterior 2 o;clock position. 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 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. | Pain Again seen is a large osteochondroma projecting from the posterolateral aspect of the proximal humeral diaphysis. This appears similar to that seen on prior studies. I see no fracture or specific findings to suggest malignancy. | Osteochondroma as above. |
Generate impression based on findings. | Occasional dyspnea. Follow-up of metastatic breast cancer. CHEST:LUNGS AND PLEURA: Diffuse pleural metastases on the right are now near-circumferential. Reference nodular focus near the right apex measures 12 mm, previously 9-mm (3/17). Second reference pleural lesion abutting the right heart border (3/49) measures 8 mm, previously 9-mm, difficult to measure on the last two examinations due to change in orientation of the pleura with the scan plane.Nodule in the cardiophrenic angle anteriorly (3/65) measures 12 mm, previously 8-mm.Moderate volume of pleural fluid on the right appears slightly decreased.Pulmonary micronodules similar in size and number.MEDIASTINUM AND HILA: Multiple new mildly enlarged bilateral paratracheal chain lymph nodes, right greater than left.Right hilar lymph node measures 16mm, previously 9-mm (3/41). Mild subcarinal lymph node enlargement. Right chest port tip at the SVC/RA junction.CHEST WALL: Right chest port. Postsurgical changes of left mastectomy. T12 lesion 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: IVC filter strut penetration into the transverse portion of the duodenum noted. No evidence of abscess, adjacent lymphadenopathy or fluid.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.IVC strut extension into the transverse portion of the duodenum to the right of midline noted.BONES, SOFT TISSUES: L3 vertebral body lesion unchanged.OTHER: No significant abnormality noted. | 1. IVC filter strut penetration into the transverse portion of the duodenum noted. If patient is asymptomatic, may be inconsequential. Dr.Fleming notified via e-mail.2. Pleural metastases on the right with reference measurements provided in the body of the report.3. Interval development of bilateral mediastinal and ipsilateral hilar lymphadenopathy.4. Stable skeletal lesions. |
Generate impression based on findings. | 21 year-old male with right ankle pain to medial, posterior malleolus and decreased range of motion status post injury 1 1/2 months ago. Evaluate for fracture. I see no fracture, malalignment, or other specific findings to account for patient's pain. | No fracture or other findings to account for patient's pain. |
Generate impression based on findings. | HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MAXILLOFACIAL: No acute facial bone fracture is identified. The temporomandibular joints are intact. No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding. The visualized paranasal sinuses and mastoid air cells are clear. No significant soft tissue swelling is identified. There is torus mandibularis. | 1.No acute intracranial hemorrhage or skull fracture.2.No acute facial bone fracture. |
Generate impression based on findings. | Knee pain status-post sports injury. Evaluate for fracture. Four views of the left knee are provided. I see no fracture, malalignment, or other specific findings to account for the patient's knee pain. The right knee likewise appears normal as seen on the frontal views. | No fracture or other findings to account for patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Giant cell tumor of left proximal tibia status post curettage x 2. Evaluate for recurrence. Again seen is a plate and screw device affixing cement within the proximal tibia at the site of giant cell tumor curettage. I see no hardware complications. I see no radiographic evidence of tumor recurrence. | Postoperative changes of giant cell tumor curettage appearing similar to the prior study. |
Generate impression based on findings. | Right femur diaphyseal cortically based lesion. Evaluate for interval change. Again seen is an elongated lucency within the cortex of the lateral aspect of the mid femoral diaphysis appearing similar to that seen on the prior study. The lesion appears slightly smaller than that seen on a study from January 2013. I see no additional lesions. Mild osteoarthritis affects the hip and knee. Overall, the bones appear demineralized suggesting osteopenia. Surgical suture and clips are noted in the pelvis. | Cortically based lesion as described above without evidence of progression. I suspect that this is benign. |
Generate impression based on findings. | Fracture Again seen is a side plate and screws affixing a fracture of the distal fibula in near anatomic alignment. I see no hardware complications. The fracture is perhaps slightly less distinct on the current study on the prior study, suggesting some interval healing. Plates and screws also affix an intra-articular fracture through the posterior aspect of the distal tibia in near anatomic alignment. There is a slight step off along the articular surface of the tibial plafond similar to that seen on the prior study accounting for slight positional differences; the remainder of the fracture is indistinct suggesting some healing. | Orthopedic fixation of fractures as above. |
Generate impression based on findings. | There is an unchanged 11 x 9 mm in hyperattenuating lesion in the roof of the third ventricle. The ventricles and basal cisterns are normal in size and unchanged. There is patchy periventricular and subcortical white matter hypoattenuation without significant change representing small vessel ischemic disease. There is no evidence of intracranial hemorrhage, or cerebral edema. There is no midline shift or herniation. There is scattered ethmoid and trace left maxillary sinus mucosal thickening. The imaged mastoid air cells are clear. There is a persistent curvilinear calcification in the subcutaneous prenasal soft tissue associated with prior rhinoplasty. The skull and extracranial soft tissues are otherwise unremarkable. | No significant change in third ventricular colloid cyst. No hydrocephalus or significant change in ventricular caliber. |
Generate impression based on findings. | Metastatic lung cancer to the right neck with vocal cord paralysis, status post Radiesse paste injection into right vocal cord. There is interval decrease in size of an ill-defined conglomerate of right level 4 lymph nodes, which measures up to 12 x 16 mm, previously 14 x 20 mm. However, there is no significant interval change in the necrotic right paratracheal lymph node, which measures up to 15 x 24 mm, previously 15 x 24 mm. Likewise, is not significant interval change in size of an irregular left upper mediastinal lymph node, now measuring up to approximately 25 mm. There are findings related to right vocal cord augmentation. A portion of the calcium hydroxyapatite paste extends to the level of the hypopharynx, which is unchanged. The right jugular vein is unchanged and occluded distal to this point. The right common and internal carotid arteries are patent. The thyroid and major salivary glands are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is a small mucosal retention cyst within the left maxillary sinus. There is unchanged cervical spondyloarthropathy. There is a right upper lobe lung mass. | 1.Interval decrease in size of an ill-defined conglomerate of right level 4 lymph nodes, but other cervical and upper mediastinal lymphadenopathy are not significantly changed.2.Partially imaged right lung mass. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Severe headache, evaluate for hemorrhage No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent mild chronic small vessel ischemic changes.Mild mucosal thickening involving the anterior ethmoid air cells. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. Calvarium is intact. | No evidence of intracranial hemorrhage or mass effect. |
Generate impression based on findings. | Status post total knee arthroplasty. Evaluate alignment. Components of a total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density within the soft tissues reflect recent surgery. | Total knee arthroplasty in near-anatomic alignment. |
Generate impression based on findings. | Cough and follow-up lung cancer CHEST:LUNGS AND PLEURA: Postsurgical changes and left upper lobe excision without new acute abnormality. Mild volume loss and associated stable appearing pleural thickening/scarring. Mild basilar atelectasis and multiple unchanged peripheral subpleural nodules in the right upper lobe (image 16 series 9). No effusions. Superimposed mild centrilobular emphysemaMEDIASTINUM AND HILA: Incompletely visualized and poorly defined heterogeneous focus in the inferior aspect of the left thyroid, unchanged grosslyThe reference AP lymph node (image 31 series 7) remains 1.3 cm in short axis. No new lymphadenopathy.Severe coronary calcifications without additional cardiac or pericardial abnormalitySmall to moderate hiatal herniaCHEST WALL: Postsurgical changes within the right breast, unchanged. Stable appearing subcutaneous focus overlying the right back just lateral of midline, likely a small cyst (image 17 series 7). Mild degenerative changes without additional new lytic or blastic lesions observedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Persistent moderate splenomegalyADRENAL GLANDS: Right adrenal nodule remains 2.3 x 2.4 cm (image 89 series 7), previously 2.2 x 2 .3 cm, and this subtle change is likely due to volume averaging and similar to the 3/7/13 CT scan. Left adrenal unremarkable.KIDNEYS, URETERS: Scattered small renal cysts unchanged bilaterallyPANCREAS: 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: Moderate scoliosis with degenerative changes. No suspicious lytic or blastic lesionsOTHER: No significant abnormality noted. | Postsurgical changes following excision of the left upper lobe. Otherwise stability in overall appearance and no new suspicious abnormalities. The scattered subcentimeter subpleural nodules the right upper lobe and reference measurements are provided |
Generate impression based on findings. | Metastatic lung cancer status post 12 cycles of MPDL3280A. LUNGS AND PLEURA: Right upper lobe mass (5/38) measures 4.6 x 1.3 cm, previously 4.6 x 1.6 cm; differences in transverse dimension may be the result of the obliquity of the lesion with scan plain as subjectively it appears similar to the prior study.Right middle lobe mass decreased in density, measuring 2 x 1.4 cm, previously 2.7 x 1.7 cm (5/53). This is noted to have a small necrotic portion on the soft tissue series (3/53).Post therapeutic changes related to radiation, but no new suspicious lesions.MEDIASTINUM AND HILA: Centrally hypoattenuating, peripherally enhancing right tracheoesophageal lesion measures 14 x 21 mm, previously 14 x 20 millimeter, not significantly changed. This has not significantly changed since the patient's initial study of 4/29/2003 and on each study has been isoattenuating with the thyroid gland, favoring an ectopic focus of the thyroid tissue.Low density centrally necrotic conglomerate lymphadenopathy in the prevascular region measures 27-mm x 23-mm (3/29), previously 9-mm in diameter. However, the numerous additional lymph nodes seen previously in the mediastinum have regressed.Small volume of pericardial fluid. Hiatal hernia. Paracaval lipoma.CHEST WALL: Right low cervical lymphadenopathy, please refer to separately reported neck CT. T12 superior endplate collapse. Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant change in right upper lobe mass however the right middle lobe lesion has decreased in density. Mixed response and lymphadenopathy with regression of previously seen enlarged mediastinal and hilar lymph nodes with the exception of an enlarging conglomerate of necrotic prevascular lymph nodes. |
Generate impression based on findings. | 66 year old with biopsy proven left breast malignancy present for needle localization prior to surgery. On review of the prior studies, the left breast mass at 5:00 is well seen sonographically. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization 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 site of procedure. The left breast cleaned with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using sonographic guidance, a 5 cm Kopans needle was placed through the lesion. On ultrasound, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated prior to the patient's procedure. Patient tolerated the procedure well and was sent to nuclear medicine in stable condition. Dr. Schacht performed the procedure and was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass and clip and spring wire to be within the specimen. Images were discussed with Dr. Jaskowiak and additional anterior tissue will be taken. | Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Esophageal cancer CHEST:LUNGS AND PLEURA: Unchanged stable mild paramediastinal fibrotic changes consistent with known prior radiation therapy. A small focal ground glass opacity in the right upper lobe has since resolved it has been replaced with a similar abnormality now observed in the mid left lung. No suspicious superimposed focal nodules or masses. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limits.Massive hiatal hernia with associated poorly defined an incompletely distended distal esophagus demonstrating diffuse circumferential thickening.CHEST WALL: Minimal degenerative changes without suspicious lytic or blastic lesionsABDOMEN: 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: Bilateral simple renal cysts unchangedPANCREAS: 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: Minimal umbilical hernia..OTHER: No significant abnormality noted. | 1. Stable unchanged distal esophageal circumferential wall thickening with post radiation changes observed throughout the midline.2. Evidence of aspiration, currently observed on the left and resolved on the right |
Generate impression based on findings. | Reason: lung nodule. missed bx at OSH History: cough LUNGS AND PLEURA: No suspicious: None masses.Minimal scarring/discoid atelectasis at the right lung base. No focal or consolidation.No pleural effusions.MEDIASTINUM AND HILA: Mild amount of residual thymic tissue in the anterior mediastinum.Several small nonenlarged anterior mediastinal lymph nodes.Cardiac size is normal without evidence of a pericardial effusion.Small bilateral Bochdalek hernias.CHEST WALL: Degenerative changes in the thoracic spineUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No suspicious pulmonary nodule or mass can be identified. |
Generate impression based on findings. | Non-small cell lung cancer CHEST:LUNGS AND PLEURA: Right lower lobe postoperative changes with an unchanged reference right upper lobe nodule (image 25 series 4) continuing to measure 8 x 7 mm. Similar unchanged reference left lower lobe nodule (image 67 series 4) again remaining 10 x 10 mm. Nodules remain suspicious for metastatic disease with spiculated appearances and associate with multiple additional left apical nodules. No suspicious new masses or nodules. Interval decreased and resolved effusions.MEDIASTINUM AND HILA: No lymphadenopathy.Extensive coronary calcifications with additional annular disease. Pericardium otherwise unremarkableCHEST WALL: Moderate degenerative changes without suspicious lytic or blastic lesionsABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small hypoattenuation not currently not visualized, spleen unremarkableADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cystPANCREAS: 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: Scattered moderate degenerative changes without additional diseaseOTHER: No significant abnormality noted. | Stable reference measurements and exam is without additional new abnormalities. |
Generate impression based on findings. | Reason: esophgeal cancer History: evaluate disease/check for progression CHEST:LUNGS AND PLEURA: New moderate sized right pleural effusion.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Esophageal stent identified in the distal esophagus with considerable amount of debris and fluid noted within the stent and esophagus proximal to the stent.No hilar or mediastinal lymphadenopathy be identified.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable small hepatic hypodensities too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts stable.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent periaortic and retroperitoneal lymph nodes not significant changed from the prior exam.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrojejunostomy tube in place.BONES, SOFT TISSUES: Stable focal osteolytic lesion in the L5 vertebrae compatible with a hemangioma.OTHER: No significant abnormality noted. | 1.Esophageal stent placement with a considerable amount of fluid/debris within the stent and esophageal lumen proximal to the stent.2.Moderate-sized right pleural effusion new from the prior exam, however unchanged from abdominal/pelvic CT dated 12/22/14. However, there has been clearing of the left-sided pleural effusion noted on the abdominal/pelvic CT exam.3.Left periaortic lymphadenopathy. |
Generate impression based on findings. | Shortness of breath rule-out underlying lung disease. COPD, pulmonary hypertension, CREST variant of scleroderma and history of lung cancer. LUNGS AND PLEURA: Left hemithorax volume loss with post surgical changes suggestive of lingulectomy. Moderate to severe centrilobular emphysema. 7-mm noncalcified indeterminate nodule left lower lobe (4/72). Scattered additional calcified and noncalcified micronodules bilaterally nonspecific but may represent granulomas. Biapical scarring, left greater than right.The background lung parenchyma uninvolved by emphysema is higher in density than expected and there is mild ground glass attenuation seen around the central bronchovascular structures. Minimal septal thickening at the lung bases. Mild air trapping.MEDIASTINUM AND HILA: Leftward tracheal and mediastinal deviation. Atherosclerotic calcification of the thoracic aorta and its branches. Upper normal to mildly enlarged bilateral mediastinal and hilar lymph nodes measuring up to 11-mm (right hilum, series 3/ image 41).The main pulmonary artery is enlarged measuring 3.9-cm in transverse dimension, consistent with pulmonary hypertension. Small volume of pericardial fluid. Mild cardiomegaly. Calcified aortic and mitral annuli. Aortic valve leaflet calcification. Severe coronary artery calcification.The thoracic esophagus is mildly patulous.14-mm indeterminate nodule containing calcification in the left thyroid lobe may be further characterized by nuclear scintigraphy if required (series 3, image 6). Additional hypoattenuating lesions in the thyroid gland are nonspecific but are most likely cysts.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the abdominal aorta which appears to involve the visualized portion of the renal arteries. 7-mm indeterminate exophytic lesion arising from the apex of the left kidney (3/88). Additional lesions are incompletely assessed but may reflect cysts. The right kidney is not included within the scanning range. Poorly defined 12-mm hypoattenuating lesion in the medial aspect of the spleen (series 3, image 83) may represent a hemangioma, lymphangioma, cyst or other lesion and is incompletely characterized. Additional subcentimeter hypoattenuating splenic lesions may reflect cysts. Mild intrahepatic biliary ductal dilatation. Nonspecific hypoattenuating foci in the liver too small to characterize. | 1. Emphysema with subtle increase in density of the background lung parenchyma, too mild to accurately characterize but potentially could be sequela of hemosiderin deposition from previous episodes of autoimmune-related alveolar hemorrhage given proximity to the bronchovascular bundles. No evidence of acute alveolar hemorrhage on the current study.2. 8mm indeterminate left lower lobe nodule. Recommend 3-month CT follow-up given history of lung cancer.3. Indeterminate solid nodule the left thyroid gland may be further characterized by nuclear scintigraphy if further evaluation is required.4. Indeterminate small nodule or hyperattenuating cystic lesion in the apex of the left kidney may be further characterized by a dedicated renal protocol CT in the next 6 to 12 months. This can alternatively be ordered at the same time as the follow-up thoracic CT scan.5. Signs of pulmonary hypertension and severe atherosclerotic disease, including involvement of the coronary and renal arteries.6. Mildly prominent mediastinal and hilar lymph nodes, nonspecific though the symmetry favors a reactive or inflammatory process. Comparison with outside prior studies to prove stability may be of use if they can be obtained and submitted by the referring clinical service. |
Generate impression based on findings. | 67 years old, Male, Reason: 67M w/ hx cholangiocarcinoma, s/p whipple, w/ PTC and IR drain in place, requires drian revision (discussed with IR) History: 67 M w/ hx cholangiocarcinoma, s/p whipple, w/ PTC and IR drain in place, requires drian revision (discussed with IR) Progression of collections, abscess ABDOMEN:LUNG BASES: Decreasing bilateral pleural effusions with underlying atelectasis.LIVER, BILIARY TRACT: Overall, the appearance the liver is unchanged compared to prior. Percutaneous biliary stent is unchanged in position and terminates at the hepatic hilum. In the right hepatic lobe the gas fluid collection again measures 3.5 x 6.5 cm (series 3, image 62). There are other smaller pockets of perihepatic fluid which are not significantly changed from prior study. The right hepatic artery stent graft remains occluded. Portal vein remains patent but somewhat narrowed at the hepatic hilum.SPLEEN: Scattered areas of splenic infarction appear similar to the prior study. Splenic granulomata.PANCREAS: Postsurgical changes of the pancreas. The remainder of the pancreatic parenchyma enhances homogeneously. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube has been removed. No evidence of bowel obstruction. Postsurgical changes of the small bowel are noted.BONES, SOFT TISSUES: Diffuse anasarca appear similar to prior exam.OTHER: A moderate amount of ascites is unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air is noted within the bladder. Bladder is decompressed with a Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites is stable. | 1.Stable right hepatic lobe biloma with drain in place. Unchanged percutaneous biliary drainage catheter.2.Narrowing of the main portal vein near the head of the pancreas.3.Mild to moderate intrahepatic biliary ductal dilatation.4.Moderate amount of ascites, unchanged from prior exam.5.Evolving splenic infarctions.6.Bilateral pleural effusions with bibasilar atelectasis have decreased in size compared to prior.7.Occluded right hepatic artery stent graft, unchanged. |
Generate impression based on findings. | Squamous cell carcinoma, status post radiation therapy and amputation LUNGS AND PLEURA: Unchanged large calcified granuloma in the apical segment of the right lower lobe. Right basilar scarring and along the major fissure, without additional suspicious new nodules or masses bilaterally. No effusions. Minimal centrilobular emphysema. Specifically no findings to suggest aspirationMEDIASTINUM AND HILA: Partially visualized and calcified heterogeneity observed in the lower left thyroid, grossly unchanged.No lymphadenopathy.Extensive coronary calcification without additional focal cardiac or pericardial abnormalityCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Extensive biliary duct dilatation, grossly unchanged. Incomplete visualization. Additionally incompletely visualized and atrophic kidneys bilaterally | No evidence of metastatic disease and interval clearance of previously described infectious or inflammatory pulmonary changes |
Generate impression based on findings. | Female, 89 years old, with altered mental status. No evidence of parenchymal edema or mass-effect is seen. No loss of gray-white distinction is evident. Mild periventricular hypoattenuation is a nonspecific finding which may reflect age indeterminate microvascular ischemic disease. A focal lucency within the left thalamus is unchanged and compatible with a small lacune. No intracranial hemorrhage or abnormal extra-axial fluid is evident. The ventricles are normal in size and morphology. Mild sulcal prominence is unchanged and compatible with parenchymal volume loss.The osseous structures of the skull are intact. The visualized paranasal sinuses and mastoid air cells are clear. | 1.No acute intracranial abnormality.2.Mild age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | Male 80 years old; Reason: monitor for abscess enlargement vs resolution History: see above ABDOMEN:LUNG BASES: Stable reticular opacities in the lung bases and in the right middle lobe, likely atelectasis or scarring.LIVER, BILIARY TRACT: Stable subcentimeter hypodensity in the inferior right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A left nephrostomy tube with tip coiled in the pelvis. Another left nephroureteral catheter is also placed with tip in the conduit. Interval resolution of left hydronephroureterosis and perinephric stranding. Unchanged cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Unchanged postsurgical changes with left descending colon/sigmoid resection with colostomy.BONES, SOFT TISSUES: 2.7-cm linear radiopaque likely foreign body is re-noted in pelvis.OTHER: Diffuse osseous sclerotic metastases again seen.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Status post cystectomy with ileal loop conduit. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated 2.9 x 2.1 cm loculated fluid collection anterior to the sacrum, in the pelvis also contains gas, and apparently tracks towards an anterior loop of small bowel. Underlying fistula not excluded. Not significantly changed since prior exam. Other presacral fluid and induration is also seen, grossly unchanged in appearance.BONES, SOFT TISSUES: Diffuse osseous sclerotic metastases again seen. | 1.Redemonstrated 2.9 x 2.1 cm loculated fluid collection in the pelvis also contains gas, and apparently tracks towards an anterior loop of small bowel. Underlying fistula not excluded. Not significantly changed since prior exam. Other presacral fluid and induration is also seen, grossly unchanged in appearance.2.Redemonstrated osseous metastatic disease and new left nephroureteral catheter with resolution of left hydronephrosis.3.Redemonstrated likely foreign body in pelvis. |
Generate impression based on findings. | 58-year-old with history of cyst aspiration in 2013. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable bilateral breast masses likely representing intramammary lymph nodes and the residua of the aspirated cyst in the right inner breast. Bilateral benign calcifications are again noted.Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Pain. Rule out fracture. The bones are demineralized, suggesting osteopenia/osteoporosis. There is a transverse fracture through the surgical neck of the humerus with slight posterior displacement of the diaphyseal fracture fragment. Several old healed right rib fractures are also noted. | Proximal humerus fracture as above. |
Generate impression based on findings. | 77 years old, Male, Reason: atypical renal cyst History: atypical renal cyst ABDOMEN:LUNG BASES: Trace right pleural effusion with bibasilar dependent atelectasis. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenic granuloma.PANCREAS: There is a small cyst in the pancreatic head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple renal hypodensities bilaterally. Three renal hypodensities and right measure fluid density and do not appear to enhance. The largest cyst in the right measures approximately 6 cm. Multiple renal hypodensities on the left, the largest two measure fluid density not appear to enhance, consistent with simple cyst. Multiple other renal hypodensities are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Entirety of the colon appears to be on the right side, with small bowel in the left side consistent with uncomplicated malrotation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: Asymmetric thickening of the bladder wall in the area of the trigonum which may represent neoplasm or asymmetric thickening secondary to chronic outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See abdomen section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Multiple benign renal cysts bilaterally.2.Incidental note is made of uncomplicated malrotation of the bowel.3.Asymmetric bladder wall thickening in the trigonum of the bladder; neoplasm cannot be excluded. Recommend correlation with cystoscopy. |
Generate impression based on findings. | 48-year-old male with history of head and neck squamous cell carcinoma of the base of tongue. Chemoradiation therapy. 10-069 protocol. CHEST:LUNGS AND PLEURA: Stable scattered pulmonary micronodules, some of which are calcified. No pleural effusion, consolidation or new nodules or masses.MEDIASTINUM AND HILA: Left thyroid coarse calcifications, unchanged. Heart size within normal limits, no pericardial effusion. No mediastinal or hilar lymphadenopathy. Interval removal of central venous catheter.CHEST WALL: Minimal degenerative changes affect the spine, unchanged. Interval removal of chest Port-A-Cath.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating liver foci, too small to characterize but likely benign cysts.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: Minimal degenerative findings, unchanged.OTHER: No significant abnormality noted. | No significant abnormality, and no evidence of metastatic disease. |
Generate impression based on findings. | Renal cell carcinoma CHEST:LUNGS AND PLEURA: Stable micronodules. Reference left cardiophrenic angle nodular focus as seen on image 91 of series 5 measures 0.6 x 0.4 cm.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Slight interval decrease in size of pancreatic mass lesions. Pancreatic neck lesion as seen on image 97 of series 3 measures 2.4 x 1.8 cm; pancreatic tail lesion best seen on image 106 of series 3 measures 3.7 x 3.3 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site clear. Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: The reference left para-aortic lymph node is no longer measurable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval decrease in size of reference pancreatic lesions as well as resolution of left periaortic enlarged lymph node. No new metastatic focus. |
Generate impression based on findings. | Female 40 years old Reason: 40 yr old patient with hx of peritoneal cancer. Ex-lap, TAH/BSO, sigmoid coln resection, ileocecal resection with side to side anastomosis, appy chole on 8-14-14 History: none CHEST:LUNGS AND PLEURA: No suspicious pleural nodules or masses identified.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: Left chest wall Port-A-Cath with tip terminating at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. There are calcifications of the hepatic capsule, unchanged.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: Postsurgical changes related to partial colectomy as well as omentectomy again evident.There is persistent peritoneal thickening along the anterior abdominal wall (image 158, series 3), appearing similar to the prior examination and consistent with peritoneal disease.There has been slight interval decrease in size of the soft tissue mass in the left upper quadrant, now measuring 3.1 x 2.3 cm (image 15, series 3), previously 3.9 x 2.9 cm. Adjacent peritoneal thickening is also not significantly changed.There is minimal development of apparent asymmetric low-density thickening of the lateral wall of the cecum, which is nonspecific, but could represent serosal disease.BONES, SOFT TISSUES: There has been interval improvement of the previously described tract extending from the periumbilical region to the underlying peritoneum, with resolution of the associated air and fluid.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval decrease in size of the upper abdominal soft tissue mass.2.Additional peritoneal nodularity and thickening without significant interval change.3.Asymmetric low-density thickening of the lateral cecal wall, may represent serosal infiltration, although this is equivocal and attention at follow-up is recommended.4.Resolution of the previously seen abdominal wall sinus tract. |
Generate impression based on findings. | Lung cancer and dyspnea CHEST:LUNGS AND PLEURA: The left upper lobe spiculated lobulated mass appears only minimally larger with increased confluence with the proximal descending aorta. Although similar when measured axially (image 48 series 5) measuring 4.3 x 2.3 cm, the craniocaudal measurement (image 28 series 8021 twos) currently measures 5.1 cm from prior measurement of 4.3 cm. Mild associated pleural thickening, posteriorly.The small cluster of left and right upper lobe nodules both appear similar. No suspicious new nodules or masses. No new effusions. Moderate centrilobular emphysematous changesMEDIASTINUM AND HILA: The reference right paratracheal lymph node remains 1.2 cm (image 30 series 3). The reference right hilar conglomerate lymph node currently measures 1.5 cm in short axis (image 47 series 3) from a prior measurement of 1.8 centimeters.Severe coronary and some annular calcifications. The cardiac and pericardium are otherwise within limits.Small hiatal herniaCHEST WALL: The right axillary lymph node previously measured, currently measures 1.0 cm from a prior measurement 1.3 cm (image 16 series 3). Scattered degenerative changes with wedge deformities of mid thoracic vertebrae all appear unchanged (specifically T8). No new lytic or blastic lesions observed.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left hepatic lobe hypoplasia and/or surgical removal. The extensive gallstones and/or sludge unchanged. No suspicious new lesions within the right hepatic lobeSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered unchanged subcentimeter cysts bilaterallyPANCREAS: 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 to moderate degenerative changes again without suspicious lytic or blastic lesions. Appearance unchanged.OTHER: No significant abnormality noted. | Overall stability in all reference measurements other than a mild craniocaudal increase in the left lower lobe pulmonary mass; see detail reference measurements provided. This change could be partially due to differences in technique and it is unclear as to whether represents definite interval change. |
Generate impression based on findings. | Assessment of alignment. Status-post ORIF. Since the prior study, there has been development of a fracture through the sideplate and screw device affixing the distal fibula. The fracture is at the level of the tibiotalar joint and there is now approximately 20 degrees of medial angulation of the distal fragment sideplate along with the distal fibula. Furthermore, there is a new vertically oriented fracture of the medial malleolus that is displaced and angulated medially along with the talus relative to the long axis of the tibia. There is also inferomedial displacement of the medial malleolar fracture itself relative to the talus. There is destruction of the tibial plafond as well as extensive heterotopic formation about the ankle. There is diffuse soft tissue swelling and arterial calcifications in the soft tissues. | Fractured fibular plate with new ankle fracture/subluxation as described above. While this could be due to a distinct traumatic episode that occurred since the prior exam, the additional destruction of the tibial plafond as well as the extensive heterotopic bone formation suggest the possibility of an underlying neuropathic arthropathy. |
Generate impression based on findings. | 51 year old male. Stroke in 2010, now with chronic cough. Evaluate for aspiration. Scout radiograph of the chest was unremarkable.Single contrast evaluation of the esophagus and gastric cardia/fundus revealed no definite morphologic abnormalities. No hiatal hernia was seen.Fluoroscopic evaluation of oropharyngeal and proximal esophageal motility demonstrated no aspiration. Fluoroscopic evaluation of esophageal peristalsis demonstrated moderate esophageal dysmotility with breakup and proximal escape of the primary peristaltic wave. When the patient was supine, significant spontaneous gastroesophageal reflux was observed to near the level of the thoracic inlet (series 17). In addition, spontaneous gastroesophageal reflux was seen while in the upright position, to the level of the mid thoracic esophagus (series 22). Normal transit of contrast was seen from the stomach into the proximal small bowel. An ingested barium pill was briefly delayed near the gastroesophageal junction but passed readily with sips of water. TOTAL FLUOROSCOPY TIME: 5:28 minutes | Moderate esophageal dysmotility with proximal escape of the primary peristaltic wave. Significant gastroesophageal reflux.No tracheal aspiration was seen. |
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