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Generate impression based on findings. | 4-month-old male with omphalocele with bilious emesis; pulmonary hypoplasia, chronic lung disease, and ventilator associated changes. Rule out small bowel obstruction or volvulus. LUNGS AND PLEURA: Dependent opacities in the right upper lobe and left lower lobe are suggestive of atelectasis. Superimposed infection is difficult to entirely exclude.MEDIASTINUM AND HILA: Tracheostomy tube tip at the thoracic inlet. Cardiothoracic ratio is increased (>50%). No pericardial effusion. No mediastinal or hilar adenopathy.CHEST WALL: No suspicious focal osseous lesion is identified. Slight left curve of the thoracic spine. Thoracic length is abnormally increased and width abnormally decreased, as expected with giant omphalocele.UPPER ABDOMEN: Two enteric tubes terminate in the stomach. The giant omphalocele measures 7 x 12 x 15 cm (transverse x AP x CC). It contains the entire liver, gallbladder, spleen, small bowel, and majority of the colon with the exception of the rectosigmoid. A moderate to large amount of fluid is contained within the sac and approaches water density (approximately 10 Hounsfield units). Two dilated bowel loops are seen in the right aspect of the omphalocele superior to the liver, likely representing ascending colon. An oblong, hypoattenuating structure at the anterior surface of the liver measures water density and is of unclear significance. The pancreas is not well visualized. The kidneys enhance symmetrically without focal lesion. Bilateral inguinal hernias containing fluid, incompletely imaged. Irregularity of the soft tissue at the anterior aspect of the omphalocele is noted, with overlying surgical mesh. | 1.Giant omphalocele containing liver, gallbladder, spleen, small bowel, and majority of the colon.2.Dilated bowel loops likely representing colon in the right aspect of the giant omphalocele, concerning for obstruction. Moderate to large amount of free fluid in the sac is additionally noted.3.Dependent opacities in the thorax may represent atelectasis, though infection cannot be excluded.4.Abnormal shape of the thorax resulting from giant omphalocele.Findings were relayed via telephone to Dr. Lipon at 4:13 PM on 1/7/2015. |
Generate impression based on findings. | Female 62 years old Reason: rule out renal recurrence History: hx of renal cell carcinoma, sp partial nephrectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the inferior right hepatic lobe are nonspecific, but special attention at follow-up is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are postsurgical changes related to partial left nephrectomy. There is no evidence of residual tumor. The ureters are well opacified on excretory phase, without evidence of filling defect to suggest urothelial lesion.RETROPERITONEUM, LYMPH NODES: There are dense and atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality noted | 1.Postsurgical findings related to partial left nephrectomy without evidence of locoregional disease recurrence or distant metastatic disease.2.Subcentimeter hepatic hypodensities are most likely benign in etiology, although special attention at follow-up is recommended. |
Generate impression based on findings. | 97-year-old female, assess prosthetic A dynamic right hip screw with distal sideplate and screws are noted in near-anatomic alignment transversing the right proximal femoral fracture. The left hip appears essentially within normal limits for the patient's age. | Dynamic hip screw in near-anatomic alignment without evidence of complication. |
Generate impression based on findings. | 30 year-old female with neck pain after MVC Cervical spine: Vertebral body alignment and heights are within normal limits. The neuroforamina appear patent. No fracture is evident. The pre-vertebral soft tissues are within normal limits.Elbow: Alignment is anatomic. No fracture or joint effusion is visualized. | No fracture or dislocation. |
Generate impression based on findings. | 32-year-old male. Reason: s/p urethroplasty on 12/19, check for extravasation of urine Scout film demonstrated no abnormal calcification.Cystografin was administered by gravity via the patient's suprapubic catheter and maximal distention was achieved at approximately 150 cc, at which point the examination was terminated secondary to patient discomfort. No mucosal abnormality was evident and the bladder contour was normal. Mild right vesicoureteral reflux. No evidence of other extravasation of contrast from the bladder during filling.Segmental luminal irregularity is seen in the mid ureter at and distal to the junction of the prostatic and bulbous portions of the urethra. The length of this irregularity measures approximately 2.5 cm. Additionally, there is a focal area of extraluminal contrast extending from the proximal portion of the aforementioned irregular segment, focus measures approximately 9 x 5 mm (series 27). Findings compatible with leak with small extravasation of contrast into the adjacent penile soft tissues. | 1. Findings suspicious for focal urine extravasation, located near the junction of the prostatic and bulbous portions of the urethra, as described.2. Segmental luminal irregularity in the mid-ureter at and distal to the expected region of the prostatic/bulbous urethra, may in part reflect postsurgical sequelae but superimposed leak also seen as above. |
Generate impression based on findings. | Male 14 years old Reason: standing with TLSO when receives History: L1 chance fractureVIEWS: Thoracic and lumbar spine PA and lateral , upright and in brace 1/7/15 (two views) L1 vertebral body wedge fracture with minimal superior plate impaction is again noted. Alignment of the thoracic and lumbar spine is anatomic. | Anatomic alignment of the thoracic and lumbar spine after brace placement. |
Generate impression based on findings. | 70 year-old female with intermittent swelling of digits bilaterally Right hand: There is slight positive ulnar variance with a cyst in the ulnar side of the lunate. Minimal osteoarthritis affects the basilar joint. Alignment is anatomic. No erosions are evident.Left hand: Minimal osteoarthritis affects the basilar joint. Alignment is anatomic. No erosions are evident. | Minimal osteoarthritis and right positive ulnar variance as described above. |
Generate impression based on findings. | Female 19 years old; Reason: Evaluate for evidence for Crohn's disease or anatomical abnormalities. History: Right abdominal quadrant pain and emesis in patient with Celiac disease in remission and normal EGD/ileocolonoscopies.EXAMINATION: MR enterography without and with IV contrast 1/7/15 ABDOMEN:LIVER, BILIARY TRACT: Normal appearance of the liver, without focal lesions or biliary ductal dilation.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance, without focal lesions or ductal dilation.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Horseshoe kidney, without focal lesions or hydroureteronephrosis. RETROPERITONEUM, LYMPH NODES: No lymphadenopathy evident.BOWEL, MESENTERY: Normal appearing bowel loops, without hyperenhancement, wall thickening, mesenteric inflammatory changes, or associated fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy evident.BOWEL, MESENTERY: Normal appearing bowel loops, without hyperenhancement, wall thickening, mesenteric inflammatory changes, or associated fluid collections. The terminal ileum is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid, which may be physiologic. | 1. No evidence of active bowel inflammation. 2. Horseshoe kidney, without evidence of obstruction. |
Generate impression based on findings. | 65-year-old female with history of osteoporosis and thoracic compression fracture, now with low back pain The bones are diffusely demineralized. There is marked kyphosis of the thoracic spine with widespread loss of vertebral body height. Lumbar vertebral body heights and disk spaces are maintained. Multiple surgical clips project over the abdomen and pelvis. | Diffuse demineralization with age indeterminate widespread loss of vertebral body height and associated kyphosis. |
Generate impression based on findings. | 67-year-old male with back pain and a history of prostate cancer. Evaluate for metastatic disease. No abnormal osseous foci are identified to indicate metastatic disease.There are degenerative changes in the cervical, thoracic, and lumbar spine, left knee and the acromioclavicular joints bilaterally. | No evidence of bone metastases. |
Generate impression based on findings. | 38-year-old male with right scrotal fullness and pain. Evaluate for hernia. RIGHT TESTIS: The right testis is normal in morphology, echogenicity, and size, measuring 2.2 x 1.9 x 3.7 cm without a discrete lesion. Spectral Doppler evaluation demonstrates arterial blood flow. There is a small hydrocele.LEFT TESTIS: The left testis is normal in morphology, echogenicity, and size, measuring 3.2 x 1.4 x 3.4 cm. Spectral Doppler evaluation demonstrates arterial blood flow. There is a small hydrocele.RIGHT EPIDIDYMIS: The right epididymis is normal in morphology, echogenicity and size.LEFT EPIDIDYMIS: The left epididymis is normal in morphology echogenicity and size.OTHER: Targeted ultrasound of the right groin area demonstrates several morphologically unremarkable and normal sized lymph nodes. No specific evidence of a hernia or other focal abnormality. | Normal testicular ultrasound. No specific findings in the right inguinal region to account for the patient's right groin pain. |
Generate impression based on findings. | Baseline exam as required by IRB # 13-1294. Metastatic renal cell cancer. There are a few enhancing lesions at the grey-white junction in the supratentorial brain. The largest located within the right superior frontal gyrus adjacent to the falx measures approximately 11 x 9 mm with surrounding vasogenic edema. There is slight adjacent sulcal effacement. There is a smaller focus of enhancement in the peripheral left middle gyrus measuring 6 x 5 mm. Furthermore, in the right occipital lobe, there is a tiny focus of enhancement measuring 5 x 4 mm. There is no significant midline shift. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. The calvarium and scalp soft tissues are intact. | Multiple metastatic lesions in the brain, the largest of which measures up to 11 mm in the right frontal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 54-year-old female with pain Glenohumeral alignment is within normal limits. There is minimal acromioclavicular joint osteoarthritis. No fracture is visualized. | Minimal osteoarthritis. |
Generate impression based on findings. | 48 years old female with a history of breast cancer, status post chemotherapy which was completed on 2/19/14. This study was performed to evaluate response to chemotherapy.RADIOPHARMACEUTICAL: 12.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates new left pleural effusion. Left frontal cranial defect noted from prior craniotomy is again noted. The right chest port with its tip in the right atrium is stable in position. Again seen are borderline enlarged right axial lymph nodes. There are scattered sclerotic osseous lesions within the spine and pelvis, with the largest lesion at T12.Today's PET examination demonstrates several new foci of increased metabolic activity are seen in the left supraclavicular region, corresponding to the normal sized lymph nodes retrospectively seen on CT portion of the study and suspicious for nodal metastasis. There are two new foci of increased activity in the L2 vertebral body and the left sacral ala, which are consistent with osseous metastasis. The SUVmax in the left sacral ala lesion is 6.9. Two faint foci of increased activity are seen in the right iliac wing, which were previously not clearly seen on the old study and may be due to increased bone marrow activity.There is interval increase in size and metabolic activity of the multiple hypermetabolic lymph nodes in the right axilla. Stable decreased metabolic activity is seen in the postsurgical area in the right frontal lobe. There are new areas decreased metabolic activity in the left temporal lobe and left occipital upper lobe, corresponding to the abnormal MRI signal changes seen on recent brain MRI study.A large area of increased activity is seen in the left posterior chest wall/pleural effusion at the level of pleural effusion, which can be due to inflammatory change or pleural metastasis.A triangular area of increased activity is seen in the anterior mediastinal region, which is most likely due to thymic rebound hyperplasia. Soft tissue density in the right hip subcutaneous tissue is most likely due to injection granuloma.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Interval progression of metastatic breast cancer with new osseous metastasis in the L2 vertebral body and the left sacral ala and nodal metastasis in the left supraclavicular region.2.Interval worsening of the nodal metastasis in the right axilla and right chest wall at subpectoral regions.3.Probable stable metastatic disease in the right iliac bone.4.New areas of decreased metabolic activity in the left frontal and occipital lobes, which can be due to brain metastasis.5.New left pleural effusion with questionable pleural/chest wall metastasis. |
Generate impression based on findings. | 44 years old, Female, Reason: patient is screening for clinical trial. please provide bidimentional measurements per RECIST v1.1 thank you History: sigmoid colon adenocarcinoma CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules bilaterally concerning for metastasis, which are new since outside exam dated 12/10/13. For reference right lower lobe pulmonary nodule measures 0.8 x 0.7 cm (series 6, image 77).MEDIASTINUM AND HILA: Right chest port with tip in SVC. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: Scattered axillary lymph nodes not meeting size criteria for lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of the hepatic trisegmentectomy and cholecystectomy are again visualized. The remaining left hepatic lobe has numerous new hypodensities consistent with metastasis. There is a large confluent mass within the hepatic parenchyma at the former porta hepatis which appears to compress, narrow, and may be invading the left portal vein, however the vein appears patent distally. This mass measures 2.7 x 3.9 cm (series 4, image 90). A nearby mass in the porta hepatis outside of the hepatic parenchyma, likely a nodal metastasis, is inseparable from the IVC and invasion cannot be excluded.A second reference lesion measures 1.6 x 1.6 cm (series 4, image 100).SPLEEN: Splenic hypodensity concerning for metastasis measures 2.5 x 2.3 cm (series 4, image 90).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes largest for reference left periaortic lymph node measures 1.3 x 1.9 cm (series 4, image 120).BOWEL, MESENTERY: No evidence of obstruction, pneumatosis, or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: See abdomen sectionBOWEL, MESENTERY: See abdomen section.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple new bilateral pulmonary nodules consistent with metastasis.2.Numerous large hepatic metastasis. Metastasis within the hepatic parenchyma at the porta hepatis narrows and may invade the left portal vein. 3.Nodal metastasis within the porta hepatis appears inseparable from the IVC and vascular invasion cannot be excluded.4.Single splenic metastasis.5.Retroperitoneal lymphadenopathy as detailed above. |
Generate impression based on findings. | Male 65 years old Reason: baseline exam prior to starting new systemic therapy History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules compatible with metastases. For reference purposes a right upper lobe nodule now measures 0.9 x 1.3 cm (image 39, series 4), previously 0.8 x 1.2 cm.MEDIASTINUM AND HILA: Hypoattenuating right thyroid nodule with an ill-defined zone of transition, may represent a primary thyroid malignancy or possibly a metastasis. There is unchanged extensive mediastinal and hilar lymphadenopathy compatible with metastases. For reference purposes a left hilar node measures 2.0 x 2.0 cm (image 57, series 3). CHEST WALL: Destructive expansile sternal and left lateral sixth rib lesions compatible with metastases. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The right adrenal gland abuts the large heterogeneous renal massKIDNEYS, URETERS: Horse kidney morphology. There is a heterogeneous mass in the superior pole of the right kidney measuring approximately 10 0.2 x 0.9 cm (image 125, series 3) compatible with the patient's known renal cell carcinoma. There is infiltration of the posterior perinephric fat planes consistent with recent biopsy. Nonobstructing right renal stone. Hypodense lesion in the superior pole left kidney is incompletely characterized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple enlarged mesenteric lymph nodes. Reference purposes a midline pelvic mesenteric lymph node measures 1.7 x 2.4 cm (image 172, series 3). Right inguinal fat containing hernia.BONES, SOFT TISSUES: There is a destructive soft tissue mass in the posterolateral L4 vertebral body, which invades the left L4 neural foramina and encroaches on the spinal cord.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: There is a destructive soft tissue mass in the posterolateral L4 vertebral body, which invades the left L4 neural foramina and encroaches on the spinal cord.OTHER: No significant abnormality noted | 1.Right renal mass compatible with a reported history of renal cell carcinoma.2.Pulmonary, osseous and nodal metastases as detailed above.3.Osseous metastasis in the posterolateral L4 vertebral body invades the left L4 neural foramina and encroaches upon the spinal canal. Further evaluation with MRI can be considered as clinically indicated.4.Horseshoe kidney. |
Generate impression based on findings. | 66 year old female with breast cancer. Lymphoscintigraphy is needed for sentinel node biopsy.RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Three foci of increased activity are noted representing sentinel nodes. The initially seen focus is located in the intramammary node just lateral to the areola of the left breast. Two additional foci are noted in the left axilla. The more lateral focus in the left axilla was the next to appear. These regions were marked with an indelible marker and numbered in order of appearance. | Sentinel nodes identified in the intramammary region and the left axilla. |
Generate impression based on findings. | 67-year-old male with rectal mucosal mass Normal physiologic radiotracer distribution is seen in the spleen, kidneys, liver, bowel and bladder. A small focus on radiotracer uptake in the soft tissues in the midline abdomen posteriorly is nonspecific. Additional focus of radiotracer uptake overlying the scrotum likely represents urine. No additional abnormal focus of activity to indicate an octreotide avid lesion. | 1. Nonspecific focus in the soft tissues in the midline abdomen posteriorly. 2. No additional abnormal focus of activity to indicate an octreotide avid lesion. |
Generate impression based on findings. | 51 year-old female with hyperparathyroidism, evaluate for parathyroid adenoma There is physiologic distribution of the radiopharmaceutical. An abnormal focus of activity inferior to the left lobe of the thyroid consistent with an enlarged parathyroid gland is seen. | Focus of radiotracer activity inferior to the left lobe of the thyroid suspicious for a parathyroid adenoma. |
Generate impression based on findings. | 56-year-old female with right upper lobe cavitary lesion possibly aspergilloma. Please evaluate for possible lung resection. The comparison chest radiograph performed on 1/4/2015 demonstrates multiple right upper lobe cavities and findings consistent with COPD. The ventilation images show multiple areas of decreased ventilation bilaterally on single-breath imaging which reach uniform distribution of activity on wash-in images. There is abnormal Xe-133 retention during the wash-out phase in the left middle lung and the right middle and lower lung.The perfusion images show decreased perfusion to the left middle lung and also to the right middle and lower lung. Quantitation of relative single breath ventilation (using the posterior image):Left lung: 61.9% (upper lung 18.8%; middle lung 17.9 %; lower lung 25.2%)Right lung: 38.1% (upper lung 12.6%; middle lung 13.9 %; lower lung 11.7%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 66.0% (upper lung 18.5%; middle lung 24.1 %; lower lung 23.4%)Right lung: 34.1% (upper lung 6.1%; middle lung 15.7 %; lower lung 12.2%) | Heterogeneously decreased bilateral ventilation and perfusion as described above. Quantification of relative ventilation and perfusion as above. |
Generate impression based on findings. | 51 year old with a hypoechoic right breast mass presents for ultrasound guided biopsy. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 7 x 3 mm at the 9 o’clock position without increased vascularity, 4 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior 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 right CC and ML views revealed the percutaneously placed clip to be in the expected location at anterior 9 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. | Female, 67 years old. Reason: abdominal pain Air-filled loops of colon, with moderate to large stool burden in the ascending colon. Relative paucity of small bowel gas. No specific evidence of bowel obstruction. Degenerative disease of the symphysis pubis. | Moderate to large stool burden in the ascending colon, correlate clinically for constipation. |
Generate impression based on findings. | Ms. Makarenko is a 31 year old female presenting with bilateral "lumpy breasts" and breast pain. Per patient, she has no focal pain or any discrete mass. Family history of breast cancer in mother. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. There is discrete no mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram can be initiated at the age of 40. Clinical exams are recommended prior to that age. For any focal physical exam finding, a targeted ultrasound should be performed. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Left neck swelling, jaw pain, status post parathyroidectomy. The images are degraded by patient motion. There are postoperative findings related to parathyroidectomy. The parapharyngeal and retropharyngeal spaces are unremarkable. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are grossly unremarkable. There is partial opacification of the mastoid air cells. There is sclerosis and subchondral cyst formation in the left mandibular condyle, along with irregular contours. The airways are patent. The imaged intracranial structures and orbits are unremarkable. There are emphysematous changes in the imaged portions of the lungs. | 1. Postoperative findings related to parathyroidectomy without evidence of edema or mass lesions, although assessment is limited by the lack of intravenous contrast and patient motion.2. Degenerative changes in the left temporomandibular joint. |
Generate impression based on findings. | Male, 77 years old. Reason: evaluate for possible G tube by GI History: chronic aspiration, unable to leave floor for nonportable exam Dobbhoff tube with tip overlying the proximal gastric body.Air-filled loops of small and large bowel, less prominent compared to prior exam. No evidence of bowel obstruction. Moderate stool burden. Lumbosacral degenerative disease. | No evidence of bowel obstruction. |
Generate impression based on findings. | History of dental abscess after tooth 3 extraction and questionable destructive process of right maxilla. Pain in the right V2 distribution. Please note that streak artifact from dental amalgam limits evaluation. There is a defect in the right maxillary alveolar ridge in the expected location of the #3 tooth, likely secondary to recent extraction. Adjacent to this lesion, there is osseous erosion extending anteriorly exposing the roots of the #4-6 teeth with full thickness bone loss adjacent to the #5 tooth (70/80340). Multiple maxillary molars are missing. There is asymmetric soft tissue thickening along the right maxillary alveolar ridge without definitive soft tissue abscess. There is periodontal lucency at tooth # 9. The paranasal sinuses are relatively hypoplastic. There is minimal mucosal thickening of the maxillary sinuses. There are scattered mildly enlarged cervical lymph nodes, which are not pathologically by CT size criteria. The ostiomeatal complexes and sphenoethmoidal recesses are clear. The orbits are unremarkable. The imaged intracranial structures are unremarkable. | An osteolytic process involving the right maxillary alveolar ridge likely represents osteomyelitis, although a neoplastic process is a differential consideration. Adjacent soft tissue thickening is present, which is likely inflammatory, although there is no definitive evidence of abscess. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female, 49 years old. Reason: Assess for obstipation History: 49 y.o. with a history of constipation, endometriosis, now more severe with abdominal discomfort Multiple air-filled loops of small bowel. Evaluation of colon shows moderate to large stool burden. No specific evidence of bowel obstruction. | Moderate to large stool burden, compatible with a history of constipation. No bowel obstruction delineated. |
Generate impression based on findings. | 65-year-old male with abdominal pressure, discomfort. Evaluate for obstruction, history of stricturing at ileocolonic anastomosis. Paucity of gas in the abdomen without evidence of obstruction. Surgical clips are visualized in the lower abdomen and right pelvis. Mild thoracolumbar dextroscoliosis. | No evidence of bowel obstruction. |
Generate impression based on findings. | Pain Four views of the left knee are provided. Mild medial compartment narrowing on the skier's view, along with tiny osteophytes, indicate mild osteoarthritis. Round and tubular opacities in the soft tissues likely represent extensive venous varicosities.Mild osteoarthritis also affects the right knee as seen on the frontal views. | Mild osteoarthritis. |
Generate impression based on findings. | 37 year-old female with pancreatitis and abdominal distention. Nonobstructive bowel gas pattern. Contrast is noted in the small bowel and residual biliary ductal contrast also present, sequela of same day cholangiogram. Right upper quadrant coil embolization material suggested. Interval removal of the right upper quadrant drain. Intrauterine device projects over the pelvis. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female, 65 years old. Reason: ng tube Nasogastric tube with distal sideport overlying the gastric body. The lower pelvis is excluded from the field of view. Contrast seen in the colon from recent prior exam. No evidence of bowel obstruction. | Nasogastric tube with distal sideport overlying the gastric body. |
Generate impression based on findings. | Foot pain. Assess alignment. Lateral knee joint pain. Four views of the right foot are provided. Alignment is within normal limits. I see no specific findings to account for the patient's pain. A small density overlying the soft tissues of the second toe may either be artifactual on the patient's skin or conceivably a small subcutaneous foreign body.Four views of the left foot are provided. Alignment is within normal limits. I see no specific findings to account for the patient's pain.Three views of left knee are provided. The knee appears normal with no specific findings to account for the patient's pain. The right knee likewise appears normal as seen on the frontal view. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | 54-year-old male with Dobbhoff tube placement. Nonobstructive bowel gas pattern. The feeding tube tip is in the antrum of the stomach. Bilateral layering pleural effusions are noted. | Feeding tube tip in the antrum of the stomach. |
Generate impression based on findings. | 73-year-old with history of right mastectomy for breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Again noted are multiple benign calcifications. Nipple noted out of profile on the CC view, but does not significantly limit the exam.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, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Right elbow pain Again seen is a pin and tension wire device affixing a transverse fracture through the olecranon process in near anatomic alignment. I see no hardware complications. There has been progression of sclerosis along the fracture line indicating some interval healing. A small focus of heterotopic ossification has formed posterior to the olecranon. There is mild soft tissue swelling posteriorly. There may also be a small joint effusion. | Orthopedic fixation of healing olecranon fracture. |
Generate impression based on findings. | cT2N3 base of tongue squamous cell carcinoma, p16 negative, status post CRT. There are post-treatment findings in the neck, include right lymph node dissection and radiation therapy effects. There is no residual significant lymphadenopathy in the neck. There is no measurable mass in the tongue base region. There is a partially calcified left thyroid nodule that appears unchanged. The salivary glands are grossly unremarkable. The airways are patent. There is a right internal jugular venous catheter. The partially imaged intracranial structures are grossly unremarkable. The osseous structures are unremarkable. There are mild patchy opacities in the partially imaged lungs. | 1. Post-treatment changes in neck without measurable residual tumor in the right tongue base region and no evidence of significant residual lymphadenopathy in the neck.2. Unchanged partially calcified thyroid nodule. |
Generate impression based on findings. | 50 year-old male with point tenderness after fall There is a nondisplaced fracture of the right lateral T8 rib. No pneumothorax is visualized. | Nondisplaced right lateral thoracic rib fracture. |
Generate impression based on findings. | 79 years old, Male, Reason: Please assess for resolution of pelvic abscess History: pelvic abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. There is no biliary dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal adenoma is unchanged measuring 1.5 x 1.5 cm (series 3, image 31), previously measuring 1.5 x 1.5 cm.KIDNEYS, URETERS: Stable bilateral perinephric fat stranding. No evidence of hydronephrosis or hydroureter. The patient is status post radical cystectomy with ileal conduit formation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is persistent diffuse mesenteric haziness and associated small mesenteric lymph nodes, unchanged from prior study. Although this is nonspecific this could conceivably represent a neoplastic process but continued follow-up is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Patient status post radical cystectomy and ileal conduit formation the right lower quadrant. Near complete resolution of previously drained left pelvic wall air and fluid collection measuring 1.1 x 1.7 cm (series 3, image 89), previously measuring 1.4 x 2.2 cm. A large benign loculated fluid collection, favored to represent a lymphocele, is unchanged in size now measuring 8.6 x 5.2 cm (series 3, image 85), previously measuring 5.3 x 8.7 cm.There is improvement of the anterior abdominal wall fluid collection which appears more loculated and measures 6.0 x 2.7 cm (series 3, image 89), previously measuring 6.1 x 3.2 cm.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Near complete resolution of previously drained left pelvic wall abscess.2.Unchanged right pelvic wall loculated fluid collection favored to represent a lymphocele.3.Improvement in anterior abdominal wall fluid collection.4.Diffuse mesenteric haziness and small mesenteric lymph nodes. Although nonspecific, this could conceivably represent a neoplastic process and continued follow-up is recommended.5.No specific evidence of metastatic disease. |
Generate impression based on findings. | Female 55 years old Reason: Evaluation of abdominal and perinephric fluid collection History: None ABDOMEN:LUNG BASES: Unchanged bibasilar atelectasis/scarring. Mild cardiomegaly.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys, with right sided hydronephrosis unchanged.Right iliac fossa transplant kidney again seen, with a nephroureteral stent in place as well as a percutaneous nephrostomy tube. There is no evidence of hydronephrosis.The fluid collection seen anterior and inferior to the transplant kidney is smaller compared to the prior examination, and the pigtail catheter position is unchanged.The fluid collection with associated soft tissue thickening along the anterior psoas muscle does not appear significantly changed in size, although the soft tissue component appears slightly thicker compared to the prior examination.RETROPERITONEUM, LYMPH NODES: There are bilateral common iliac artery and external iliac artery stents in place. Left femoral artery graft material is seen extending into the left lower leg.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Fluid collection anterior and inferior to the transplant kidney decreased in size with, the pigtail catheter unchanged in position.2.Fluid collection seen along the anterior psoas muscle with a soft tissue rim, without significant change in size; however, the soft tissue component appears slightly thicker. |
Generate impression based on findings. | 21-year-old female status post orthotopic liver transplant with portal vein stenosis status post stent and multiple angioplasties. Evaluate portal venous blood flow. LIMITED ABDOMENLIVER: The liver parenchyma is moderately coarsened, unchanged. No intrahepatic biliary dilatation or focal hepatic lesion is evident. It is normal in size, measuring 17 cm in the craniocaudal dimension. The liver capsule is relatively smooth.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm at the pancreatic head. No gallbladder is present.PANCREAS: The visualized pancreatic body and head are grossly unremarkable.SPLEEN: The spleen is moderately enlarged, measuring 16.9 cm in length. RIGHT KIDNEY: The right kidney measures 8.2 cm in length without a gross abnormality.OTHER: The left kidney measures 10.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow. | 1. Patent vasculature. The main portal vein peak systolic velocity is slightly elevated but improved from the prior study. 2. Coarse liver parenchyma is compatible with parenchymal dysfunction, unchanged. 3. Splenomegaly. |
Generate impression based on findings. | Reason: ruling out PE History: sob, tachycardia, hypoxia PULMONARY ARTERIES: Technically adequate study without pulmonary embolus.LUNGS AND PLEURA: Previously noted right middle lobe mass now appears more flat and measures 3.7 x 2.4 cm (image 89, series 12) previously 4.5 x 2.4 cm. Scattered pulmonary micronodules, some which are calcified, are similar to the prior study. Basilar scarring/atelectasis is present. No pleural effusion or consolidation.MEDIASTINUM AND HILA: Nodular enlargement of the right thyroid gland is unchanged. Prominent mediastinal lymph nodes are unchanged. The previously referenced subcarinal lymph node now measures 13 mm in short axis (image 149, series 11), previously 11 mm. The heart is normal in size and there is no pericardial effusion. Moderate coronary artery calcifications are present. CHEST WALL: Right port catheter is again seen in place with its tip within the right atrium.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube is partially visualized. | 1.No pulmonary embolism. 2.Prominent mediastinal lymph nodes without significant interval change.3.Right middle lobe mass now appears more flat and may represent post infectious scarring/atelectasis.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 11 years old; Constipation and enuresis.VIEW: Abdomen AP (one view) 1/7/15 Moderate amount of rectal stool is present, with a small amount of stool throughout the rest of the colon. The stomach is distended with luminal contents. No pneumatosis, portal venous gas, or pneumoperitoneum is evident. | Moderate amount of rectal stool. |
Generate impression based on findings. | Male 54 years old Reason: Does L iliacus abscess need further drainage? History: elevated WBC count, left pelvic pain, s/p drainage on IV ABX PROSTATE, SEMINAL VESICLES: The prostate is not definitely identified.BLADDER: There are a number of surgical clips around a non-opacified urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant colostomy.BONES, SOFT TISSUES: Postsurgical findings related to amputation of the pelvis and sacrum are again noted. There is a fluid collection extending along the lateral aspect of the left iliac bone extending into the remnant soft tissues of the superior left thigh, but also extends into the retroperitoneal cavity within the iliacus is muscle. This fluid collection was present on the prior examination, although it has increased in size from the prior exam. This collection now measures approximately 5.3 x 6.5 cm (image 47, series 3). There is cortical disruption and fracturing of the left iliac bone with of a possible sinus tract extending into the fluid collection, best seen on image 39 series 3, most consistent with acute on chronic osteomyelitis.A bullet fragment is seen along the left transverse process of the L5 vertebrae. Enhancing lymph nodes are seen in the soft tissues posterior to the left iliac bone, which are presumably reactive.There is a large sacral decubitus ulcer, appearing similar to to the prior exam.OTHER: No significant abnormality noted | 1.Abscess in the soft tissues of the left hemipelvis extending into the retroperitoneal cavity via the iliacus muscle, as detailed above. 2.Cortical breakthrough and fracturing of the left iliac bone with possible sinus tract to the pelvic abscess, most consistent with acute on chronic osteomyelitis.3.Sacral decubitus ulcer, appearing similar to the prior examination.4.Extensive postsurgical changes related to amputation of the pelvis and sacrum again noted. |
Generate impression based on findings. | Female, 87 years old. Question of new brain metastases. Requires large volume tap, 4-5 ml within 4 tubes. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Chlorhexidine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues. Using fluoroscopic guidance, a 25 gauge x 3.5 inch spinal needle was localized into the thecal sac at the L3-L4 level. There was immediate return of clear cerebral spinal fluid, approximately 19-20 cc of which was collected into four sterile tubes and provided to the clinical service. The stylette was replaced, the needle removed, and hemostasis achieved with manual compression. The patient tolerated the procedure well with no immediate complications. FLUOROSCOPY TIME: 0.5 mins. Air Kerma: frontal 6.67 mGy, lateral 32.62 mGy | Successful fluoroscopic guided lumbar puncture. |
Generate impression based on findings. | Female 7 months old Reason: evaluate for intra-abdominal pathology History: s/p liver transplant, abdominal distension, increased JP output ABDOMEN: Note is made that interpretation of the exam is diminished by lack of oral and or IV contrast.LUNG BASES: Bibasilar atelectasis with no effusions.LIVER, BILIARY TRACT: Transplanted kidney appearance in these limited CT exam is normal. No discrete biliary duct dilatation. No perihepatic fluid collections.SPLEEN: Spleen is 7.4 cm in length. With no evidence for laceration.PANCREAS: Not clearly visualized.ADRENAL GLANDS: Not clearly identifiedKIDNEYS, URETERS: Right kidney is 7.6 cm and the left kidney is 6.3 cm in length. No evidence of hydronephrosis. Surgical sutures are identified in the right Morrison's pouchRETROPERITONEUM, LYMPH NODES: A stent is noted in the intra-and intrahepatic IVCBOWEL, MESENTERY: Feeding tube terminates at the fourth portion of the duodenum or proximal jejunum. No evidence of free or loculated fluid. No evidence of obstruction or free air.BONES, SOFT TISSUES: Upper abdominal wall surgical mesh and a rubber catheter applied to the skin are noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not clearly visualizedBLADDER: Partially distended urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please refer to the abdominal paragraphBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Severe limitation in the evaluation of the abdomen and pelvis due to lack of oral and or IV contrast. Within these limitations no evidence of discrete loculated or free fluid collections noted. No evidence of obstruction or free air. |
Generate impression based on findings. | Cystic hygroma right neck. Assess for pathology. There is an infiltrative, largely hypoattenuating lesion involving the right floor of the mouth, sublingual space, submandibular space, pre-epiglottic space, and anterior right neck. Some components of this lesion are mildly hyperattenuating which may reflect proteinaceous contents or blood product. The lesion does not appear to have significantly change in size or distribution of involved spaces compared to prior studies, given long interval and differences in positioning and technique. There are subcentimeter right level IIa and left level Ia lymph nodes. The thyroid gland and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Infiltrative multi-spatial right neck lesion compatible with patient's history of cystic hygroma which has not significantly changed in size or distribution given long interval since the prior study and differences in positioning and technique. |
Generate impression based on findings. | Brain. Foot injury. Tender to third metatarsal Three views of the left ankle reveal no evidence of ankle fractures. Note is made of the metatarsal fractures.Three views of the left foot reveal nondisplaced fractures of the third and fourth distal metatarsals. Note is made of a hallux valgus deformity with degenerative changes at the first metatarsophalangeal joint. | Nondisplaced fractures of the third and fourth metatarsals. |
Generate impression based on findings. | 66 years old, Female, Reason: patient is screening for a clinical trial, please provide bidimensional measurments per RECIST v1.1 History: endometrial adenocarcinoma CHEST:LUNGS AND PLEURA: Right lower lobe pleural-based nodule measures 5 mm (series 5, image 73). Small scattered nodular groundglass opacities in the left lower lobe are favored to be infectious, although metastasis cannot be excluded and follow-up is recommended. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segment 4 in segment 5 subcentimeter hypodensities which are too small to characterize, but are favored to be benign. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureteral stents.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is a necrotic appearing mass in the right pelvis measuring 3.0 x 4.3 cm (series 3, image 168). There is another mass anterior to the vagina which measures 3.6 x 2.0 cm (series 3, image 25).BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy is present. For reference a pelvic lymph node anterior to the sacrum measures 1.4 x 1.0 cm (series 3, image 159).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive soft tissue destructive changes of the sacrum and iliumOTHER: No significant abnormality noted. | 1.Soft tissue mass in the posterior pelvis with extensive invasion and destruction of the sacrum and ilium.2.Multiple masses within the pelvis, one of which appears to be necrotic, as detailed above.3.Pelvic lymphadenopathy as measured above. 4.Pleural-based nodule in the right lung. Left lower lobe nodular groundglass opacities which are favored to be benign.5.Multiple liver hypodensities which are favored to be benign. |
Generate impression based on findings. | 21-year-old male with history of metastatic osteosarcoma of rib, status post thoracotomies. Evaluate for pulmonary metastases/interval change. LUNGS AND PLEURA: Postsurgical changes/scarring in the left lower lobe are redemonstrated. Scattered bilateral micronodules are stable. No suspicious pulmonary nodules identified.MEDIASTINUM AND HILA: Heart size normal no pericardial effusion. No mediastinal or hilar adenopathy.CHEST WALL: Surgical absence of the posterior lateral left eighth rib.UPPER ABDOMEN: Atrophy of the left rectus abdominis muscle is again noted. No other significant abnormality is identified in the upper abdomen. | Stable scattered bilateral pulmonary micronodules. No specific evidence of metastatic disease. |
Generate impression based on findings. | History of shoulder dislocation Four views of the left shoulder reveal a Hill-Sachs compression fracture from a previous anterior dislocation. This is unchanged from the previous exam of December 12, 2014. In addition there is what appears to small ossicle superimposed over the axillary recess that may represent a loose body in the joint | Hill-Sachs deformity. Possible loose body in the axillary recess |
Generate impression based on findings. | Metastatic breast cancer baseline scan before starting chemotherapy. Former smoker, stopped in distant past. CHEST:LUNGS AND PLEURA: Right upper lobe ground glass nodule measures 7 mm (series 5, image 23), unchanged.Numerous pulmonary micronodules ranging from groundglass to sub-solid in density within the upper lung zones similar in extent and number to previous.No pleural effusions or pneumothorax. Minimal basilar atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. No coronary artery atherosclerotic calcifications on this non-gated examination.CHEST WALL: Unchanged nodular thyroid gland. Bilateral breast prostheses. Right sided chest port with tip in the SVC/right atrial junction.Sclerotic osseous lesions consistent with known metastatic disease not significantly changed.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hepatic metastases and cysts again noted. 2.2-cm lesion in the anterior aspect of the right hepatic lobe (3/100) may have increased in size, less well visualized on the prior study but previously measuring around 16mm.Reference segment II lesion (3/83) measures 17 x 12 mm, previously 15 x 11 mm. Status post cholecystectomy.SPLEEN: Stable splenomegaly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter again noted. Calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Postsurgical changes in the jejunum. Circumferential bowel wall thickening with narrowing of the lumen involving the pylorus chronic and unchanged (3/115).BONES, SOFT TISSUES: Multiple lytic and sclerotic lesions involving the lumbar spine and pelvis are stable.OTHER: No significant abnormality noted. | 1. Unchanged appearance of the thorax.2. Stable skeletal metastases.3. Slight increase in size of two of the larger hepatic lesions.4. Chronic wall thickening involving the pylorus unchanged. |
Generate impression based on findings. | Five day old male for assessment of left kidney function The posterior abdominal radionuclide angiogram demonstrates delayed, decreased perfusion of the left kidney and prompt, normal perfusion of the right kidney. Sequential renal images show the left kidney to be enlarged with a large photopenic area in the mid and lower portion of the kidney consistent with hydronephrosis. The right kidney appears to be of normal size and morphology. There is delayed excretion of the radiopharmaceutical by the left kidney with excretion noted at 8 minutes. There is also delayed washout of radiopharmaceutical from the left kidney. There is normal excretion of the radiopharmaceutical by the right kidney with excretion noted at 6 minutes. There is also delayed washout of radiopharmaceutical from the left kidney.The estimated contribution of the right kidney to total renal function is 59% and that of the left kidney is 41%. There are no apparent abnormalities of the ureters or bladder.Despite the administration of the diuretic, there was a lack of washout of collecting system radiotracer into the bladder. The T1/2 washout from the dilated left collecting system was 35 minutes. The T1/2 washout from the right kidney was also slightly prolonged at 23 minutes. | Abnormal left renal perfusion, function and morphology may represent obstruction. Follow-up renal scan is suggested to assess for interval change in renal function. |
Generate impression based on findings. | Feeding intolerance, anemia.VIEWS: Abdomen AP 1/7/15 (1 view/s) Bilateral coxa valga deformity and partial uncovering of both femoral heads. Disorganized, nonspecific abdominal gas pattern. No evince of obstruction or free air. No fecal impaction. | Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | History of shoulder dislocation Four views of the left shoulder reveal no evidence of any fractures or dislocations. Note is made of a partially fused growth plate. | Negative left shoulder exam. |
Generate impression based on findings. | 40 year-old female with pain Right foot: Again seen is a lucency partially traversing the base of the fifth metatarsal consistent with an incomplete stress fracture, with adjacent sclerosis centrally noted within the bone. A multipartite os peroneum is identified, a normal anatomic variant.Left foot: No fracture, malalignment, or other specific findings to account for the patient's pain. | Findings consistent with healing stress fracture of the base of the right fifth metatarsal, appearing similar to the prior study. |
Generate impression based on findings. | 51 year-old female with right knee pain for 3 months Tiny osteophytes indicate mild osteoarthritis, essentially within normal limits for the patient's age. A 7-mm focal round opacity overlying the lateral aspect of the joint seen on the AP view is not seen on other views and may be artifactual in etiology. Mild osteoarthritis affects the left knee as seen on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | Cervical myelopathy. Preop evaluation. The cervicothoracic junction is not well visualized on the lateral view due to overlying anatomy. Mild degenerative disease affects C5/6 and C6/7, with small anterior vertebral body osteophytes also noted at C4. There is loss of the normal cervical lordosis but otherwise alignment is within normal limits. | Degenerative disk disease. |
Generate impression based on findings. | Restaging. Base of tongue squamous cell carcinoma,. There is a soft tissue mass at the base of tongue with exophytic component extending posteriorly on the right. There is some extension to the left of the midline. Mass measures approximately 3 cm in the transverse dimension (although transverse dimensions are not well defined), 2.1 cm in the AP dimension, and 2.8 cm in the craniocaudal dimension. Mass effaces the bilateral vallecula. Mass abuts the epiglottis and demonstrates downward mass-effect on it. Preepiglottic fat is preserved. Remainder of the oral cavity and pharyngeal soft tissues are unremarkable. Tori mandibularis incidentally noted.There is a necrotic right level 2 nodal mass measuring 3.5 x 3.0 x 5.3 cm in the AP, transverse, and craniocaudal dimensions. Previously nodal mass measured 3.1 x 2.5 x 3.4 cm. There is loss of fat planes with the right sternocleidomastoid muscle consistent with extracapsular extension. There is mild anterior displacement of the submandibular gland. There is mass effect on the right internal jugular vein without occlusion. Additional scattered small lymph nodes are seen including rounded right level 2 and 3 lymph nodes measuring 6 mm which are somewhat suspicious although not enlarged by CT criteria. Additional nonspecific lymph nodes are seen including in the left neck which are not pathologically enlarged by CT criteria.The airway remains patent. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. No suspicion osseous lesions are seen. Visualized portion of the brain is unremarkable. The imaged portions of the lungs are clear. | 1. 2.1 x 3.0 x 2.8 cm (APxtrvxcraniocaudal) mass centered at the right base of tongue consistent with known neoplasm. There is effacement of the bilateral vallecula and mass effect on the epiglottis without clear evidence of epiglottic invasion. Please note the lateral margins/transverse dimension are not well defined but there does appear to be extension to the left of the midline. 2. 3.5 x 3.0 x 5.3 cm right level 2 mass compatible with nodal metastasis. There is evidence extracapsular invasion. There is mild enlargement compared to 12/18/2014. Additional rounded right level 3 lymph node although subcentimeter is somewhat suspicious. No other pathologically enlarged lymph nodes are seen. |
Generate impression based on findings. | CMV positive, SGA. Question of sequelae of CMV. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact with the white matter is appropriately immature. There are no definite areas of tissue loss. There is no periventricular or intraparenchymal calcification. The ventricles are normal in size. The basal cisterns are patent. There is no midline shift or herniation. The imaged pneumatized ethmoid air cells and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No acute intracranial abnormality, hemorrhage, or calcification. |
Generate impression based on findings. | 38-year-old male with history of head and neck cancer (base of tongue), restaging for start of treatment. CHEST:LUNGS AND PLEURA: No pleural effusion, no consolidation and no suspicious nodules or masses.MEDIASTINUM AND HILA: Heart size within normal limits, and no pericardial effusion. No appreciable coronary artery calcifications. Minimal residual thymus. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right inferior T11 vertebral body sclerotic focus, nonspecific but likely benign.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant abnormality, and no evidence of metastatic disease. |
Generate impression based on findings. | Male, 78 years old. Reason: new dht Dobbhoff tube with tip just below the gastroesophageal junction.Air-filled loops of small and large bowel, with moderate to large stool burden seen in the ascending colon and rectum.Decreased osseous mineralization. Degenerative disease of the spine. | Dobbhoff tube with tip just below the gastroesophageal junction, recommend advancing tube approximately 8 cm. |
Generate impression based on findings. | Male 9 years old; Reason: r/o abscess or other upper tract infection History: 9 y/o M with h/o ALL in remission w/ UTI BLADDER Wall Thickness: Normal Contents: Non-distended Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 10.5 cm Left: 10.4 cm Mean for age: 8 cm Range for age: 7 - 9.3 cmADDITIONAL OBSERVATIONS: No perirenal collections identified. | Mildly large kidneys, without focal lesions or perirenal collections.*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. | Male, 39 years old. Reason: evaluating for stricture/ partial obstruction/constipation History: abdominal pain, epigastric and midabdominal, waxing/waning No evidence of bowel obstruction. Small to moderate stool burden in the ascending colon and rectum. | No evidence of obstruction. Small to moderate stool burden. |
Generate impression based on findings. | 36 year old female, infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defect in the uterine cavity, a previously visualized filling defect in the right uterine cavity is not seen on this exam.The left fallopian tube was freely opacified, with free spillage into the left pelvis, indicating tubal patency. Opacification of the right fallopian tube was not definitively seen. No contrast spillage was seen in the right hemipelvis/adnexal area. Over time and in the process of repositioning the patient for imaging in the oblique planes, free contrast from the left pelvis migrated in a rightward direction in the pelvis.TOTAL FLUOROSCOPY TIME: 1:36 minutes | 1. Findings compatible with left fallopian tube patency. No peritoneal spillage of contrast delineated on the right side, concerning for right tubal occlusion. 2. Normal morphology of the uterine cavity. A previously visualized filling defect in the right uterine cavity is not seen on this exam. |
Generate impression based on findings. | 44-year-old male with history of persistent asthma. Evaluate for ABPA. LUNGS AND PLEURA: Linear opacities the underlying are most consistent with subsegmental atelectasis, although a component of scarring is possible.No bronchiectasis, no masses and no pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. Minimal coronary artery calcifications.No mediastinal or hilar lymphadenopathy. CHEST WALL: Minimal degenerative disease of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Dependent atelectasis/scarring, without characteristics of ABPA. |
Generate impression based on findings. | 85 year-old female with history of fall. There is a lobulated hyperdensity in the right parietal scalp, presumably a subgaleal hematoma. No underlying skull fracture. There is no evidence of acute intracranial hemorrhage. There is mild periventricular and subcortical white matter hypoattenuation compatible with chronic ischemic small vessel disease. Tiny focus of hypoattenuation within the anterior limb of the right internal capsule is stable. No midline shift or mass effect. Ventricular size and configuration is age appropriate. The basal cisterns are normal. There has been interval left lens removal with new soft tissue nodule along the medial aspect of the globe dorsally . The visualized paranasal sinuses are clear. | 1. No evidence of acute intracranial hemorrhage. Hyperdensity in the right parietal scalp presumably a rounded hematoma; correlate with direct examination.2. Interval removal of left intraocular lens with new soft tissue nodule in the posterior aspect of the globe medially. Unclear if this is postsurgical material; correlate with ophthalmological history and examination. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 67-year-old female with a history of DVT and right ventricular dysfunction. Evaluate for venous thromboembolism. The comparison chest radiograph performed on 1/7/2015 demonstrates small bilateral persistent pleural effusions with borderline enlarged cardiac silhouette. The ventilation images show decreased ventilation in the left lower lung on single-breath images. There is otherwise uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a matched perfusion defect in the left lower lung. There is normal physiologic distribution of pulmonary perfusion of the right lung. | Low probability for pulmonary embolism. |
Generate impression based on findings. | Trauma. Follow-up fracture. Four views of the left shoulder reveal no acute fractures or dislocations. Note again is made of a comminuted fracture of the distal clavicle that has not changed from the previous. | Comminuted fracture distal clavicle unchanged |
Generate impression based on findings. | Ms. Hargrave is a 60 year old female with a personal history of benign right surgical excisional biopsy in 2010. Per patient, she has not had a mammogram since the biopsy in 2010. She was recalled from screening mammogram for an abnormal finding in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear marker is placed overlying a scar in the right superior breast, presumably at the site of prior surgical excisional biopsy. Immediately underneath this marker is an area of architectural distortion. No discrete mass or suspicious microcalcifications are identified in the right breast.RIGHT ULTRASOUND | Area of distortion on mammography along with vague shadowing on US are seen directly underneath the visible scar from prior benign excisional surgery. These findings are presumably all post-surgical in etiology. However, given the lack of other years mammograms since surgery to compare with, a short-term follow-up examination is recommended to confirm stability of these findings. All results and recommendations were relayed to the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | PICC placement. Gunshot wound. Lower extremity ulcers.VIEW: Chest AP (one view) 1/7/15, 1551 Left upper extremity PICC tip is in right atrium.Projectile fragments are again seen in the upper chest. Spinal fusion instrumentation remains in place.Cardiothymic silhouette is normal. No focal lung opacity is present. | PICC tip in right atrium. |
Generate impression based on findings. | Evaluate for TMJ dislocation versus pharyngeal abscess due to right facial pain and trismus. There is a lytic lesion in the right mandibular condyles, without evidence of pathologic fracture or temporomandibular joint dislocation. There is also a lytic lesion involving in the right petrous apex and clivus with dehiscence of the carotid canal. In addition, there is a lytic lesion in the left greater wing of the sphenoid. Assessment for associated intracranial involvement is limited due to the lack of intravenous contrast. There are prominent arachnoid granulations in the occipital bone. There are numerous prominent cervical lymph nodes, particularly in the left supraclavicular region. For example a left supraclavicular lymph node measures 15 x 24 mm. There are also enlarged axillary and mediastinal lymph nodes. Otherwise, there is no definite evidence of mass lesions or abscess, although assessment is limited due to the lack of intravenous contrast. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The airways are patent. The imaged orbits are unremarkable. There is a subcentimeter nodule in the left lung apex. | 1. A lytic lesion in the right mandibular condyles, without evidence of pathologic fracture is compatible with sarcoidosis, although other etiologies are not excluded. 2. Additional lytic lesions in the skull base are also compatible with sarcoidosis, although other etiologies are not excluded.3. Multiple enlarged cervical, mediastinal, and axillary lymph nodes may represent sarcoidosis, although other etiologies are not excluded.4. A subcentimeter nodule in the left lung apex may be related to sarcoidosis as well, although this is nonspecific. A dedicated chest CT may be useful for further evaluation.Discussed with Susan Glick at 4:10 PM on 1/7/15. |
Generate impression based on findings. | 58-year-old with left breast calcifications for which magnification views were requested. An ML view and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The calcifications of interest in the left upper outer breast are not suspicious in morphology or distribution. Additionally, they are very minimally, if at all, changed compared to prior studies allowing for differences in technique. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 54 year-old woman with history of pain, evaluate bunion formation. Right foot: There is a moderate hallux valgus deformity, progressed from the prior study. Mild osteoarthritis affects the first metatarsophalangeal joint. Also, there is mild pes planus deformity with small midfoot osteophytes appearing similar to the prior study.Left foot: There is a moderate hallux valgus deformity, progressed from the prior study. Mild to moderate osteoarthritis, also progressed from the prior study, affects the first metatarsophalangeal joint. There is a mild pes planus deformity with midfoot osteophytes which have progressed compared to the prior study. | Slight progression of hallux valgus deformities and arthritic changes as described above. |
Generate impression based on findings. | 56-year-old male status post right knee revision Status post revision of right total knee arthroplasty with long tibial and femoral stems in near-anatomic alignment. The proximal aspect of the femoral stem is not visualized. Drain and gas in the soft tissues reflects recent surgery. | TKA revision, as above. |
Generate impression based on findings. | 56-year-old female with pain Alignment is anatomic. There is a small plantar spur, but no fracture or other specific findings to account for the patient's pain. | Small plantar spur without other specific findings to account for the patient's pain. |
Generate impression based on findings. | 80 year-old female with left distal fibular fracture, assess medial joint space There is a spiral fracture of the distal fibula extending to the articular surface. Mild widening of the medial tibiotalar joint is also noted. Diffuse soft tissue swelling about the ankle. | Distal fibular fracture and medial tibiotalar joint space widening (SER type 4). |
Generate impression based on findings. | 38-year-old male with cancer of the base of the tongue. Evaluate for staging.RADIOPHARMACEUTICAL: 12.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion of the pelvis grossly demonstrates no significant abnormality. A right inferior T11 vertebral body sclerotic focus is visualized without FDG-avid correlation on PET examination.Today's PET examination demonstrates a hypermetabolic lesion in the base of the tongue which correlates with soft tissue mass seen on diagnostic CT of the head and neck from 1/7/2015. For reference, maximal SUV = 20.6. There is an additional focus of hypermetabolic activity in the right level 2 cervical region which corresponds to necrotic nodal mass seen on diagnostic CT and is compatible with nodal metastasis. For reference, the right nodal mass has maximal SUV = 15.8. No additional FDG-avid nodal metastases are seen in the neck. There is no abnormal FDG-avid lesion in the chest, abdomen, or pelvis. | 1.FDG-avid lesion in the base of tongue consistent with known neoplasm with associated hypermetabolic right level 2 lesion compatible with nodal metastasis.2. No abnormal FDG-avid lesion in the chest, abdomen, or pelvis.Diagnostic CTs of the head and neck and chest/abdomen also performed at today's visit will be reported separately. |
Generate impression based on findings. | 30 year-old female with knee pain for 4 years Alignment is anatomic. There is no fracture or other finding to explain the patient's symptoms. | Unremarkable knee without findings to explain the patient's symptoms. |
Generate impression based on findings. | 80 year-old female with distal fibular fracture There is increased medial joint space widening of 9 mm compared with 5 mm on the nonstress view. The spiral distal fibular fracture is also again visualized with mild lateral displacement of the distal fragment. There is soft tissue swelling about the ankle. | Increased medial joint space widening indicating deltoid ligament injury. |
Generate impression based on findings. | 61-year-old male with pancreatic cancer, treated with chemotherapy, SBRT and now with liver metastasesRADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates low attenuated lesions in the right lobe of the liver, pneumobilia, gastric stent, and biliary stent. Small subpleural opacities are normal in the right lower lobe. Chest port with tip at the superior cavoatrial junction is noted.Today's PET examination demonstrates at least 5 foci of increased FDG uptake in the liver, the largest in segment 8, with SUV max 13.0. There is linear hypermetabolism in the perihepatic space adjacent to this lesion suggestive of peritoneal involvement. There is increased activity in the distal body of the pancreas corresponding to a cystic lesion seen on diagnostic CT 12/4/2014. There are multiple foci of FDG uptake in the peripancreatic head region likely representing metastatic involvement of lymph nodes. There is also a FDG avid lesion in the superior aspect of the spleen, SUV max 9.7. | 1.Multiple liver metastases with extension and probable involvement of the perihepatic peritoneum.2.Pancreatic lesion with increased activity in the distal pancreatic body suspicious for tumor.3.Several foci of increased activity in the peripancreatic region may represent regional lymph node metastases.4.Hypermetabolic splenic lesion suspicious for metastasis |
Generate impression based on findings. | 89-year-old female with history of fall. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage. There is hypoattenuation involving the periventricular white matter adjacent to the left frontal horn extending into the anterior limb of the internal capsule on the left, compatible with chronic infarct. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are normal. The calvarium and scalp soft tissues are within normal limits. | 1. No evidence of acute intracranial hemorrhage. 2. Chronic infarct in the left frontal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Ms. Rodgers is a 39 year old female presenting with bilateral self detected lumps. She denies any history of trauma, fever/chills, or focal pain. Three standard views of both breasts along with seven spot compression views (two left, five right) were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty.Triangular markers are placed at site of palpable abnormality in each breast. There is no discrete mass or areas of architectural distortion underneath these markers. In the right central breast, there are two adjacent focal asymmetries present. Spot compression views of this area confirms persistence of two circumscribed, ovoid masses.BILATERAL ULTRASOUND | 1.No mammographic or sonographic abnormality to correlate with patient's bilateral palpable areas of concern. These areas should be followed up clinically.2.Two adjacent circumscribed ovoid masses in the right central breast with no discrete sonographic correlate. Given the benign appearance on the mammogram, a short term follow-up is recommended to confirm stability of these lesions.3.All results and recommendations were relayed to the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | 88 years old, Male, Reason: hx of metatstatic colon ca on chemo- evaluate response to tx. History: none CHEST:LUNGS AND PLEURA: Changes of chronic lung disease. Trace bilateral pleural effusions right greater left.MEDIASTINUM AND HILA: The heart is enlarged. Coronary calcifications are present. Right chest wall port with tip in SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic lesions, many of which appear smaller in size. Reference segment 5 lesion measures 3.0 x 2.7 cm (series 3, image 17) previously measuring 5.5 x 4.3 cm. Hepatic and portal veins appear patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal nodules appears smaller in size. The left adrenal nodule measures 1.1 x 2.3 cm (series 3, image 98), previously measuring 2.4 x 1.1 cm. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the abdominal aorta.BOWEL, MESENTERY: Omental and mesenteric carcinomatosis. The left lower abdominal reference peritoneal mass measures 1.2 x 1 .3 cm (series 3, image 146), previously measuring 2.5 x 1.6 cm.BONES, SOFT TISSUES: Postsurgical changes in the anterior wall of the hernia mesh repair. Degenerative changes affect the lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: See abdomen.OTHER: No significant abnormality noted | Decrease in size of hepatic metastases, lymphadenopathy, and previously noted mesenteric mass. |
Generate impression based on findings. | Male 70 years old Reason: right sided hydronephrosis seen on US, r/o stone or reason for obstruction History: AKI ABDOMEN:LUNG BASES: Pleural nodularity and calcifications again seen, likely related to prior asbestos exposure.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is mild/moderate right-sided hydronephrosis as well as hydroureter extending to the pelvis, where there is a 4-mm calcific density seen in the distal right ureter (image 13, series 3), distal to which the ureter takes on a more normal caliber, consistent with an obstructing renal stone. An additional 3-mm punctate density is seen just proximal to the vesicoureteral junction consistent with an additional ureteral stone.RETROPERITONEUM, LYMPH NODES: There is an aortobifemoral bypass graft in place. There are punctate foci of gas within the graft, at the level of the third portion of the duodenum, which is anterior to, and nearly inseparable from the graft material. There is nonspecific haziness of the surrounding mesentery. These findings are worrisome for an infected graft or possible enteric-graft fistula. 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 | 1.4-mm obstructing right ureteral stone with associated mild/moderate hydronephrosis. Additional 3-mm ureteral stone seen just proximal to the vesicoureteral junction.2.Nonspecific foci of gas within the aortobifemoral bypass graft with haziness of the surrounding mesentry, worrisome for an infected graft or possible enteric-graft fistula. Further evaluation with CT angiography is recommended.These findings were relayed to Dr. Anderson at 16:49 on 1/7/2015 via telephone. |
Generate impression based on findings. | 74 year-old woman with history of humeral fracture, evaluate for dislocation. A single Velpeau view of the shoulder was obtained. A surgical neck fracture of the humerus is not well seen on this study. Glenohumeral alignment is within normal limits. | Glenohumeral alignment is within normal limits. Surgical neck fracture of the humerus not well seen on this study. |
Generate impression based on findings. | Neck swelling. There is diffuse enlargement and hyperenhancement of the left parotid gland with surrounding fat stranding. There is no evidence of radioattenuating calculi or ductal dilatation. The other salivary glands are unremarkable. There are mildly prominent cervical lymph nodes, particularly in the left suprahyoid region, which are likely reactive. The thyroid gland is unremarkable. The paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Diffuse enlargement and hyperenhancement of the left parotid gland with surrounding fat stranding is compatible with parotitis, without evidence of abscess. |
Generate impression based on findings. | Female 10 years old Reason: r/o fracture History: pain in right ankle, has been playing sportsVIEWS: Right ankle AP, lateral and oblique 1/7/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Female 50 years old Reason: history of gestational trophoblastic disease now for follow up CT aftter chemo History: cough CHEST:LUNGS AND PLEURA: Interval decrease in size of the pulmonary metastases. The reference right middle lobe index lesion now measures 3 mm (image 35, series 4), previously 8 mm. Additional non-index lesions are also decreased in size.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: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic hypodensities are too small to characterize and likely benign in etiology.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: Retroperitoneal lymph nodes seen along the left psoas muscle are not significantly changed in size, now measuring 1.0 x 1.5 cm (image 112, series 3), previously 1.1 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes affect both hips and sacroiliac joints. Multiple dystrophic calcifications are seen in the subcutaneous fat overlying the gluteal musculature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus has decreased in size, although still prominent, and the previously seen enhancing parenchymal foci are no longer evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes affect both hips and sacroiliac joints. Multiple dystrophic calcifications are seen in the subcutaneous fat overlying the gluteal musculature.OTHER: No significant abnormality noted. | Treatment response: Decrease in size of the pulmonary metastases as well in the uterus with resolution of the previously seen enhancing intraparenchymal foci. |
Generate impression based on findings. | 23-year-old female with a history of AML. Evaluate GFR for pre-transplant evaluation. The patient’s weight of 67.1 kg and height of 162.5 cm were used for all calculations.Raw GFR = 89 mL/minBSA = 1.77 m2Estimated GFR/m2 = 51 mL/min/m2Estimated GFR/m2 * 1.73 m2 (average adult BSA) = 88 mL/min (adult GFR equivalent) | GFR measurements as above. |
Generate impression based on findings. | 67 years old female with a history of vaginal bleeding and rectal cancer with rectovaginal fistula. To assess for extent of primary disease, lymphadenopathy and metastases. Recent CT demonstrates questionable left inguinal lymphadenopathy and right middle lobe lung nodule. RADIOPHARMACEUTICAL: 8.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 139 mg/dL. Today's CT portion grossly demonstrates extensive calcifications in the coronary arteries. There is a small nodular density in the right middle lobe.Today's PET examination demonstrates no evidence of FDG avid tumor in the neck, chest, abdomen and pelvis. A linear area of increased activity is seen in the right hip over the right femoral greater trochanter, which is most likely due to bursitis.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. There is no abnormal FDG uptake in the small nodular density in the right middle lobe of lung. | 1.No evidence of FDG avid tumor.2.Extensive coronary artery calcifications which may suggest clinically significant coronary artery disease. |
Generate impression based on findings. | 10-year-old female with neuroblastoma now with left hip pain Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. There is an abnormal focus of activity along the left paraspinal region that appears decreased in intensity when compared to the prior exam. No new MIBG avid lesion or areas of osseous radiotracer uptake are identified. | Radiotracer uptake along the left paraspinal region is decreased in intensity when compared to the prior exam. No findings to account for the patient's left hip pain. |
Generate impression based on findings. | 86-year-old female with shortness of breath, evaluate for pulmonary embolus The comparison chest radiograph performed on 1/7/2015 demonstrates mild CHF.The ventilation images show small, nonsegmental decreased ventilation in the left lower lobe on single breath images with uniform distribution of activity on wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion. | No evidence of pulmonary embolism. |
Generate impression based on findings. | A patient submitted the following outside studies for review.1. Bilateral digital diagnostic mammogram 12/23/20142. Right breast ultrasound 12/23/2014 Submitted studies for review were performed at St. Anthony Hospital in Chicago IL. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM (12/23/2014): Two standard views of both breasts and an additional left MLO view were obtained. The breast parenchyma is composed of scattered fibroglandular elements. Triangular markers were placed on the skin of the right upper outer quadrant denoting palpable masses. At the site of palpable concern, two 4 cm round masses with spiculated margins are present. Diffuse skin thickening and trabecular edema are present. Multiple enlarged right axillary lymph nodes are present. The constellation of findings are highly suspicious for inflammatory breast carcinoma. In the medial superior left breast, a 1 cm mass is present that was not further evaluated. Arterial calcifications are present bilaterally. No suspicious microcalcifications or areas of architectural distortion are noted in either breast. RIGHT BREAST ULTRASOUND (12/23/2014): Multiple static images from a right breast ultrasound were submitted. Labeled right breast 10:00-12:00, a 3.4 x 4.0 x 3.6 cm hypoechoic mass is present with angular margins. Labeled right breast 6:00-8:00, a 3.6 x 3.7 x 2.5 cm mass is present with lobulated margins and internal vascularity. Labeled right breast 12 o'clock anterior third, a 1.4 cm cyst is present. Images of the right axilla reveal multiple abnormal morphology axillary lymph nodes, the largest measuring 3 x 1.8 cm. | 1. Two 4 cm right breast masses with associated trabecular edema, skin thickening and axillary lymphadenopathy. The findings are highly suspicious for inflammatory breast cancer. Surgical consultation is recommended. If not already performed, tissue sampling of the right breast masses and abnormal right axillary lymph nodes as well as a punch biopsy of the skin is recommended.2. 1 cm left breast mass. Spot compression imaging and ultrasound are recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Male, 50 years old. Reason: r/o retained products History: ingestion of bag of drugs Air filled loops of small bowel and colon, with moderate stool burden in the descending colon. No specific evidence of obstruction. No evidence of radiopaque foreign object within the abdomen to indicate a retained bag of drugs. | No evidence of radiopaque foreign object within the abdomen to indicate a retained bag of drugs. |
Generate impression based on findings. | Female, 68 years old. Reason: Assess stool burden History: see above Exam limited by patient body habitus. Nonobstructive bowel gas pattern. Moderate stool burden. | Moderate stool burden. |
Generate impression based on findings. | 67 years old, Female, Reason: abd pain c/f mesenteric ischemia History: abd pain Angiogram: No evidence of aortic aneurysm, dissection or other aortic pathology. There is focal narrowing at the portion of the celiac artery measuring approximately 3 mm (series 9, image 49). There is complete opacification of the branches of the celiac artery. The SMA, renal arteries, and IMA are intact and patent. There appears to be duplicated left renal artery with the inferior artery arising at the level of the origin of the IMA. There are atherosclerotic calcifications the proximal left common iliac artery.ABDOMEN:LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodensity in the left kidney which is too small to characterize. The right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No evidence of obstruction, pneumatosis, or free air. No bowel wall thickening. No hyper enhancement of the bowel wall or fluid within the mesentery.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: Colonic diverticulosis without evidence of diverticulitis. No evidence of obstruction, pneumatosis, or free air. No bowel wall thickening. No hyper enhancement of the bowel wall or fluid within the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Atherosclerotic disease as detailed above. Complete opacification of the celiac axis, SMA, and IMA. 2.No evidence of bowel ischemia as clinically questioned. |
Generate impression based on findings. | Male 64 years old Reason: aortic arch and carotid pseudoaneurysm on MRA, p/w strokes History: aortic arch and carotid pseudoaneurysm on MRA, p/w strokes ANGIOGRAM: Small broad-based focal outpouching at the level of the aortic arch projecting inferolaterally (image 46, series 9) consistent with an ulcerated mural plaque. There is no evidence of submural hematoma or dissection. There are severe atherosclerotic calcifications and mural thrombus affecting ]the thoracic aorta and there are severe coronary arterial calcifications. The great vessels of the chest are normal in caliber. Please see neck CT angiogram findings from the same day for full evaluation of the cervical vasculature. Incompletely imaged lack of contrast opacification in the infrarenal abdominal aorta could reflect aortic occlusion or possibly related to timing of the contrast bolus. There is stenosis of the origins of the bilateral renal arteries.LUNGS AND PLEURA: Spiculated partially solid partially groundglass nodule in the right upper lobe (image 24, series 8) contains calcium and is likely benign in etiology. 4-mm spiculated right middle lobe nodule is nonspecific, but follow-up is recommended (image 52, series 3). There is moderate centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Hypoattenuating nodules in the right lobe of the thyroid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hypertrophy of the caudate lobe and widening of the fissures suggests chronic liver disease. Arterially enhancing lesion in hepatic segment IVa/IVb and hepatic segment VIII are incompletely characterized on this examination. Hypoattenuating lesions scattered throughout the hepatic parenchyma are too small to characterize, but presumably benign in etiology. There is nonspecific prominence of the pancreatic duct measuring up to 5 cm, without evidence of obstructing mass. | 1.Ulcerated mural plaque affecting the aortic arch without evidence of aortic dissection or aneurysmal dilatation.2.Lack of opacification of the infrarenal aorta is incompletely is worrisome for complete aortic occlusion; however, this fails reflect bolus timing. Full evaluation with abdomen and pelvis CTA can be considered as clinically indicated.3.Arterially enhancing hepatic lesions as detailed above. Further evaluation with hepatic MRI is recommended.4.Spiculated right middle lobe nodule is nonspecific, but follow-up in 6 to 12 months is recommended to confirm stability/resolution.5.Nonspecific prominence of the pancreatic duct. |
Generate impression based on findings. | Female, 99 years old. Reason: Dobbhoff History: Dobbhoff Dobbhoff tube with tip overlying the gastric body.Nonobstructive bowel gas pattern.Bilateral pleural effusions. Cardiomegaly. Degenerative disease of the spine and left hip. Partially visualized right hip prosthesis.Multifocal airspace opacity grossly unchanged compared with prior chest radiograph dated 1/5/2015. | Dobbhoff tube tip overlying the gastric body. |
Generate impression based on findings. | Female, 24 years old. Reason: evaluate for degree of stool burden and gastric distension History: chronic, refractory nausea and vomiting, LLQ abdominal pain Nonobstructive bowel gas pattern. Moderate stool burden.Surgical clips in the right upper quadrant. Post-surgical material overlying the right lower quadrant. | Moderate stool burden. |
Generate impression based on findings. | Female, 44 years old. Reason: Evaluation of small bowel obstruction History: Small bowel obstruction Nasogastric tube coiled within the stomach, with distal side port below the level of the GE junction.Dilated small bowel loops seen centrally, compatible with small bowel obstruction as seen on recent CT exam. Enteric contrast within the colon from recent prior study.Left-sided percutaneous nephroureteral tube. Right-sided nephroureteral stent in expected location. | Findings compatible with small bowel obstruction as seen on recent CT exam. |
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