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Generate impression based on findings. | The patient submitted outside digital mammograms dated 10/2/2012, 9/18/2012 and 10/6/2011 from Mt. Sinai Medical Center in Chicago IL. Submitted outside studies were compared to the current mammogram dated 11/28/2014. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Stable benign calcifications are present. No new masses, suspicious calcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination is unremarkable, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 25-year-old male with pain in wrist for one month following minimal trauma Alignment is anatomic. No fracture or other specific findings to account for patient's symptoms. | No fracture or other specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Male, 65 years old. Reason: please assess Dobbhoff tube placement History: new tube placement Interval placement of Dobbhoff tube, with tip overlying the region of the pylorus.Examination is limited by overlying lines and tubes. Nonobstructive bowel gas pattern.Postsurgical changes, support devices come and tubes are again seen, with similar appearance to the prior exam. Contrast seen in the urinary bladder, with Foley catheter in place. | Dobbhoff tube with tip overlying the region of the pylorus. |
Generate impression based on findings. | 56 year old female status post L1/S1 ALIF+PSF Posterior stabilization members with transpedicular screws entering the vertebral bodies of L1 through L5 and S1 in near-anatomic alignment without evidence of complication. Status post diskectomies with interbody bone graft within the disk spaces of L1/2, L2/3, L3/4 and L4/5. Surgical clips overlie the abdomen. | Postoperative lumbar fixation as described above without evidence of complication. |
Generate impression based on findings. | Male, 64 years old. Reason: r/o obstruction History: nausea, low urine output The lower abdomen and pelvis are excluded from the field-of-view. Partially visualized nonobstructive bowel gas pattern.Surgical changes of a median sternotomy and aortic stent graft. | Partially visualized nonobstructive bowel gas pattern. See same day CT abdomen pelvis for additional findings. |
Generate impression based on findings. | Evaluate for CVA, left-sided facial droop and left arm heaviness No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored advanced small vessel ischemic changes. There is volume loss involving the right superior cerebral hemisphere compatible with chronic infarct.There is patchy mucosal thickening involving the bilateral ethmoid air cells and mild mucosal thickening in the right sphenoid sinus. Mastoid air cells are clear. Calvarium is intact. | No evidence of acute intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | 65-year-old male with shoulder pain, question of acromio-clavicular joint OA. Glenohumeral alignment is within normal limits. There is moderate osteoarthritis affecting the acromioclavicular joint and mild osteoarthritis affecting the glenohumeral joint. | Osteoarthritis, as described above. |
Generate impression based on findings. | 40 year-old female with history of hypoxia and shortness of breath, chest pain. Evaluate for PE. Smoking history, so evaluate for underlying lung disease. PULMONARY ARTERIES: No pulmonary embolus. The main pulmonary artery diameter is 3.4 cm, which may be seen in cases of pulmonary arterial hypertension.LUNGS AND PLEURA: Linear bilateral, predominantly dependent opacities, likely patchy subsegmental atelectasis although some small part of scarring is likely present. Mild bronchial wall thickening. No significant pleural effusion.MEDIASTINUM AND HILA: Minimally enlarged mediastinal and hilar lymph nodes, unchanged. Heart size within normal limits. No appreciable coronary artery calcifications.CHEST WALL: Minimal degenerative changes affect the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolus. 2.Bronchial wall thickening and subsegmental atelectasis, are suggestive of reactive airway disease/bronchitis with areas of mucus plugging.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 2-year-old male with suspected sepsis. Evaluate lung fields.VIEW: Chest AP (one view) 1/7/2015, 1908 The aortic arch, cardiac apex, and stomach are left-sided.Focal right middle lobe opacity may represent atelectasis or consolidation.Normal cardiothymic silhouette. | Right middle lobe atelectasis or consolidation. |
Generate impression based on findings. | 56-year-old male status post right TKA Hardware components of a right TKA revision with long tibial and femoral stem are present in near-anatomic alignment without evidence of complication. Drain, staples and gas in the soft tissues reflect recent surgery. | TKA revision without evidence of complication. |
Generate impression based on findings. | Male, 77 years old. Reason: assess for ileus History: distension Gas-filled colon with small to moderate stool burden. No specific evidence of bowel obstruction.Degenerative disease of the spine. Left hip prosthesis. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: tachycardia, SOB - assess for PE History: tachycardia, SOB - assess for PE PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is of normal caliber.LUNGS AND PLEURA: Debris is noted within the trachea.Severe centrilobular and paraseptal emphysema; apical bullae/scarring.Masslike pleural thickening in the right upper lobe is unchanged.The reference left apical nodule is stable measuring 5 mm (series 9, image 25).Left lower lobe pleural-based nodule measures 11 x 5 mm (series 9, image 127), previously 7 x 4 mm.Interval development of bilateral pleural effusions, left greater than right, with associated compressive atelectasis.There is consolidation overlying the left pleural effusion with associated air bronchograms, which may indicate developing pneumonia.Significant bronchial wall thickening suggest chronic bronchitis.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. Moderate to severe coronary artery calcifications.Scattered mediastinal/hilar lymphadenopathy, which appears worse when compared previous.Reference AP window node measures 16 mm in short axis (series 8, image 125), previously 14 mm.CHEST WALL: Old right rib fracture deformity.No significant axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without evidence of acute cholecystitis.Scattered atherosclerotic calcification of the abdominal aorta and its branches. | 1. No evidence of pulmonary embolism.2. Interval development of bilateral pleural effusions and consolidation/atelectasis, which may represent developing pneumonia in the left lower lobe.3. Interval growth of left lower lobe pleural-based nodule, concerning for recurrent/metastatic disease.4. Interval enlargement of multiple mediastinal/hilar lymph nodes.5. Stable appearance of masslike pleural thickening in the right upper lobe.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Bilious emesis. Sepsis.VIEW: Abdomen AP (one view) 1/8/15 0534 NG tube tip is in the antropyloric region. Partially imaged central line is present, with tip in the right atrium.The bowel gas pattern is disorganized and nonobstructive, with an ileus pattern similar to prior. The previously seen tubular loop of bowel in the right lower abdominal quadrant has resolved. No pneumatosis, portal venous gas, or pneumoperitoneum is evident. Contrast is noted within the bladder. | Unchanged ileus bowel gas pattern. |
Generate impression based on findings. | 68 years old, Male, Reason: Rule out obstruction. PLease comment on gall bladder History: Abd pain, n/v/d ABDOMEN:LUNG BASES: Mild bibasilar atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No evidence of biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Punctate hypodense foci in the body and tail of the pancreas (series 3, image 39) is unchanged from prior exam and remains nonspecific. Differential for lesion includes small focus of intrapancreatic fat or alternatively a cystic pancreatic neoplasm such as IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes not meeting size criteria for lymphadenopathy. Atherosclerotic calcifications of the abdominal aorta and common iliac vessels.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. No evidence of obstruction. The appendix is normal in appearance. No bowel wall thickening.BONES, SOFT TISSUES: Bullet fragment is again noted in the L4 vertebral body.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. No evidence of obstruction. The appendix is normal in appearance. No bowel wall thickening.BONES, SOFT TISSUES: Bullet fragment is again noted in the L4 vertebral body.OTHER: No significant abnormality noted | 1. No evidence of obstruction as clinically questioned. No specific findings to account for the patient's symptoms.2. Punctate foci in the body and tail of the pancreas are unchanged and may represent small foci of intrapancreatic fat or much less likely cystic pancreatic neoplasm such as IPMN. |
Generate impression based on findings. | Female 35 years old Reason: concern for intraabdominal process s/p ir drain placement History: nausea/vomiting ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated compressive atelectasis.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. New moderate volume perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in the bilateral renal parenchyma are too small to characterize, but likely benign in etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post total colectomy with right lower quadrant end ileostomy formation. There is diffuse dilatation of the small bowel measuring up to approximately 3.7 cm in maximal diameter, as well as distention of the stomach. Multiple transition points are seen within the pelvis, consistent with small bowel obstruction, likely related to adhesive disease. There is new ascites, worrisome for ischemia in the setting of bowel obstruction. There is no evidence of mucosal hyper-enhancement are hypo-enhancement to suggest necrosis. There is no evidence of intramural air or pneumoperitoneum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New small volume ascites.PELVIS:UTERUS, ADNEXA: Fluid collection along the left adnexa likely reflects ascites; however, this collection could be adnexal in etiology.BLADDER: There is a Foley catheter in place.LYMPH NODES: Several slightly prominent pelvic lymph nodes likely reactive in etiology.BOWEL, MESENTERY: The patient is status post total colectomy with right lower quadrant end ileostomy formation. There is diffuse dilatation of the small bowel measuring up to approximately 3.7 cm in maximal diameter, as well as distention of the stomach. Multiple transition points are seen within the pelvis, consistent with small bowel obstruction, likely related to adhesive disease. There is new ascites, worrisome for ischemia in the setting of bowel obstruction. There is no evidence of mucosal hyper-enhancement are hypo-enhancement to suggest necrosis. There is no evidence of intramural air or pneumoperitoneum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: The fluid collection in the deep left pelvis has decreased in size from the prior examination, and there is a pigtail catheter in place. There is a small volume pelvic ascites. | 1.Small bowel obstruction with multifocal transition points seen within the pelvis likely reflecting small bowel adhesive disease. New ascites in the setting of small bowel obstruction is worrisome for possible ischemia.2.Decrease in size of the deep left pelvic fluid collection.3.Small bilateral pleural effusions.These findings were discussed with Dr. Sutter via telephone at 9:27 on 1/8/2015. |
Generate impression based on findings. | 5-month-old female with desaturations, tachypnea. Evaluate for signs of pneumonia, consolidation.VIEWS: Chest AP/lateral (two views) 1/7/2015, 2303 hrs. The aortic arch, cardiac apex and stomach are left-sided.Mild peribronchial thickening is present.Scattered subsegmental atelectasis.No pleural effusion or pneumothorax.Normal cardiothymic silhouette. | Bronchiolitis/reactive airways disease pattern. |
Generate impression based on findings. | The patient submitted outside digital mammograms dated 10/2/2012, 9/18/2012 and 10/6/2011 from Mt. Sinai Medical Center in Chicago IL. Submitted outside studies were compared to the current mammogram dated 11/28/2014. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Stable benign calcifications are present. No new masses, suspicious calcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination is unremarkable, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Fever and abdominal pain. History of left adrenal neuroblastoma. ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis is present, without pleural effusions. Partially imaged central line is noted, with tip in the right atrium.LIVER, BILIARY TRACT: The liver is normal in appearance without focal hepatic lesions. The main portal vein is patent. The gallbladder is normal in appearance.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: The partially calcified left adrenal mass is again seen, measuring 4.0 x 2.9 cm at its largest point on axial plane (series 3, image 37), previously 4.1 x 3.4 cm. The mass extends over approximately 7.5 cm in craniocaudal dimension, previously 8 cm. The mass continues to displace the left kidney laterally and left renal artery anteriorly. The splenic artery and left renal artery are not encased. The right adrenal gland is normal in appearance.KIDNEYS, URETERS: Left kidney is lobulated in appearance and smaller than the right, similar to the prior study. Mild left hydronephrosis is present. The right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffusely dilated loops of small and large bowel throughout the abdomen and pelvis, without a definite transition point to indicate obstruction. No pneumatosis, portal venous gas, or pneumoperitoneum is present. A small amount of interloop free fluid is noted. The distal esophagus is patulous with wall thickening, suspicious for inflammation.BONES, SOFT TISSUES: No osseous lesions are evident.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffusely dilated loops of small and large bowel throughout the abdomen and pelvis, without a definite transition point to indicate obstruction. No pneumatosis, portal venous gas, or pneumoperitoneum is present. A small amount of interloop free fluid is noted. The cecum and ascending colon are without evidence of typhlitis. BONES, SOFT TISSUES: No osseous lesions are evident. | 1. Ileus bowel gas pattern.2. Slightly decreased size of the left adrenal mass. |
Generate impression based on findings. | There is a prominent right lateral parietal subgaleal hematoma measuring 9 mm in greatest thickness. Along its posterior margin, there is a nondisplaced fracture extending from the convexity down through the anterior margin of the subgaleal hematoma. Intracranially, there is thin underlying extra axial mild hyperdensity on 8045/31 measuring 2 mm in greatest thickness, consistent with subdural hematoma.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal attenuation. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Prominent right lateral parietal subgaleal hematoma with underlying nondisplaced right parietal bone fracture and trace subacute subdural hematoma. |
Generate impression based on findings. | 4-month-old male status post PICC. PICC placement.VIEWS: Chest and abdomen AP (two views) 1/8/2015, 0440 Tracheostomy tube tip at the thoracic inlet. Two enteric tubes terminate in the stomach, which is within the giant omphalocele as seen on recent CT.Lung bases are obscured by the omphalocele. No focal pulmonary opacity or pleural effusion is identified. Normal cardiac silhouette size.Dilated bowel loop in the right upper aspect of the giant omphalocele is mildly increased in distention from the previous exam. No evidence of pneumatosis, portal venous gas, or free air.Thoracic length is increased and width is decreased as expected. | Increasing bowel loop distention. Obstruction cannot be excluded. |
Generate impression based on findings. | Female 56 years old Reason: eval for appendicitis History: RLQ pain for one week ABDOMEN:LUNG BASES: Trace bibasilar atelectasis.LIVER, BILIARY TRACT: There is an apparent partially calcified stone in the neck of the gallbladder, without evidence of cholecystitis. The connection between the fundus of the gallbladder neck is difficult to identify, which is of uncertain clinical significance.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant and is normal in appearance. Solitary stool filled diverticulum near the ileocecal valve is identified, but without evidence of inflammation.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: The appendix is identified in the right lower quadrant and is normal in appearance. Solitary stool filled diverticulum near the ileocecal valve is identified, but without evidence of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings seen to account for the patient's pain, specifically no evidence of appendicitis or diverticulitis. |
Generate impression based on findings. | 56 year old female status post fall, rule out fracture There is mild sharpening of the tibial spines and small osteophytes consistent with mild osteoarthritis. No fracture is identified. | Mild osteoarthritis without fracture evident. |
Generate impression based on findings. | 88-year-old female s/p ORIF, assess intramedullary nail A dynamic screw transverses the comminuted intertrochanteric fracture without evidence of hardware complication. Foci of gas, soft tissue swelling and clips reflect recent surgery. | Orthopedic fixation as described above without evidence of complication. |
Generate impression based on findings. | 61-year-old female with right knee edema/erythema There is diffuse soft tissue swelling about the knee and calf. Bandages obscure underlying osseous detail. A small joint effusion is identified. Mild osteoarthritis affects the knee. There is no osteolysis.There is a small soft tissue defect along the anterior tibia at the level of the tibial tubercle without underlying erosion to suggest osteomyelitis. | 1. Soft tissue abnormalities as described above without radiographic evidence of osteomyelitis.2. Small joint effusion. |
Generate impression based on findings. | 25-year-old male w/ hx saw injury, eval for healed PIP fusion The fingers appear demineralized.Index finger: Two K wires affix the PIP joint in near-anatomic alignment with minimal osseous bridging without evidence of hardware complication. Soft tissue swelling is present about the finger.Middle finger: Two K wires affix the PIP joint in near-anatomic alignment without evidence of hardware complication.Fourth finger: A single K wire now transverses the PIP joint with partial osseous bridging extending across the joint. Lucency extending along the proximal aspect of the K wire is unchanged. | PIP joint fixations as described above without evidence of complication |
Generate impression based on findings. | 15-year-old female with hand pain after fall. Rule out fracture, infection.VIEWS: Right hand PA/lateral/oblique (3 views), right wrist PA/lateral/oblique (3 views), 1/8/2015, 0211 hours. Marked, diffuse soft tissue swelling about the hand, particularly at the dorsal and lateral aspects. There is also focal swelling at the lateral aspect of the interphalangeal joint of the first digit. The bones of the hand and wrist appear normal without fracture or malalignment. No osteolysis to suggest osteomyelitis. | No evidence of fracture or osteomyelitis. |
Generate impression based on findings. | 89-year-old woman with history of fall, evaluate for fracture. Mild osteoarthritis affects the lower lumbar spine and sacroiliac joints. Mild to moderate osteoarthritis affects the bilateral hips with superior joint space narrowing and osteophyte formation. There is no acute fracture or malalignment. | Osteoarthritis without acute fracture or malalignment. |
Generate impression based on findings. | Female 19 years old Reason: 19F with celiac disease and UC, s/p J-pouch in past, ileostomy takedown on 12/15/14 c/b pain, fevers. underwent re-creation of ileostomy at OSH with drainage of abscess. please eval for any intraabdominal processes. History: 19F with celiac disease and UC, s/p J-pouch in past, ileostomy takedown on 12/15/14 c/b pain, fevers. underwent re-creation of ileostomy at OSH with drainage of absce ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is distention of the left renal vein proximal to where it passes posterior to the superior mesenteric artery, where it is narrowed. Distal to this the vein takes on a more normal caliber, suggestive of Nutcracker syndrome.RETROPERITONEUM, LYMPH NODES: Multiple prominent retroperitoneal lymph nodes identified, presumably reactive in etiology.BOWEL, MESENTERY: Extensive postsurgical changes including total colectomy, J-pouch formation and right lower quadrant diverting ileostomy formation. There are multiple small bowel to small bowel anastomoses. There is no evidence of bowel obstruction.There are multiple complex, partially interconnected fluid collections in the left hemipelvis, which demonstrate hyperattenuating rims, consistent with postoperative fluid collections, possibly infected. The largest measures 2.3 x 2.7 cm (image 103, series 3) and is seen along the left pelvic sidewall. Multiple additional abscesses are seen extending inferiorly and posteriorly, the most inferior posterior present anterior to the sacrum measures 1.7 x 1.9 cm (image 110, series 3).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Significant volume of air within the bladder is evident, correlate for recent instrumentation.LYMPH NODES: Scattered prominent pelvic lymph nodes, which are presumably reactive in etiology.BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Extensive postsurgical changes related to total colectomy, J-pouch formation and ileostomy creation, with multiple complex interconnected postoperative fluid collections in the pelvis, which are possibly infected. |
Generate impression based on findings. | 32 years old, Male, Reason: 32M HIV, h/o rectal abscess, with recurring draining perianal wound History: draining perianal wound PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction, pneumatosis, or free air.BONES, SOFT TISSUES: Induration of the subcutaneous tissues in the right perianal area tracking along the distal rectum consistent with residual fibrotic tract of known perianal wound. No drainable fluid collection. There is a small focus of air in the area of the left the consistent with known recent intramuscular injection.OTHER: No significant abnormality noted | 1.No rectal abscess. Induration in the area of the right buttock consistent with residual fibrotic tract of chronic perianal wound.2.Small focus of air in the left buttock consistent with known recent intramuscular penicillin injection. |
Generate impression based on findings. | 75 year-old woman with history of gangrene, evaluate for osteomyelitis. There is soft tissue swelling of the first and second toes, but there is no evidence of osteolysis. Arterial calcifications are noted. We see no acute fracture or malalignment. | No acute fracture, malalignment, or evidence of osteomyelitis. |
Generate impression based on findings. | 21 year old female with history of tachycardia, shortness of breath, anxiety and d-dimer. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: No consolidation, no pleural effusion and no suspicious nodules or masses. No pneumothorax. Mild bronchial wall thickening, which in this age group is most consistent with asthma.MEDIASTINUM AND HILA: Heart size normal limits comment a pericardial effusion. No appreciable coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Minimal degenerative changes of the spine, including subtle minimal endplate irregularities of the mid thoracic vertebrae.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No pulmonary embolus.2.Mild bronchial wall thickening, which in this age is most consistent with asthma.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 2-day-old male with abdominal distention. Evaluate for perforation.VIEW: Abdomen left lateral decubitus AP (one view) 1/8/2015, 0343 Dilated rectosigmoid colon is again seen. Distal bowel obstruction pattern without evidence of perforation. | Distal bowel obstruction pattern without evidence of perforation. |
Generate impression based on findings. | 27 year-old woman with history of stepping on glass, evaluate for foreign body. The right foot appears normal without acute fracture or malalignment. There is no unexpected radiopaque foreign body. | No acute fracture, malalignment, or radiopaque foreign body. |
Generate impression based on findings. | There has been no significant interval change in the appearance of a 9-10 mm right lateral parietal subgaleal hematoma. Along its posterior margin, there is a nondisplaced fracture extending from the convexity down through the inferior margin of the subgaleal hematoma. Intracranially, there is redemonstration of thin underlying extra axial mild hyperdensity again measuring 2 mm in greatest thickness, best seen on the thin section images, consistent with trace subdural hematoma.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal attenuation. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Stable right lateral parietal subgaleal hematoma with underlying nondisplaced right parietal bone fracture and trace subacute subdural hematoma. |
Generate impression based on findings. | 62-year-old man with history of right great toe pain, evaluate for osteomyelitis. There is soft tissue ulceration along the medial aspect of the first interphalangeal joint with extension to the underlying bone. There is cortical destruction involving the proximal and distal aspects of the distal first phalanx. Degenerative changes affect the first MTP joint. An intra-medullary rod with screws is seen in the tibia. | Findings of osteomyelitis affecting the first distal phalanx. |
Generate impression based on findings. | 2 year old male with NB 2 days status post SCT with fevers and tachycardia. VIEW: Chest AP and Abdomen AP (2 views) 1/7/15 1656 Left PICC tip is in the right atrium. Right jugular venous catheter tip is in the SVC. The cardiothymic silhouette is normal. Left lower lobe subsegmental atelectasis is present, without focal lung opacities or pleural effusions. The bowel gas pattern is disorganized and nonobstructive, with an ileus pattern. No pneumatosis, portal venous gas, or pneumoperitoneum is evident. | Ileus bowel gas pattern. |
Generate impression based on findings. | Female 84 years old Reason: eval for diverticulitis History: loose stiool, fever, abd pain hx dumping syndrome, hx chole, appy ABDOMEN:LUNG BASES: New small left pleural effusion with associated compressive atelectasis.LIVER, BILIARY TRACT: Hypoattenuating lesions scattered throughout the hepatic parenchyma are unchanged from the prior examination, presumably benign etiology. Patient status post cholecystectomy. There is mild intrahepatic biliary ductal dilatation, which appears sightly increase in the prior examination; however, the etiology of which is uncertain.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.8-cm heterogeneous mass in the inferior pole the right kidney, is unchanged from the prior examination and is worrisome for a primary renal malignancy. Additional 0.8-cm lesion in the interpolar region of the left kidney is also unchanged and may represent a synchronous renal malignancy.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and its branches. There is unchanged mild aneurysmal dilatation of the infrarenal aorta, measuring up to 2.3 cm in maximal diameter.BOWEL, MESENTERY: Large hiatal hernia with approximately one third of the gastric fundus within the thoracic cavity. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Unchanged lumbar spinal fusion hardware. Degenerative changes of the thoracolumbar spine with a compression fracture of T9, which is unchanged. Right total hip arthroplasty device in place. There is infiltration of the fat of the bilateral gluteal clefts, which is of uncertain significance.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large hiatal hernia with approximately one third of the gastric fundus within the thoracic cavity. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Unchanged lumbar spinal fusion hardware. Degenerative changes of the thoracolumbar spine with a compression fracture of T9, which is unchanged. Right total hip arthroplasty device in place. There is infiltration of the fat of the bilateral gluteal clefts, which is of uncertain significance.OTHER: No significant abnormality noted | 1.No specific findings seen to account for the patient's abdominal pain.2.Bilateral renal masses worrisome for synchronous renal malignancies.3.Nonspecific mild intrahepatic biliary ductal dilatation, slightly increased from the prior examination, likely related to prior cholecystectomy.4.Large hiatal hernia as detailed above. |
Generate impression based on findings. | 2-day-old male with abdominal distention. Evaluate for free air.VIEW: Chest AP upright (one view) 1/8/2015, 0340 hours. Enteric tube tip in the stomach. Scattered streaky lung opacities, suggestive of atelectasis. No pleural effusion or pneumothorax. Dilated bowel seen incompletely evaluated. No gross intraperitoneal free air in the upper abdomen. | Dilated bowel in the upper abdomen, better evaluated on abdomen radiographs. |
Generate impression based on findings. | 2 day old male with abdominal distension. Evaluate for perforation.VIEWS: Abdomen AP and cross-table lateral (two views) 1/8/2015, 0245 Dilated rectosigmoid colon. Multiple differential air-fluid levels. Distal bowel obstruction pattern. No free air is identified. | Distal bowel obstruction pattern without evidence of perforation. |
Generate impression based on findings. | Pain and fullness in right superior breast since 2013. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A circumscribed mass in the left upper outer quadrant is smaller than on the prior study. Additional circumscribed masses in both breasts are stable. Benign calcifications are present. Benign lymph nodes project over both axillae.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. RIGHT BREAST ULTRASOUND: On physical examination, the the patient complains of pain in the superior right breast with palpation. No discrete masses are felt. A focused right breast ultrasound was performed for the area of clinical concern. No suspicious cystic or solid masses were present in the right breast by ultrasound. | No mammographic or sonographic correlate for patient's complaint of tender fullness in the right superior breast. Patient's complaint should be managed clinically. Benign bilateral circumscribed masses. No mammographic evidence for malignancy. If patient's physical examination is unremarkable, screening mammogram in one year is recommended. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Exam is limited by patient motion and difficulty in patient positioning. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. This includes a chronic lacunar infarct of the right external capsule extending into the right caudate. There is no gross pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small mucosal retention cyst in the left maxillary sinus. There is minimal right mastoid fluid. Left mastoid air cells and middle ear are fluid opacified. There are aerated secretions in the right greater than left sphenoid sinus. | 1. No gross acute abnormality within limitations of significant motion artifact. Mild chronic small vessel ischemic changes.2. Left greater than right mastoid air cell fluid opacification and left middle ear opacification. Aerated secretions in the sphenoid sinus. Please correlate clinically. |
Generate impression based on findings. | Battery this morning with large scalp hematoma, confusion, and neck pain BrainNo intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift, or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Is diffuse opacification of the left maxillary sinus. Mastoid air cells are clear. Subdural hematoma is noted in the left for head and right parietal region. Calvarium is intact.Cervical SpineMild loss of cervical lordosis, which may be in part positional. Vertebral body heights and alignment in the cervical spine are otherwise normal. No evidence of fracture or subluxation. Small disk osteophyte complexes are seen at the C5-C6 and C6-C7 levels with mild spinal canal narrowing. There is at least mild right C5-C6 neural foramina stenosis secondary to disk component. No significant spinal canal or neural foramina stenosis is seen at any level.Paraspinous soft tissues are unremarkable. Mild emphysematous changes in the lung apices. | 1. No evidence of acute intracranial hemorrhage or mass effect. Subgaleal hematoma in the left frontal and right parietal region.2. No acute fracture or subluxation in the cervical spine. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal to mild low attenuations on bilateral periventricular white matter indicating non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. Right maxillary sinus shows pacification. | No evidence of acute ischemic or hemorrhagic lesion on this scan. |
Generate impression based on findings. | Reason: PE History: DOE; recently diagnosed DVT PULMONARY ARTERIES: Multiple bilateral pulmonary emboli. The most proximal of which is in the distal left pulmonary artery, extending predominantly into the inferior segmental and subsegmental levels.On the right, there are also numerous pulmonary emboli involving the inferior submental/subsegmental arteries.The main pulmonary artery is of normal caliber.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No specific evidence of right heart strain.The heart size is within normal limits, no significant pericardial effusion. No significant hilar/mediastinal lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy.Mild degenerative disease of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | Bilateral pulmonary emboli, most proximal of which is in the distal left main pulmonary artery. PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Negative. |
Generate impression based on findings. | 50 years old, Male, Reason: diverticulitis; intra-abdminal abscess History: LLQ abd pain; diarrhea ABDOMEN:LUNG BASES: Mild bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis. No evidence of bowel wall thickening, pneumatosis, or free air.BONES, SOFT TISSUES: No evidence of hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. No evidence of bowel wall thickening, hernia, pneumatosis, or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Diverticulosis without evidence of diverticulitis. No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | LIVER: 9.7 cm in length. The liver echogenicity is within normal limits. No focal hepatic lesions are seen. The portal vein is patent with hepatopetal flow. GALLBLADDER, BILIARY TRACT: The gallbladder appearance is within normal limits. There is no intrahepatic or extrahepatic biliary ductal dilatation. PANCREAS: Normal appearance of the visualized portions of the pancreatic head and body.KIDNEY: The right kidney is 7.5 cm in length. The left kidney is 7.9 cm in length. The kidneys are normal in appearance without focal lesions or hydronephrosis.SPLEEN: 8.8 cm in length, without focal lesions.OTHER: No significant abnormality noted. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Chronic constipationVIEW: Abdomen AP 1/7/15 Moderate amount of fecal burden. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Moderate amount of fecal burden without obstruction. |
Generate impression based on findings. | ARDS intubatedVIEW: Chest AP 1/8/15 ET tube tip below thoracic inlet and above the carina. Feeding tube tip extends below the hemidiaphragm and not visualized. Right central line in place. Cardiothymic silhouette normal. Interval improvement in the left lower lobe atelectasis. Patchy opacities in the right lower lobe. Probable bilateral small pleural effusions. | Left lower lobe atelectasis improved in the interval. |
Generate impression based on findings. | fall downstairs There is localized acute subarachnoid hemorrhage on the right sylvian fissure posterior limb with overlying scalp hematoma on the right parietal area indicating possible traumatic nature.There is no evidence of overlying skull fracture.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, or midline shift. The osseous structures are unremarkable. The mastoid air cells are clear. The left maxillary sinus shows opacification without evidence of fracture. | Traumatic acute subarachnoid hemorrhage on the right sylvian fissure posterior limb with evidence of overlying parietal area scalp hematoma but without overlying skull fracture. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Prominent upper cervical lymph nodes are partially visualized, which are nonspecific but likely reactive in a patient of this age. There is also significant soft tissue in the visualized posterior nasopharynx, likely representing hypertrophied lymphoid tissue within the adenoids. | No acute intracranial abnormality. |
Generate impression based on findings. | Intracranial hemorrhage, intubatedVIEW: Chest AP 1/8/15 ET tube tip immediately above the carina. NG tube tip at the pyloric region of the stomach. Left central line with tip in the left brachiocephalic vein. Cardiothymic silhouette normal. Bilateral atelectasis in the right lower lobe and left lower lobe not significantly changed. Bilateral small pleural effusions unchanged. | Bilateral atelectasis and pleural effusions not significantly changed. |
Generate impression based on findings. | PneumothoraxVIEW: Chest AP 1/8/15 ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Left upper extremity PICC unchanged. There are three chest tubes on the right with the upper chest tube sidehole in the subcutaneous tissue. There is moderate right pneumothorax not significantly change with mild mediastinal shift from right to left. Cystic lung changes are present at the left lower lobe. Minimal atelectasis in the left upper lobe and lingula. Cardiothymic silhouette normal. Marked body wall edema. | Moderate right pneumothorax not significantly changed. |
Generate impression based on findings. | Images are somewhat limited by patient motion artifact. T2* images are not diagnostic. The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are minimal scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but likely represent mild chronic small vessel ischemic changes. There is no gross pathological enhancement within limitations of motion artifact. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in both maxillary sinuses.CERVICAL SPINE | 1. No acute abnormality. Probable mild chronic small vessel ischemic changes, without gross enhancement given motion limitation.2. Significantly motion limited cervical spine exam without definite cord abnormality. Previously questioned cord signal abnormality was artifactual. C4-C5 and C5-C6 moderate to severe right foraminal narrowing. |
Generate impression based on findings. | There is restricted diffusion involving the splenium of the corpus callosum on the left, posterior lateral left thalamus, as well as the left hippocampal tail and posterior left parahippocampal gyrus. Punctate focus also seen in the left occipital lobe. There is associated flair hyperintensity with mild expansile appearance. Remainder of the brain parenchyma demonstrates moderate degree of flair hyperintensity in the periventricular and subcortical white matter most compatible with chronic small vessel ischemic disease. Chronic infarct is noted at the left temporo-occipital junction and a smaller one in the left superior parietal lobule. Prior infarcts also noted in the posterior cerebellar hemispheres, left greater than right. Additional lacunar infarcts also seen in the right basal ganglia and left posterior frontal corona radiata. Few nonspecific microhemorrhages are seen in the left frontoparietal lobes. There is 4-mm focus of T2 hyperintensity with a rim of T2 hypointensity and susceptibility effect in the pons likely representing a small cavernous malformation.No hydrocephalus. No extra-axial collections. There is global parenchymal volume loss commensurate with age. Evidence of right intraocular lens replacement. MRA HEAD | 1. Restricted diffusion involving the left callosal splenium, posterior thalamus, left hippocampal tail/posterior parahippocampal gyrus, and left occipital lobe consistent with acute infarcts. There is mild expansile appearance associated likely related to edema. 2. Evidence of chronic small vessel ischemic disease and multiple chronic infarcts including the left temporo-occipital lobe, left parietal lobe, left greater than right posterior cerebellar hemispheres, and right basal ganglia as detailed above.3. 4-mm focus of chronic microhemorrhage involving the pons most likely represents a small cavernous confirmation.4. High-grade stenosis/occlusion involving the left distal P2 and P3 left posterior cerebral artery.5. Atherosclerotic plaque at the right common carotid artery bifurcation with less than 50 percent stenosis. No significant stenosis is seen in the course of the carotid or vertebral arteries in the neck.6. Ectatic appearance of the bilateral cavernous internal carotid arteries with small 4-5 mm bilateral cavernous ICA aneurysms. 2 mm outpouchings at the opthalmic artery origins are also seen which may represent infundibula or tiny aneurysms. These can be followed up as clinically indicated. |
Generate impression based on findings. | Respiratory insufficiencyVIEW: Chest AP 1/8/15 Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette at the upper limits of normal. Patchy atelectasis bilaterally in the right lower lobe and left lower lobe. Probable bilateral small pleural effusions. Multiple surgical clips in the upper abdomen. | Bilateral atelectasis in the right lower lobe and left lower lobe increased in the interval. |
Generate impression based on findings. | 76 your old male with history of base of tongue mass. LUNGS AND PLEURA: Scattered nonspecific stable pulmonary micronodules, consistent with prior granulomatous disease. No pleural effusion, and no pulmonary metastases. Small amount of debris/secretions in the airway.MEDIASTINUM AND HILA: Heart size within normal limits comment a pericardial effusion. Severe coronary artery calcifications. Atherosclerosis affects the aorta and its branches. Small calcified lymph nodes, without mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes affect the visualized spine, particularly at the cervical level. Sternotomy fixation wires, unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Upper abdomen surgical clips. Small hiatal hernia. Small renal cyst partially visualized. | No metastatic disease, and no interval change. |
Generate impression based on findings. | Pleural effusionVIEW: Chest AP 1/8/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left PICC and left chest tube unchanged. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally but improved from prior study. No pleural effusion or pneumothorax. | Bilateral atelectasis improved from prior study. |
Generate impression based on findings. | 60 year-old male, postoperative evaluation There has been resection of the proximal interphalangeal joints of the fingers and replacement with hinged type prostheses. There is a partially healed fracture deformity of the base of the middle phalanx of the fourth digit. Mild diffuse soft tissue swelling involves the fingers. Marked narrowing of the distal interphalangeal joints of the fingers and severe basilar joint osteoarthritis. | Postoperative and degenerative changes as described above. |
Generate impression based on findings. | Abdominal distentionVIEW: Abdomen AP 1/8/15 NG tube tip in the stomach. There is absent bowel gas within the abdomen. Patchy atelectasis in the right lower lobe and left lower lobe with small pleural effusions bilaterally. No evidence of pneumoperitoneum. | Absent bowel gas unchanged from prior study. |
Generate impression based on findings. | Suspected pseudoaneurysm on MRA and stroke, with history of alcohol use. There is a focal high-grade stenosis of the P1 segment of the left posterior cerebral artery. There is also mild stenosis of the right posterior cerebral artery. There is moderate stenosis at the left carotid bifurcation, with an irregular contour of the proximal left internal carotid artery associated with calcified atherosclerotic plaque. There is minimal scattered atherosclerotic plaque along the course of the left common carotid artery. There is minimal scattered atherosclerotic plaque along the course of the right common and internal carotid arteries. There is a high-grade focal stenosis of the origin of the right vertebral artery. There is severe steno-occlusive disease of the left vertebral artery near the origin and the vessel continues distally predominantly in the form of a deep cervical artery collateral with very faint opacification of the remainder of the cervical left vertebral artery. There is a focal outpouching along the left lateral aspect of the aorta that measures up to 8 mm in width. There is a subcentimeter area of hypoattenuation in the posterior limb of the left internal capsule. There are foci of hypoattenuation within the bilateral basal ganglia and thalami and patchy hypoattenuation in the cerebral white matter. There are multiple dental caries and an expansile left mandibular periapical lucency. There are emphysematous changes in the lungs. There is mild multilevel degenerative spondylosis in the cervical spine. | 1. The recent infarct in the posterior limb of the left internal capsule, chronic lacunar infarcts, and chronic small vessel ischemic disease in the cerebral white matter are better depicted on the prior MRI.2. Focal high-grade stenosis of the left posterior cerebral artery.3. Moderate stenosis at the left carotid bifurcation, with an apparent deformity of the proximal left internal carotid artery is atherosclerotic in nature. 4. Severe steno-occlusive diseases of the left vertebral artery near the origin and the vessel continues distally predominantly in the form of a deep cervical collateral artery. 5. Atherosclerotic high-grade focal stenosis of the origin of the right vertebral artery.6. A focal outpouching along the left lateral aspect of the aorta may represent an ulcerating plaque or pseudoaneurysm. 7. Multiple dental caries and an associated left mandibular periapical cyst. |
Generate impression based on findings. | Sickle cell disease hypoxiaVIEWS: Chest AP and lateral Cardiomegaly unchanged. Minimal prominence to the pulmonary vasculature unchanged. Patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. Bony changes representing sickle cell disease unchanged. | Patchy atelectasis left lower lobe new from prior study. |
Generate impression based on findings. | History of right lumpectomy 3/2014 for DCIS. Patient received radiation. No new breast complaints. Three standard views of both breasts and two right spot magnification views 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. A linear marker was placed on the scar overlying the right breast. Postsurgical architectural distortion and surgical clips are present in the lumpectomy bed. Scattered benign calcifications are present.No new masses or suspicious microcalcifications are present in either breast. | Expected postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | T3N1M0 right tonsil squamous cell carcinoma, completed FHX in May 2010. There are post-treatment findings in the neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild atherosclerotic plaque at the bilateral carotid bifurcations and stenosis of the left vertebral artery origin. There is multilevel degenerative spondylosis. There are secretions within the trachea. The imaged portions of the lungs are clear. There is minimal opacification of the mastoid air cells and maxillary sinuses. There is right temporo-occipital region and left cerebellar encephalomalacia secondary to prior infarcts. | 1. Post-treatment findings in the neck without evidence of measurable mass lesions or significant cervical lymphadenopathy.2. Secretions within the trachea may indicate aspiration.3. Chronic right temporo-occipital and left cerebellar infarctions. |
Generate impression based on findings. | 64 year old female with history of Sjogren's/SLE and severe lung disease with scoliosis. Evaluate for ILD. LUNGS AND PLEURA: Bibasilar linear scarring, similar to prior. No focal consolidation or pleural effusions. Stable scattered pulmonary micronodules, some of which are calcified. No significant air trapping. No evidence of interstitial lung disease.MEDIASTINUM AND HILA: Heart size within normal limits, with no pericardial effusion. No appreciable coronary artery calcifications. No mediastinal or hilar lymphadenopathy. Small hilum hernia.CHEST WALL: Unchanged severe dextroscoliosis of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Persistent bibasilar scarring, without interval change. No evidence of interstitial lung disease. |
Generate impression based on findings. | 78 year-old female with history of syncope and bilateral 100% internal carotid artery occlusions on recent Doppler. CT head without contrast: No evidence of intracranial hemorrhage. There is a wedge-shaped area of hypoattenuation within the left posterior temporal and occipital lobe compatible with evolving infarction. There is an additional region of hypoattenuation within the left middle frontal gyrus compatible with evolving infarction although this lesion appears more acute and compared to the aforementioned parietooccipital lesion. No evidence of hemorrhagic transformation or areas of acute hemorrhagic lesion.There is mild periventricular and subcortical white matter hypoattenuation compatible with age-indeterminant ischemic small vessel disease. There is no midline shift or mass effect. The ventricles size and configuration is age appropriate. The basal cisterns are unremarkable. The visualized mastoid air cells are clear. Frontal sinus shows osteoma, otherwise paranasal sinus appears to be unremarkable.The orbits are normal. The calvarium and scalp are unremarkable.CT Angiography Head and Neck: Arthrosclerotic disease affects the aorta and aortic root vessels.There is a less than 50% stenosis of the left subclavian artery near its origin. There are dense calcifications at the carotid bifurcation bilaterally resulting in complete occlusion of bilateral internal carotid arteries. There is a tight stenosis of the right external carotid artery at its origin. The left external carotid artery is relatively patient. There is calcification of the left vertebral artery at its origin. The anterior circulation appears to be supplied by the posterior circulation via bilateral Pcom arteries. The vertebral arteries are tortuous, but patent. Bilateral PCOMs are large and patent. There is narrowing of the left M1 segment. No evidence of intracranial aneurysm.There is a multinodular goiter. | 1. Age indeterminate likely to be older than subacute, evolving ischemic infarcts in the left frontal and left temporo-occipital lobes.2. Moderate age indeterminant small vessel ischemic disease.3. Bilateral complete occlusion of extracranial internal carotid arteries at the bifurcation with the anterior circulation being supplied by an intact posterior circulation. Reconstitution of bilateral ICAs were from the level of Pcom arteries. (paraclinoid segment) Minimal irregularities on bilateral ACA A1 segments.4. Less than 50% stenosis of the left subclavian artery near its origin.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 23 years old, Male, Reason: History metastatic metastatic teratoma from GCT testes, s/p several surgeries, assess extent of disease CHEST:LUNGS AND PLEURA: Postsurgical changes multiple wedge resections with stable soft tissue around the suture lines. There has been interval wedge resection of previously noted right lower lobe nodule without definite evidence of local recurrence. Reference left lower lobe nodule appears larger in size measuring 1.8 x 1.9 cm (series 4, image 77) previously measuring 1.4 x 1.3 cm.Left upper lobe nodule adjacent to the left border of the heart is another nodule (series 4, image 60) which is unchanged in size and may be pleural-based. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Median sternotomy hardware is noted.ABDOMEN:LIVER, BILIARY TRACT: There is hypoattenuation in the posterior right hepatic lobe which is concerning for new metastasis. This lesion measures 2.1 x 2.7 cm (series 3, image 108). No vessel is seen running through this lesion. Follow-up imaging is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Numerous retroperitoneal surgical clips from prior lymph node dissection. Soft tissue attenuation around the celiac axis and proximal SMA appears unchanged. No residual retroperitoneal lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Enlargement of left lower lobe metastasis.2.New hepatic metastasis. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild left maxillary sinus mucosal thickening. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage or mass effect. If there is continued suspicion for intracranial structural abnormality, consider MRI for more sensitive evaluation. |
Generate impression based on findings. | Left neck mass. Assess for lymphadenopathy. There is no evidence of mass lesions. There are multiple upper cervical subcentimeter lymph nodes, though no significant cervical lymphadenopathy by CT size criteria. The major salivary glands are unremarkable. There is a subcentimeter hypoattenuating right thyroid nodule. The major cervical vessels are patent. The airways are patent. The osseous structures are unremarkable. There is mucosal thickening of the bilateral maxillary sinuses. The mastoid air cells are clear. The imaged portions of the lungs are clear. | 1. No significant cervical lymphadenopathy.2. Hypoattenuating right thyroid nodule; correlate with prior thyroid ultrasound. |
Generate impression based on findings. | IntubatedVIEW: Chest AP (one view) 1/8/15 0417 ET tube tip is at the thoracic inlet. Enteric tube tip is in the stomach.The cardiothymic silhouette is normal.Peribronchial thickening is present, with increased bilateral subsegmental atelectasis. No focal lung opacities or pleural effusions are evident. | Bronchiolitis/reactive airway disease pattern with increased atelectasis. |
Generate impression based on findings. | 17 year-old female status post MVA. Rule out foreign body/glass in wound.VIEWS: Skull AP/lateral (two views) 1/7/2015, 1726 hrs. No skull fracture or lesion is identified. No evidence of unexpected radiopaque foreign body. Paranasal sinuses are clear. Dental hardware is noted. | No unexpected radiopaque foreign body. |
Generate impression based on findings. | 56-year-old female with history of known lung cancer. Evaluate for metastases. Additional history per EPIC "Stage 4 RUL adenocarcinoma, COPD" CHEST:LUNGS AND PLEURA: Approximately 4 x 4.1 x 3.5 cm right upper lobe soft tissue mass which abuts the hilum and invades the adjacent mediastinum. There is mild associated obstructive atelectasis/consolidation, and narrowing of the superior lobar bronchus and its branches. Multiple other small pulmonary nodules in the right thorax are seen, likely metastatic disease. Small right pleural effusion.MEDIASTINUM AND HILA: The right upper lobe mass causes adjacent mediastinal pleural thickening and nodularity, with obliteration of some of the fat within the mediastinum adjacent to this mass suggestive of invasion. Multiple enlarged mediastinal and hilar lymph nodes, with an enhancing, necrotic R4/lower pretracheal lymph node mass measuring approximately 16 mm (4/29).CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Solitary this anteriorly adjacent ligament may be focal fat infiltration.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: Enlarged right apical axillary lymph node (4/12) measures approximately 12 mm.OTHER: No significant abnormality noted. | 1.Right upper lobe soft tissue mass abutting the hilum and extending into the mediastinum, consistent with given history of primary lung adenocarcinoma, with multiple right lung, pleural and chest wall nodules, and small right pleural effusion.2.Mediastinal and right axillary lymphadenopathy. |
Generate impression based on findings. | 11-year-old male with pain after fall.VIEWS: Left shoulder AP internal/external rotation, left humerus AP/lateral, left elbow AP/lateral/oblique (7 views), 1/8/2015, 0912 hours. Humerus:Moderate soft tissue swelling about the upper arm. There is a comminuted, minimally displaced, mid left humeral diaphyseal fracture and an additional oblique nondisplaced distal humeral diaphyseal fracture.Shoulder:No evidence of malalignment or additional fracture in the shoulder.Elbow:Irregularity of the lateral aspect of the capitellum is likely normal variation. No joint effusion is present. No specific evidence of additional fracture or malalignment in the elbow. | Humerus fractures, as above.Findings relayed via telephone to Dr. DeFrates at 10:06 a.m. on 1/8/2015. |
Generate impression based on findings. | Oxygen dependentVIEW: Chest AP 1/8/15 NG tube and left PICC have been removed in the interval. Cardiothymic silhouette normal. Bilateral patchy atelectasis in the right lower lobe and left lower lobe new from prior study. No pleural effusion or pneumothorax. | Bilateral atelectasis new from prior study. |
Generate impression based on findings. | headache, concern for subarachnoid hemorrhage NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKNon optimal enhancement of intracranial vessels, thus precise evaluation was not possible. There is no evidence of intracranial aneurysm on this scan.The basilar artery shows mild to moderate (less than 50%) stenosis with tortuosity. There are arterial wall calcifications shown on bilateral distal ICA paraclinoid and cavernous sinus segments Indicating atherosclerotic changes.Acom artery and left Pcom artery are patent but the right Pcom artery is not seen.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. No evidence of intracranial arterial aneurysm or significant arterial stenosis. |
Generate impression based on findings. | Male 64 years old Reason: s/p EVAR with b/l renal stents, now w/ oliguria, eval graft and renal flow. GFR = 25, but benefits outweighs the risks of contrast toxicity History: above ANGIOGRAM: There has been interval placement of an aortobi-iliac bypass graft as well as stents within the origins of the bilateral renal arteries. There is aneurysmal dilatation of the infrarenal aorta measuring up to 6.5 x 4.4 cm in cross-sectional dimension (image 23, series 7), not significantly changed from the prior examination. There are several punctate foci of gas within the aneurysm sac, which are presumably postoperative in etiology. Due to poor contrast opacification, the patency of the renal artery stents is difficult to determine; however, the aortic stent graft and iliac stent grafts are patent. As this was not a dedicated stent protocol, delayed phase imaging is not available to assess for endograft leak; however, no endograft leak is evident on the arterial phase. There are severe atherosclerotic calcifications of the abdominal aorta and its branches. There is additional focal aneurysmal dilatation of the aorta just proximal to the bilateral iliac arteries, not significantly changed from the prior examination, now measuring approximately 4.2 x 5.0 cm in cross-sectional dimension (image 85, series 7).ABDOMEN:LUNG BASES: There are new small bilateral pleural effusions with associated compressive atelectasis/consolidation.LIVER, BILIARY TRACT: Contrast within the gallbladder consistent with vicarious excretion of contrast.SPLEEN: No significant abnormality notedPANCREAS: Scattered parenchymal calcifications suggest sequela of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are new bilateral striated nephrograms as well as large areas of hypoattenuation within the right kidney, likely reflecting sequelae of ischemia. There are new bilateral stents at the origins of the renal arteries, the patency of which is unable to be determined on the basis of this examination secondary to poor contrast opacification. There is increased perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: Air within the retroperitoneum likely reflects right iliac artery conduit formation.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Incidental note is made of an appendicolith within the proximal appendix.BONES, SOFT TISSUES: There is extensive subcutaneous emphysema affecting the right body wall, presumably postprocedural in etiology.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is a Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Incidental note is made of an appendicular than the proximal appendix.BONES, SOFT TISSUES: There is extensive subcutaneous emphysema affecting the right body wall, presumably postprocedural in etiology.OTHER: No significant abnormality noted | 1.Postsurgical changes related to aortobiiliac bypass graft placement as well as proximal renal artery stents. The aortobiiliac stent grafts are patent; however, the patency of the renal stent cannot be assessed secondary to poor contrast opacification.2.Renal parenchymal hypoattenuation and striated nephrograms, consistent with ischemia, the genesis of which is uncertain as the patency of the grafts cannot be determined secondary to poor contrast opacification.3.Aortic aneurysms as detailed above, without significant interval change.4.No evidence of endograft leak on the arterial phase; however, this was not a dedicated stent protocol and delayed phase imaging was not obtained. Follow up stent graft protocol can be considered as clinically indicated.5.Retroperitoneal air likely related to right iliac artery conduit formation.6.Basilar atelectasis/consolidation. |
Generate impression based on findings. | Recurrent hyperparathyroidism with abnormal parathyroid activity near the isthmus. There are postoperative findings related to anterior neck exploration. There is a soft tissue attenuation mass that measures up to 25 mm in the midline of the neck anterior to the larynx, adjacent to a surgical clip. The mass is indistinct from the underlying strap muscles, but the laryngeal cartilage appears to be intact. Otherwise, there is no evidence of significant cervical lymphadenopathy or mass lesions elsewhere in the neck. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is an air-fluid level in the right maxillary sinus and mild mucosal thickening in the left maxillary sinus with associated osteitis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. A soft tissue attenuation mass in the midline of the neck anterior to the larynx that measures up to 25 mm may represent a recurrent parathyroid adenoma or carcinoma, lymph node metastasis, among other possibilities. The mass appears to be intimately associated with the underlying strap muscles, but the laryngeal cartilages appear to be intact.2. Findings suggestive of acute right maxillary sinusitis. |
Generate impression based on findings. | 18-month-old male with sleep apnea. Evaluate for adenoid hypertrophy.VIEWS: Soft tissue neck lateral (one views) 1/7/2015, 1711 hrs. There is mild enlargement of the adenoids without obstruction of the nasopharyngeal airway. The subglottic airway is also patent. No prevertebral soft tissue swelling is present. The visualized paranasal sinuses are clear. | Mild enlargement of the adenoids without nasopharyngeal airway compromise. |
Generate impression based on findings. | Midline tenderness status-post fall two days ago. Question of fracture. Head: There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. There is mild periventricular white matter hypoattenuation which is nonspecific but likely represents small vessel ischemic disease. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants and left orbital surgical hardware. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Cervical spine: There is no evidence of fracture. There is straightening of the normal cervical lordosis. There are multilevel cervical degenerative changes most predominantly from C4 to C7. There is grade 1 retrolisthesis of C5 on C6 with moderate to severe loss of disc space height and a posterior disc-osteophyte complex. There is grade 1 anterolisthesis of C7 on T1. There is no prevertebral soft tissue swelling. The airway is patent. There is atherosclerotic calcification of the bilateral carotid bifurcations and imaged aortic arch. There is a left upper lobe calcified granuloma. | 1. No evidence of acute intracranial hemorrhage.2. Multilevel cervical degenerative changes, most predominately at C5-C6, without acute fracture. |
Generate impression based on findings. | worst headache of life. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral distal ICAs, MCAs and ACAs.Acom artery is patent and the right pcom artery is patent but the left pcom artery is not shown.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. No evidence of intracranial arterial aneurysm or stenosis.3. Extracranial cervico-carotid arterial system appears to be normal. |
Generate impression based on findings. | There are postoperative changes of a suboccipital decompression with a suboccipital pseudomeningocele measuring approximately 4.7 x 1.3 x 3.2 cm (AP x craniocaudal x transverse), which is slightly larger in size compared to the most recent study. There is right cerebellar tonsillar herniation through the neo-foramen magnum to the lower margin of the anterior arch of C1, which is grossly similar to the prior exam though direct comparison is difficult. The CSF flow study demonstrates decreased flow through the fourth ventricle and dorsal to the medulla. There is relatively similar appearing biphasic flow ventral and dorsal to the upper cervical cord. Flow is also seen around the tonsils. A flash of flow is noted in the extra-axial space just deep to the pseudomeningocele. There is redemonstration of a continuous syrinx extending from the cervicocranial junction to the level T11 with more prominent focal areas of dilatation proximally and a smaller focal dilatation distally. The syrinx measures 8 x 9 mm on the axial plane at the level of T1 (image 3, series 11). This is grossly unchanged compared to the prior study. The lumbar spine is grossly unremarkable. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. | 1. Post-operative findings of a Chiari I decompression with a slightly larger suboccipital pseudomeningocele.2. Decreased CSF flow through the fourth ventricle and dorsal to the medulla, but flow identified ventral and dorsal to the upper cervical cord. Grossly similar tonsillar position.3. No significant change in size of cervicothoracic syringomyelia. |
Generate impression based on findings. | Male 50 years old Reason: eval for recurrence History: h/o RCC. CHEST:LUNGS AND PLEURA: Region of groundglass opacity seen in the lingula series 5 image 64 seen on prior exams, including earliest scan of record 4/23/14. This can be followed.No concerning nodules or effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Few hypodensities likely cysts, unchangedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes left kidney. Previously seen gas is resolved. There is no contrast in the collecting system in this single phase study, thus it cannot compare a presumed urinoma seen on the prior exam. The hypodense collection is decreased in size however. Residual hypodensity and sutures associated perirenal fat stranding. No evidence of tumor recurrence.9-mm hypodense lesion left lobe pole series 3 image 137, too small to characterize, but slightly larger than on the 5/21/14 study, series 37 image 78, where it measured 7 mm. This can be followed.Few punctate foci of calcification bilaterally represent nephrolithiasis some are new. No hydronephrosis hydroureter.RETROPERITONEUM, LYMPH NODES: Stable shotty retroperitoneal nodes. Small portacaval and peripancreatic nodes unchanged. Fat stranding around the origin of the left renal vasculature may be related to prior surgery.BOWEL, MESENTERY: Small mesenteric and gastrohepatic ligament nodes unchanged.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 | No evidence of metastatic disease. Continued visualization of postsurgical changes left kidney decreasing in size. Stable small retroperitoneal nodes. Punctate nephrolithiasis bilaterally.Stable groundglass opacity lingula.9-mm nonspecific hypodensity right lower pole may be slightly increased in size compared to July 2014. This should be followed. Discussed with Dr. David Vanderweele. |
Generate impression based on findings. | Bilateral worsening knee pain. Rule-out fracture. Most likely Osgood-Schlatter.VIEWS: Right knee AP/lateral/oblique (3 views), left knee AP/lateral/oblique (3 views) 01/08/15 No joint effusion is present. There appears to be a small defect in the articular surface of the lateral aspect of the left medial femoral condyle. The articular surfaces on the right are normal. No fracture is identified. | Possible left osteochondral defect. MR may be helpful in further evaluation. |
Generate impression based on findings. | 49 years old, Female, Reason: evaluate hepatic vasculature and echotexture, compare to previous imaging. also pt has h/o of hematuria please eval pelvis History: Biliary Cirrhosis, drains in place, history of hematuria, being evaluated for liver transplant Lack of IV contrast limits evaluation of abdominal parenchyma. Within these limitations the following observations are made:ABDOMEN:LUNG BASES: Scattered calcified and noncalcified micronodules bilaterally. Left pleural effusion with associated atelectasis and consolidation. Underlying infection cannot be excluded.LIVER, BILIARY TRACT: Postsurgical changes of hepaticojejunostomy and cholecystectomy. Right-sided percutaneous biliary drain is present. The liver has a nodular contour with subtle enlargement left hepatic lobe consistent with cirrhosis. There is a calcification in the hepatic segment 7. No significant hepatic vascular calcifications.SPLEEN: Spleen is enlarged measuring 17 cm in coronal plane. The spleen has mild mass effect on the left kidney.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or renal calculus. No evidence of hydroureter or calculus within the ureters.RETROPERITONEUM, LYMPH NODES: No significant calcifications of the abdominal aorta or its branches. Scattered retroperitoneal lymph nodes not meeting size criteria for lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes of hepaticojejunostomy. No definite evidence of obstruction. BONES, SOFT TISSUES: A moderate amount of anasarca within the soft tissues.OTHER: There is a large amount of ascites within the pelvis, paracolic gutters, and in the rest of the abdomen.PELVIS: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: Large amount of ascites within the pelvis. | 1.Nodular contour of the liver and large amount ascites consistent with cirrhosis. No calcifications of the hepatic vasculature.2.Left pleural effusion with associated atelectasis and/or consolidation. Underlying infection cannot be excluded.3.No evidence of nephrolithiasis or calculus within the ureters. |
Generate impression based on findings. | Male 48 years old Reason: pain History: pain Bone mineralization is normal. Alignment is anatomic. The joint spaces are appropriate for age. No acute fracture is evident. | Unremarkable right hand radiographs. |
Generate impression based on findings. | 55 year old female with chest pain and shortness of breath, evaluate for pulmonary embolism The comparison chest radiograph performed on 1/8/2015 demonstrates a band of subsegmental atelectasis in the left lower lobe.The ventilation images show mild decreased radiotracer in the left lower lobe on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase.The perfusion images show a perfusion defect throughout the majority of the left lower lobe, much larger than the ventilation defect and matched to the radiographic abnormality. | Intermediate probability for pulmonary embolism. |
Generate impression based on findings. | Reason: Pleural mesothelioma please compare to prior exam per recist. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Extensive nodular pleural thickening in the right hemithorax consistent with mesothelioma with a moderately large pleural effusion.Reference measurements as follows:1. At the level of the aortic arch (series 5/28) at 11 o'clock: 20 mm, increased from 18 mm previously.2. At the level of the carina (series 5/37) at 8 o'clock: 30 mm, increased from 28 mm previously.3. At the level of the right pulmonary artery (series 5/47) at 12 o'clock: A pleural mass invading the chest wall measuring 36 mm in thickness, increased from 28 mm previously.4. At the level of the right pulmonary artery (series 5/48) at 9 o'clock: 18 mm, increased from 16 mm previously.Increased pleural effusion with underlying atelectasis at the right base.New subpleural micronodule in the left upper lobe (series 6/44) which is nonspecific.MEDIASTINUM AND HILA: Pleural mass invading the anterior mediastinum (series 5/47) slightly increased compared to previous, with pericardial invasion further inferiorly.Mild coronary artery calcification.No significant pericardial effusion.Mildly enlarged subcarinal lymph nodes, unchanged.CHEST WALL: Anterior chest wall invasion by tumor as described, slightly increased.New areas of cortical erosion at the right fourth and fifth ribs laterally.Increased pleural thickening at the right base with possible invasion of the right hemidiaphragm.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hemangioma in the right lobe, unchanged.Additional very small hypodensities, most likely cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cysts and nonobstructing calculus right.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: Unchanged focal radiolucency in the L4 vertebra, most likely an hemangioma.OTHER: No significant abnormality noted. | Interval increase in pleural thickening in the right hemithorax with chest wall, diaphragmatic and pericardial invasion. |
Generate impression based on findings. | Male 58 years old Reason: NHL, re-eval and compare to previous History: right inguinal and femoral CHEST:LUNGS AND PLEURA: Pulmonary micronodules unchanged.MEDIASTINUM AND HILA: Mild coronary arterial calcifications. There is no evidence of mediastinal or hilar lymphadenopathy on the basis of size criteria.CHEST WALL: There is no evidence of axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria.ABDOMEN:LIVER, BILIARY TRACT: Patient status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right-sided myelolipoma unchanged.KIDNEYS, URETERS: Nonobstructing left renal stones.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. Mild atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged sclerotic lesion in the right femoral head.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Interval increase in size of the right-sided pelvic and inguinal lymphadenopathy. Reference right external iliac chain lymph node now measures 3.0 x 4.4 cm (image 171, series 3), previously 2.5 x 3.6 cm. Conglomerate of right inguinal lymph nodes now measures 7.6 x 6.2 cm (image 28, series 3), previously 5.6 x 5.7 cm. This conglomerate of lymph nodes encases the right femoral artery and vein, now demonstrating mild attenuation of both vessels.Previously seen soft tissue extending from the common iliac bifurcation to the left pelvic side wall appears similar to the prior examination, consistent with treated disease.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged sclerotic lesion in the right femoral head.OTHER: No significant abnormality noted | 1.Interval increase in size of the right-sided pelvic and inguinal lymphadenopathy.2.No new foci of lymphadenopathy identified. |
Generate impression based on findings. | There is interval evolution/redistribution of the focus of subarachnoid hemorrhage in the posterior limb of the right sylvian fissure which is no longer clearly seen. No new hemorrhage. There is no significant mass effect, or cerebral edema. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. There is persistent opacification of the left maxillary sinus. The imaged mastoid air cells are clear. The skull is intact. There is persistent right parietal scalp soft tissue swelling. | interval evolution/redistribution of the small focus of subarachnoid hemorrhage in the posterior limb of the right sylvian fissure which is no longer clearly seen. No new hemorrhage. |
Generate impression based on findings. | 59-year-old female with palpitations and tenderness with concern for pheochromocytoma. There is no abnormal focus of activity to indicate current MIBG avid tumor.There is a focus of increased MIBG activity just inferior to the liver which corresponds on CT to physiologic excretion in a prominent right renal collecting system. Prominent diffuse persistent pulmonary activity is also noted which is a physiologic variant.Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. | No MIBG avid lesion to suggest pheochromocytoma. |
Generate impression based on findings. | Male 80 years old Reason: evaluation of gross hematuria History: hematuria ABDOMEN:LUNG BASES: New left basilar patchy consolidation, most like reflecting aspiration. Calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease. There are severe atherosclerotic calcifications of the coronary arteries.LIVER, BILIARY TRACT: Punctate intraparenchymal calcifications suggest prior granulomatous disease. Cholelithiasis without evidence of cholecystitis.SPLEEN: Punctate intraparenchymal calcifications suggest prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: 2 cm left adrenal nodule (image 46, series 80568), is unchanged the prior examination, but sightly increased in size 2005 CT examination.KIDNEYS, URETERS: The ureters are well opacified during the excretory phase and no filling defects are evident to suggest urothelial tumor. The bladder is incompletely filled with contrast. There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and its branches. There is stable aneurysmal dilatation of left common iliac artery measuring up to 2.9 x 2.7 cm in cross-sectional dimension (image 13, series 30568). There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: There is new nonspecific mesenteric and retroperitoneal fat stranding about the hepatic flexure, which is nonspecific, but could reflect diverticulitis. There are numerous diverticuli affecting the entirety of the colon.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is a Foley catheter in place there is nonspecific mild bladder wall thickening which may reflect chronic inflammation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is new nonspecific mesenteric and retroperitoneal fat stranding about the hepatic flexure, which is nonspecific, but could reflect diverticulitis. There are numerous diverticuli affecting the entirety of the colon.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality noted | 1.Mild bladder wall thickening, which is nonspecific but could reflect chronic inflammation. Otherwise, no specific finding seen to account for the patient's hematuria.2.Mesenteric and retroperitoneal fat stranding about the hepatic flexure of the colon could reflect diverticulitis, although this is a nonspecific finding. Clinical correlation is recommended. |
Generate impression based on findings. | Male 81 years old Reason: Colon cancer; evaluate for response to therapy History: See Above CHEST:LUNGS AND PLEURA: Diffuse bilateral nodules, grossly unchanged.Index right upper lobe nodule series 4 image 111, 5 x 4 mm previously described is 6 x 5 mm on series 4 image 112 on the 10/3/14 exam.Index left upper lobe nodule series 4 image 131 5 x 4 mm. Previously 5 x 5 mm.MEDIASTINUM AND HILA: Index lymph node in the aortopulmonary window series 2 image 37, 1.8 x 1.6 cm. Previously 1.9 x 1.8 cm.No new nodes.Central port tip SVC RA junction.CHEST WALL: Port-A-Cath right chest wall. Small nonpathologic sized axillary nodes, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesion in the posterior segment of the right lobe series 3 image 92, .9 x 0.7-cm. Previously 1.3 x 1 cm. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Presumptive bilateral cysts unchanged. Previously described indeterminate lesion left pole likely a cyst, unchangedRETROPERITONEUM, LYMPH NODES: Cluster of left periaortic nodes, Series III image 126, 1.9 x 1.2 cm. Previously 2.1 x 1.4 cm.Mild atherosclerotic changes. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneous enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Index right external iliac node Series III image 173, 0.7 x 0.6 cm. Previously 0.7 x 0.7 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable sclerotic focus right iliac wing and acetabulum.OTHER: Moderate atherosclerotic changes.Bilateral fat containing inguinal hernias. Inguinal hernia on the left also contains a portion of urinary bladder. See coronal image 62 | Index lesions as above are stable with some nodes slightly decreased in size.Bilateral inguinal hernias with portion of urinary bladder in the left inguinal hernia. |
Generate impression based on findings. | 29-year-old male with history of squamous cell carcinoma of the left lateral tongue status post partial glossectomy and left neck dissection. LUNGS AND PLEURA: Stable scattered bilateral pulmonary micronodules, without suspicious nodules or masses.MEDIASTINUM AND HILA: Residual thymic tissue, unchanged. Heart size within normal limits comment no pericardial effusion. No coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Minimal degenerative changes affect the spine, unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant abnormality, no evidence of metastatic disease. |
Generate impression based on findings. | 29 year-old woman with history of right thumb pain. The right thumb appears normal without acute fracture, malalignment, or significant degenerative change. | No specific finding to account for the patient's pain. |
Generate impression based on findings. | 18-year-old man with history of distal ulnar fracture. No fracture line is identified. There is no malalignment. | No fracture identified. |
Generate impression based on findings. | Ms. Coffey is a 49 year old female with a personal history of left breast lumpectomy in Feb 2014 for DCIS followed by radiation therapy. She has no current breast related complaints. Three standard views of both breasts, additional left ML view and three left spot magnification views 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. Round markers were placed on skin lesions and a linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present in the left lumpectomy site. Coarse benign calcifications are also seen within the left lumpectomy site. A stable benign mass is present in the posterior depth of the right breast. No new masses or suspicious microcalcifications are identified in either breast. Benign lymph nodes are projected over both axillae. | Expected postsurgical changes in the left breast. Stable right breast mass. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: lung nodule History: metastatic renal cell carcinoma, s/p LLL wedge, following RML nodule LUNGS AND PLEURA: Left lower lobe postsurgical scarring, pleural thickening and loculated effusion, unchanged.Reference right middle lobe subpleural nodule (series 4/66) 11 x 8 mm, not significantly changed.Right upper lobe nodule (series 4/45) measuring 5 x 5 mm, not significantly changed.Additional pulmonary nodules and micronodules are also unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy or pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation with no gross abnormalities. | Stable disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard and two implant pushback digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Retropectoral silicone implants are again noted bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 63 years old Reason: hx of left renal cyst, please evaluate change History: see above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nodular hepatic contour suggestive of chronic liver disease.SPLEEN: Punctate intraparenchymal calcifications suggest prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland nodule now measures 2.0 x 2.1 cm (image 48, series 7), unchanged from the CT dated 11/2011.KIDNEYS, URETERS: Minimally complex, lobulated and partially calcified cyst arising from the inferior pole left kidney, is unchanged from 2011. The ureters are well opacified with contrast on the delayed phase, without evidence of filling defect.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right hip arthroplasty device. Moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality notedPELVIS: Evaluation of the lower pelvis limited by beam hardening artifact from the patient's arthroplasty device.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right hip arthroplasty device. Moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality noted | Stable left adrenal nodule and minimally complex left adrenal cyst, without significant interval change from 11/2011 examination. |
Generate impression based on findings. | 60 year-old male with history of chronic tobacco use and chronic pulmonary nodules, with concern for Langerhans versus chronic infection. LUNGS AND PLEURA: Multiple bilateral solid/sub-solid pulmonary nodules are again seen, decreased in size and number from previous exam. Several previously seen nodules are now predominately thin-walled cysts, with only a rare minority having a persistent soft tissue density component. Minimal persistent groundglass opacities, particularly at the periphery and bases. No pleural effusion, new nodules or consolidation.MEDIASTINUM AND HILA: Right hilar lymph node (3/39) measures 11 mm, similar to prior measurement of 12 mm. Other mildly enlarged lymph nodes in the mediastinum and hila are similar to prior. Heart size within normal limits, no pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Bilateral neck base/supraclavicular lymph nodes are again seen, with a right supraclavicular lymph node reference measurement (3/1) unchanged, at 9 mm. Degenerative changes affect the spine, similar to prior.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the aorta and its branches. Hyperattenuating focus in the area of the gallbladder, likely a partially visualized gallstone. | Interval improvement in the multiple bilateral pulmonary nodules, with some of which having completely resolved. Scattered bilateral thin-walled cysts are present where many of the solid/sub-solid lesions were previously seen. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Few scattered benign calcifications bilaterally are present. No suspicious mass, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
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