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Generate impression based on findings. | Reason: heart transplant patient with shortness of breath, focal egophony, evaluate for infection History: shortness of breath LUNGS AND PLEURA: Exam was completed in partial expiratory phase of imaging.Small bilateral pleural effusions/thickening, and associated compressive atelectasis.Thickened interseptal lines suggests pulmonary edema.Multiple bilateral calcified pulmonary micronodules likely reflect previous granulomatous disease.Mild bronchial wall thickening suggests chronic bronchitis/bronchiolitis.MEDIASTINUM AND HILA: Status post heart transplant, multiple surgical clips noted at the aortic root.Mild cardiac enlargement, without significant pericardial effusion.Scattered prominent mediastinal/hilar lymph nodes, some of which are partially calcified, likely representing previous granulomatous disease.Mildly prominent main pulmonary artery suggests pulmonary arterial hypertension.CHEST WALL: Status post median sternotomy.Mild degenerative disease of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. Small bilateral pleural effusions/thickening and mild pulmonary edema. No focal consolidation or specific evidence of infection.2. Multiple prominent hilar/mediastinal lymph nodes are nonspecific, likely reactive in nature.3. Status post heart transplant.4. Stable bilateral calcified pulmonary micronodules, compatible with previous granulomatous disease. |
Generate impression based on findings. | 23-year-old male with pain, rule out subtalar coalition A prominent bony projection along the talonavicular joint consistent with a talar beak is again visualized. The posterior subtalar facet appears normal. The middle subtalar facet is narrowed with minimal sclerosis raising the question of underlying fibrous coalition. There is no osseous bridging visualized. The visualized soft tissues appear unremarkable. | Prominent talar beak and narrowing of the middle subtalar facet raising the question of underlying fibrous coalition. No osseous bridging is evident. |
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 composed of scattered fibroglandular density, unchanged in pattern and distribution. Grouped punctate calcifications in the upper outer quadrant of the right breast adjacent to a focal asymmetry are new compared to prior. No suspicious microcalcifications in the left breast. There are additional benign calcifications bilaterally. No dominant mass or architectural distortion. | New grouped calcifications with associated focal asymmetry in the right upper outer breast. Further evaluation with spot magnification views and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Male 75 years old Reason: restaging PCa History: PCa, with progressive fatigue CHEST:LUNGS AND PLEURA: Bibasilar atelectasis or scarring. 6-mm right middle lobe smaller compared to the previous exam. Additional scattered calcified and noncalcified pleural micronodules are nonspecific and unchanged.MEDIASTINUM AND HILA: There are severe coronary arterial calcifications. The heart is enlarged. The main pulmonary artery is enlarged measuring 3.7 cm in maximal diameter, which is nonspecific, but may be seen in the setting of pulmonary arterial hypertension.CHEST WALL: Sclerotic foci in the posterior left third rib unchanged. Sclerotic lesion in the T5 vertebral body appears unchanged. There is a new sclerotic lesion affecting the left clavicular head. Chronic appearing fracture and deformity affecting the posterior right sixth and seventh ribs. There are postoperative changes related to prior sternotomy. ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypoattenuating lesions are too small to characterize, but stable from the prior study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific adrenal thickening unchanged.KIDNEYS, URETERS: Atrophic appearance of the kidneys. Multiple bilateral hypoattenuating lesions most of which measure near water density.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with right hemicolectomy again seen.BONES, SOFT TISSUES: Sclerotic foci in the posterior left third rib unchanged. Sclerotic lesion in the T5 vertebral body appears unchanged. Unchanged sclerotic lesions are evident in the L2 and T10 vertebral bodies, consistent with additional metastatic foci. There is a new sclerotic lesion affecting the left clavicular head. There are multiple sclerotic lesions affecting the pelvis, which appear more dense when compared to the prior examination.Chronic appearing fracture and deformity affecting the posterior right sixth and seventh ribs. There are postoperative changes related to prior sternotomy. Partially imaged soft tissue mass in the superior left thigh is incompletely imaged, but not significantly changed.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is heterogeneously enlarged. There is median lobe hypertrophy which indents the bladder.BLADDER: There is mild nonspecific urinary bladder wall thickening.LYMPH NODES: Right external iliac chain node measures 0.9 x 1.5 cm (image 170, series 3), previously measuring 0.6 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic foci in the posterior left third rib unchanged. Sclerotic lesion in the T5 vertebral body appears unchanged. Unchanged sclerotic lesions are evident in the L2 and T10 vertebral bodies, consistent with additional metastatic foci. There is a new sclerotic lesion affecting the left clavicular head. There are multiple sclerotic lesions affecting the pelvis, which appear more dense when compared to the prior examination.Chronic appearing fracture and deformity affecting the posterior right sixth and seventh ribs. There are postoperative changes related to prior sternotomy. Partially imaged soft tissue mass in the superior left thigh is incompletely imaged, but not significantly changed. | 1.Sclerotic lesions scattered throughout the axial skeleton consistent with metastatic disease, somewhat progressed from the prior examination. Please see nuclear medicine bone scan for full evaluation of the osseous metastases.2.Stable pelvic lymphadenopathy.3.Nonspecific urinary bladder wall thickening, correlation for cystitis is recommended as clinically indicated.4.Unchanged soft tissue mass in the posterior right thigh, which is incompletely imaged and characterized. |
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, unchanged in pattern and distribution. Skin markers overlie the left upper outer breast. Scattered bilateral focal asymmetries also appear similar to prior. Scattered benign appearing calcifications bilaterally are not significantly changed from prior. 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. | New onset left-sided facial droop, left sided weakness, slurred speech for greater than 12 hours. Question of bleed or ischemia. There is no evidence of acute intracranial hemorrhage. There are multiple foci of hypoattenuation located within the right caudate head, right globus pallidus, and right precentral gyrus near the junction with the superior frontal gyrus along with patchy hypoattenuation within the right frontal deep and subcortical white matter. There is questionable subtle effacement of the frontal horn of the right lateral ventricle. The basal cisterns are patent. There is no midline shift or herniation. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage.2. Multiple foci of hypoattenuation within the right basal ganglia and right frontal lobe may represent age indeterminate ischemic infarcts; MRI is recommended for further evaluation. |
Generate impression based on findings. | Left leg pain.VIEWS: Left tibia-fibula AP/lateral (two views) 01/08/15 The bones are normal in appearance. No fracture is seen. No soft tissue abnormality is identified. | Normal examination. |
Generate impression based on findings. | 65-year-old female with the progressive change in mental status, paraneoplastic syndrome, possible malignancyRADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 236 mg/dL. Today's CT portion grossly demonstrates new bibasilar opacities and small pleural effusion likely representing aspiration/infection, extensive atherosclerotic coronary artery calcifications, a left adrenal nodule containing fat likely representing a benign adenoma, two hypodense liver lesions, stranding around bilateral kidneys likely related to medical renal disease, and diverticular disease without evidence of diverticulitis. An ET tube and Foley catheter are noted.Today's PET examination demonstrates a focal hypermetabolic nodule in the left anterior thyroid, SUV max 7.9. There are numerous borderline enlarged, moderately hypermetabolic bilateral cervical lymph nodes, SUV max 5.4. There is mild activity at both lung bases corresponding to new infiltrate consistent with inflammation. There is diffusely increased parenchymal uptake in the kidneys bilaterally suggestive of medical renal disease. There is a significantly hypermetabolic focus in a small loop of bowel in the left lower quadrant, SUV max 9.7. The segment 6/7 hepatic lesion seen on recent CT demonstrates decreased FDG uptake favoring a benign etiology such as hemangioma. No FDG activity is seen in the right lobe lesion. | 1.Hypermetabolic focus in the left thyroid may represent a benign or malignant primary thyroid nodule. Correlation with ultrasound may be useful2.Bilateral, symmetric, significantly FDG avid, borderline enlarged cervical lymph nodes. Considerations include lymphoma, metastatic thyroid cancer, or inflammatory lymph nodes.3.Significantly hypermetabolic focal small bowel lesion which may represent unusually focal benign physiologic / inflammatory appearance. A primary small bowel lesion is conceivable however.4.Additional findings suggestive of medical renal disease. |
Generate impression based on findings. | 64-year-old male with history of metastatic prostate cancer and dyspnea on exertion. LUNGS AND PLEURA: Stable scattered micronodules, some of which are calcified. Reference right middle lobe subpleural nodule (6/51) is unchanged in size, currently measuring 3 mm.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. Severe coronary artery calcifications. No mediastinal or hilar lymphadenopathy.Left thyroid nodule, unchanged.CHEST WALL: T11 vertebral body sclerosis has increased slightly from prior, nonspecific.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | T11 vertebral body sclerosis is subjectively increased when compared to prior. No additional significant anomalies. |
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 extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Female 68 years old Reason: eval for OA History: groin and buttock pain Right hip: Bone mineralization is normal. Alignment is anatomic. There is mild to moderate joint space narrowing and small superolateral acetabular osteophytes. No acute fracture or dislocation. Mild osteoarthritis affects the right sacroiliac joint.Left hip: Bone mineralization is normal. Alignment is anatomic. There is mild joint space narrowing and small superolateral acetabular osteophytes. No acute fracture or dislocation. Mild osteoarthritis affects the left sacroiliac joint.Vessel calcifications are noted in the pelvis. | Mild to moderate right hip osteoarthritis and mild left hip osteoarthritis. |
Generate impression based on findings. | 59-year-old female presents for routine screening mammography. Notes occasional tenderness in the bilateral upper breasts for two months. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round circumscribed masses in the right inner breast posterior depth previously shown to be a fibroadenoma (more anteriorly) and intramammary lymph node (more posteriorly), are not significantly changed. Within the upper inner left breast there is a new focal asymmetry. No suspicious microcalcifications or areas of architectural distortion are present. | New focal asymmetry in the left upper inner breast. Further evaluation with spot compression views and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Reason: lung nodule, see PET in PACS, super D protocol History: copd LUNGS AND PLEURA: Severe upper lobe predominant centrilobular emphysema with large bilateral apical bullae.Spiculated 16mm by 26-mm right lower lobe mass compatible with primary neoplasm.No additional suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Left paratracheal lymph node (image 36 series 4) measuring 12 mm in its short axis.Prominent pretracheal lymph node) image 24 series 4 measuring 11 mm in short axis. Hilar adenopathy cannot be adequately evaluated without IV contrast.Moderate-sized hiatal hernia. Cardiac size normal evidence of a pericardial effusion.CHEST WALL: Sclerotic lesion involving the T3 vertebrae and posterior elements as well as left transverse process.Sclerotic focus in the T8 vertebrae.No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Spiculated right lower lobe nodule compatible with a primary neoplasm.2.Mediastinal lymphadenopathy and osseous metastatic disease. |
Generate impression based on findings. | History of osteomyelitis evaluate healingVIEWS: Right wrist AP and lateral Again noted rarefaction involving the metaphysis of the distal radius and ulna with periosteal reaction reflecting interval healing of the osteomyelitis. There is associated soft tissue swelling. | Interval healing of the osteomyelitis involving the distal radius and ulna. |
Generate impression based on findings. | Dislocated hipVIEWS: Pelvis AP and frog leg There is lateral uncovering of both femoral heads in the AP projection. Both the acetabula are dysplastic. In the frog leg projection both the femoral heads are seated within the acetabula. | Lateral uncovering of both femoral heads in the AP projection with dysplastic acetabula. |
Generate impression based on findings. | 55-year-old female with pain, preoperative evaluation Severe osteoarthritis affects the right knee with lateral greater than medial joint space narrowing. There is approximately 9 degrees of valgus angulation of the knee relative to the neutral mechanical axis. | Severe osteoarthritis and valgus angulation about the knee. |
Generate impression based on findings. | 18 year-old female with severe right hip pain over past 72 hours, unable to bear weight. No fevers. History of Crohn's and psoriatic arthritis.VIEWS: Pelvis AP and frog leg (two views) 1/8/2015, 1350 hrs. The left sacroiliac joint is obscured by the overlying shield. Smooth, round femoral heads are well directed into normally formed acetabula. There is slight right hip joint space narrowing with respect to the left, which appears similar to that seen on CT. Few pelvic phleboliths are noted incidentally. | Slight right hip joint space narrowing. |
Generate impression based on findings. | Female 37 years old Reason: bleed History: sudden hg drop after chole tube removal. The exam is not sensitive for detecting lesions in the solid organs of vasculature due to the lack of intravenous contrast. Given that limitation, the following observations are made:ABDOMEN:LUNG BASES: Bibasilar atelectasis or consolidation. Probable small pleural effusions bilaterally.LIVER, BILIARY TRACT: Status post recent cholecystectomy with an air and fluid in the gallbladder fossa No evidence of subcapsular hematoma. Minimal pneumobilia consistent with recent tube removal.SPLEEN: Prominent, 14.8 cm in length coronal image 53.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate generalized low density ascites is nonspecific. No high density to suggest hemoperitoneum or organizing hematoma. No bowel wall thickening or dilatation.BONES, SOFT TISSUES: Marked generalized anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: IUD in place.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked generalized anasarca.OTHER: No significant abnormality noted | Nonspecific ascites and postoperative changes in the gallbladder fossa. Bibasilar atelectasis or consolidation. Severe generalized anasarca. |
Generate impression based on findings. | 57-year-old female status post total hip arthroplasty Hardware components of a total left hip arthroplasty are situated in near-anatomic alignment without evidence of complication. A cerclage wire is again noted along the proximal femoral diaphysis.Severe osteoarthritis affects the contralateral hip as seen on the AP view of the pelvis. | Status post THA without evidence of complication. |
Generate impression based on findings. | FractureVIEWS: Right forearm AP and lateral There are healing fractures involving the distal radius and ulna. There is periosteal reaction reflecting interval healing. The distal radial fracture fragment is displaced dorsally. The overlying cast obscures fine bony detail. | Healing forearm fractures as described above. |
Generate impression based on findings. | Male 47 years old pain Bone mineralization is normal. Moderate osteoarthritis affects the tibiotalar joint with osteophyte formation and subchondral sclerosis and cystic change in the distal tibia. Healed fracture through the posterior malleolus and fibula.There is ossification across a syndesmotic ligament and bony spurring in the medial and lateral gutter. No acute fracture is evident. There is mild soft tissue swelling. | Moderate left ankle osteoarthritis, likely a sequelae of trauma. |
Generate impression based on findings. | 79-year-old woman with history of ulnar neuropathy, rheumatoid arthritis, and osteoarthritis. The bones are diffusely demineralized. Severe osteoarthritis affects the humeral-ulnar articulation and appears to have progressed from prior study. Additionally, there is likely resection of the radial head. | Severe osteoarthritis of the elbow, worsened from the prior examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in both the paternal and maternal grandmothers. Two standard digital views of both breasts along with repeat bilateral MLO views were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Circumscribed mass in the left upper outer breast posterior depth has benign morphology and a fatty hilum on tomosynthesis, compatible with an intramammary lymph node. No suspicious morphology masses, calcifications or architectural distortion. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | 63 years old, Female, Reason: 63 year old female with follicular lymphoma s/p 4 cycles of bendamustine and rituxan therapy. Compare to prior scans. CHEST:LUNGS AND PLEURA: Mild dependent bibasilar atelectasis.MEDIASTINUM AND HILA: No significantly enlarged supraclavicular lymph nodes meeting criteria for lymphadenopathy.CHEST WALL: Clips are noted within the left axilla.ABDOMEN:LIVER, BILIARY TRACT: Three subcentimeter nonspecific hypodensities in the right lobe of the liver are too small to accurately characterize. These lesions are unchanged since prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal haziness with decreased lymphadenopathy. Previously noted left para-aortic lymph node is no longer definitely measurable.BOWEL, MESENTERY: Mesenteric haziness with significant decrease in previously noted conglomerate of mesenteric lymph nodes. The previously noted mass of lymph nodes is no longer measurable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter inguinal lymph nodes which do not meet size criteria for lymphadenopathy. Previously noted index right inguinal node is significantly smaller in size measuring 0.5 x 1.2 cm (series 3, image 176), previously measuring 2.1 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left total hip arthroplasty device in place and unchanged.OTHER: No significant abnormality noted. | 1.Near complete resolution of retroperitoneal, mesenteric, and pelvic lymphadenopathy.2.No evidence of new lesions. |
Generate impression based on findings. | History of two benign right breast biopsies. No new breast complaints. History of breast cancer in mother diagnosed at the age of 62. Three standard views of both breasts and two right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying both breasts. An X shaped clip is present at the 12 o'clock position of the right breast and a Hydromark clip is present in the right retroareolar region. Asymmetry at the 12 o'clock position of the right breast disperses into normal breast with spot compression imaging.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Benign lymph nodes are projected over both axillae. | 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. | Reason: patient w/ persistent tachycardia, sob, wheezing, LE edema, eval for PE History: wheezing, tachycardia, sob PULMONARY ARTERIES: Significant motion limits sensitivity. No evidence of acute pulmonary embolism. The main pulmonary artery is of normal caliber.LUNGS AND PLEURA: Exam was completed in expiratory phase of imaging. Debris is noted within the trachea.Bilateral pleural effusions with associated atelectasis, left greater than right.No focal consolidation.MEDIASTINUM AND HILA: Heart size is normal without significant pericardial effusion.Scattered, nonenlarged hilar/mediastinal lymph nodes. Moderate coronary artery calcifications, significant atherosclerotic calcification of the thoracic aorta.CHEST WALL: No significant axillary lymphadenopathy. Extensive degenerative disease of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Extensive vascular calcifications and mural thrombus of the abdominal aorta. Extensive atherosclerotic disease of the aortic branches including left renal and splenic arteries.The right kidney is not visualized. | 1. Significant motion limits sensitivity. However, no evidence of acute pulmonary embolism.2. Small bilateral pleural effusions, left greater than right.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 56 years old Reason: 55yr old female with history of MLL; pre-auto sctx evaluation CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Scattered nonspecific subpleural nodules are not significantly changed from the prior examination.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy on the basis of size criteria.CHEST WALL: There are nonspecific somewhat prominent bilateral axillary lymph nodes, most which have normal fatty hila.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked interval improvement of the retroperitoneal lymphadenopathy. Reference aortocaval node measures 0.9 x 1.5 cm (image 17, series 3), previously 3.8 x 2.0 cm. Reference pancreaticoduodenal space node now measures 0.8 x 1.7 cm (image 24, series 3), previously 2.7 x 2.0 cm.BOWEL, MESENTERY: There is mild nonspecific induration of the mesenteric fat of the mid upper abdomen.BONES, SOFT TISSUES: The bones appear demineralized.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac chain node now measures 0.7 x 1.5 cm (image 163, series 3), previously 1.5 x 1.1 cm. Additional non-reference lymph nodes have also decreased in size.BOWEL, MESENTERY: There is mild nonspecific induration of the mesenteric fat of the mid upper abdomen.BONES, SOFT TISSUES: The bones appear demineralized. | Treatment response suggested with marked interval decrease in size of both reference and non-reference retroperitoneal and pelvic lymph nodes, without new lymphadenopathy evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. BRCA1 mutation carrier. History of breast cancer in mother, sister and maternal aunt. History of ovarian cancer in maternal cousin. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of thyroid cancer. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign morphology bilateral axillary lymph nodes appear similar to prior. | 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. | 68-year-old male with history of lung cancer status post chemo, compared to previous with measurements please. CHEST:LUNGS AND PLEURA: Left upper lobe spiculated nodule (5/45) now measures 26 x 20 mm, previously 25 x 16 mm.Moderate upper lobe emphysema no consolidation, pleural effusion or new suspicious nodules or masses..MEDIASTINUM AND HILA: AP window enlarged lymph node (3/38) measures 15 mm, unchanged. No new mediastinal or hilar lymphadenopathy. Heart size within normal limits. No pericardial effusion. No appreciable coronary artery calcifications. Right central venous catheter tip is in the SVC.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subtle intrahepatic biliary dilation, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval increase in size of left upper lobe spiculated nodule, consistent with given history of lung cancer.2.Enlarged AP window lymph node unchanged in size. |
Generate impression based on findings. | Female 82 years old Reason: History of right lung mass, pain, weight loss ABDOMEN:LUNG BASES: Trace right basilar atelectasis.LIVER, BILIARY TRACT: Subcentimeter hypodensity in hepatic segment 8 is too small to characterize. There is cholelithiasis without evidence of cholecystitis. There is partial peripheral calcification of the fundus of the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating renal lesions measure significantly higher than fluid density and are consistent with hyperdense cysts. There is no evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: There is a cluster of subcentimeter gastrohepatic ligament nodes (image 21, series 4), which are not pathologically enlarged by size criteria, although special attention at follow-up is recommended.BOWEL, MESENTERY: There is a large hiatal hernia. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Nonspecific sclerotic focus in the sacrum is presumably benign in etiology. There is a compression fracture of the L1 vertebral body with approximate 25% loss of height, which is of indeterminate age. There is less than 25% loss of vertebral body height affecting multiple additional thoracic vertebral bodies more superiorly, which are of indeterminate age.PELVIS:UTERUS, ADNEXA: There is a 4.4 x 5.3 cm (image 82, series 4) partially cystic/partially solid mass in the right adnexa, which is worrisome for a ovarian neoplasm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a large hiatal hernia. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Nonspecific sclerotic focus in the sacrum is presumably benign in etiology. There is a compression fracture of the L1 vertebral body with approximate 25% loss of height, which is of indeterminate age. There is less than 25% loss of vertebral body height affecting multiple additional thoracic vertebral bodies more superiorly, which are of indeterminate age. | 1.No specific evidence of metastatic disease.2.Cluster of gastrohepatic ligament nodes are nonspecific, but attention on follow-up imaging recommended.3.Partially solid/partially cystic right adnexal mass, worrisome for neoplasm/primary ovarian malignancy. Further evaluation with pelvic ultrasound or MRI may be considered as clinically indicated. |
Generate impression based on findings. | Check healing Three views of the right foot reveal an fracture the base of the fifth metatarsal. There is some bone resorption at the fracture line consistent with healing. No change in alignment from the previous | Healing fracture base of fifth metatarsal |
Generate impression based on findings. | Male 44 years old Reason: right knee pain History: right knee pain Bone mineralization is normal. Alignment is anatomic. No acute fracture or dislocation.Tiny osteophytes are noted within the medial compartment. | No acute bony abnormality. Small medial compartment osteophytes |
Generate impression based on findings. | Reason: NHL, pulmonary nodule History: NHL, pulmonary nodule LUNGS AND PLEURA: Stable appearance of right middle lobe nodule with central calcification, measuring 10 x 9 mm (series 4, image 79).Unchanged appearance of calcified bilateral micronodules.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. The main pulmonary artery is of normal caliber.No significant hilar/mediastinal lymphadenopathy.Stable fluid density in the prevascular space, (series 3, image 40).CHEST WALL: No significant axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Unchanged, subcentimeter hepatic hypodensity, likely benign cyst. | Stable appearance of right middle lobe nodule, with central calcification, most likely representing a granuloma. No new suspicious nodule/mass. No significant interval change. |
Generate impression based on findings. | Tibial plateau fracture Two views of the right knee reveal two sideplates and multiple screws fixing a tibial plateau fracture. The fracture line is difficult to visualize consistent with healing. No change in position from the previous. | Fixation of tibial plateau fracture in anatomic alignment |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Skin markers identify cutaneous abnormality is in the left lower inner breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. Note is made of scattered vascular and benign parenchymal calcifications. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 70 years old Reason: right hip pain History: right hip pain Pelvis: Moderate degenerative changes affect the sacroiliac joints and pubic symphysis. Bone mineralization is normal. Linear sclerotic changes are noted in both hips compatible with avascular necrosis.Right Hip: Two views of the right hip shows pronounced linear sclerotic changes in the right hip compatible with avascular necrosis.No evidence for articular collapse. There is mild joint space narrowing. There are small acetabular osteophytes. | Findings of bilateral avascular necrosis of the femoral heads. |
Generate impression based on findings. | Follicular lymphoma status post 4 cycles of bendamustine and Rituxan therapy. Also history of breast invasive ductal carcinoma, stage T1cN0Mx, status post lumpectomy. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. Indeed, the right level 1A lymph nodes have decreased in size, now measuring up to 5 mm. The thyroid and major salivary glands are unchanged. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged paranasal sinuses and mastoid air cells are clear. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | No evidence of recurrent lymphoma in the neck. |
Generate impression based on findings. | 43 female with left hip osteoarthritis There is marked superior joint space narrowing with subchondral cysts and osteophyte formation consistent with severe osteoarthritis. The visualized soft tissue structures appear unremarkable. Degenerative arthritic changes also affect the contralateral hip. | Severe osteoarthritis. |
Generate impression based on findings. | 42 year-old woman with history of lupus, now with lateral jointline tenderness. The left knee appears normal without acute fracture or malalignment. There is no significant joint effusion. | No specific finding to account for the patient's pain. |
Generate impression based on findings. | 60 year-old female, preoperative evaluation There is approximately 6 degrees varus angulation of the knee relative to the neutral mechanical axis. Severe osteoarthritis affects the knee. | Severe osteoarthritis and mild varus angulation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign left breast biopsy in 2001. Family history of breast cancer in the patient's maternal grandmother diagnosed at the age of 65. Two standard digital views of both breasts were performed with tomosynthesis. 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 skin marker overlying the left upper outer breast identifies a cutaneous abnormality. Multiple stable circumscribed masses are present within both breasts. 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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 43 year-old woman with history of right wrist pain near the basilar joint. There is no acute fracture, malalignment, or significant degenerative change. | Normal-appearing right wrist without finding to account for the patient's pain. |
Generate impression based on findings. | Patient with lymphoma, methotrexate induced toxicity, multiple venous clots, on Lovenox. There is no significant cervical lymphadenopathy. The major salivary glands and thyroid are unremarkable. The airway is patent. There is normal contrast opacification of the bilateral carotid arteries. The left internal jugular vein is small in caliber and does not opacify compatible with chronic thrombosis, which is unchanged from the prior study. The left subclavian vein is poorly opacified and is inadequately evaluated on this examination. A right internal jugular chest port is present with the catheter tip outside the field-of-view. The right internal jugular vein appears patent. There is minimal mucosal thickening of the bilateral maxillary sinuses. The mastoid air cells are clear. The osseous structures are unremarkable. The thymus is partially imaged. There is no significant change of a left upper lobe pulmonary micronodule. There is a punctate calcified left upper lobe granuloma. | 1. Chronic left internal jugular venous thrombosis. Patent right internal jugular vein. 2. No significant cervical lymphadenopathy by CT size criteria. |
Generate impression based on findings. | 45 year-old woman with history of inflammatory arthritis and pain. Left hand: There are nonspecific, well defined cystic changes in the lunate. Joint spaces are preserved and there are no significant degenerative or erosive changes of the left hand.Right hand: There are nonspecific, well defined cystic changes in the lunate. The joint spaces are preserved and there are no significant degenerative or erosive changes of the right hand. A bony excrescence extending from the distal interphalangeal joint of the fourth digit is possibly due to old trauma.Left knee: Severe osteoarthritis affects the left knee with medial joint space narrowing, subchondral cyst, and tricompartmental osteophyte formation. Right knee: Moderate osteoarthritis affects the right knee with medial joint space narrowing and tricompartmental osteophytes.Left foot: Mild osteoarthritis affects the first metatarsophalangeal joint, otherwise the joint spaces are preserved and there are no erosions to suggest inflammatory arthritis.Right foot: Mild osteoarthritis affects the first metatarsophalangeal joint, otherwise the joint spaces are preserved and there are no erosions to suggest inflammatory arthritis. A side plate and screw device is seen affixing the distal fibula. | Degenerative changes as described above without specific findings of inflammatory arthritis. |
Generate impression based on findings. | Female, 82 years old, with chest pain and right chest mass, assess for neck involvement. A large right chest wall mass is redemonstrated. The inferior extent of this lesion is not included in the field of view of this exam, but superiorly, infiltrative tumor extends into the supraclavicular fossa and along the right paraspinal soft tissues to the C4 level.This mass encases the first and second right ribs, both of which show evidence of lytic destruction. Mild lytic destruction of the right C7 transverse process is also suspected. Tumor invades both the right C6-7 and C7-T1 neural foramina but without significant extension into the spinal canal itself.The right subclavian vein drapes over the anterior margin of the mass. However, the right subclavian artery is encased and perhaps mildly narrowed by the tumor. The right common carotid artery runs along the anterior margin of the mass but is neither encased nor compressed. The V1 segment of the right vertebral artery does not opacify well and may be compressed or encased by tumor. Upon entering the foramen transversarium at C5, the vessel seems to enhance normally.The thyroid is expanded by numerous heterogeneous predominantly hypoattenuating nodules which measure up to 30 mm in diameter. Two of the larger nodules demonstrate CT attenuation and morphology which is similar to the adjacent chest wall mass. The airway is mildly deformed by the thickened thyroid gland but is not severely compromised.Axillary lymph nodes are better assessed on chest imaging. Elsewhere in the neck, no pathologic adenopathy is detected by size criteria. The salivary glands are unremarkable. The aerodigestive mucosa is free of focal lesions. | Large right-sided chest wall mass with extension superiorly into the supraclavicular fossa and along the right lateral paraspinal soft tissues to the level of C4. The mass results in lytic destruction of the first two ribs on the right as well as the right C7 transverse process. Tumor invades the right C6-7 and C7-T1 neural foramina without significant encroachment upon the spinal canal itself.The right subclavian vein is encased and mildly narrowed by tumor in the supraclavicular fossa. The first segment of the right vertebral artery is not well seen and may also be involved by tumor.No pathologic adenopathy is detected more superiorly in the neck. However, the thyroid gland is diffusely thickened by the presence of numerous heterogeneous hypoattenuating nodules, some of which bear resemblance to the chest wall mass which would suggest that they are part of the same process. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. Note is made of scattered benign calcifications in the right breast. | 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. | Male 43 years old Reason: right foot pain History: foot pain with weight bearing, lateral right foot Bone mineralization is normal. Mild osteoarthritis affects the first MTP joint. There is some spurring in the anterior talus/tibia. Alignment is near-anatomic. | Etiology for the lateral foot pain is not evident. Other findings as detailed above. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (12/12/14), ultrasound images of right breast and right axilla (12/18/14), ultrasound guided biopsy of right breast and post procedural right mammographic images (12/23/14) performed at Palo's Diagnostic and Women's Health Center. For comparison, digital mammographic images (10/10/13, 6/13/12, 6/6/12, 10/15/10) are available. DIGITAL MAMMOGRAPHIC IMAGES (12/12/14):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A new lobulated mass, measuring 7 mm, is present in the posterior lower inner quadrant in the right breast.Stable focal asymmetry is seen in the upper outer quadrant in the right breast.No suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (12/18/14):A round mass with echogenic rim, measuring 6 mm, is detected at 5 o'clock position, 7 cm from the nipple, in the right breast, corresponding to the new mass on the mammogram. One normal appearing lymph node is seen in the right axilla.ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (12/23/14):Ultrasound guided needle biopsy was performed for the mass in the right breast at the 5 o'clock position, with an appropriate needle placement. Postprocedural right mammographic images show a marker clip placed posterior portion of the mass at posterior 5 o'clock position.Per outside pathology report, the result was malignant; invasive ductal carcinoma, grade 3. | 1. Biopsy proven invasive cancer in the right breast at posterior 5 o'clock position.2. No mammographic evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 66 years old Reason: restaging CT exam after chemo CHEST:LUNGS AND PLEURA: Interval decrease in size of the previously seen right upper lobe pulmonary micronodule. The focal airspace opacity in the superior segment of the right lower lobe has decreased in density, although the overall size is similar, likely reflecting resolving inflammation/infection.MEDIASTINUM AND HILA: The heart size is normal as is the caliber the great vessels. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. There are mild coronary arterial calcifications.CHEST WALL: Right chest all Port-A-Cath with tip has retracted and now terminates in the innominate region.ABDOMEN:LIVER, BILIARY TRACT: Hepatic segment 4A and hepatic segment 8 hemangiomas are unchanged. Hypoattenuating focus in hepatic segment 3 is not well seen on today's examination, which may reflect treatment response or relate to differences in phase of contrast.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Postsurgical changes related to right hemicolectomy.BONES, SOFT TISSUES: There are moderate/severe degenerative changes of the lower lumbar spine. Ventral fat-containing hernia.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Postsurgical changes related to right hemicolectomy.BONES, SOFT TISSUES: There are moderate/severe degenerative changes of the lower lumbar spine. Ventral fat-containing hernia. | 1.Interval decrease in density of the right lower lobe airspace opacity, likely reflecting resolving infection or inflammation. Follow up to resolution is recommended.2.Decrease in size of the reference right upper lobe pulmonary micronodule.3.Incompletely characterized subcentimeter hypoattenuating lesion in hepatic segment 3 has decreased in size, which may reflect treatment response or relate to differences in phase of contrast enhancement. 4.No new metastatic foci identified. |
Generate impression based on findings. | Follow-up for asymmetry in the right breast. No new breast complaints. 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. Focal asymmetry in the right breast is less conspicuous than on the prior study. Benign calcifications are present bilaterally.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Benign lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 73-year-old male with new onset gait disorder, concern for parkinsonian syndrome. Decreased bilateral putaminal activity, right worse than left. Decrease in overall basal ganglia activity compared to background activity indicating globally decreased phasic and clear activity. | Abnormal study indicating nigrostriatal dopaminergic deficiency. Given the history, this may represent Parkinson's disease. |
Generate impression based on findings. | 69-year-old female with history of lung cancer status post chemo. CHEST:LUNGS AND PLEURA: Previously described left lower lobe mass is less well visualized on the current exam. Increased left lower lobe interstitial opacities, bronchiectasis and pleural effusion.MEDIASTINUM AND HILA: Subcarinal lymph node (3/47) is unchanged in size, measuring 15 mm in the short axis.Left hilar lymph node (3/49) is unchanged, measuring 11 mm.No no significant lymphadenopathy.Cardiac size within normal limits. No pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Degenerative changes affect the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right upper quadrant cholecystectomy clips, and mild stable associated biliary dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral hypoattenuating foci, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Left lower lobe mass is not well visualized on this exam, and there is increased left lower lung interstitial opacities, project a cyst and pleural effusion. Other findings are unchanged. No new sites of disease. |
Generate impression based on findings. | The marrow matrix of the right mandible is within normal limits, without CT evidence of metastasis. Some sclerosis is noted at the roots, which can be seen with greater prevalence in African Americans and is of no clinical significance.The visualized teeth are intact without evidence of periapical abnormality.Technique limits visualization of the adjacent soft tissues. | 1.The marrow matrix of the right mandible is within normal limits, without CT evidence of metastasis. 2.Some sclerosis is noted at the roots, which can be seen with greater prevalence in African Americans and is of no clinical significance. |
Generate impression based on findings. | 15-year-old male with boxer's fracture.VIEWS: Left hand PA/lateral/oblique (3 views) 1/8/2015, 1415 hrs. Moderate soft tissue swelling about the fifth metacarpophalangeal joint. There is a 6-mm osseous fracture fragment with donor site seen in the lateral aspect of the fifth metacarpal head, with approximately 3-mm dorsolateral displacement. | Fifth metacarpal head fracture. |
Generate impression based on findings. | Increasing fall frequency, mild confusion. There is no evidence of intracranial hemorrhage or mass. There is minimal nonspecific cerbral white matter hypoattenuation, which may be related to small vessel ischemic diseae. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or hydrocephalus. |
Generate impression based on findings. | Syncopal episode. Question of signs of ischemia or lesions. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. The ventricles are normal size and configuration. The basal cisterns are patent. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is no depressed skull fracture. The scalp soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Male 62 years old Reason: evaluate for diverticulitis History: diarrhea, leukocytosis ABDOMEN:LUNG BASES: Mild cardiomegaly.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: There are moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There is a large stool burden distributed throughout the rectosigmoid colon, with wall thickening affecting the rectum with associated presacral edema, raising concern for stercoral colitis. Narrowing and apparent wall thickening of the distal sigmoid colon (coronal image 48), may reflect peristalsis, although focal inflammation is not excluded. There are no secondary signs of appendicitis.BONES, SOFT TISSUES: There is air in the subcutaneous fat, consistent with recent injection.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is heterogeneous, correlation for possible prostatitis is recommended as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a large stool burden distributed throughout the rectosigmoid colon, with wall thickening affecting the rectum with associated presacral edema, raising concern for stercoral colitis. Narrowing and apparent wall thickening of the distal sigmoid colon (coronal image 48), may reflect peristalsis, although focal inflammation is not excluded. There are no secondary signs of appendicitis.BONES, SOFT TISSUES: There is air in the subcutaneous fat consistent with recent injection. | 1.Large stool burden distributed throughout the rectosigmoid colon with findings concerning for possible stercoral colitis.2.Focal narrowing of the distal sigmoid colon with apparent wall thickening may reflect peristalsis; however, focal inflammation is not entirely excluded.3.No specific evidence of diverticulitis.4.Heterogeneous prostate gland, correlation for prostatitis is recommended as clinically indicated. |
Generate impression based on findings. | Ms. Lamothe is a 87 year old female with a personal history of known left breast cancer and metastatic lymph node currently being treated with chemotherapy. She presents today to assess for imaging response to therapy. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There has been an interval decrease in size of the known malignancy within the left inferior breast. The Hydromark clip remains within the central aspect of this malignancy. In addition, there has been an interval decrease in size of the metastatic lymph node. The Hydromark clip also remains within the central aspect of this node. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. LEFT ULTRASOUND | Marked interval decrease in size of left breast primary malignancy and left axillary lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 66-year-old male with history of recent pneumonia, rule out fracture of right posterior ribs A left chest wall generator is noted with leads extending to the right atrium and right ventricle. No fracture is identified. Moderate colonic stool burden. | No displaced rib fracture evident. |
Generate impression based on findings. | Ms. Delatorre is a 49 year old female returning for a short-term follow-up of calcifications in the right upper inner breast. Three standard views of the right breast with 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. Loosely grouped punctate calcifications are again identified in the right upper inner breast, posterior depth. The size and appearance of these calcifications have not changed since the prior exam. There is no new mass or areas of architectural distortion identified in the right breast. | High probability benign calcifications in the right upper inner breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram with right spot magnification views is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Right eye ptosis. History of metastatic gastric adenocarcinoma to the right orbit status post RT. Evaluate interval change. There is redemonstration of an infiltrative soft tissue mass within the extra- and intraconal right orbit which is grossly similar in size compared to the prior study. The lesion completely surrounds the right optic nerve. There is no definite intracranial extension or abnormal parenchymal enhancement. There is no definite extension through the inferior orbital fissure. The gray-white differentiation appears preserved. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The previously described lucency within the left frontal bone measuring 11 mm is unchanged. Other scattered similar appearing lucencies within the skull are also noted and grossly unchanged. The scalp soft tissues are unremarkable. | 1. No significant change in an infiltrative right orbital metastatic lesion. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | 69-year-old woman with knee pain, preoperative evaluation. There is 16 degrees varus angulation of the knee. Severe osteoarthritis affects the right knee and mild osteoarthritis affects the right ankle. | 16 degrees varus angulation of the right knee. |
Generate impression based on findings. | Metastatic thyroid cancer, evaluate for treatment. Neck: There are postoperative findings related to total thyroidectomy and neck dissection. There is unchanged ill-defined soft tissue along the inferior right carotid sheath and in the thyroidectomy bed, which may be treatment-related. Otherwise, there is no evidence of mass lesions or significant cervical lymphadenopathy. The salivary glands are unchanged. The right internal jugular vein is partially absent. There is degenerative cervical spondylosis. The airways are patent. However, there are numerous nodules within the partially imaged lungs. Head: There are multiple enhancing lesions in the brain, including the bilateral frontal lobes, left paracentral, and right cerebellar hemisphere. The largest of these lesions measures up to approximately 15 mm and some of the lesions are partially calcified and are associated with mild vasogenic edema. However, there is no midline shift or herniation. The ventricles are unchanged in size and configuration. There is minimal paranasal sinus opacification. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is a right lens implant. | 1. Postoperative findings related to total thyroidectomy and neck dissection, without evidence of locoregional tumor recurrence or significant lymphadenopathy in the neck.2. Multiple intracranial metastases.3. Numerous nodules within the partially imaged lungs are compatible with metastases. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | 13 year old male with hepatomegaly, severe ascites, status post Fontan procedure. Evaluate cirrhotic morphology of the liver. ABDOMEN:LUNG BASES: No consolidation or pleural effusion. Trace pericardial effusion is noted. Postsurgical changes in the heart, incompletely evaluated.LIVER, BILIARY TRACT: Nodular liver contour with heterogeneous parenchyma. No focal lesion is identified within the limitations of a single phase study. No biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: Normal spleen size.PANCREAS: Normal-appearing pancreas without focal lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically. A subcentimeter right renal hypodensity is too small to further characterize.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy is present.BOWEL, MESENTERY: Diffuse mesenteric haziness, likely representing edema secondary to ascites.BONES, SOFT TISSUES: No focal osseous lesion.OTHER: Moderate amount of perihepatic and parasplenic free fluid, tracking into the paracolic gutters bilaterally. | 1.Nodular heterogenous liver, compatible with stated history of cirrhosis. No focal lesion within the limitations of a single phase study.2.Moderate abdominal free fluid. |
Generate impression based on findings. | 66-year-old male with metastatic papillary thyroid cancer prior to clinical trialRADIOPHARMACEUTICAL: 14.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 152 mg/dL. Today's CT portion of the pelvis demonstrates lytic lesions in the right iliac wing and posterior left T12 vertebral body. Please see diagnostic CT reports for details of the head, neck, chest, and upper abdomen.Today's PET examination demonstrates innumerable, markedly hypermetabolic pulmonary parenchymal and mediastinal metastases which have increased in size, number, and metabolic activity when compared to previous exam. A reference metabolically active, new right infrahilar lesion measures SUV max 12.7. Multiple hypermetabolic osseous metastases in the right iliac wing (SUV max 8.0), posterior left T12 vertebral body, and right gluteal muscle (SUV max 7.1) are new from previous. | Marked progression of hypermetabolic thoracic and musculoskeletal metastases.Diagnostic CTs of the head, neck, chest, and upper abdomen also performed at today's visit will be reported separately. |
Generate impression based on findings. | Ms. Bowen is a 43 year old female returning for a short-term follow-up of calcifications in the right lower inner breast. Three standard views of the right breast with two right spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A 2 mm group of calcifications are again identified in the right lower inner breast, mid depth. The size and appearance of these calcifications have not changed since the prior exam. There is no new mass or areas of architectural distortion identified in the right breast. | High probability benign calcifications in the right lower inner breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram with right spot magnification views is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 43-year-old male status post fall from 15 feet There is a comminuted fracture of the distal tibia and fibula with multiple fragments projecting at various angles. Gas is noted within the soft tissues. Several small osseous fragments project over the tibiotalar joint. The left knee appears unremarkable.Moderate degenerative arthritic changes affect the right ankle without fracture. The right tibia and fibula appear normal. | Comminuted distal tibia and fibula fractures. |
Generate impression based on findings. | 57 year-old female with right foot pain at distal fourth and fifth metatarsal, history of distal first metatarsal fracture There is a minimally displaced fracture of the distal fourth metatarsal. Mild degenerative changes affect the 1st MTP joint. Mild soft tissue swelling is present along the foot. | Fourth metatarsal fracture, as above. |
Generate impression based on findings. | 51 year old female with bilateral pelvic iliac crest tenderness Alignment is anatomic. Degenerative changes affect the SI joints. The bones otherwise appear unremarkable. | SI joint osteoarthritis. |
Generate impression based on findings. | 46 showed female slipped on ice with tenderness on lateral and anterior aspect of the ankle Alignment is anatomic. No fracture is identified. No joint effusion is evident. | No fracture or other findings to account for the patient's pain. |
Generate impression based on findings. | Female 69 years old Reason: right shoulder pain History: right shoulder pain Bone mineralization is slightly decreased.Mild to moderate osteoarthritis affects the right glenohumeral joint with small osteophytes and subchondral cystic changes. Mild to moderate osteoarthritis affects the right AC joint. No acute fracture or dislocation. | Right glenohumeral and AC joint osteoarthritis. |
Generate impression based on findings. | T3N2C base of tongue squamous cell carcinoma on EPIC (CFHX) completed in 12/07. Neck: There is persistent treatment-related pharyngeal mucosal edema. There are postoperative findings related to neck dissection. There is no evidence of measurable mass in the tongue base or significant cervical lymphadenopathy. The thyroid and remaining salivary glands are unchanged. There has been interval increase in size of the sclerotic lesions in multiple partially imaged ribs and within the T3, T4, and partially imaged T5 vertebrae. There is extensive ossification of the posterior longitudinal ligament and anterior flowing osteophytes in the cervical spine with spinal canal narrowing, which is suggestive of diffuse idiopathic skeletal hyperostosis. The major cervical arteries are grossly patent. There is partially imaged left pleural thickening and biapical scarring. Head: There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a tiny retention cyst in the left sphenoid sinus. The mastoid air cells are clear. The skull and scalp soft tissues appear unremarkable. | 1. Post-treatment findings in the neck with appreciable evidence of recurrent tongue base tumor or significant cervical lymphadenopathy.2. Multiple osseous metastases have again slightly increased in size.3. Partially imaged left pleural thickening. Please refer to the separate chest CT report for additional details.4. No evidence of intracranial metastases.5. Evidence of diffuse idiopathic skeletal hyperostosis in the cervical spine. |
Generate impression based on findings. | Female, 56 years old, with history of laminectomy in 2010 now with increasing back pain. Again seen is evidence of laminectomy at L5 with partial resection of the L4 and L5 spinous processes. The postoperative findings have not significantly changed.There remains a chronic defect of the right L4 pars interarticularis. The adjacent right L4-5 facet joint is degenerated with evidence of vacuum phenomenon, also unchanged.No other fractures are detected. There may be a trace anterolisthesis of L3 relative to L4, but spinal alignment is otherwise unremarkable.L1-2: Mild facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No significant interval changes.L3-4: Moderate facet hypertrophy with ligamentum flavum thickening. Mild bulging disk and disk uncovering. Moderate generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No significant interval changes.L4-5: Marked right and moderate left facet hypertrophy. Posterior spinal canal surgical decompression. Large bulging disk similar to prior. Moderate to severe neuroforaminal narrowing bilaterally. No significant interval changes.L5-S1: Moderate facet hypertrophy. No significant spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes. | 1. Redemonstration of postoperative findings related to laminectomy at L5. Also unchanged is the appearance of a chronic right pars interarticularis defect at L4 with marked right L4-5 facet joint hypertrophy.2. Mild to moderate degenerative findings at other levels are unchanged. |
Generate impression based on findings. | 41-year-old female with history of lymphoma and headaches. Evaluate for intracranial bleed, mass, or infection. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No midline shift or mass effect. Ventricular configuration is age appropriate. The basal cisterns are intact. The paranasal sinuses and mastoid air cells are clear. The orbits are normal. The calvarium and scalp soft tissue are unremarkable. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: lung cancer; indwelling right BI bronchial stent History: cough, intermittent hemoptysis; hoarseness LUNGS AND PLEURA: Right bronchial stent in expected location. Soft tissue density within right main bronchial lumen, extending into the stent lumen may represent neoplastic invasion.Apical predominant paraseptal emphysema, with multiple apical bullae and peripheral scarring.Reference right lower lobe mass is obscured by radiation reaction. Consolidation/atelectasis, traction bronchiectasis, and surrounding ground glass opacities in the superior right lower lobe is compatible with radiation reaction.MEDIASTINUM AND HILA: Left chest port terminates at the cavoatrial junction.The heart size is within normal limits, no significant pericardial effusion. Mild coronary artery calcifications.Reference left paratracheal lymph node is no longer measurable.Enlarged subcarinal and right hilar nodes are not well demarcated the absence of IV contrast.Moderate hiatal hernia.Partially calcified mediastinal lymph nodes may represent previous adenomatous disease versus treated metastases.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. Endobronchial debris/soft tissue density which extends into the right bronchial stent lumen may represent neoplastic invasion or hematoma.2. Reference right lower lobe mass has been replaced by extensive radiation reaction.3. Interval improvement of mediastinal lymphadenopathy. |
Generate impression based on findings. | 30 year old female with right breast cancer status post chemotherapy. Needs lymphoscintigraphy for surgery.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.0 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | Female 73 years old Reason: pre-op History: pain There is 21 degrees varus angulation of the left knee.There are bone infarctions involving the distal femur, proximal tibia and distal tibia. Severe osteoarthritic changes affects the medial compartment with bone-on-bone apposition. | Bone infarctions and osteoarthritis as detailed above. |
Generate impression based on findings. | 47-year-old female with neurofibromatosis type I with right inguinal neurofibroma causing increased pain. Please compare to previous PET regarding right femoral/inguinal neurofibroma.RADIOPHARMACEUTICAL: 12.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates innumerable cutaneous soft tissue lesions in the neck, chest, abdomen, and pelvis which are not significantly changed. A right midthoracic paraspinal lesion is identified. A left lateral pleural based lesion is visualized. Masslike enlargement of the left psoas is seen. Right inguinal soft tissue mass is visualized. Lobular masslike enlargement around the uterus is noted. Patient is status post amputation at the level of the left proximal femur. Today's PET examination redemonstrates a small intensely hypermetabolic lesion in the right posterior thyroid lobe with maximal SUV of 16.3 (previous maximal SUV 13.6). In addition, there is a small mild to moderately hypermetabolic lesion in the inferior pole of the left thyroid lobe with maximal SUV of 5.4. The thyroid lesions are stable in size with increase in FDG activity and likely represent primary thyroid nodules which may be benign or malignant in nature.Again seen is a right midthoracic paraspinal lesion with mild to moderate FDG activity and maximal SUV of 4.7 (previous maximal SUV 2.6) and appears similar to previous study.In the left psoas muscle, there is mild to moderate hypermetabolic activity with maximal SUV of 4.2 which is slightly increased from previous study maximal SUV of 2.8.Within the pelvis, there is a medium-sized markedly hypermetabolic right inguinal lesion which has somewhat increased both in size and activity. Maximal SUV is now 16.4 (previous maximal SUV of 11.9).Additional hypermetabolic pelvic lesions which are left of the midline including and surrounding the uterus continue to be present. These lesions have areas of mild to markedly increased uptake, although overall, they are decreased in size and activity compared to prior study.Reidentified are numerous similar cutaneous lesions with mild activity.Physiologic activity is seen in the liver, spleen, kidneys, intestines, and bladder. | 1.Multiple hypermetabolic soft tissue masses in the chest, abdomen, and pelvis consistent with neurofibromatosis. The most metabolically active lesions are present within the pelvis and may represent malignant nerve sheath tumors. The lesion in the right inguinal region has progressed in size and FDG avidity. The left pelvic lesions have slightly improved. 2.Bilateral hypermetabolic thyroid nodules which could represent benign thyroid nodules, thyroid cancer, or additional nerve sheath tumors. |
Generate impression based on findings. | Female 47 years old Reason: restaging after chemo x 3 months. gastric cancer with peritoneal mets s/p resection and HIPEC. Right orbit metastasis s/p RT. CHEST:LUNGS AND PLEURA: Calcified micronodules again seen. No new nodules. No pleural effusions.MEDIASTINUM AND HILA: Port-A-Cath tip in the superior vena cava.CHEST WALL: Port-A-Cath left chest wall.ABDOMEN:LIVER, BILIARY TRACT: A few small hypodense lesions likely cysts unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index nodule situated between the liver and the right crus of the diaphragm as seen on series 3 image 97 and measures 1 x 0.6 cm. Previously 0.9 x 0.7 cm.Index small left periaortic node is too small to accurately measure probably corresponds to series 3 image 132, 0.8 x 0.6 cm. Previously 0.7-cm in maximal dimension.No new nodes.BOWEL, MESENTERY: Postsurgical changes stomach. Small amount of generalized ascites. No measurable carcinomatosis. No bowel wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites the dependent portion of the pelvis probably unchanged. No bowel wall thickening or dilatation. No measurable carcinomatosis.BONES, SOFT TISSUES: A few punctate sclerotic foci in the pelvic bones and right femur likely bone islands, unchanged from older scansOTHER: No significant abnormality noted. | Stable exam. |
Generate impression based on findings. | Reason: HNSCC. Compare to previous. 13-0311 protocol. History: as above CHEST:LUNGS AND PLEURA: Loculated left pleural effusion and volume loss in left lung similar to the prior exam.Left lower lobe nodule (image 73 series 6) is stable measuring 25 mm and 27 mm.Reference lingular 8-mm nodule (image 51 series 6) is stable.Increasing groundglass and centrilobular nodules in the right lung base are compatible with aspiration bronchiolitis.MEDIASTINUM AND HILA: Reference right paratracheal lymph node (image 29 series 4) measures 6 mm in short axis previously measuring 7 mm.Reference subcarinal lymph node (image 44 series 4) is stable measuring 13 mm.Additional mediastinal, hila, and left cardiophrenic lymph nodes are unchanged.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Redemonstration of multiple sclerotic rib, sternal, and vertebral metastases.Stable left infraspinatus intramuscular lipoma.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic hypodensities are not as well visualized with left hepatic lesion (image 96 series 4) unchanged measuring 2.8 cm.Right hepatic hypodensity measures 12 mm (image 90 series 4) previously measuring 14 mm.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal peripelvic cysts.PANCREAS: Stable pancreatic tail cyst.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: Redemonstration of the multiple prepuberal pelvic sclerotic metastases.OTHER: No significant abnormality noted. | On1.Pulmonary metastases are stable. No new nodules identified.2.Stable mediastinal lymphadenopathy.3.Stable hepatic and osseous metastatic disease.4.No new sites of disease identified.5.Interval increase in right basilar groundglass centrilobular nodules compatible aspiration bronchiolitis. |
Generate impression based on findings. | 51-year-old male with chronic back pain Vertebral body heights and alignment are maintained. Minimal degenerative disk disease affects L5/S1. | Minimal degenerative arthritic changes, as above. |
Generate impression based on findings. | 45-year-old female with ankle pain and swelling status post fallVIEWS: Three views of the left ankle, 3 views of the left foot Ankle: Alignment is anatomic. No fractureis evident.Foot: No fracture or dislocation. | No fracture or dislocation. |
Generate impression based on findings. | 64-year-old male status post EVAR with bilateral renal artery stents, now acutely anuric. RIGHT KIDNEY: The right kidney measures 10.7 centimeters in length without hydronephrosis or shadowing calculus. Renal cortical echogenicity within normal limits.LEFT KIDNEY: The left kidney measures 10.6 cm in length without hydronephrosis or shadowing calculus. Renal cortical echogenicity within normal limits.URINARY BLADDER: The urinary bladder is contracted and not visualized. | No hydronephrosis. |
Generate impression based on findings. | Female 50 years old Reason: h/o liver microabscesses on antibiotic therapy from previous CT. Pleas eval if resolved. History: h/o liver microabscesses ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are two classes of lesions in the liver: Most lesions are simple hypodense lesions most of which are unchanged from the prior exam and could represent cysts or healed abscesses and it least one of these lesions in segment 7, series 3 image 28, measures slightly larger, 1.4 x 1 cm.It least one lesion has (and had) peripheral nodular enhancement and is nearly isodense with liver likely representing an hemangioma, located in the medial segment of the left lobe (probably Series III image 26) but is seen better on the prior exam Series #3, image #17.Some of the other small hypodense lesions for example those along the subcapsular aspect of the left lobe near the dome are no longer visible. These could represent healed abscesses or hemangiomas that are now isodense with liver in this phase.There are no new lesions.Hepatic and portal veins enhance normally. No biliary dilatation. No perihepatic fluid or fat stranding. Small granuloma unchanged.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: Previously seen colonic wall thickening is markedly diminished and the pericolonic fat stranding is resolved. The transition zone between normal and abnormal colon is seen in the mid transverse colon, series 3 image 52. Small bowel is normal. There is no evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Marked decrease in colonic wall thickening involving the distal half of the colon with resolution of the pericolonic fat stranding and fluid. Fibrofatty proliferation and an ahaustral is still seen consistent with history of Crohn's disease. Small bowel is normal. There is no free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | I believe that the liver lesions may represent a combination of cysts, hemangiomas and healed abscesses.Marked decrease in the colonic wall thickening and resolution the pericolonic fat stranding. |
Generate impression based on findings. | 49-year-old man with history of neck pain for two months, no history of trauma. The cervical spine is seen to the cervicothoracic junction. Alignment is within normal limits. Vertebral body and intervertebral disc heights are preserved. | No finding to account for the patient's pain. |
Generate impression based on findings. | Head injury. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No acute intracranial abnormality. |
Generate impression based on findings. | 23 old female with snuffbox tenderness There is a subtle cortical step off along the radial styloid suggesting a nondisplaced fracture. The carpal bones appear within normal limits. | Subtle, nondisplaced radial styloid fracture. Follow up radiographs may be considered in 7 to 10 days for further evaluation if clinically warranted. |
Generate impression based on findings. | Counting convention assumes 12 rib bearing vertebrae, with no evidence of cervical ribs or hypoplastic L1 ribs. The last fully formed disk space on the sagittal reformatted images is designated as L1-L2. Please this is different than the prior counting convention.There is slight increased conspicuity of trace grade 1 anterolisthesis of T2 on T3. The scout lateral view and the sagittal reformatted images demonstrate the thoracic spine to be otherwise in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk space heights are well-maintained. Dorsal osteophytes are again noted at T9-T10. There is no acute fracture. There is redemonstration of a spinal cord stimulator which enters through the bony central spinal canal at the T11-T12 level, unchanged in position to the prior exam. There is slight widening of the interlaminar space at this level. There is no discontinuity of the electrodes. A battery pack is out of the field of view.The axial images do not demonstrate any significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.Limited views through the retroperitoneum demonstrate no gross abnormalities. Surgical clips are seen within the gallbladder fossa which likely relate to previous cholecystectomy. Scattered blebs are noted. | Stable appearance of the thoracic spine with evidence of spinal cord stimulator entering the bony central spinal canal at the T11-T12 level. Please note that the current counting convention is different from that utilized on the prior exam, with the current counting assuming 12 rib bearing vertebrae. |
Generate impression based on findings. | 75 years old, Male, Reason: recent diagnosis of tonsil CA History: tonsil ca, Weight loss, LAD CHEST:LUNGS AND PLEURA: Scattered calcified noncalcified and micronodules. No suspicious pulmonary nodules or masses. Mild dependent bibasilar atelectasis.MEDIASTINUM AND HILA: Enlarged left paratracheal lymph node measures 2.0 cm by 1.4 cm (series 3, image 33). Calcified right hilar lymph nodes. Moderate coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There are no focal hepatic lesions. Gallbladder is normal in appearance. Scattered lymph nodes within the porta hepatis not meeting size criteria for lymphadenopathy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scarring of the right kidney possibly due to prior infection.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral hip arthroplasty devices are present.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral hip arthroplasty devices are present.OTHER: No significant abnormality noted | Single enlarged left paratracheal lymph node. No other evidence of distant metastasis. |
Generate impression based on findings. | Skull fracture. Rule-out other injury.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 01/08/15 Right parietal soft tissue swelling is identified. A linear fracture of the right parietal bone measures approximately 4 cm in length.Bone mineralization and modeling are normal. No other fractures are seen.A small umbilical hernia is present. | Isolated right parietal fracture. |
Generate impression based on findings. | Male, 62 years old, status post falls. Assess for intracranial hemorrhage. Extensive chronic cortical ischemia is seen in the right cerebral hemisphere with areas of hypoattenuation and/or encephalomalacia involving the periventricular white matter, the right parietal lobe, insula and temporal lobe.Mild patchy white matter hypoattenuation is seen in the left hemisphere which is nonspecific but compatible with age indeterminate small vessel ischemic disease. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ex vacuo dilatation of the right lateral ventricle is seen but the ventricular system is otherwise unremarkable. No evidence of parenchymal edema or mass effect is seen.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear. | 1. Extensive chronic right sided cortical ischemia is seen in the distribution of the MCA.2. No evidence of acute intracranial hemorrhage or any other definite acute abnormalities. |
Generate impression based on findings. | Right breast cancer. Evaluate prior to right axillary sentinel node biopsy.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.0 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | Abnormal gait, mental status change. Question of NPH. There is no evidence of acute intracranial hemorrhage. Moderate periventricular white matter hypoattenuation is nonspecific but likely represents small vessel ischemic disease. The ventricles and cortical sulci are proportionally prominent and unchanged compared to the prior exam. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. No definite evidence of normal pressure hydrocephalus or interval change in ventricular size. 2. No acute findings or significant interval change. |
Generate impression based on findings. | Dementia. Evaluate for Alzheimer's versus frontotemporal dementia.RADIOPHARMACEUTICAL: 10.0 mCi F-18 fluorodeoxyglucose (FDG)BLOOD GLUCOSE (FASTING): 86 mg/dL Today's CT portion grossly demonstrates fairly generalized atrophy but no evidence of intracranial mass or hemorrhage.Today's PET portion demonstrates markedly decreased radiotracer activity involving the right posterior parietal as well as throughout the right occipital lobe. There is also markedly decreased activity throughout the right precuneus. Significantly milder but still abnormally decreased activity is seen involving the left posterior parietal, left occipital, and left precuneus.There is relative sparing of the frontal lobes as well as the temporal lobes bilaterally. | Significant hypometabolism involving the right posterior cerebrum as detailed above with much milder decreases in similar regions on the left. Given the posterior parietal and precuneal involvement, Alzheimer's is a possibility. However, given the substantial occipital abnormalities, Lewy body dementia should also be considered. The appearance is not typical for frontotemporal dementia. |
Generate impression based on findings. | Female 57 years old Reason: r/o fracture History: pain, swelling, tenderness, inability to bear weight Bone mineralization is decreased. There is a fracture involving the distal fibular metaphyses with mild displacement of the fracture fragments. There is a subtle lucency through the medial malleolus seen on the oblique view highly suspicious for a nondisplaced fracture.There is severe swelling about the ankle.Metallic fragments are projected adjacent to the lateral aspect of the foot.The talar dome is intact. | Findings of a distal fibular fracture and findings highly suspicious for a medial malleolus fracture. |
Generate impression based on findings. | Female 56 years old Reason: assess for bony abnormalities History: 3rd MCP pain Bone mineralization is normal. Alignment is anatomic. There is mild interphalangeal joint space narrowing compatible with osteoarthritis. There is mild metacarpophalangeal joint space narrowing with tiny osteophytes. No acute fracture is evident. | Mild interphalangeal and metacarpophalangeal joint osteoarthritis |
Generate impression based on findings. | Female 49 years old Reason: eval for fracture History: pain s/p mVC Bone mineralization is normal. Alignment is anatomic. Mild osteoarthritis affects the hips with small osteophytes and joint space narrowing. No acute fracture is evident. | Mild bilateral hip osteoarthritis without evident fracture. |
Generate impression based on findings. | Female 26 years old Reason: visualize the hardware History: pain Postsurgical changes in the lumbar spine and left sacrum with bone graft material. Pedicle screws extend through the L4 and L5 vertebral bodies with additional hardware in the right sacrum, right ilium and left ilium.No definite evidence of hardware complication. Alignment is unchanged. | Postsurgical changes in the lower lumbar spine and sacrum as detailed above |
Generate impression based on findings. | Female 55 years old Reason: hx B TKA, s/p MVC, with knee pain anterior History: hx B TKA, s/p MVC, with knee pain anterior Right knee: Components of a total right knee arthroplasty device is situated in near-anatomic alignment. No joint effusion. No acute fracture.Left knee: Components of total left knee arthroplasty device is situated in near anatomic alignment. No joint effusion. No acute fracture. | No acute fracture or dislocation. |
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