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Generate impression based on findings. | 46-year-old female who presents for short-term evaluation of focal asymmetry in the upper inner right breast. No current breast complaints. History of breast cancer in mother diagnosed at age 70 and maternal aunt diagnosed at age 49. 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. Previously noted focal asymmetry in the right upper inner breast is not as conspicuous on the current examination and was most likely overlapping breast parenchyma. Benign calcifications are present bilaterally, the majority of which are in the skin. No suspicious masses, microcalcifications or areas of architectural distortion are present in either breast. Stable lymph nodes are present in the superior left breast. | Focal asymmetry in the medial superior right breast is less conspicuous than on prior studies. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | History of bleed, planning to start aspirin. Compared to 12/20/2014, interval resolution of previously seen cerebral edema and development of global parenchymal volume loss, consistent with evolution of global hypoxic injury.There is been evolution of multiple previously seen intraparenchymal hematomas. There is small residual intraparenchymal hematoma involving the cuneus of the left occipital lobe and measuring 3 x 9 mm, previously 6 x 18 mm. There is also small residual hematoma involving the left lateral occipital lobe, measuring 4 x 7 mm, previously 6 x 7 mm. There is mild surrounding edema/gliosis. Additional smaller foci of hemorrhage are less conspicuous or no longer seen.No new hemorrhage. No evidence of mass-effect. No hydrocephalus. No extra-axial collections. Calvarium is intact. | 1. Compared to CT 12/22/2014, there has been resolution of previously seen cerebral edema and development of global parenchymal volume loss compatible with evolution of global ischemic injury.2. Evolution of previously seen hemorrhages with subcentimeter residual intraparenchymal hematomas in the left occipital lobe. No new hemorrhage. No significant mass effect or hydrocephalus. |
Generate impression based on findings. | Right upper lobe lesion. History bladder cancer. Pathology report states left lower lobe invasive adenocarcinoma in 2008. LUNGS AND PLEURA: Left pneumonectomy cavity filled with fluid, unchanged in appearance.Spherical right upper lobe nodule abutting the fissure remains predominantly groundglass in density at contains several branching "bronchiolar" appearing focal densities, highly suspicious for adenocarcinoma, measuring 22 x 16 mm, previously 20 x 15 mm (series 4, image 53). This has significantly increased in size from previous exam such as 12/2011, where it measured 10-mm.Right apical ground glass density nodule measures 10 mm, unchanged (series 4, image 11).The adjacent right upper lobe nodule (series 4, image 15) is similar in density containing groundglass and some solid components, measuring 21 x 11 mm, previously 18 x 8mm.Nodular scarring at the right apex stable over multiple prior studies.Numerous additional groundglass nodules in the right upper lobe are not significantly changed, a small 7-mm lesion (series 5 image 68) contains a knee stable punctate solid component.4-mm apart solid nodule right lower lobe previously 3-mm on the last exam and not present prior to the study. Additional right lower lobe lesions not significantly changed.MEDIASTINUM AND HILA: Small left mediastinal lymph nodes stable to slightly decreased in size, measuring up to 5-6 mm. Leftward mediastinal shift, ectasia of the thoracic aorta, cardiomegaly unchanged. Coronary artery calcifications. Nodal dissection clips, no new lymph nodes appreciated.CHEST WALL: Previously identified lymph nodes contained within the subpleural fat of the left apex appear slightly decreased in size.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta and its branches. Left extrarenal pelvis wall thickening incompletely assessed (3/107) more prominent than expected for peripheral vasculature; hydronephrosis was present previously. Hypoattenuating lesion at the apex of the right kidney poorly visualized but not appreciably changed. Hypoattenuating lesion in the interpolar region of the right kidney anteriorly increased in size from prior studies but measures 24 HU, favoring a cyst, incompletely assessed. Hypoattenuating lesions in the left kidney are most consistent with cysts. | 1. Stable to improved appearance of small lymph nodes of unclear etiology or clinical significance.2. Right upper lobe nodule abutting the fissure continues to increase in size and is highly compatible with an indolent adenocarcinoma; the small branching solid components could reflect tumor within the distal airways/ invasive component.3. Second-largest lesion in the right upper lobe but measures slightly larger, the apical lesion is unchanged; these are also suspicious for indolent adenocarcinomas.3. Numerous additional lesions may range from atypical adenomatous hyperplasia to AIS/MIA and should continue to be monitored. |
Generate impression based on findings. | Reason: lt mca stroke s/p tpa, mechanical thrombectomy History: 24hr CT post tPA There is residual contrast present within the vasculature in this patient with chronic renal failure. There is enhancement of the cortical and leptomeningeal structures of the left MCA territory. Since the prior exam cortical hyperdensity has extended further and there is mass effect with effacement of sulci and mild medial deviation of the uncus.Coils are present in the region of the left cavernous sinus .The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.Contrast enhancement within the left MCA territory cortex and leptomeninges likely represent infarcted tissue indicating large left MCA territory infarction. There is greater mass effect on the current exam when compared to the prior with a very minimal uncal shift.2.Intravascular contrast still remains. |
Generate impression based on findings. | 26 show male with history of incidental lung nodule. LUNGS AND PLEURA: Previously seen left lower lobe micronodular is again seen, and is unchanged in size. Additional pulmonary micronodules are present, and were noted previously. No new pulmonary nodules, no pleural effusion and no consolidation.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. No mediastinal or hilar lymphadenopathy. No coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left renal cyst, unchanged. | Scattered pulmonary micronodules, similar to prior. Patient of this age, without known cancer or other risk factors, these are almost certainly benign. If imaging follow-up desired, low-dose CT chest without contrast in one year may be obtained. |
Generate impression based on findings. | Reason: severe family hx of mesothelioma. Chest pain. RUL pleural thickening History: chest pain LUNGS AND PLEURA: Right upper lobe likely calcified micronodules.Punctate subpleural micronodules versus punctate pleural thickening is likely benign, and there is no evidence of mesothelioma.No pleural effusion.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.No evidence of coronary calcifications, the heart and pericardium appear normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant abnormality, and no evidence of pleural mesothelioma. |
Generate impression based on findings. | Male; 39 years old. Reason: s/p left foot/ankle injury History: left foot/ankle pain and swelling Three views of the left ankle demonstrate mild diffuse soft tissue swelling. Ankle mortise is intact. No acute fracture or malalignment is evident.Three views of the left foot demonstrate mild hallux valgus deformity. No acute fracture or malalignment is evident. | No acute fracture or malalignment. |
Generate impression based on findings. | Female; 61 years old. Reason: Right shoulder pain History: Right shoulder pain Three views of the right shoulder demonstrate minimal glenohumeral joint osteoarthritis, slight spurring of the greater tuberosity, and moderate AC joint osteoarthritis. No acute fracture or malalignment is evident. Mild calcifications of the coracoclavicular ligament of unclear etiology, potentially due to old trauma. Axillary surgical clips noted. | Degenerative arthritic changes as described above. |
Generate impression based on findings. | 33-year-old female with right breast palpable abnormality who presents for evaluation. Patient also with spontaneous milky discharge from the right nipple. History of breast cancer in paternal aunt. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts, two right spot compression views and two right spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. A triangular marker was placed on the skin at the site of palpable concern. No suspicious masses, microcalcifications or areas of architectural distortion are present in either breast even with spot compression imaging at the 12 o'clock position of the right breast. TARGETED RIGHT BREAST ULTRASOUND: On physical examination, there is a small palpable lesion at the right 12 o'clock position. No discharge could be elicited from the nipple upon manual expression. A targeted right breast ultrasound was performed for the patient’s palpable area of concern. There is no suspicious solid mass identified. There is a circumscribed, hypoechoic lesion with posterior acoustic enhancement and no vascularity at the right 12 o'clock position, 1 cm from the nipple, measuring 2.1 x 1.1 x 1.2 cm, consistent with a simple cyst. | Findings consistent with a simple cyst at the right 12 o'clock position. No mammographic or sonographic evidence of malignancy. Follow up per the clinical service is recommended. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Female, 71 years old. Reason: Eval if J tube tip is distal to ligament of Treitz History: Eval where J tube tip is located Percutaneous gastrostomy tube overlying the left upper abdomen. Percutaneous J-tube overlying the midabdomen, slightly left of midline. Based on the local paucity of small bowel gas, location of the J-tube can not be determined on this exam relative to the ligament of Treitz.Nonobstructive bowel gas pattern. Contrast is seen within the colon from recent prior procedure.Lumbar spinal fixation hardware. | Indeterminate location of the J-tube relative to the ligament of Treitz. Repeat abdominal radiograph immediately following administration of enteric contrast through the J-tube can be helpful for further evaluation. |
Generate impression based on findings. | Evaluate for brain and spine metastasis HEADNo abnormal enhancement to suggest metastatic disease. No intracranial mass or evidence of mass-effect. No intracranial hemorrhage is identified. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.CERVICAL, THORACIC, LUMBAR SPINEVertebral body heights in the cervical, thoracic, and lumbar spine are normal. There is straightening and dextrocurvature of the thoracolumbar spine which is likely positional. Alignment is grossly maintained. There is an 11-mm sclerotic focus involving the posterior lateral aspect of the L2 vertebral body on the left. involving the dorsal L2 vertebral body, which was seen previously. Otherwise, no destructive lesions are seen to suggest metastatic disease.No significant spinal canal or neural foraminal stenosis is seen in the cervical, thoracic, or lumbar spine.Please refer to separate report regarding findings in the chest, abdomen, and pelvis. | 1. No evidence of intracranial metastatic disease.2. 9x11 mm sclerotic focus involving the left aspect of the L2 vertebral body is unchanged since at least 7/10/2014. Lesion may represent a benign bone island but is indeterminate. Otherwise, no evidence of metastatic disease to the cervical, thoracic, or lumbar spine.3. Please refer to separate report for findings in the chest, abdomen, and pelvis. |
Generate impression based on findings. | There is marked interval increase in size of diffuse cervical lymph nodes. For example, a right level 1B lymph node measures 18 x 30 mm, previously 5 x 15 mm, a left level 2A lymph node measures 12 x 12 mm, previously 5 x 6 mm, and a left level 4 lymph node measures 10 x 18 mm, previously 5 x 6 mm. Likewise, bilateral axillary and subpectoral lymph nodes have markedly increased in size. The major salivary glands and thyroid gland are unremarkable. The carotid and vertebral vasculature are patent. The left carotid artery has a retropharyngeal course. The internal jugular veins are patent. There is unchanged multilevel degenerative spondylosis. There is an incomplete posterior arch of C1, which is a normal variant. There is unchanged anterior wedging of C6. There is an unchanged well-defined lucent lesion in the right basiclivus that measures. The imaged portions of the brain are grossly unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1.Recurrent diffuse cervical and bilateral axillary and subpectoral lymphadenopathy, compatible with relapsed leukemia. 2. Unchanged nonspecific lucent lesion in the right basiclivus. |
Generate impression based on findings. | Reason: eval size of known hematomas (intraparencyhmal and subdural) History: see above The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a focus of encephalomalacia located along the right middle frontal gyrus and the right pre-central gyrusA hypodense focus in the left frontal lobe at the orbital gyrus previously represented an intraparenchymal hematoma. It is now smaller and measures approximately 24 by 27 mm axial dimensions. There is hypodensity present in the adjacent periventricular white matter. There is associated 3mm left subdural collection.There is demonstration of a punctate hypodense focus in the left posterior limb of internal capsule appeared this has been stable over the previous exams.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses and demonstrate minor opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Findings are suspicious for proptosis. The distance between the interzygomatic line and the cornea is 27 mm. | 1.There is a chronic stage hematoma present in the left orbital gyrus which has regressed in dimensions when compared to the previous exam and associated with a small extra-axial component.2.A small focus of encephalomalacia is present at the subcortical white matter of the posterior right frontal lobe. This is stable since the prior exam. It is suspected to most likely be vascular related.3.Findings are suspicious for proptosis. Please correlate with physical findings and clinical exam. This is stable compared to previous exams |
Generate impression based on findings. | 57-year-old male with newly diagnosed lung cancerRADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 73 mg/dL. Today's CT portion grossly demonstrates small circular calcification in the posterior horn of the left lateral ventricle, partially visualized. Partial opacification of bilateral maxillary sinuses. There is lymphadenopathy in the right paratracheal, AP window, subcarina, and right hila. There are new patchy opacities in the right hilum and right lower lobe. There is a ground glass opacity in the left upper lobe. There is a lucency in the left iliac bone, new from prior. There is mild interstitial septal thickening.Today's PET examination demonstrates increased activity corresponding to right paratracheal, right perihilar, and mediastinal lymphadenopathy which is worse compared to the prior exam, SUV max 9.7, previously 2.4. There is hypermetabolic activity in the right hila corresponding to lymphadenopathy and the right perihilar mass. There is increased FDG uptake corresponding to right lower lobe opacity which may be inflammatory or neoplastic. There is mild increased activity corresponding to groundglass opacity in the left upper lobe which is probably inflammatory. There is questionable uptake in the left L4 vertebral body, new from prior. There is mildly increased uptake corresponding to a lucent lesion in the left iliac bone. There is a left, posterior sixth rib lesion. | 1.Hypermetabolic activity in patchy opacities in the right upper and lower lobe may be neoplastic in etiology, increased from the prior exam. Associated hypermetabolic activity corresponding to right paratracheal, right perihilar, and mediastinal lymphadenopathy likely represents metastatic involvement, increased since the prior exam.2.Questionable osseous hypermetabolic activity in the left L4 vertebral body, left iliac bone, and posterior sixth rib may represent metastatic disease. |
Generate impression based on findings. | Base of tongue mucoepithelial status post chemo. CHEST:LUNGS AND PLEURA: Large right pleural fluid collection increased in volume. Extensive pleural metastatic disease increased. Right-sided chest tube is present with tip at the level of the right third rib posteriorly. The right lower lobe and middle lobe are collapsed. Compressive atelectasis involving the posterior aspects of the right upper lobe. Previously noted areas of nodular air space consolidation in the right upper lobe have significantly improved with near complete clearing. There is a residual focal air space opacity (5/44) distal to an endobronchial metastasis in an anterior right upper lobe subsegment.Left lower lobe endobronchial or peribronchial lesion (5/49) causing mild compression of the subsegmental airway unchanged. 8mm nodule superior to this lesion, also appearing endobronchial has enlarged, previously 6-mm.MEDIASTINUM AND HILA: Right chest port tip in the right atrium. Normal heart size. Interval decrease in pericardial fluid volume. Pericardial and cardiophrenic nodal metastases unchanged.CHEST WALL: Numeral metastases in the soft tissues of the chest wall and the partially visualized left shoulder/upper extremity. Reference lesion on the right measures 2 x 1.7 cm, previously 1.5 x 1.4 cm (3/42). The previously described axillary soft tissue nodule is better seen on today's study and contained within the breast, measuring 14-mm, previously 12-mm (3/54. Numerous lesions are seen in the breasts bilaterally. Right internal mammary lymphadenopathy, mild. Numerous small lymph nodes in the axillary and subpectoral regions bilaterally not significantly changed. Enhancing lesion anterior to or arising from the left thyroid gland better seen on today's study.Numerous small sclerotic metastases throughout the skeleton increased in density since the prior examination but were in retrospect present previously, new from the scan of 9/16/2014. The previously mentioned T9 lesion is about the same.Small enhancing intramuscular metastases in the paraspinal musculature and musculature surrounding the scapulae, left greater than right, some of which are new.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic metastases increased in size and number. Right lobe lesion measures 5.1 x 3.4 scan, previously 2.5 x 1.5 cm (3/84).SPLEEN: Splenic metastases increased in number.ADRENAL GLANDS: Nodular thickening of left adrenal gland unchanged.KIDNEYS, URETERS: New lesion in the anterior left kidney interpolar region. Left posterior pararenal soft tissue nodule increased in size.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.New soft tissue nodule adjacent to the duodenal lobe (3/108) causes mild mass effect.BONES, SOFT TISSUES: Intramuscular metastasis knee left inferior psoas (3/134) and an additional lesion in the fat posterior to the psoas musculature on the right (3/127).OTHER: No significant abnormality noted. | Interval progression of disease with new and enlarging metastases. Interval clearance pneumonia with the exception of a focal area due to proximal endobronchial obstruction. |
Generate impression based on findings. | Female, 18 years old, with right tonsillar swelling and uvular deviation. The right palatine tonsil is thickened and contains a central hypoattenuating region with mild peripheral enhancement which measures 24 x 17 mm transaxial and up to 27 mm craniocaudal. This process results in partial effacement of the oro-pharyngeal airway. Below this level, the airway is widely patent.Multiple prominent, likely reactive lymph nodes are seen on both sides of the neck. The salivary glands and thyroid are unremarkable. The cervical vessels enhance normally. Lung apices are clear. No concerning osseous lesions are demonstrated. | Large right peritonsillar abscess. |
Generate impression based on findings. | Female, 45 years old. Reason: evaluate for ileus/SBO after vaginal hysterectomy History: abdominal distention and pain Nonobstructive bowel gas pattern. Moderate colonic stool burden.Multiple rounded calcifications throughout the abdomen and pelvis most likely represent phleboliths. | Nonobstructive bowel gas pattern. Moderate colonic stool burden. |
Generate impression based on findings. | Male, 78 years old. Reason: DHT History: DHT Interval adjustment of Dobbhoff tube, now with tip overlying the gastric body.The pelvis is excluded from the field-of-view. Partially visualized bowel gas pattern shows air-filled loops of colon with moderate stool burden.Multiple healing right rib fractures. | Dobbhoff tube with tip overlying the gastric body. |
Generate impression based on findings. | Evaluate fatty liver and gallstones. Abdominal pain which is waxing and waning. Limited exam secondary patient body habitus.LIVER: Liver measures 19.8 cm in length. Echogenic parenchyma is compatible with fatty infiltration. No dominant lesions were evident.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Limited visualization with no significant abnormalities identified.RIGHT KIDNEY: No hydronephrosis. The right kidney measured 12.8 cm in length.OTHER: The left kidney measured 13.2 cm in length. No hydronephrosis. The spleen measured 13 cm in length. | Somewhat limited exam secondary patient body habitus. Echogenic liver which may reflect fatty infiltration. |
Generate impression based on findings. | 12 month-old male with point tenderness over anterior tibia just above the the ankle. Evaluate for fracture or joint effusion.VIEWS: Left ankle AP/lateral/oblique (3 views) 1/9/2015, 1531 hrs. Periosteal reaction of the distal tibia. There is questionable oblique lucency, though no certain fracture line is evident. No definite joint effusion. | Periosteal reaction of the distal tibia. Toddler's fracture is suspected, though in the absence of distinct fracture line, infection is not excluded. Recommend dedicated left tibia/fibula radiographs.Findings and recommendation relayed via telephone to Dr. Kniepkamp at 4:03 PM on 1/9/2015. |
Generate impression based on findings. | Male, 61 years old. S/p renal transplant Interval removal of multiple lines and tubes. Partially visualized median sternotomy plates and wires. Mild gaseous prominence of loops of small bowel in the left abdomen, and moderate stool within colon. Gas seen within the rectum. | No evidence of bowel obstruction. Moderate colonic stool burden. |
Generate impression based on findings. | Female 23 years old; Reason: obstruction, gallstones, appendicitis, mass History: 23yoF hx sickle cell disease, intermittent episodes of diffuse abdominal pain, self reported hematemesis over last month. ABDOMEN:LUNG BASES: CardiomegalyLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Atrophic.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patchy wedge-shaped opacities involving the left kidney. Mild right caliectasis again seen. No renal stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Concentric thickening of the bladder is nonspecific, could be due to cystitis.LYMPH NODES: Prominent nonspecific inguinal lymph nodes are increased in size compared to prior exam, and may be reactive.Similar increase in size is seen in the pelvic lymph nodes, including external iliac nodes. For example, a left external iliac node previously measures 7 mm in short axis, now 9 mm. A left inguinal node previously measured 8 mm, now 1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Patchy wedge-shaped opacities primarily involving the left kidney with concentric bladder wall thickening, likely related to cystitis and pyelonephritis. However, given history of sickle cell disease, micro-infarctions are not entirely excluded. Correlate with urinalysis.Slowly enlarging pelvic and inguinal lymph nodes could be reactive to above described process, but follow up suggested. |
Generate impression based on findings. | Male; 13 years old. Reason: sp IM nailing History: same Two views of the left femur show an intramedullary rod and screw device with cerclage wire affixing a subtrochanteric fracture in near-anatomic alignment. No evidence of hardware complication. There has been interval callus formation around the fracture, compatible with some interval healing. Bullet fragments are again noted in the soft tissues. | Left femur subtrochanteric fracture with some interval healing. |
Generate impression based on findings. | Follow-up of T4aN1 left acinic cell carcinoma status post surgery, TFHX and radiation. There are postoperative findings related to left total parotidectomy with residual diffuse thickening of the skin, subcutaneous tissues, and muscles along the surgical incision plane. No discrete mass lesions are apparent in the surgical bed. There is no significant cervical lymphadenopathy. The remaining salivary glands are unremarkable. The thyroid gland appears unchanged. The cervical vasculature is patent. The osseous structures are unchanged. The paranasal sinuses are clear. There is partial opacification of the left mastoid air cells. The partially imaged intracranial structures are grossly unremarkable. There is an unchanged skin excrescence in the midline of the upper chest. | Stable post-treatment findings without definite evidence of measurable tumor or significant lymphadenopathy in the neck. |
Generate impression based on findings. | Follow-up for focal asymmetry in the right breast. History of fatty tissue removed from both axillae. Three standard views of both breasts and an additional right CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying the left breast. A 6 mm focal asymmetry in the central right breast is stable.No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Benign lymph nodes are projected over both axillae. | Stable right focal asymmetry. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Evaluate aortic and iliac vessels for kidney transplant ABDOMEN:LUNG BASES: No significant abnormality noted. Pacemaker wires.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys compatible with endstage renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Thickening anteriorly and superiorly in a segment of sigmoid colon (image 91; series 3 and image 66; 80280). Muscular hypertrophy secondary to diverticular disease versus peristalsis versus intramural mass. Suggest correlation with colonoscopy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Minimal calcifications and mild tortuosity of the iliac vasculature. | Equivocal abnormality in the sigmoid colon for which colonoscopy is recommended. Minimal calcification and tortuosity of the iliac vasculature. |
Generate impression based on findings. | Female 48 years old Reason: mets lung cancer, s/p multiple chemo and active MS as well. Pls c/w previous study and evaluate tx response and dz status. History: lung ca ABDOMEN:LUNG BASES: Please see chest CT report from the same day for full thoracic findings.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Slight interval increase in size of the extensive necrotic hepatic metastases. Index hepatic dome lesion now measures 6.0 x 7.7 cm (image 53, series 3), previously 6.2 x 7.0 cm. There is marked attenuation of the hepatic veins secondary to compression. Probable invasion of the gallbladder wall secondary to tumor.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Conglomerate retroperitoneal necrotic lymph nodes do not appear significantly changed, reference left para-node now measures 3.2 x 3.6 cm (image 92, series 3), previously 3.2 x 3.9 cm. Index precaval node now measures 0.9 x 1.4 cm (image 128, series 3), previously 0.8 x 1.6 cm. There is marked narrowing of the SMA as it traverses the bulky retroperitoneal lymphadenopathy without complete occlusion. Similarly, there is narrowing of the origins of the bilateral renal arteries.BOWEL, MESENTERY: Diffuse mesenteric lymphadenopathy, appears similar to the prior examination. Slightly increased small volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is moderate body wall edema. Baclofen pump is seen in the subcutaneous fat of the left hemipelvis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nodular thickening of the right pelvic sidewall and associated cluster of pericecal lymph nodes appears similar to the prior examination.BONES, SOFT TISSUES: There is moderate body wall edema. Baclofen pump is seen in the subcutaneous fat of the left hemipelvis.OTHER: No significant abnormality noted. | 1.Increased hepatic metastases as detailed above.2.Stable retroperitoneal lymphadenopathy.3.Stable mesenteric lymphadenopathy and soft tissue thickening of the right pelvic sidewall.4.Please see chest CT report from the same day for full evaluation of the thorax. |
Generate impression based on findings. | 54 year old female with esophageal cancer. Evaluate for restaging.RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion of the neck grossly demonstrates no significant abnormality.Today's PET examination demonstrates a segment of markedly hypermetabolic activity including the distal esophagus and GE junction. Maximal SUV measures 12.0 and previously measured 8.7. These findings correspond to the dilated esophagus and esophageal wall thickening seen on CT examination and are consistent with patient's known history of esophageal cancer.In addition, there is a new focus of increased metabolic activity likely representing a distal paraesophageal lymph node.There is mildly increased activity in the anterior midline abdomen likely secondary to postsurgical changes. Several foci of soft tissue density on CT imaging are visualized of which 3 have mildly hypermetabolic activity. These likely represent injection granulomas and are likely benign in nature.No other suspicious FDG-avid lesion is seen in the chest, abdomen, or pelvis. Physiologic uptake is seen in the liver, spleen, kidneys, bowel, and bladder. | 1.Markedly hypermetabolic mass extending from the distal esophagus including the gastroesophageal junction consistent with patient's known history of esophageal cancer.2.Interval development of a hypermetabolic focus in a distal paraesophageal lymph node suspicious for local lymph node metastasis.3.No other suspicious FDG-avid lesion in the chest, abdomen, or pelvis. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 72 year old female with history of left upper lung nodule. Preoperative. CHEST:LUNGS AND PLEURA: Left upper lobe spiculated nodule (6/15) measures approximately 11 x 14 mm. No additional nodules or masses are seen. No pleural effusion, no consolidation.MEDIASTINUM AND HILA: Heart size within normal limits, and no pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications. Atherosclerosis affects the aorta and its branches.CHEST WALL: Mild degenerative changes affect the spine, with upper thoracic kyphosis. No significant axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral iliac surgical clips.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Left lower quadrants colostomy sites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Left upper lobe spiculated lesion suspicious for pulmonary malignancy. No evidence of metastatic disease. |
Generate impression based on findings. | Malignant neoplasm of the parotid gland. Radiotherapy follow up. CHEST:LUNGS AND PLEURA: No pleural fluid or pneumothorax. No new nodules.Nodule in the lingula has irregular margins and is inseparable from the mediastinal pleural surface, unchanged measuring 11-mm (4/60).Left apical nodule measures 7 mm, previously 6-mm nodule (4/19).Left lower lobe nodule measures 6 mm, unchanged since the prior study but increased in size from the outside exam dated 3/21/2014 where it measured 3-mm (4/117). MEDIASTINUM AND HILA: Normal heart size. No pericardial fluid. No lymphadenopathy. Right chest port tip at the superior vena cava level. Ascending aorta ectatic measuring 4.6-cm in in the AP dimension, unchanged.CHEST WALL: Left neck dissection with left jugular vein ligation. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodularity the left adrenal gland unchanged.KIDNEYS, URETERS: Unchanged probable cyst in the interpolar region of the right kidney.PANCREAS: Hypoattenuating nodules in the pancreas similar to the previous study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube. Calcified nodule anterior to the stomach (3/84) has shifted in position, now abutting the hepatic margin.Mild mesenteric fat stranding.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No significant change in size of pulmonary nodules since the prior study.2. Hypoattenuating nodules in the pancreas of unclear etiology but unchanged.3. Ectasia of ascending aorta. |
Generate impression based on findings. | Hematuria, unspecified ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Tiny hypodense doc nodule the dome of the right lobe is unchanged compared to prior and probably a cyst. No enhancing lesions are evident.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral calculi. No hydronephrosis. No enhancing masses. Narrowing of the left renal vein as it crosses under the superior mesenteric artery is typically a normal anatomic variant although occasionally it is associated with hematuria (a.k.a. "Nutcracker phenomenon"). This narrowing is more pronounced on venous phase images compared to delayed images suggesting a dynamic component. It is also more severe than it was on the prior examination from 2009.Atypical no origin of the left renal artery is stable.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air in the bladder is presumably secondary to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered colonic diverticula.BONES, SOFT TISSUES: Benign-appearing bony lesion of the right iliac wing appear similar to prior and may represent Paget's disease or fibrous dysplasia.OTHER: No significant abnormality noted | No definite etiology of hematuria. Dynamic narrowing of the left renal vein as it crosses under the superior mesenteric artery (Nutcracker phenomenon) may represent a normal variant but has been associated with hematuria in some individuals. |
Generate impression based on findings. | 21 years old, Male, Reason: bicuspid aorticv valve, assess for aortic root dilatation History: syncope Angiogram: Ascending aorta measures 2.9 cm in greatest dimension. No evidence of dissection or focal aneurysmal dilatation. The vessels appear patent and there is no evidence of mural thrombus.CHEST:LUNGS AND PLEURA: No focal consolidation to suggest infection. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality noted | No evidence of aortic aneurysmal dilatation, dissection, or thrombus. |
Generate impression based on findings. | Recurrent left parotid gland adenoid cystic carcinoma status post total parotidectomy and radiation therapy at another hospital in 2005 and completed 5palliative chemotherapy on August 22, 2014. There are postoperative findings related to left neck dissection, including parotid and submandibular gland resection, with flap reconstruction. There is persistent ill-defined soft tissue in treatment bed. However, there is persistent ill-defined soft tissue in the left parotidectomy bed and interval increase in hyperattenuating nodularity in the fat planes of the left posterior triangle of the neck. There is also interval decreased swelling of the left aryepiglottic fold, but otherwise increased edema within the rest of the supraglottic region. The left tongue demonstrates fatty attenuation, which is compatible denervation atrophy. There is chronic thrombosis of the right internal jugular vein. There is no significant lymphadenopathy in the right neck. There is persistent opacification of left mastoid air cells. There are degenerative changes of the cervical spine, most prominent at the C6-7 level, resulting in narrowing of the bilateral neural foramina. The imaged intracranial structures are grossly unremarkable. There is a subcentimeter nodule in the partially imaged left lung. | 1. Post-treatment findings in the neck with persistent nonspecific ill-defined soft tissue in the region of the left parotidectomy bed.2. No significant lymphadenopathy in the neck.3. Chronic thrombosis of the right internal jugular vein. 4. A subcentimeter left lung nodule is compatible metastatic disease. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Female, 53 years old, with new urinary retention. Evaluate for demyelinating disease. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues. Using fluoroscopic guidance, a 22 gauge x 3.5 inch spinal needle was localized into the thecal sac at the L2-3 level. There was immediate return of clear cerebral spinal fluid, approximately 13 of which was collected into three sterile tubes and provided to the clinical service. The stylette was replaced, the needle removed, and hemostasis achieved with manual compression. The patient tolerated the procedure. | Successful fluoroscopically guided lumbar puncture. |
Generate impression based on findings. | Male 63 years old Reason: h/o lung ca and bone mets, s/p chemo, eval response, compare to previous, measurements pls History: none ABDOMEN:LUNG BASES: Please see chest CT report from the same day for full evaluation of the thorax.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific hypoattenuating right adrenal gland nodules, which was hypermetabolic the prior CT examination and is consistent with a metastasis. The nodule has increased in size, now measuring 0.9 x 1.3 cm (image 13, series 3), previously 0.2 x 0.8 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are atherosclerotic calcifications of the abdominal aorta and its branches. Hypermetabolic gastric hepatic ligament node/conglomerate of nodes measures approximately 2.4 x 3.3 cm (image 93, series 3), previously 2.0 x 2.2 cm. Additional retroperitoneal lymph nodes are not pathologically enlarged on the basis of size criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a sclerotic lesion in the L2 vertebral body which has an expansile soft tissue component, which impinge on the spinal canal at this level. Further evaluation with MRI is recommended as clinically indicated. Additionally there is a sclerotic lesion in the left iliac bone, appearing progressed from the prior exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No evidence of lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is a sclerotic lesion in the L2 vertebral body which has an expansile soft tissue component, which impinge on the spinal canal at this level. Further evaluation with MRI is recommended as clinically indicated. Additionally there is a sclerotic lesion in the left iliac bone, appearing progressed from the prior exam.OTHER: Trace fluid in the pelvis. | 1.Cluster of gastrohepatic ligament nodes consistent with nodal metastases increase in size from the prior exam.2.Right adrenal nodule consistent with an adrenal metastasis increased in size from the prior exam.3.Please see chest CT report from the same day for full evaluation of the thorax.4.Interval increased osseous metastatic disease. Expansile L2 vertebral body lesion with possible impingement on the spinal canal at this level. Further evaluation with MRI can be considered as clinically indicated. |
Generate impression based on findings. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 21 x 11-mm axial dimension hyperdense focus in the left postcentral gyrus associated with a halo of hypodensity. Compared to CT of the head earlier and has not changed.Periventricular and subcortical white matter hypodensities of a mild degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are scleral calcifications present adjacent to the insertion sites of the ciliary bodies most likely representing scleral plaque. | 1.A left postcentral gyrus hemorrhage is stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | 74 years old, Male, Reason: Rule out ischemia History: Abdominal pain Motion degrades detail of abdominal parenchyma.ABDOMEN:LUNG BASES: Respiratory motion limits fine detail of lung parenchyma. New reticulonodular opacity in the right lower lobe since prior exam likely represents infection, consider aspiration.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Extensive pancreatic parenchymal atrophy and dystrophic calcification seen throughout. Likely sequela of chronic calcific pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild hydronephrosis on the right.RETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No evidence of bowel obstruction, bowel wall edema, pneumatosis, or free air. There is a large stool burden again noted particularly in the rectum. Impaction versus early stercoral colitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is extremely dilated measuring 17 cm in craniocaudal dimension.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue induration seen in the medial right gluteal and perianal regions. No definite underlying bony destruction to suggest osteomyelitis. Diffuse osseous demineralization, degenerative disease of the spine, and right hip unchanged. Stable mild compressive deformity of L3.OTHER: No significant abnormality noted. | 1.Markedly dilated urinary bladder.2.No evidence of bowel ischemia.3.Impaction versus early stercoral colitis.4.Right lower lobe pneumonia, concerning for aspiration pneumonia. |
Generate impression based on findings. | Two-month old female with bilateral hydronephrosis. History of cloacal malformation with bilateral ureterostomies and colostomy. Evaluate for drainage and flow of bilateral kidneys. The posterior abdominal radionuclide angiogram demonstrates prompt perfusion of the right kidney with slight decrease in perfusion to the left kidney. Sequential renal images show the kidneys to demonstrate mild bilateral hydronephrosis. There is prompt uptake and excretion of the radiopharmaceutical by the right kidney with mild delayed uptake and normal excretion by the left kidney. The estimated contribution of the right kidney to total renal function is 57.7% and that of the left kidney is 42.3%. The patient has bilateral ureterostomies with increased activity visualized in the midpelvis which is no longer present after removing the wet diaper. Following administration of the diuretic, there was prompt washout of collecting system radiotracer into the bladder without evidence of current obstruction. The T1/2 washout from the dilated right collecting system was 6.75 minutes. The T1/2 washout from the dilated left collecting system was 8.50 minutes. | Minimally decreased function of the left kidney. No evidence of current collecting system obstruction. |
Generate impression based on findings. | 69-year-old male with loss of balance, very mild Parkinsonianism Slight decreased activity in the right putamen. Symmetric activity is seen within bilateral caudate nuclei. | Asymmetrically decreased activity in the right putamen suggestive of Parkinson's disease. |
Generate impression based on findings. | History of bladder cancer status post radical cystectomy. Routine surveillance. ABDOMEN:LUNGS BASES: Stable subcentimeter groundglass nodule (image 8; series 12).LIVER, BILIARY TRACT: Marked diffuse fatty liver as noted previously. No focal lesions. No evidence of cirrhotic morphology, biliary dilatation or vascular thrombosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atypical renal cyst left lower pole is unchanged and was described in detail on the prior examination. It is unchanged in size from prior exams. No evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Small shotty nodes unchanged. No pathologic size nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large ventral incisional hernia containing bowel and omentum, nonobstructive. Other postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoscopy and prostatectomy.BLADDER: Neobladder. On the right pelvic sidewall (image 136; series 13), there is a 3.3 x 3.4 cm soft tissue mass, presumably representing recurrent tumor.LYMPH NODES: Lymph node dissection clips. No pathologic size nodes.BOWEL, MESENTERY: Postsurgical changes. Scattered colonic diverticulosis. Incisional hernia, nonobstructive.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall. Incisional hernia. No sclerotic or lytic lesions in the bones.OTHER: No significant abnormality noted. | New right pelvic sidewall soft tissue mass, presumably representing recurrent tumor. Finding discussed with clinical service (2650 at time of dicatation). Stable micronodule left lower lobe. Atypical cyst left lower pole, also unchanged. |
Generate impression based on findings. | 64 years old Female. Reason: evaluate chemotherapy response. History: breast cancer. RADIOPHARMACEUTICAL: 12.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 84 mg/dL. Today's CT portion of study demonstrates a stable low-attenuation lesion in the right frontal lobe. A right chest port is present with tip in the right atrium. Left mastectomy changes are present with postradiation appearance of the left upper lobe. Stable patchy opacity is seen in the right lower lobe superior segment. Severe lymphedema is present and stable in the left upper extremity. Stable soft tissue infiltration of the left anterior thorax with multiple subcutaneous nodular densities throughout the left chest wall and along the humerus. A hypodense left renal lesion is likely a cyst.Today's PET examination demonstrates interval resolution of the right axillary hypermetabolic lymph nodes. There is interval near complete resolution of hypermetabolic tumor in the left upper extremity, left supraclavicular region, and left axilla.Persistent mild to moderate hypermetabolic foci are noted in the soft tissue of the proximal portion of the left upper extremity, and left upper chest wall at subpectoral region.There is interval increase in size,, number and metabolic activity of the multiple hepatic metastatic lesions. The maximal SUV in the left lobe of liver lesion near the gallbladder fossa is 33.2 (it was 15.7 on prior study).A new focus of increased activity is seen in the L3 vertebral body, highly suspicious for osseous metastasis.Mild FDG uptake is seen in the patchy opacities in the left upper lobe, left lingular lobe, and right lower lobe superior segment, which are consistent with the inflammatory change.Low-attenuation lesion in the right frontal lobe with decreased metabolic activity is most likely due to brain infarction. | Interval mixed response to therapy.1. Interval decrease in size, number and metabolic activity of multiple hypermetabolic lymph nodes in the left lower neck, left chest wall, bilateral axillary regions and left upper extremity.2. Interval progression of hepatic metastasis.3. New FDG avid osseous metastasis in the L3 vertebral body. |
Generate impression based on findings. | 56-year-old male with tremor, dysphasia, and gait disorder There is decreased activity in bilateral putaminal and right caudate nuclei. | Decreased activity in bilateral putaminal and right caudate nuclei suggestive of Parkinson's disease. |
Generate impression based on findings. | The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Several attempted aspirations yielded no fluid. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. Exposure time: 18 seconds | Successful attempted right hip aspiration, which yielded no fluid. |
Generate impression based on findings. | Abdominal painVIEW: Abdomen AP Moderate amount of fecal burden. Nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Moderate amount of fecal burden without obstruction. |
Generate impression based on findings. | MENISCI: There is subtle vertically oriented signal abnormality propagating within the posterior horn of the lateral meniscus and meniscal fascicle from the attachment of the ligament of Wrisberg suggestive of a longitudinal tear ("Wrisberg rip") extending to the femoral surface.The medial meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is edema consistent with contusions in the anterior lateral and femoral condyles and the medial and lateral posterior tibial plateau.LIGAMENTS: There is complete rupture of the ACL. The PCL is intact. The lateral collateral ligament complex and medial collateral ligament are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL | 1. Complete rupture of the ACL with bone contusions in the anterior femoral condyles and along the posterior tibial plateau.2. Moderate joint effusion and hemarthrosis.3. Findings suggestive of a longitudinal tear ("Wrisberg rip") of the posterior horn of the lateral meniscus as described above. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.Images of the brain demonstrate ventricles and sulci to be within normal limits. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Low-lying cerebellar tonsils incidentally noted without convincing evidence of Chiari 1. Mild mucosal thickening in the paranasal sinuses. | Unremarkable MRI examination of the internal auditory canals. |
Generate impression based on findings. | Female 50 years old Reason: evaluate for diverticulitis History: LLQ pain ABDOMEN:LUNG BASES: Trace dependent bibasilar atelectasis. Nonspecific 3-mm right lower lobe nodule.LIVER, BILIARY TRACT: Hypoattenuating lesion in the dome of the liver measures near water density and is consistent with a simple hepatic cyst.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 radioopaque nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Scattered slightly prominent retroperitoneal lymph nodes do not meet size criteria for lymphadenopathy.BOWEL, MESENTERY: Extensive diverticular disease affects the entirety of the colon. There is marked mesenteric fat stranding about the distal descending and proximal sigmoid colon, consistent with acute diverticulitis. There is no definite evidence of extraluminal air and no evidence of abscess formation. Scattered slightly prominent mesenteric lymph nodes are likely reactive.PELVIS:UTERUS, ADNEXA: There is trace free fluid in the dependent pelvis.BLADDER: No significant abnormality notedBOWEL, MESENTERY: Extensive diverticular disease affects the entirety of the colon. There is marked mesenteric fat stranding about the distal descending and proximal sigmoid colon, consistent with diverticulitis. There is no definite evidence extraluminal air and no evidence of abscess formation. Scattered slightly prominent mesenteric lymph nodes are likely reactive.BONES, SOFT TISSUES: No significant abnormality noted | Findings consistent with active diverticulitis of the distal descending and proximal sigmoid colon without evidence of complication. Although sites of microperforation not entirely excluded, the small air-containing foci in region of aforementioned inflamed colon more likely air-containing diverticula. |
Generate impression based on findings. | Male 63 years old Reason: evaluate for stone, hydro History: right flank pain, dysuria, hematuria Within the limits of a non IV contrast enhanced examination, which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations were made: ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measures 8 Hounsfield units, consistent with a lipid rich adenoma.KIDNEYS, URETERS: Punctate bilateral calcifications within both kidneys are most consistent with nonobstructing renal stones. There is mild asymmetric prominence and "boggy" appearance of the right kidney with associated mild perinephric fat stranding and prominence of the ureter, as well as an equivocal 5-mm stone in the bladder (although this is possibly in the prostate), suggestive of a recently passed stone. However, pyelonephritis cannot be excluded given the appearance of the kidney. Hypoattenuating lesion in the interpolar region of the right kidney is incompletely characterized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Approximately 25% loss of height of the T12 vertebral body consistent with a compression fracture of indeterminate age.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 5-mm punctate density in the dependent portion of the bladder, suggestive of a passed stone; however, this could also reside within the prostate.BONES, SOFT TISSUES: Approximately 25% loss of height of the T12 vertebral body consistent with a compression fracture of indeterminate age. | Findings suggestive of a recently passed stone with mild enlargement of the right kidney, perinephric fat stranding and prominence of the right ureter. However, pyelonephritis cannot be entirely excluded, suboptimally assessed on this noncontrast exam, correlation with patient's clinical history and laboratory values recommended. |
Generate impression based on findings. | Male 65 years old Reason: Patient with RCC s/p biopsy of mass w/ Hgb of 6.1 concern for bleed Within the limits of a non IV contrast enhanced examination, which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations were made: ABDOMEN:LUNG BASES: Pulmonary nodules again identified, consistent with metastatic disease. Please refer to CT chest abdomen and pelvis dated 1/7/2015 for reference measurements.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Horseshoe kidney morphology again identified. The heterogeneous mass in the superior pole the right kidney again measures 10.0 x 9.0 cm (image 62, series 3). Infiltration of the fat planes of the posterior pararenal fascia without significant change, consistent with recent biopsy. Nonobstructing right renal stone. Additional left superior renal parenchymal heterogeneity not well assessed.RETROPERITONEUM, LYMPH NODES: Multiple large mesenteric lymph nodes again identified, without significant interval change. Please refer to CT chest abdomen and pelvis dated 1/7/2015 for reference measurements. No evidence retroperitoneal hemorrhage as clinically questioned.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: The destructive soft tissue mass in the posterolateral L4 vertebral body without significant change. Associated invasion into the left L4 neural foramina and encroachment on the spinal cord also unchanged. Partially imaged expansile destructive left sixth rib lesion again seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: The destructive soft tissue mass in the posterolateral L4 vertebral body without significant change. Associated invasion into the left L4 neural foramina and encroachment on the spinal cord also unchanged. Partially imaged expansile destructive left sixth rib lesion again seen. | 1.Findings compatible with metastatic renal cell carcinoma as detailed above. Please see chest CT report dated 1/7/2015 for reference measurements. No significant change from prior 1/7/15 CT abdomen/pelvis imaging.2.No specific findings seen to account for the patient's anemia, specifically no evidence of intraperitoneal or retroperitoneal hemorrhage.3.Destructive metastasis in the posterolateral L4 vertebral body with associated invasion of the left L4 neural foramina encroachment on the spinal cord unchanged. Further evaluation with MRI may be considered as clinically indicated. |
Generate impression based on findings. | There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | Normal MRI of the brain. |
Generate impression based on findings. | Female 60 years old Reason: 60 female with Hodgkin's Lymphoma, now with abdominal pain/fever. Evaluate for colitis/enteritis versus progressive LAD, aware study suboptimal without IV contrast History: abdominal pain/fever CHEST:LUNGS AND PLEURA: Trace atelectasis without evidence of consolidation.MEDIASTINUM AND HILA: Reference left paratracheal lymph node measures 0.9 x 1.9 cm (image 32, series 3), previously 1.1 x 2.0 cm. Reference cardiophrenic node measures 0.8 x 1.0 cm (image 62, series 3), previously 0.7 x 1.1 cm. Additional non-index lymph nodes without significant interval change. New small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left paraaortic reference lymph node now measures 0.8 x 1.4 cm (image 126, series 3), previously 0.8 x 1.1 cm. There is an infrarenal IVC filter in place. Mild atherosclerotic calcifications affect the abdominal aorta and its branches. Additional scattered retroperitoneal and mesenteric lymph nodes without significant interval change.BOWEL, MESENTERY: There is a ventriculoperitoneal shunt catheter in place, position unchanged. There are no findings to suggest acute colitis or enteritis. Normal-appearing appendix identified in the right lower quadrant.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac chain node measures 1.5 x 3.1 cm (image 176, series 3), previously 1.6 x 3.4 cm. Reference left inguinal lymph node/conglomerate of lymph nodes measures 1.7 x 1.7 cm (image 195, series 3), previously 1.8 x 1.9 cm.BONES, SOFT TISSUES: No significant abnormality noted. | 1.No specific finding seen to account for the patient's abdominal pain/fever. Specifically, no definite CT evidence of colitis or enteritis as clinically questioned.2.New small pericardial effusion.3.Stable reference and non-reference lymph nodes. |
Generate impression based on findings. | 77-year-old male with history of chronic low back pain, hip pain, right knee pain Knee: There is disproportionate patellofemoral joint space narrowing and chondrocalcinosis consistent with CPPD arthropathy. The bones are demineralized. No fracture is evident. A small loose body is noted posteriorly, likely in a Baker's cyst. Shotgun pellet is noted.Hip: Moderate osteoarthritis affects the hip, pubic symphysis and visualized portion of the SI joint. Vascular calcifications are present in the soft tissues. Shotgun pellets are noted.Lumbar spine: Large osteophytes and severe degenerative disk disease, worst at L3-L4 and L4-L5. | CPPD arthropathy affecting the knee, severe degenerative disk disease of the lumbar spine and moderate osteoarthritis affecting the hip. |
Generate impression based on findings. | Point tenderness at the anterior tibiaVIEWS: Left tibia/fibula AP/lateral (2 views) 1/9/15 1655 Periosteal reaction is present along the anterior and medial aspect of the mid and distal tibia. No distinct fracture line is evident. No malalignment is present. | Periosteal reaction at the distal tibia, representing a healing toddler's fracture. |
Generate impression based on findings. | Nasogastric tube placement, evaluate location Enteric tube seen with side-port near junction of gastric fundus and body. Incompletely imaged abdomen demonstrates no definitive evidence of bowel obstruction. Right upper quadrant surgical clip. Please refer to concomitant chest radiography for additional findings. | Enteric tube as above. |
Generate impression based on findings. | There is no diffusion abnormality. No intracranial mass or mass effect. There is global parenchymal volume loss, commensurate with age. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Extensive confluent T2/flair hyperintensity in the periventricular and subcortical white matter as well as the pons are most compatible with chronic small vessel ischemic changes. Multiple foci of susceptibility are seen including the left cerebellar hemisphere, as well as scattered within the bilateral cerebral hemispheres in a peripheral lobar distribution. There is moderate mucosal thickening involving the right maxillary sinus.MRA HEAD | 1. No evidence of acute ischemia.2. Advanced chronic small vessel ischemic disease.3. Multiple foci of susceptibility effect, majority of which are in a peripheral lobar distribution most suggestive of amyloid angiopathy.4. No significant stenosis involving the intracranial or extracranial vasculature in the neck. |
Generate impression based on findings. | There are numerous lytic lesions in the vertebral bodies and posterior elements of the thoracic and upper lumbar spine, the relative largest of which is in the T4 vertebral body measuring 13x6 mm (sagittal series 80273 and image 30). Lesion in the right transverse process at T10 with an associated pathologic fracture (series 5 image 74 and sagittal series 80273 image 22). Vertebral body heights and alignment are maintained. There is no significant spinal canal or neural foraminal narrowing at any level. The visualized intra-abdominal and paraspinal contents are unremarkable. | 1.Multiple lytic lesions throughout the thoracic and upper lumbar spine consistent with known multiple myeloma.2.Pathologic fracture involving the right T10 transverse process.3.No vertebral body compression fractures or spinal canal stenosis. |
Generate impression based on findings. | 54-year-old female with question of humerus fracture A subtle curvilinear lucency is present through the greater tuberosity, suggestive of a nondisplaced fracture. The distal humerus is intact. | Nondisplaced greater tuberosity fracture. |
Generate impression based on findings. | 64-year-old female with frostbite Left foot: There is marked soft tissue swelling and foci of gas about the distal first through third digits. There is a fracture through the base of the first proximal phalanx. Acroosteolysis affects the first through third digits.Right foot: There is a fracture through the mid diaphysis of the third proximal phalanx. Acroosteolysis affects the first through fourth toes with marked resorption of the third digit. There is marked soft tissue swelling and foci of gas about the distal foot. | Fractures and findings consistent with for infection and/or frostbite involving the toes as described above. |
Generate impression based on findings. | 53-year-old male with catheter pain and swelling Ankle: There is soft tissue swelling about the ankle without underlying fracture evident. Vascular calcifications are noted in the soft tissues.Knee: Ossification adjacent to the medial femoral condyle is compatible with prior MCL injury. A lucency through the inferior aspect of the patella may represent a nondisplaced fracture, correlate for point tenderness. There is no significant overlying soft tissue swelling. There is a questionable joint effusion. | 1. Lucency through the patella, which may represent nondisplaced fracture, correlate with point tenderness.2. Soft tissue swelling about the ankle without underlying fracture evident. |
Generate impression based on findings. | History of humeral fracture at OSH 3 days prior.VIEWS: Right humerus AP/lateral (2 views) 1/9/15 1702 Mild non-specific cortical irregularity is present at the medial aspect of the proximal humeral diaphysis. No definite fracture is evident. No malalignment is present. | Mild non-specific cortical irregularity at the medial proximal humerus, without definite fracture evident. Follow-up radiographs are recommended in 10-14 days. |
Generate impression based on findings. | 44-year-old male with history of shoulder relocation No fracture is evident. Glenohumeral alignment is grossly intact. There is acromioclavicular joint separation, appearing similar to the prior exam. | Unchanged acromioclavicular joint separation without acute fracture evident. |
Generate impression based on findings. | 75 year-old female with right foot erythema and ulceration The bones are diffusely generalized. There is no specific radiographic evidence of osteomyelitis. Soft tissue swelling is present about the foot and ankle. A distal tibial infarct is noted. | Demineralization and soft tissue swelling without specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | 72-year-old female with right shoulder pain after fall Glenohumeral alignment is within normal limits. No fracture is identified. Surgical clips project over the axilla. | No fracture or dislocation. |
Generate impression based on findings. | 79-year-old male with history of asbestos exposure. Query mesothelioma. Also with severe MR. Known right decortication and right hemidiaphragmatic elevation. Progressive shortness of breath. LUNGS AND PLEURA: Mild lower lung fibrosis and bronchial wall thickening. Multiple areas of pleural thickening with calcific plaque formation, and adjacent scar like consolidation. Very small loculated right pleural effusion, and no left pleural effusion. No evidence of chest wall invasion.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. Severe coronary artery calcifications, as well as calcifications of the aorta and its branches. Air fluid level in the esophagus, may represent reflux of gastric contents. Scattered small mediastinal and hilar lymph nodes.CHEST WALL: Sternotomy fixation wires. Anterior and lateral spinal osteophytes, with ossification of the anterior longitudinal ligament.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild bibasilar fibrosis and multiple bilateral foci of pleural thickening with calcific plaque formation and associated overlying mild consolidation. No evidence of chest wall invasion or significant lymphadenopathy, and only a very small loculated right pleural effusion. |
Generate impression based on findings. | 56-year-old female with left hip pain No hip or pelvic fracture is identified. Mild degenerative changes affect the lower lumbar spine. | No fracture or dislocation. |
Generate impression based on findings. | Male 36 years old Reason: evaluate for aortic dissection History: chest pain, severe hypertension ANGIOGRAM: The great vessels of the aortic arch demonstrate conventional anatomy. There is no evidence of aneurysmal dilatation of the thoracic or abdominal aorta. There is no evidence of aortic dissection. There is no evidence of central emboli. The celiac axis is patent. The peripheral vasculature is well opacified consistent with appropriate blood flow.CHEST:LUNGS AND PLEURA: Trace bibasilar dependent atelectasis.MEDIASTINUM AND HILA: The heart size is normal. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of radioopaque nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | No evidence of aortic aneurysm or dissection as clinically indicated. No specific finding seen to account for the patient's chest pain. |
Generate impression based on findings. | Respiratory distressVIEW: Chest AP (one view) 1/9/15 1731 Left chest port tip is in the SVC.The cardiac silhouette is mildly enlarged.The bilateral diffuse lung opacities are significantly increased. Small to moderate bilateral pleural effusions are slightly larger than on the CT. | Increased bilateral pulmonary opacities and pleural effusions suggestive of infection or edema. |
Generate impression based on findings. | Respiratory distressVIEW: Chest AP (one view) 1/9/15 1926 The ET tube tip is below the thoracic inlet and above the carina.The cardiothymic silhouette is normal.The lung volumes are large. Patchy opacities in the lingula and left lower lobe are increased. The atelectasis in the right upper lobe persists. Small bilateral pleural effusions are new. | Increased left lung opacities, likely representing bacterial pneumonia complicating bronchiolitis. |
Generate impression based on findings. | 3-month-old male patient with soft tissue cyst without communication to intracranial space. There is a hypoattenuating cystic structure contacting the metopic suture immediately anterior to the anterior fontanelle that measures 11 x 8 x 9 mm. There is associated well-defined scalloping of the frontal bone. There is no intracranial extension of the cyst. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. | Small lesion just anterior to the anterior fontanelle compatible with a cystic lesion such as dermoid. No intracranial extension. |
Generate impression based on findings. | 3 month old female with hydrocephalus. There has been interval placement of a right parietal approach ventriculostomy catheter terminating near the left foramen of Monro. There is unchanged ventriculomegaly and periventricular low-attenuation which may represent transependymal CSF flow and/or unmyelinated white matter. There is vermian and cerebellar hemisphere hypoplasia, with superior displacement of the residual hemispheres and communication between the fourth ventricle and the retrocerebellar CSF space. There is also anterior displacement of the brainstem. There is no evidence of intracranial hemorrhage. | 1.Interval ventriculostomy catheter placement with no significant change in severe ventriculomegaly.2.Posterior fossa findings compatible with Dandy-Walker variant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Evaluate for instability, especially C1-C2, neck pain, status post C2-C3 fracture. Again seen are postsurgical changes of anterior cervical fusion from C2 to C4 with anterior plate and screws and interbody grafts appearing without malposition or peri-hardware lucency. Atlantodental interval is normal. Evolution of postsurgical changes is noted.Again seen are minimally displaced fracture of the right C2 body, extending to the right pedicle and the right pars interarticularis, and involving the right foramen transversarium and posterior tubercle of the right transverse process. There is also a minimally displaced oblique fracture through the left lamina of C2. There is a fracture of the right C3 pedicle, which extends down into the right inferior articular facet, and the left lamina of C3, with approximately 3 mm of posterior displacement of the posterior elements similar to prior. No significant callus formation is seen compared to relative recent CT from 12/24/2014 and can be assessed on follow-up studies.There is trace anterolisthesis at C2 and C3 unchanged from prior. No new fracture or subluxation is seen in the cervical spine. No significant spinal canal stenosis or foramina stenosis is appreciated any level. | 1. Postoperative changes of anterior fusion extending from C2 to C4 again seen without evidence of hardware complication.2. Fractures of C2 including bilateral posterior elements as well at C3 including the posterior elements with mild displacement appear similar to prior. Trace anterolisthesis of C2 and C3 is also unchanged. No new fracture or subluxation.3. Atlantodental interval is normal without evidence of instability at the C1-2 level. |
Generate impression based on findings. | Obstructive hydrocephalus and ventriculoperitoneal shunt placement.VIEWS: Shunt series: Skull AP/lateral (two views), chest and abdomen AP/lateral (4 views) 01/09/15 Ventriculostomy tube tip is to the left of midline in the middle cranial fossa. Burr hole is in right parietooccipital region. Distal shunt tubing courses along the right neck and chest. It enters the peritoneal space in the right upper quadrant. Shunt tube tip is in left lower quadrant.The skull is large with respect to the face. No focal lung opacity is present. Bowel gas pattern is slightly disorganized. | No evidence of extracranial shunt malfunction. |
Generate impression based on findings. | Cough and feverVIEWS: Chest AP/lateral (two views) 1/10/15 0113 The cardiothymic silhouette is normal.Left lower opacity is compatible with pneumonia. Mild peribronchial thickening likely reflects reactive airway disease or bronchiolitis. No pleural effusions are present. | Left lower lobe pneumonia. |
Generate impression based on findings. | 61-year-old female with left knee pain after MVC Alignment is anatomic. No fracture is evident. | No fracture or other specific findings to account for the patient's knee pain. |
Generate impression based on findings. | 64-year-old female with fractures Plaster obscures underlying osseous detail. Two K wires affix a distal phalangeal fracture. | Orthopedic fixation of distal phalangeal fracture with underlying osseous detail obscured by plaster. |
Generate impression based on findings. | Nausea, concern for ileus Upper quadrant surgical clips. Nonobstructive bowel gas pattern. Rounded radiodensities in left upper and mid abdomen, may be ingested material, correlate with patient's clinical history.Right hemidiaphragm elevation. Please refer to concomitant chest radiography from same day for additional findings.Degenerative disease of spine. Bilateral postsurgical hip hardware. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 45-year-old male patient with a history of multiple strokes presents after a syncopal episode. Evaluate for traumatic injury or new stroke. There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is global parenchymal volume loss, appearing similar to the prior study but advanced for the patient's age. The ventricles and basal cisterns are otherwise normal in size and configuration. The calvaria and skull base are radiographically normal. There is no scalp hematoma. The visualized mastoid air cells and paranasal sinuses are within normal limits. | 1. No intracranial hemorrhage or CT evidence of acute large vascular territory ischemia. If there is continued clinical concern for acute ischemia, MRI is recommended.2. Advanced global parenchymal volume loss for age. |
Generate impression based on findings. | The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no acute fracture or pre-vertebral soft tissue swelling. There is no significant spinal canal stenosis. The visualized intracranial structures and lung apices appear normal. | No evidence of cervical spine fracture or subluxation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 40 year-old female with history of pleuritic chest pain, elevated d-dimer. PULMONARY ARTERIES: No pulmonary embolus. LUNGS AND PLEURA: No consolidation or pleural effusion. No pneumothorax. Minimal dependent atelectasis.MEDIASTINUM AND HILA: Heart size within normal limits comment no pericardial effusion. No appreciable coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Scattered small axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating liver focus, nonspecific but most likely benign hemangioma. Focus of enhancement in the right anterior hepatic lobe, nonspecific but given this patient's relatively normal liver parenchyma this is most likely a flash filling hemangioma. | No pulmonary embolus, or other findings to explain the patient's pain.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 72-year-old female patient with headache. Evaluate known intracranial lesion. Again seen are ill-defined permeative lesions in the left frontal and right parietal calvarium with intracranial and superficial soft tissue extension; findings suspicious for metastatic disease. Mild mass effect on the left frontal lobe. There also appears to be a lesion in the right parieto-occipital calvarium with overlying soft tissue thickening. Findings are unchanged from prior. There is no acute intracranial hemorrhage or new extra-axial collection. No midline shift or uncal herniation. | Multiple calvarial lesions with scalp and mild intracranial extension involving the left frontal and right parietal lesions . No intracranial hemorrhage. Consider MRI for further evaluation. |
Generate impression based on findings. | 72-year-old female patient with history of breast cancer presents with swelling of forehead. Per clinical service, no history of trauma. There is an ill-defined permeative lytic lesion of the left frontal bone with soft tissue extension into the scalp and intracranially into the extra-axial space. There is opacification of the left frontal and anterior ethmoid air cells which may be on an inflammatory basis. There is no evidence of orbital involvement. The lesion measures approximately 4.4 x 5.3 cm. There is no acute calvarial fracture. There are no other calvarial lesions or intracranial lesions identified.There may be mild local mass effect on the left frontal lobe. Otherwise no intracranial mass effect is appreciated. There is no midline shift or herniation. No intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is an air-fluid level in the right sphenoid sinus and partial opacification of the left mastoid air cells. | Ill-defined left frontal bone lesion with mild intracranial extension suspicious for metastatic disease. MRI may be helpful for further evaluation. |
Generate impression based on findings. | LIVER: Diffusely decreased echogenicity of the liver is suggestive of hepatitis. The liver is 16.6 cm in length. No focal hepatic lesion is identified. The main portal vein is patent with hepatopetal flow of 20 cm/sec.GALLBLADDER, BILIARY TRACT: No cholelithiasis is present. Diffuse gallbladder wall thickening is again noted and is non-specific in the setting of ascites. No biliary ductal dilatation is present. PANCREAS: The pancreas is largely obscured by bowel gas.SPLEEN: Spleen is 9.2 cm in length, without focal lesion identified.KIDNEYS: Right kidney is 10.6 cm in length and left kidney is 11.8 cm. No hydronephrosis or focal lesions are present. OTHER: The abdominal ascites is increased, now moderate in quantity.Small to moderate right pleural effusion is present with consolidation of right base.A urinary bladder catheter is in place in the bladder is decompressed. | 1. Diffusely decreased liver echogenicity suggestive of hepatitis. 2. Increased ascites, now moderate.3. Persistent gallbladder wall thickening, which is non-specific in the setting of ascites. |
Generate impression based on findings. | 59 year old female POD #0 s/p anterior cranial fossa skull base craniotomy and dural repair. There are postoperative findings related to left frontal craniotomy for repair of an anterior cranial fossa dural defect. There is minimal high attenuation subjacent to the craniotomy compatible with blood products as well as pneumocephalus. There is minimal opacification within the right frontal and bilateral sphenoid sinuses. There is complete opacification of the right mastoid air cells and fluid within the right middle ear cavity. There are unchanged small patchy foci of low attenuation within the parietal white matter most compatible with mild chronic small vessel ischemic disease. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. | 1.Expected postoperative findings related to left frontal craniotomy and anterior cranial fossa dural defect repair.2.Unchanged complete opacification of the right mastoid air cells and middle ear cavity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 58 years old Reason: sbo History: abdominal pain, N/V ABDOMEN:LUNG BASES: Again seen are multiple well-circumscribed pulmonary cysts, nonspecific but which could reflect lymphangioleiomyomatosis.LIVER, BILIARY TRACT: The liver is enlarged measuring approximately 22 cm in length. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney is atrophic, with its parenchyma nearly completely replaced by cysts. The left kidney is not identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilatation of multiple loops of small bowel measuring up to 3.9 cm in maximal diameter, with fecalization of the small bowel contents distally, with a transition point in the ventral right lower abdomen, appearing similar to the prior examination. However, there is new small volume ascites. Given the presence of ascites and reported acute pain, active small bowel obstruction is considered more likely; however, the prior imaging appearance could reflect a component of chronicity.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: There are mild/moderate degenerative changes of the thoracolumbar spine. | 1.Findings consistent with small bowel obstruction with associated ascites, suggesting an acute process; however, the similarity of the appearance to prior imaging exam may reflect a component of chronicity.2.Multiple pulmonary cysts, which could be related to underlying lymphangioleiomyomatosis.3.Atrophic right kidney with its parenchyma nearly completely replaced with cysts, suggesting acquired cysts secondary to end-stage renal disease. |
Generate impression based on findings. | Bilious emesis.VIEW: Abdomen AP (one view) 01/09/15, 2332 Feeding tube tip is in gastric body.Multiple mildly to moderately dilated bowel loops are present in a disorganized pattern. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is present.Periosteal reaction is noted in both proximal femurs. The appearance of the left proximal femoral metaphysis suggests healing fracture. Proximal femoral metaphyses are flattened. | Disorganized bowel gas pattern with no evidence of NEC.Rickets. |
Generate impression based on findings. | 24-year-old male with history of sudden onset chest pain. Evaluate for PE. PULMONARY ARTERIES: Limited exam due to image noise and contrast opacification. Within the limitations of this exam, no pulmonary embolus through the lobar level.LUNGS AND PLEURA: Bilateral, right moderate and left small, pleural effusions have slightly increased in size over the interval. Overlying superimposed atelectasis/consolidation is unchanged. The left lower lobe is almost completely atelectatic. Interval improved right upper lung groundglass opacitiesMEDIASTINUM AND HILA: Mild cardiomegaly and improved small pericardial effusion. No appreciable coronary artery calcifications. Right IJ central venous catheter tip in the right atrium. Reference rights hilar lymph node (6/11) measures 13 mm, unchanged. Reference subcarinal lymph node (6/112) measures 14 mm, unchanged.CHEST WALL: Biaxillary lymphadenopathy, unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific splenic hypoattenuation come unchanged. Small amount of abdominal ascites. | 1.No pulmonary embolus to the lobar level.2.Slightly increased right moderate and small left pleural effusions.3.Stable reference lymph nodes.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Posterior stabilization rods with screws extending into the L4 and L5 vertebral bodies in near anatomic alignment without evidence of complication. There is mild dextroscoliosis of the lumbar spine. Severe degenerative disk disease particularly affects L3/L4 and L4/L5. | Orthopedic fixation of the lumbar spine without evidence of hardware complication. |
Generate impression based on findings. | 72-year-old male patient with clinical findings suggestive of cerebral edema in the setting of SVC syndrome. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. Gray-white matter differentiation is maintained. There is mild periventricular and subcortical white matter hypoattenuation, appearing similar compared to prior exam. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. There is hyperattenuating material in the left posterior globe without significant interval change. There is minimal mucosal thickening in the right frontal sinus, otherwise, the paranasal sinuses and mastoid air cells are clear. There is edema in the right periorbital soft tissues. | 1.No evidence of cerebral edema.2.Mild chronic small vessel ischemic disease without significant change. If there is clinical concern for an acute nonhemorrhagic infarct, an MRI can be obtained.3.Stable findings related to known left globe retinal detachment with subretinal hemorrhagic collection.4. There is edema in the right periorbital soft tissues which extends inferiorly outside the field of view and appears increased since prior CT head from 12/26/2014. |
Generate impression based on findings. | 7-week-old former 27 week gestational age patient with chylothorax. Increased frequency of desaturations.VIEWS: Chest AP/lateral (two views) 01/10/15, 0021, 0029, 0030 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in the stomach. Left upper extremity PICC tip is at junction of brachiocephalic veins. Left chest tube tip overlies middle mediastinum.The hemithoraces are almost completely opacified. Heart borders are not visible.Soft tissue edema continues. | Worsening appearance of the chest with almost complete opacification of the hemithorax is most likely due to pleural effusion. |
Generate impression based on findings. | 50 year-old female with pain There is a comminuted fracture of the distal radius extending to the articular surface in near-anatomic alignment. A nondisplaced ulnar styloid fracture is also noted. | Comminuted intra-articular distal radius fracture and nondisplaced ulnar styloid fracture. |
Generate impression based on findings. | 58 year-old female with pain to left shoulder for several months Glenohumeral alignment is within normal limits. No fracture is identified. | No fracture or dislocation. |
Generate impression based on findings. | 61 year-old female with decreased range of motion of the the left hip and point tenderness to the left buttocks Pelvis: No pelvic fracture is identified. Marked degenerative changes affect the lower lumbar spine.Right hip: Small osteophytes consistent with mild degenerative changes.Left hip: Small osteophytes indicate mild osteoarthritis. No fracture or malalignment. | Degenerative changes as described above without fracture or dislocation. |
Generate impression based on findings. | ET tube placementVIEW: Chest AP (one view) 1/10/15 0312 The ET tube tip is below the thoracic inlet and above the carina. Left subclavian line terminates at the confluence of the brachiocephalic veins. Enteric tube tip is in the antropyloric region of the stomach.The cardiothymic silhouette is normal.Bilateral lower lobe atelectasis persists, with increased right upper lobe atelectasis. Possible small pleural effusions are present. | Increased right upper lobe atelectasis. |
Generate impression based on findings. | 47-year-old male with pain, evaluate for fracture. Mild osteoarthritis affects both hips. Degenerative changes affect the visualized lower lumbar spine. No fracture is identified. Alignment is anatomic. | No fracture or malalignment. |
Generate impression based on findings. | 27-year-old female patient with "worst headache of life," nausea and visual disturbance. Evaluate for subarachnoid hemorrhage. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | 79-year-old female with ulcer, rule out osteomyelitis The bones are diffusely demineralized. Ulceration is noted posterior to calcaneus, which appears to extend near to the bone. There is soft tissue swelling about the foot and ankle. No gross osseous destruction is visualized. Degenerative changes affect the midfoot. | Soft tissue swelling and ulceration extending to the posterior calcaneus without underlying bone destruction. Osteomyelitis cannot be excluded. |
Generate impression based on findings. | 43-year-old male, left ankle fracture, preoperative planning An external fixation device is noted anchored within the calcaneus and the mid diaphysis of the tibia. Gas in the soft tissues reflects recent surgery. There is a comminuted fracture of the distal tibia with intra-articular extension snd numerous associated bone fragments. There is a comminuted fracture distal fibula fracture with a distal large bone fragment angled laterally.The talus and subtalar joint are intact. An os trigonum is noted. | Comminuted intra-articular tibia and fibula fractures with external fixation as described above. |
Generate impression based on findings. | 54 year-old female, evaluate fracture A fractured side plate with screws affixes the comminuted distal fibula fracture with medial angulation of the distal fragment. There is a comminuted fracture of the distal tibia and its articular surface with marked bony fragmentation and medial angulation of the medial malleolus, compatible with a deltoid ligament disruption. A comminuted fracture of the talar dome is also noted. The subtalar joint is intact. The calcaneocuboid articulation is intact. | Comminuted distal tibia and fibula fractures with fractured fibular sideplate and comminuted fracture of the talar dome as described above. An underlying neuropathic joint may be considered. |
Generate impression based on findings. | 48-year-old female with history of malignant neoplasm of bronchus and lung. LUNGS AND PLEURA: Stable post therapy changes in the left lower lung. No new suspicious nodules or masses. No pleural effusion.MEDIASTINUM AND HILA: Unchanged small lymph nodes in the mediastinum and hila, some of which are calcified. Heart size within normal limits, no pericardial effusion. Mild coronary artery calcifications. Small lymph nodes in the pericardial fat and cardiophrenic angle are unchanged. Small amount of fluid density material anterior to the hepatic dome, without enhancement.CHEST WALL: Mild degenerative changes of the spine, including endplate sclerosis and small Schmorl's nodes.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Diffuse hepatic metastases, similar to prior. | No interval change in the left lower lung post therapy changes or previously seen hepatic metastases. |
Generate impression based on findings. | 91 year-old female status post fall, rule out injury There is a high riding humeral head, consistent with a chronic rotator cuff tear. No acute fracture is evident. Mild degenerative changes affect the glenohumeral joint. The distal humerus is intact. | Findings consistent with a chronic rotator cuff tear without acute fracture evident. |
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