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Generate impression based on findings. | Evaluate for obstruction, GJ tube placement Percutaneous GJ tube present, tip appears to be in region of pylorus, apparent discontinuous appearance proximally may be related to radiolucent portion of tube. Moderate gastric distention suggested. Nonobstructive bowel gas pattern. Please refer to concomitant chest radiography from same day for additional findings. Incompletely imaged right hip hardware. Diffusely decreased osseous mineralization and levoscoliosis of lumber spine. | Enteric tube as above. If clinical concern persists, further evaluation of tube following instillation of contrast recommended. |
Generate impression based on findings. | Respiratory distress on BiPAP.VIEW: Chest AP (one view) 01/10/15, 0303 Left upper extremity PICC tip is at junction of superior vena cava and right atrium. Upper abdominal surgical clips and gastrostomy tube are noted.Left lower lobe opacity has worsened in the interval. Hazy opacity has developed on the right. Cardiothymic silhouette is normal. | Worsening opacities in the lung bases may be related to atelectasis. |
Generate impression based on findings. | 91-year-old female patient with altered mental status and fall. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage or mass. Compared to 7/30/2014, there is has been increase in hypodensity and volume loss involving the right posterior frontal and anterior parietal lobes extending inferiorly to the operculum compatible with evolution of prior infarct. Additional areas of periventricular and subcortical hypoattenuation of the white matter appear similar and compatible with chronic small vessel ischemic changes. Mild prominence of the ventricular system is not significant changed. There is no large scalp hematoma or skull fracture. There is no midline shift or herniation. There is partial opacification of the right mastoid air cells. The paranasal sinuses are clear. | 1.Evolution of prior right frontoparietal infarct. No intracranial hemorrhage or mass effect. Note that non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. If there is significant concern for an acute nonhemorrhagic infarct, MRI can be obtained.2.Unchanged prominence of the ventricular system likely related to volume loss. |
Generate impression based on findings. | ET tube placementVIEW: Chest AP (one view) 1/10/15 0614 The ET tube tip is below the thoracic inlet and above the carina. The left jugular central venous catheter tip is in the right atrium. The enteric tube tip is distal to the stomach. An IVC stent and upper abdominal surgical clips/suture are again noted. A drain projects over the right hemiabdomen.The cardiothymic silhouette size is mildly enlarged, though unchanged. The lung volumes are low. The small to moderate bilateral pleural effusions and bilateral patchy pulmonary opacities are unchanged. | Unchanged bilateral pleural effusions and bilateral patchy pulmonary opacities. |
Generate impression based on findings. | Increasing abdominal distention Incompletely imaged thickened ascending colon, correlating to findings seen on prior CT imaging. Mild small bowel wall thickening seen in left lower abdominal pelvic area, nonspecific in setting of mesenteric edema/ascites. Nonobstructive bowel gas pattern. Degenerative disease of spine. Lower lung fields not well assessed. | Incompletely imaged bowel thickening as above, no bowel obstruction. |
Generate impression based on findings. | Female 27 years old Reason: evaluate for nephrolithiasis History: L flank radiating to LLQ pain, w/ 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: 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: The appendix is not definitely identified; however, there are no secondary signs of acute appendicitis seen. There is no evidence of diverticulitis.PELVIS:UTERUS, ADNEXA: There is nonspecific heterogeneous enlargement of the uterus, which may be physiologic or reflecting a leiomyomatous uterus. There is trace free fluid in the pelvis, likely physiologic in etiology.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | No specific findings seen to account for the patient's left flank pain, specifically, no evidence of obstructing radioopaque urolithiasis. |
Generate impression based on findings. | Increased respiratory distressVIEW: Chest AP (one view) 1/10/15 0514 The left jugular central venous catheter tip is in the right atrium. The enteric tube tip is at the duodenojejunal junction. An IVC stent and upper abdominal surgical clips/suture are again noted. The cardiothymic silhouette size is slightly enlarged, though unchanged. The lung volumes are low. Small to moderate bilateral pleural effusions and bilateral patchy pulmonary opacities are new. | Development of bilateral pleural effusions and bilateral patchy pulmonary opacities. |
Generate impression based on findings. | Constipation No definitive evidence of bowel obstruction. Mild gaseous gastric prominence, air seen distally in bowel. Air containing bowel seen overlying region of right femoral head, likely due to underlying bowel containing hernia. Tube seen in region of pelvis, may be a Foley catheter and correlation with patient's clinical history/physical exam recommended. Amorphous radiodensities in pelvis, more pronounced on right than on left, reflecting portions of calcified fibroid uterus. Decreased osseous mineralization and multilevel degenerative changes of spine. | No definitive evidence of bowel obstruction, additional findings as above. |
Generate impression based on findings. | Fever, mild tachypneaVIEWS: Chest AP/lateral (two views) 1/10/15 0518 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal.Moderate peribronchial thickening and large lung volumes likely reflect reactive airway disease or bronchiolitis. No focal lung opacities or pleural effusions are present. | Bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | Female 73 years old Reason: evaluate for obstruction, mass History: vomiting, little flatus/stool, known peritoneal cancer 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: Nonspecific right basilar pleural thickening, nonspecific.LIVER, BILIARY TRACT: There is an approximately 7.2 x 8.6 cm (image 22, series 3) hypoattenuating mass in the region the gastrohepatic ligament, which is felt to represent a conglomerate of gastrohepatic ligament nodal metastases; however, acute angles at the margins of the mass liver interface could reflect an intrahepatic origin, additionally, the fat plane between the proximal lesser curvature of the stomach and the mass itself are not identified, which may reflect a gastric origin or underlying gastric invasion. The remainder of the stomach is displaced anteriorly by this mass.SPLEEN: No significant abnormality notedPANCREAS: The pancreas appears separate from the previously described mass centered in the gastrohepatic ligament; however, evaluation is suboptimal given the lack of IV contrast.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of radioopaque nephrolithiasis.RETROPERITONEUM, LYMPH NODES: There is an infrarenal IVC filter in place. There are several prominent retroperitoneal lymph nodes, the largest measuring 1.2 x 1.2 cm (image 59, series 3).BOWEL, MESENTERY: There are multiple large partially cystic/partially solid masses within the peritoneum. For reference purposes, a lesion near the pancreatic tail measures 5.1 x 5.6 cm (image 35, series 3). These masses predominantly affect the pelvis, and are centered about the expected location of the uterus and adnexa.There is a large loculated fluid collection extending from the pelvis into the right upper quadrant measuring up to 9 x 14 cm (image 82, series 3), which could reflect loculated ascites or cystic composition of one of the peritoneal masses.There is no evidence of bowel obstruction or active inflammation.PELVIS:UTERUS, ADNEXA: The uterus and adnexa are not visualized and in the expected location of these structures are multiple heterogeneous partially solid/partially cystic masses, suspicious for a primary gynecological malignancy.BLADDER: The bladder is somewhat difficult to differentiate from the surrounding tumor, but appears decompressed.BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality noted | 1.Multiple partially solid/partially cystic peritoneal masses, seen in abdomen and pelvis but predominantly affecting the latter, most suspicious for metastases from a primary gynecologic malignancy.2.Mass centered in the region of the gastrohepatic ligament nodes, may represent conglomerate nodal metastasis, although an intrahepatic epicenter or gastric origin cannot be entirely excluded.3.Large loculated fluid collection extending from the pelvis into the right upper quadrant, may reflect loculated ascites or cystic/mucinous composition of peritoneal metastatic disease.4.No definite evidence of bowel obstruction or active inflammation. |
Generate impression based on findings. | 62-year-old female patient with headache and vision changes after anticoagulation for catheterization. Evaluate for acute bleed. 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. There is polypoid opacification at the right sphenoethmoidal recess. Otherwise, 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. | 59 year old female POD #1 status post left frontal craniotomy for repair of an anterior cranial fossa dural defect. There are unchanged postoperative findings related to left frontal craniotomy and repair of an anterior cranial fossa dural defect. There is minimal essentially unchanged high attenuation subjacent to the craniotomy compatible with blood products as well as pneumocephalus. No significant change in edema involving the gyri recti and orbital frontal gyri. 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. The skull and extracranial soft tissues are unremarkable. | 1.Essentially unchanged postoperative findings related to left frontal craniotomy and anterior cranial fossa dural defect repair. No significant change in localized edema involving the gyri recti and orbital frontal gyri. No large hemorrhage or significant mass effect.2.Unchanged complete opacification of the right mastoid air cells and middle ear cavity which may represent otomastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Rectal tube placement, history of bowel distention Incompletely imaged right hip arthroplasty. Rectal tube seen coiled in expected region of mid to distal descending colon, tip located in mid descending colon. Enteric tube with side port beyond gastroesophageal junction, similar in appearance to prior exam. Dystrophic calcifications in pelvis (may reflect coarse calcifications in prostate) versus small stool in rectum, unchanged. Diffusely distended colon, moderate stool present. Incompletely imaged right femoral vascular line. | Unchanged gaseous distention of colon, rectal tube as above. |
Generate impression based on findings. | Increased respiratory distressVIEWS: Chest and abdomen AP (two views) 1/10/15 0627 Tracheostomy tube tip at the thoracic inlet. The enteric tube terminates in the stomach, which is within the giant omphalocele. A right lower extremity venous catheter tip is likely within a right iliac vein.The cardiac silhouette size is normal.No focal pulmonary opacity or pleural effusion is identified. No pneumothorax is evident.Dilated bowel loops are again noted in the right upper aspect of the giant omphalocele. Increased bowel gas is noted throughout the omphalocele compared to prior. No pneumatosis, portal venous gas, or free air is evident.Thoracic length is increased and width is decreased, as expected. | Persistent bowel loop distention. |
Generate impression based on findings. | 75-year-old female patient with history of stroke and recent carotid endarterectomy presents with altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage. There are chronic infarcts in the right caudate head and corona radiata and possibly right cerebellar hemisphere, similar to prior exam. There is unchanged mild patchy periventricular white matter low-attenuation that likely represents ischemic small vessel disease. There are extensive calcification of vertebral arteries bilaterally, basilar artery, and both internal carotid arteries. The ventricles and sulci are unchanged in size. There are no masses, mass effect or midline shift. There is moderate right and mild left maxillary sinus mucosal thickening. There is mild mucosal thickening in the right sphenoid sinus. | 1.No evidence of acute intracranial hemorrhage. Please note non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct and follow-up CT or MR should be considered as clinically indicated.2.Extensive calcifications of the major intracranial arteries.3.Stable chronic right caudate head/corona radiata lacunar infarcts.4.Paranasal sinus disease. |
Generate impression based on findings. | 31 year old male with head trauma. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull is unremarkable. There is soft tissue swelling in the right frontotemporal region. There is a punctate high attenuation focus within the right lateral supraorbital soft tissues. | 1.No evidence of intracranial hemorrhage or skull fracture.2.There is soft tissue swelling in the right frontotemporal region without underlying calvarial fracture. Punctate high attenuation focus within the right lateral supraorbital soft tissues may represent a foreign body. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Rectal tube placement, evaluate location No significant change from prior exam. Persistent colonic gaseous distention. Moderate stool. Enteric tube seen with side-port beyond gastroesophageal junction. Rectal tube seen coiled in descending colon with tip in midportion. Multiple radiodensities in lower pelvis, may be small stool in rectum versus calcified prostate. Right femoral vascular line present. Decreased osseous mineralization. | Stable exam as described. |
Generate impression based on findings. | Evaluate stool burden Nonobstructive bowel gas pattern. Small stool burden, for example, in rectum. Incompletely imaged cardiac device. | Small stool burden. No bowel obstruction. |
Generate impression based on findings. | Female 42 years old; Reason: Evaluate for abdominal abscess, evaluate for nephrolithiasis History: severe 10/10 abdominal pain, flank pain bilaterally ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Multiple gallstones in gallbladder, no secondary signs of acute cholecystitis. Mild intrahepatic biliary duct prominence. No extrahepatic biliary duct dilatation. Patent portal veins and patent SMV and splenic vein.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal hypoattenuating focus, too small to characterize, image 52 series 3. Symmetric renal parenchymal enhancement. No definite radiopaque intrarenal calculus. RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal and retroaortic lymph nodes, nonspecific.BOWEL, MESENTERY: Small to moderate stool burden. No bowel obstruction. No secondary signs of acute appendicitis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific subcentimeter inguinal lymph nodes, measuring up to 9 mm in short axis dimension on right, image 158 series 3.BONES, SOFT TISSUES: Minimal degenerative changes of spine. Mild to moderate bilateral hip osteoarthritis. | Subcentimeter lymph nodes as above, nonspecific. Unremarkable exam otherwise. |
Generate impression based on findings. | 44-year-old male with history of cough and dyspnea. Clinical history of asthma and questionable sarcoidosis. LUNGS AND PLEURA: No consolidation or pleural effusion. No fibrosis or significant emphysema.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia. | No pneumonia or pulmonary fibrosis. |
Generate impression based on findings. | Female 92 years old Reason: evaluate for ureteral obstruction, history of elevated bicarb ABDOMEN:LUNG BASES: There is moderate centrilobular paraseptal emphysema, with fibrotic changes apparent in the bases. There is mild dependent atelectasis.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. Punctate intraparenchymal calcifications suggest prior granulomatous disease.SPLEEN: Punctate intraparenchymal calcifications suggest prior granulomatous disease.PANCREAS: 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. There are multiple hypoattenuating lesions within both kidneys, suggestive of simple renal cysts, although incompletely characterized on this examination.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: There is a Foley catheter in place and the bladder is collapsed.BONES, SOFT TISSUES: There are moderate degenerative changes of the thoracolumbar spine. | No specific finding seen to account for the patient's elevated bicarbonate levels. Specifically, no evidence of ureteral obstruction as clinically questioned. |
Generate impression based on findings. | Chylothorax and chest tube. 7-week-old former 27 week gestational age patient.VIEW: Chest AP (one view) 01/10/15, 0909 Opacification of the hemithoraces has decreased. Residual hazy and patchy opacities continue. Cardiac silhouette size is upper limits of normal.Soft tissue edema continues.Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in gastric body. Left upper extremity PICC has its tip at junction of brachiocephalic veins. Left chest tube remains in place. | Improvement in appearance of chest with decreased pleural effusions. |
Generate impression based on findings. | 80 year-old female with history of right upper lung nodule on chest radiograph. LUNGS AND PLEURA: Stable scattered pulmonary micronodules, some of which are calcified. No consolidation or significant pleural effusion. The previously described chest radiograph abnormality is most likely overlapping soft tissues. Minimal basilar atelectasis / scarring.MEDIASTINUM AND HILA: Heart size within normal limits, and no pericardial effusion. Moderate coronary artery calcifications. Left chest AICD with leads in the expected location.CHEST WALL: Mild degenerative changes affect the visualized spine. Osseous demineralization is noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerosis affects the aorta and its branches. | No suspicious nodules or masses to explain the recent chest radiograph finding, and this was likely related to overlapping soft tissues. |
Generate impression based on findings. | Respiratory insufficiency. Pentobarb induced coma.VIEW: Chest AP (one view) 01/10/15, 0319 Endotracheal tube tip is thoracic inlet and carina. Feeding tube tip is in antropyloric region. Jugular line has its tip at junction of superior vena cava and right atrium.Cardiothymic silhouette is normal. Focal opacity in left lower lobe persists. Hazy opacity in right lower lobe has increased. | Continued opacities in lung bases. Atelectasis is likely. |
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. | Female 62 years old; Reason: adrenal protocol, please evaluate left adrenal nodule History: please evaluate left adrenal nodule ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable 1 cm hepatic segment 2/3 measuring simple fluid and demonstrating no significant postcontrast enhancement, compatible with a cyst. Possible focal adenomyomatosis at level of gastric fundus.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Accounting for differences in technique, unchanged left adrenal nodule, measuring 9 x 9 mm, image 37 series 14. Associated Hounsfield units on noncontrast imaging measure approximately 38. Nodule measures 110 Hounsfield units on postcontrast imaging, image 36 series 7, and measures 52 Hounsfield units on more delayed 15 minute imaging. Findings compatible with a lipid poor benign adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Terminal ileal submucosal fat deposition, likely reflecting sequela of chronic inflammation. Interval improvement of previously seen small bowel distention and thickening.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disease of spine. | Left adrenal nodule demonstrating imaging characteristics consistent with a benign (lipid poor) adenoma. |
Generate impression based on findings. | Male 48 years old Reason: cholangiocarcinoma, recurrent after resection, on palliative chemotherapy. Refractory hyperbilirubinemia, restaging on chemotherapy for 3 months History: jaundice CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy on the basis of size criteria.CHEST WALL: Right chest wall Port-A-Cath with tip terminating in the high right atrium. Fusion of the lateral right fifth and sixth ribs, may be posttraumatic or iatrogenic in etiology.ABDOMEN:LIVER, BILIARY TRACT: Again seen are bilobar percutaneous biliary drainage catheters, with the tips terminating within the second portion of the duodenum. There is essentially stable diffuse biliary ductal dilatation. There are new/increased hypoattenuating lesions scattered throughout the hepatic parenchyma, suspicious for intrahepatic metastases or extension of primary neoplasm. For reference purposes, a hepatic segment 6 lesion measures 1.5 x 1.9 cm (image 116, series 3), not well seen on the prior exam. Ill-defined hypoattenuating mass at the hepatic hilum now measuring approximately 2.0 x 4.4 cm (image 12, series 3), previously 2.7 x 4.5 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: New/increased mesenteric lymphadenopathy, reference midline mesenteric lymph node now measures 1.0 x 1.6 cm (image 134, series 3), previously 0.8 x 1.2 cm. Scattered retroperitoneal lymph nodes appear similar in size compared to the prior examination, reference aortocaval node measures 1.2 x 1.8 cm (image 121, series 3), previously 1.1 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nodule previously seen inferior to the right rectus sheath is not identified on today's examination. Fusion of the lateral right fifth and sixth ribs may be posttraumatic or iatrogenic in etiology.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered slightly prominent pelvic lymph nodes do not meet size criteria for lymphadenopathy.BONES, SOFT TISSUES: Fusion of the lateral right fifth and sixth ribs may be posttraumatic or iatrogenic in etiology. | 1.New/increased hypoattenuating lesions in the hepatic parenchyma, suggestive of intrahepatic metastases or spread of primary neoplasm.2.Essentially stable hepatic hilar mass.3.Bilobar percutaneous biliary drainage catheters, position unchanged, with stable diffuse intrahepatic biliary ductal dilatation.4.Increased mesenteric lymphadenopathy. |
Generate impression based on findings. | 7-month-old former 23 week gestational age patient with bilious emesis.VIEW: Abdomen AP (one view) 01/10/15, 0559 Feeding tube tip is in gastric body and side port is at GE junction. Osseous changes from rickets continued.Multiple mildly to moderately dilated bowel loops are seen. Bowel gas pattern has changed. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is seen. | Continued bowel dilatation. |
Generate impression based on findings. | 53 year old female with history of constrictive pericarditis, lymphoma and mediastinal radiation after pulmonary fibroma less resection. Evaluate the pericardium. LUNGS AND PLEURA: Interval decrease size of moderate right loculated pleural effusion. Small loculated left pleural effusion has also decreased in size. Interval increased patchy consolidation, particularly in the right upper lobe, bilateral mid lungs medially, and bilateral lower lobes.Stable left lower lobe nodule adjacent to the fissure, likely a benign lymph node. Subpleural nodule in the left major fissure (6/53) measures 12 mm, unchanged. Previously described left lower lobe peribronchial nodule is no longer well visualized. New right pleurex catheter.MEDIASTINUM AND HILA: Mediastinal edema and small amount of fluid around the heart is grossly similar to prior. Heart size within normal limits. Moderate coronary artery calcifications. Right chest cardiac assist device with leads in their expected location. No significant pericardial thickening, no pericardial calcifications and no significant narrowing of the atrioventricular groove.CHEST WALL: Bilateral breast prostheses, unchanged. Vertebral body appearance is unchanged, with heterogeneous sclerosis.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Persistent hepatomegaly, with the liver parenchyma appearing heterogeneous in attenuation and enhancement. Left renal cortical scar. | 1.Interval decreased pleural effusions, with the right pleurex catheter.2.Small amount of pericardial fluid, without significant pericardial thickening, pericardial calcification or narrowing of the AV waist.3.Increased consolidation along the left fissure in the left upper lobe, which may be seen in pulmonary lymphoma. |
Generate impression based on findings. | 60 year old female with lymphoma and altered mental status. This exam is mildly degraded by motion artifact.HEAD: There are unchanged postoperative findings related to right pterional craniotomy and cranioplasty for aneurysm clipping. There is also an unchanged left parietal approach ventriculostomy catheter which terminates in the right lateral ventricle. There are unchanged regions of low-attenuation within the right frontal lobe subjacent to the craniotomy site likely represent encephalomalacia. The ventricles are unchanged in size and not significantly enlarged. There are additional unchanged areas of low-attenuation within the supratentorial white matter which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage. There is no midline shift or herniation. SINUSES: There are postoperative findings related to left orbital floor and lateral orbital wall repair. There is a right maxillary sinus mucus retention cyst. The paranasal sinuses are otherwise clear. The nasal cavity is also clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid groove and optic canals are covered by bone. The nasopharynx and facial soft tissues are unremarkable. | 1.Unchanged postoperative findings related to right pterional craniotomy and cranioplasty for aneurysm clipping as well as ventriculostomy catheter placement and left orbital repair. 2.No evidence of acute intracranial hemorrhage. 3.Unchanged low attenuation regions within the supratentorial white matter are most compatible with a combination of postoperative encephalomalacia and chronic small vessel ischemic disease.4.With the exception of a right maxillary sinus retention cyst, the paranasal sinuses and mastoid air cells are clear.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Right pneumothorax. On oscillator. VIEW: Chest AP (one view) 1/10/15 0608 ET tube tip is below thoracic inlet and above the carina. NG tube tip is in the stomach. Left upper extremity PICC tip is in the SVC. Two chest tubes remain on the right. The cardiothymic silhouette is normal. The leftward mediastinal shift is similar to prior.Background lung changes of PIE persist, with large right lower lung pneumatoceles. No pneumothorax is evident. Mild left upper lobe atelectasis persists. Soft tissue edema is noted. Metaphyseal changes of metabolic bone disease are noted in the proximal humeri. | PIE with large right lower lung pneumatoceles, without pneumothorax. |
Generate impression based on findings. | Female 67 years old Reason: evaluate for sbo, biliary stent obstruction History: abdominal pain ABDOMEN:LUNG BASES: Small right pleural effusion with associated compressive atelectasis, new from the prior examination.LIVER, BILIARY TRACT: Interval increased intrahepatic and extrahepatic biliary ductal dilatation. There is a common bile duct stent in place, position unchanged. Lack of expected pneumobilia suggests component of ductal obstruction, perhaps related to stent occlusion. The hepatic artery again appears encased by tumor. The portal vein, splenic vein and superior mesenteric vein are patent. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating periampullary/pancreatic head mass again identified, measuring approximately 1.7 x 2.6 cm (image 64, series 3), previously 1.8 x 2.5 cm. There is persistent pancreatic ductal dilatation and parenchymal atrophy, without significant interval change.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The proximal small bowel is dilated, measuring up to approximately 4.1 cm in maximal diameter, with fecalization of the small bowel contents, consistent with small bowel obstruction, with a transition point in the central pelvis (image 128, series 3), likely related to adhesive disease. There is no evidence of pneumatosis intestinalis or free intraperitoneal air. There is a duodenal stent in place extending from the gastric antrum into the third part of duodenum, with debris evident within the stent, but without definite evidence of occlusion.OTHER: New small volume ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: New small volume pelvic ascites. | 1.Small bowel obstruction with transition point seen in the central pelvis, likely reflecting adhesive disease.2.New small volume ascites and right pleural effusion.3.Increased intrahepatic and extrahepatic biliary ductal dilatation without expected pneumobilia, likely reflecting biliary obstruction, perhaps secondary to stent occlusion.4.Stable periampullary/pancreatic head mass with associated parenchymal atrophy and ductal dilatation. |
Generate impression based on findings. | 50 year old female with history of cirrhosis and CHF. LUNGS AND PLEURA: Compared with the 1/5/2015 CT abdomen, there has been decreased small , right greater left pleural effusions and associated atelectasis/consolidation. Bilateral patchy groundglass opacities.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. Mild coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis, unchanged. Interval decreased ascites. | 1.Decreased small pleural effusions with improved but persistent atelectasis/consolidation and patchy groundglass opacities. 2.Interval decreased abdominal ascites, and other findings as above. |
Generate impression based on findings. | 38 year old male with congenital hydrocephalus and mild agitation with recent EVD removal. There has been interval removal of a right frontal approach external ventriculostomy catheter. There are bilateral parietal approach ventriculostomy catheters, with the left draining into the cervical subarachnoid space. There is also a unchanged remnant of a left frontal approach ventriculostomy catheter. The ventricular system has increased in size. For example, the frontal horns measure 43 mm in transverse dimension, previously 36 mm, and the third ventricle measures 11 mm in transverse dimension, previously 6 mm. The fourth ventricle is nondilated and unchanged in size. There is no evidence of acute intracranial hemorrhage. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is minimal unchanged nonspecific fluid within the bilateral mastoid air cells. | 1.Interval mild increase in size of the lateral and third ventricles.2.Interval removal of a right frontal EVD and placement of left ventriculo-cisternal shunt. These finding were called by Dr. Michael Rozenfeld to Dr. Sean Polster on 1/10/2015 at 10:26 AM.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 88-year-old male with history of new onset dyspnea and tachycardia. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Interval increased moderate left and small right pleural effusions with associated atelectasis/consolidation. Pulmonary nodules, likely post infectious/post inflammatory, are unchanged. Postoperative findings in the right middle lobe, unchanged.MEDIASTINUM AND HILA: Heart size normal, with increased moderate sized pericardial effusion. Severe coronary artery calcifications. Scattered mediastinal and hilar lymph nodes are again seen.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolus.2.Increased moderate left and small right pleural effusions.3.Increased moderate pericardial effusion.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 57 year old female with recent subarachnoid hemorrhage and endovascular coiling of a basilar tip aneurysm There are postoperative findings related to endovascular coil embolization of a basal tip aneurysm and placement of a right frontal approach ventriculostomy catheter which terminates near the foramen of Monro. There is extensive streak artifact from the packed coils which limits this exam. There has been a decrease in the amount of intraventricular blood products and subarachnoid blood products. The lateral ventricles have mildly decreased in size (with the frontal horns currently measuring 25 mm in transverse dimension, previously 28 mm). There are unchanged regions of low-attenuation within the bilateral supratentorial white matter that may represent chronic small vessel ischemic disease as well as a larger regions of low attenuation within the bilateral cerebellar hemispheres which are compatible with subacute to chronic infarcts. There is atherosclerotic calcification of the distal vertebral and internal carotid arteries. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening as well as near complete opacification of the left maxillary sinus. There is unchanged fluid within the bilateral mastoid air cells. Multiple periapical lucencies consistent with dental disease. | 1.Postoperative findings related to endovascular coil embolization of a basilar tip aneurysm and ventriculostomy catheter placement.2.Slight decrease in ventricular size.3.Slight decrease in intraventricular hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 68-year-old male with history of tonsil cancer and chemo radiation therapy. CHEST:LUNGS AND PLEURA: Scattered stable pulmonary micronodules. No new suspicious nodules or masses. Mild apical predominant emphysema. No pleural effusion or consolidation.MEDIASTINUM AND HILA: Heterogeneous thyroid, unchanged no mediastinal or hilar lymphadenopathy. Heart size within normal limits, and there is no pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Mild degenerative findings affect the spine, including endplate sclerosis and small anterior and posterior osteophytes.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: Right renal cyst, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 29 year old female with history of resected posterior fossa PA and ventricular shunt now with worsening ataxia. There is a right frontal approach ventriculostomy catheter terminating near the foramen of Monro. The ventricles are unchanged in size with near complete collapse of the right lateral ventricle. There are postoperative findings related to occipital craniotomy for resection of a posterior fossa mass. There is no evidence of acute intracranial hemorrhage. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. | Unchanged ventriculostomy catheter position and ventricular size.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | HeadNo evidence of acute intracranial hemorrhage or mass effect. No midline shift or uncal herniation. Again seen are areas of encephalomalacia in bilateral parietal lobes and the medial aspect of the posterior left temporal lobe extending into the left occipital lobe lingual gyrus with ex vacuo dilatation of the left lateral ventricle consistent with chronic infarctions. The gray-white matter differentiation is otherwise preserved. No hydrocephalus. The left frontal sinus is underdeveloped, but otherwise the paranasal sinuses and mastoid air cells are clear. Calvarium and orbital walls are intact. Cervical SpineNo evidence of acute fracture or traumatic subluxation within the cervical spine. Vertebral body heights are normal. There is loss of cervical lordosis. There is mild retrolisthesis of of C5 on C6 and minimal at C3 on C4 likely on a degenerative basis.Multilevel degenerative changes are seen with severe loss of intervertebral disk space, disk osteophyte complex formation, and endplate irregularities at C3-C4, C5-C6, and C6-7. Well-defined subchondral lucencies may be on a degenerative basis, however can also be seen with inflammatory spondyloarthropathies. There is mild spinal canal narrowing at the C4-C5 and C5-C6 levels. There is moderate bilateral neural foraminal stenosis at C4-C5. Prominent left C4-C5 facet arthropathy.Right pleural effusion is again seen and present on prior chest CT. | 1.No evidence of intracranial hemorrhage. No orbital or calvarial fracture is evident.2.Multiple prior bilateral chronic infarcts, which appears similar to prior.3.No acute fracture or subluxation in the cervical spine.4.Multilevel degenerative changes as detailed above.5.Right pleural effusion. |
Generate impression based on findings. | Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at the L1 level. The vertebral body heights are maintained. Again seen is increased left-sided epidural fat at the L2 level along the ventral aspect of the spinal canal, resulting in subtle mass effect on the thecal sac and displacement posteriorly on the left. Findings appear similar to prior exam and are compatible with epidural lipomatosis. There are no abnormal enhancing lesions in the bone marrow to suggest metastatic disease. Low T1 and T2 focus at L4 posteriorly is unchanged and may represent an old sclerotic lesion. Foci of enhancment at the superior and inferior L4 endplates are likely on a degenerative basis/Schmorl nodes. Bilateral renal cysts are again noted.T12/L1: There is no neural foraminal or spinal canal narrowing.L1/2: There is no neural foraminal or spinal canal narrowing.L2/3: There is mild ligamentum flavum hypertrophy. There is no neural foraminal or spinal canal narrowing. L3/4: There is epidural lipomatosis and mild ligamentum flavum hypertrophy. There is mild spinal canal narrowing. No neural foraminal stenosis.L4/5: There is epidural lipomatosis, a posterior disk osteophytes complex and ligamentum flavum hypertrophy, resulting in severe spinal canal stenosis. There is minimal bilateral neural foramina narrowing. There is mild facet arthropathy.L5/S1: There is epidural lipomatosis, posterior disk osteophyte complex and mild ligamentum flavum hypertrophy. There is moderate to severe spinal canal narrowing and mild to moderate right and mild left foraminal narrowing. | 1.No significant change in degenerative changes in the lower lumbar spine with severe spinal canal stenosis at L4-L5 related to epidural lipomatosis and superimposed degenerative disease. Individual levels as above.2.No enhancing lesions to suggest active metastatic disease. Previously seen right L2 transverse process and right sacral ala lesions are no longer identified. |
Generate impression based on findings. | Respiratory failure with reintubationVIEW: Chest AP (one view) 1/10/15 1109 The ET tube tip is below the thoracic inlet and above the carina. The left jugular central venous catheter tip is in the right atrium. The enteric tube tip is distal to the stomach. An IVC stent and upper abdominal surgical clips/suture are again noted. A drain projects over the right hemiabdomen.The cardiothymic silhouette size is mildly enlarged and unchanged. The lung volumes are low. The small to moderate bilateral pleural effusions are similar to prior. The bilateral pulmonary opacities are increased and more diffuse. | Increasing bilateral pulmonary opacities. |
Generate impression based on findings. | CT HEAD: There is no evidence of acute intracranial hemorrhage. There are somewhat more clearly defined regions of low-attenuation within the right frontal and parietal white matter as well as a smaller punctate focus of low-attenuation within the genu of the right internal capsule compatible with acute to subacute infarcts. There is mild global volume loss and atherosclerotic calcification of the distal internal carotid arteries. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA HEAD: There is mild atherosclerotic calcification and narrowing of the intracranial internal carotid arteries without hemodynamically significant stenosis. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber with bilateral fetal PCA origins. There is no evidence of flow-limiting stenosis or aneurysm. Prominence of the pial collaterals with possible mild leptomeningeal enhancement is again noted.CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.MISCELLANEOUS: There is mild pulmonary emphysema. There are small bilateral cervical lymph nodes that are not significantly enlarged. The thyroid is mildly enlarged. There is cervical spondyloarthropathy without significant spinal canal stenosis. There are multiple dental caries and periapical lucencies. | 1.Multiple right cerebral hemisphere acute infarcts. No evidence of mass-effect. As suggested on recent MRI, if there is possibility of associated infection and infectious vasculopathy, consider lumbar puncture. However, no significant steno-occlusive lesion within the head or neck is seen. No appreciable mycotic aneurysms.2.Multiple dental caries and periapical lucencies. 3.Mild emphysematous changes at the lung apices. 4.Non-specific mild thyroid enlargement. |
Generate impression based on findings. | There are linear lucencies through the right transverse processes at L1 and L2. There is a linear transversely oriented lucency through the L5 vertebral body without height loss. The vertebral column alignment is within normal limits. The paravertebral soft tissues are unremarkable. There is heterotopic bone between L4 and L5 spinous processes. There is multi-level spondyloarthropathy that is most severe at L4-L5 and L5-S1 where there have been probable remote left laminotomies. At L4-L5, there is end plate degenerative change, and a disc bulge asymmetric to the left as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in at least mild spinal canal stenosis. At L5-S1 there is mild loss of disc height, endplate degenerative change, and a mild disc bulge as well as a large osteophyte within the left neural foramen. There is also left facet arthropathy. These findings result in severe left neural foramen stenosis. | 1.Fractures of the right L1 and L2 transverse processes which may be acute. Correlate with focal tenderness.2.Vertical lucency extending to the L5 vertebral body, possibly related to remote trauma versus developmental variant. Of note, no edema is seen on recent MRI to suggest an acute injury at this level.3.Remote postsurgical changes at the left L4-L5 and L5-S1 levels.4.Large osteophyte within the left L5-S1 neural foramen resulting in severe stenosis.5.Please refer to separate MRI report for individual levels of spinal canal or neural foramina stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 72-year-old male with right upper extremity swelling. Concern for airway and neck mass. There is an irregular soft tissue mass that extends from the right paratracheal mediastinum at the level of the aortic arch superiorly to the surgical bed in the cervical neck. There is minimal peripheral enhancement of the mass. The mass circumferentially encases the right subclavian artery and the common carotid artery. There is associated attenuation of the common carotid artery without occlusion. The right brachiocephalic vein is not visualized. The approximate extent of this mass measures 5.2 x 5.5 x 8.8 cm (coronal series 80354 image 60 and sagittal series 80355 image 49). There is a new (compared to prior CT neck, similar to prior chest CT) hypoattenuating lesion in the left lobe of the thyroid that measures 1.3 x 1.3 cm (series 5 image 68). The right lobe of the thyroid is nearly completely obliterated by the soft tissue mass. There is leftward tracheal deviation. There appears to be mild airway narrowing at the supraglottic level.There are postsurgical changes of the radical neck dissection again noted. There is a well-defined fluid collection in the right neck surgical bed (likely seroma) that is slightly decreased in size compared to prior examination and measures 5.7 x 2.9 x 1.9 cm (previously 1.9 x 3.2 x 6.0 cm). There is emphysema in the imaged portions of the lungs. There are numerous pleural-based soft tissue nodules near the right lung apex that measure 1.5 x 1.8 cm (coronal series 80354 image 85) and 1.8 x 1.3 cm (coronal series 80354 image 78). Additionally, there is an incompletely imaged parenchymal nodule in the posterior right upper lobe. Some of these appear larger compared to chest CT 12/30/2014.There is right periorbital soft tissue edema with reticulation that extends down to the neck.OTHER: Please refer to head CT dated 1/9/2015 for intracranial findings. | 1. Compared to prior CT neck from 9/9/2014, there is evidence of tumor recurrence with soft tissue mass seen extending from the mediastinum to the right neck and encasing the right common carotid and right subclavian arteries. There is mild progression of metastatic disease in the chest compared to CT chest from 12/30/2014. 2. Increased soft tissue edema in the right neck extending to the right periorbital region may be related to central venous obstruction.4. Left tracheal deviation and mild airway narrowing at the supraglottic level.5. Bilateral thyroid lesions are also compatible with metastasis.6. Unchanged left globe retinal detachment with subretinal hemorrhagic collection. |
Generate impression based on findings. | 42 year old male with left submandibular swelling. The thyroid and major salivary glands are unremarkable, including the left submandibular gland. There is borderline bilateral cervical lymphadenopathy with lymph nodes increased in both size and number. For example, a left level Ib lymph node has a rounded configuration and measures up to 16 mm, just anterior to the submandibular gland. A somewhat rounded right level Ib lymph node measures up to 15 mm. There is non-specific prominence of the nasopharyngeal soft tissues/adenoids tonsils. There is no evidence of mass lesions. There is anterior translation of the mandibular condyles in relation to the to the submandibular joint, which is likely positional. The major cervical vessels are patent. The osseous structures are unremarkable. There is evidence of removal of left posterior mandibular molar. No fluid collections or evidence of abscess.The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1.Mildly enlarged bilateral submandibular lymph nodes, which may be reactive. There is 16mm left level Ib lymph node, which may correspond to the palpable abnormality.2.Non-specific prominence of the adenoid tonsils with associated narrowing of the nasopharyngeal airway. 3.There is evidence of removal of left posterior mandibular molar. No fluid collections or evidence of abscess.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 68 year old male with altered mental status This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. There is a nasogastric tube. There is fluid within the bilateral mastoid air cells as well as within the maxillary sinuses, slightly increased compared with the prior exam. | No evidence of intracranial hemorrhage or significant mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 74-year-old female patient with altered mental status. Evaluate for stroke. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. Again noted is slight asymmetric volume loss in the left cerebral hemisphere compared to the right. Otherwise, the ventricles and sulci are are within normal limits for age. 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. Bilateral lens prostheses noted. | No evidence of intracranial hemorrhage or mass effect. If there is continued clinical concern for acute infarct, an MRI of the brain is recommended. |
Generate impression based on findings. | 52 year old male with head trauma three days prior. There is no evidence of acute intracranial hemorrhage. There are unchanged foci of high attenuation within the right cingulate gyrus and right inferior frontal gyrus. There is an unchanged focus of low attenuation within the left periventricular white matter extending into the caudate nucleus as well as new small foci of low-attenuation within the bilateral thalami and right callosal genu. There is an unchanged sellar mass that extends into the suprasellar cistern and measures 18 x 18 x 20 mm in transverse by cc dimensions. There is likely mass effect upon the optic chiasm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.No evidence of acute intracranial hemorrhage or skull fracture.2.Unchanged foci of high attenuation within the right cingulate gyrus and right inferior frontal gyrus may represent calcification or mineralization and are nonspecific.3.Unchanged left periventricular and caudate nucleus chronic lacunar infarct.4.Age-indeterminant but likely chronic lacunar infarcts within the bilateral thalami and right callosal genu are new since the prior exam.5.Unchanged presumed macroadenoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 68 year old male with T4bN2b p16+ SCC of the L palatine tonsil with chemo/RT completed in September 2013 per EPIC and metastatic thyroid cancer per order indication. There are post-treatment findings with persistent but mildly decreased pharyngeal mucosal edema and mild airway narrowing. There is no evidence of discrete mass lesions or significant cervical lymphadenopathy. There multiple unchanged hypoattenuating subcentimeter nodules within the thyroid gland. The major salivary glands are unchanged. There is partial opacification of the ethmoid and maxillary sinuses. There is moderate atherosclerotic plaque at the carotid bifurcations bilaterally without hemodynamically significant stenosis, as well as calcification at the aortic arch. The internal jugular veins are patent. There is multilevel degenerative spondylosis. The imaged portions of the lungs are clear. | 1.No evidence of locoregional tumor recurrence or significant lymphadenopathy.2.Multiple unchanged non-specific subcentimeter nodules within the thyroid gland. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Newborn 24 week gestational age patient.VIEWS: Chest and abdomen AP (two views) 01/10/15, 1413 Endotracheal tube tip is in right mainstem bronchus. Umbilical arterial line tip is at T7. Umbilical venous line tip is in an unknown location in the right upper quadrant.Mediastinum is shifted to the left and left lower lobe is atelectatic. No right lung opacities are present. Cardiothymic silhouette is probably normal.Gas pattern is normal. | Right mainstem bronchus intubation and left lower lobe atelectasis. Umbilical venous line in an abnormal location. Normal bowel gas pattern. |
Generate impression based on findings. | Right lower quadrant pain. Rule-out appendicitis. ABDOMEN:LUNG BASES: No focal opacity. No pleural effusion.LIVER, BILIARY TRACT: Normal enhancement. No biliary duct dilation. Distended a normal appearing gallbladder.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric enhancement. No pelvicaliceal dilation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple dilated small bowel loops are present. Fluid tracks along the root of the mesentery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free air is identified.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended and normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is dilated, fluid-filled, and contains an appendicolith. Edema is present around the appendix. Free fluid is seen in the right paracolic gutter and in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Acute appendicitis.Free fluid. |
Generate impression based on findings. | Newborn 24 week gestational age patient with umbilical venous line replacement.VIEWS: Chest and abdomen AP (two views) 01/10/15, 1459 Endotracheal tube tip is in right main stem bronchus. Umbilical venous line tip is in left atrium. Umbilical arterial line has its tip at T7.Atelectasis of the left lung is present. The right lung is normal. Cardiac silhouette size cannot be evaluated. Mediastinum is shifted to the left.Bowel gas pattern is normal. | Right mainstem bronchus intubation. Umbilical venous line tip in left atrium. |
Generate impression based on findings. | There is minimally increased opacification within the left maxillary ostium and infundibulum. The mucosal thickening involving the ethmoid, maxillary, and sphenoid sinuses is otherwise unchanged. There is no evidence of retromaxillary, orbital, or intracranial extension. The nasal cavity is clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid groove and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There is a dental caries and periapical lucency involving ADA tooth number 16. | 1.Compared to 12/31/2014, no significant change in paranasal sinus mucosal thickening without evidence of orbital, retromaxillary, or intracranial extension. There is improvement compared to 12/24/2014.2.Dental caries and periapical lucency involving ADA tooth number 16.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 32 year old male with new onset paranoia and psychosis. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a smooth, shallow, well corticated defect within the outer table of the frontal bone on the right that may be likely related to remote trauma. The skull and extracranial soft tissues are otherwise unremarkable. | 1. No evidence of intracranial hemorrhage or mass effect.2. Smooth lytic defect in the right frontal calvarium is nonspecific. No adjacent mass is appreciated. Correlate for remote history of prior infection, trauma, or surgery. Linear soft tissue (possibly scar) seen in the adjacent scalp.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 27 year old male with cerebral palsy presenting after fainting and possible seizure. There is no evidence of intracranial hemorrhage. The lateral ventricles are asymmetric with the left being larger than the right. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of intracranial hemorrhage. 2. Asymmetric enlargement of the left lateral ventricle. Finding may be related to adjacent remote parenchymal injury (especially given history of cerebral palsy), which can be better assessed with MRI. Underlying cystic lesion such as a neuroepithelial cyst would also be in the differential. Consider comparison with priors if available.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 12 year old female with diabetes, hyperglycemia, and altered mental status. There is no evidence of intracranial hemorrhage. There is mild loss of grey-white differentiation and sulci diffusely. The ventricles and basal cisterns appear small. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | Mild loss of grey-white differentiation and global sulcal effacement suggestive of global cerebral edema. No herniation.Findings discussed with Dr. Tothy at 4:20pm on 1/10/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 3 year old male with submental swelling and induration. This exam is degraded by motion artifact. There is minimal swelling and stranding within the subcutaneous fat of the submental region. There is no discrete fluid collection. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Motion degraded exam with minimal submental swelling and fat stranding without evidence of abscess. Given motion degradation on exam, if there is high suspicion for a palpable mass, ultrasound may be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 71 years old; Reason: please evaluate for infectious source History: septic shock, recent microperf of bladder CHEST:LUNGS AND PLEURA: Mild interval improvement in size of small left pleural effusion. Increasing right pleural effusion. Underlying atelectasis/consolidation present. Mild vague airspace disease in visualized aerated lung.MEDIASTINUM AND HILA: Severe calcified coronary artery disease and cardiomegaly. Status post sternotomy and cardiac assist devices present in superior and lower aspects of left thorax, associated beam hardening artifact makes evaluation suboptimal. Cardiac leads in right atrium and right ventricle. Stable aneurysmal ascending aorta measuring up to 3.9 cm. Mild interval decreased prominence of pericardial effusion. Right-sided dual lumen central venous catheter seen with tip location in distal SVC. Tracheostomy tube placement. Enteric tube seen with tip in region of third portion of duodenum. Small mediastinal nodes. Heterogeneous thyroid gland containing coarse calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenules seen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic atherosclerotic calcifications.BOWEL, MESENTERY: Interval improvement in degree of small bowel dilatation. Colonic diverticula. Moderate stool burden. PELVIS:PROSTATE, SEMINAL VESICLES: Multiple brachytherapy seeds. BLADDER: Increasing now moderate to large amount of ascites. Again seen is small amount of layering hyperdensity in left lower quadrant loculated fluid collection, hyperdensity within is improved from earlier exam, image 183 series 4, structure not significantly changed in size accounting for differences in technique, measuring approximately 5.5 x 2.9 cm, image 180 series 4. Collection appears to be contiguous with superolateral aspect of bladder dome, image 191 series 4, site of defect measures approximately 1.3 cm on transaxial imaging. Interval removal of previously seen Foley catheter. BONES, SOFT TISSUES: Soft tissue edema and gaseous foci seen in soft tissues deep to the sacrum, extending to level of the bony sacrum itself and correlation with the patient's clinical history and physical exam recommended to exclude underlying decubitus ulcer formation. Visualized osseous structures stable otherwise, including subcentimeter sclerotic focus in right humeral head, may be a bone island. Decreased osseous mineralization. Multilevel degenerative changes of spine. Moderate to marked anasarca. Interval improvement in previously visualized pneumoperitoneum and soft tissue emphysema. | 1. Again seen is small amount of layering hyperdensity in left lower quadrant loculated fluid collection, structure not significantly changed in size accounting for differences in technique, and appears to be contiguous with superolateral aspect of bladder dome. Given patient's reported history, findings may reflect contained bladder perforation with associated evolving blood products (also noted within bladder itself). Increasing now moderate to large amount of ascites. 2. Soft tissue edema and gaseous foci seen in soft tissues deep to the sacrum, extending to level of the bony sacrum itself and correlation with the patient's clinical history and physical exam recommended to exclude underlying decubitus ulcer formation and/or external material, e.g., gauze.3. Bilateral pleural effusions, underlying atelectasis/consolidation present. Mild vague airspace disease in visualized aerated lung.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is a small irregular lytic lucency within the posterior right maxillary alveolus with an absent molar. There is no evidence of fluid collection, abscess, or soft tissue swelling. Asymmetrically prominent left jugulodigastric lymph node. No significant cervical lymphadenopathy.No maxillofacial fractures. The imaged paranasal sinuses and mastoid air cells are clear. There is a partially empty sella. | Small lytic defect within the posterior right maxillary alveolus without adjacent inflammatory changes or abscess. This is non-specific and may represent an area of current or prior infection among other etiologies. Recommend direct visualization. This finding was discussed with the ER attending on shift at 9:00 am on 1/11/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 3-year-old male status post fall with altered mental status No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift, or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Minimal mucosal thickening in the paranasal sinuses. Mastoid air cells are clear. Calvarium is intact. | No evidence of acute intracranial hemorrhage or mass effect. No calvarial fracture. |
Generate impression based on findings. | Headaches, status post fall, loss of consciousness. Evaluate for bleed. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift, or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Tiny mucus retention cysts. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. Calvarium is intact. | No evidence of acute intracranial hemorrhage or mass effect. No calvarial fracture. |
Generate impression based on findings. | CVA, left-sided weakness No intracranial hemorrhage is identified. Similar to CT dated 12/14/2014 again seen are areas of regions of hypoattenuation in the watershed distribution of the right cerebral hemisphere compatible with recent infarcts with slight evolution. Additional scattered ill-defined and focal hypoattenuating lesions are redemonstrated in the bilateral cerebral hemispheres, brainstem and cerebellum, compatible with chronic small vessel ischemic disease and lacunar infarcts.No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Mild scattered paranasal sinus mucosal thickening. Calvarium is intact. | 1. No evidence of acute intracranial hemorrhage.2. Multiple right cerebral hemispheric infarcts in a watershed distribution again seen and similar to prior CT and MRI from 12/14/2014 and 12/17/2014, respectively, with mild evolution. No evidence of hemorrhagic transformation or mass-effect. Additional supratentorial and infratentorial chronic infarcts also again seen.3. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | Reason: new multiple strokes, evaluate vessels History: as above Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right internal carotid artery is smaller than the left internal carotid artery.There are multilevel degenerative changes present in the cervical spine with disk bulges, loss of disk space height, endplate osteophytes and uncovertebral osteophytes which are worse at C4-5, C5-6 and C6-7. There are endplate erosive changes present at the right half of the C6-7 disk space. There is narrowing of the spinal canal suspicious for spinal stenosis and neural foramen encroachment at C4-5, C5-6 and C6-7. There are air-bubbles in the epidural space.Brain CTA: There is opacification of the distal internal carotid arteries up to the proximal communicating segments, the distal vertebral arteries and the proximal posterior cerebral arteries. The communicating segments distal to the posterior communicating artery origins do not opacify. There is non-opacification of the proximal anterior and middle cerebral arteries.The right anterior cerebral artery does not readily opacify along the A2 and A3 segments. The splenial arteries and parietoccipital arteries are prominent suggesting collateral reconstitution via pial collaterals.The posterior communicating arteries are identified and are intact, however, the left is larger than the right.There is a 5mmx10mm broad-based extra-axial mass adjacent to the left parietal lobe.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. New right sided hypodense foci are present in the right basal ganglia and the right medial frontal lobe gray matter and subcortical white matter and to a lesser degree parietal lobe. These are better seen on the recent MRI on diffusion weighted images .No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. | 1.Findings suggest Moya-Moya like phenomenon with bilateral distal ICA and proximal ACA and MCA occlusions with pial collateral reconstitution.2.Subacute infarctions predominantly along the medial right frontal lobe and basal gangila are better depicted on the recent MRI exam.3.There are multilevel degenerative changes associated with narrowing of the spinal canal suspicious for spinal stenosis and neural foramen encroachment at C4-5, C5-6 and C6-7.4.Small extra-axial mass adjacent to the left parietal lobe most likely represent a small meningioma. |
Generate impression based on findings. | Female 58 years old; Reason: Evaluate for fistula, invading wall process History: hx of rectal and vaginal bleeding ABDOMEN:LUNGS BASES: Small right base atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy. Heterogeneous fluid containing collection with associated relative hyperdensity/soft tissue attenuation seen in the right posteroinferior perihepatic region with extension into Morison's pouch and into abdominal wall posterolaterally. Air containing component of collection or tract seen extending to junction of second and third portions of duodenum, image 40 series 3. Collection measures approximately 5.7 x 3.8 cm on image 35 series 3. Collection may have subcapsular hepatic component or origin. Additional 1.6 x 1.4 cm focus seen inferior to region of ligamentum teres on image 44 series 3, may reflect additional small abscess. Patent portal veins. Patent splenic vein and SMV.SPLEEN: Indeterminant 2.1-cm hypoattenuating lesion (does not measure simple fluid) in posterior spleen, image 29 series 3. Differential considerations include complex cyst, hemangioma or infectious or neoplastic etiology.PANCREAS: No definite abnormality noted.ADRENAL GLANDS: Indeterminant bilateral left greater than right adrenal nodularity, particularly involving medial limbs.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Calcified aortobiiliac atherosclerotic disease. Mild gastrohepatic and periceliac adenopathy. Additional nodular soft tissue focus seen in right anterior mesentery, measuring 10 x 7 mm, image 66 series 3, may be a lymph node.BOWEL, MESENTERY: Linear relatively hyperattenuating tract with associated foci of air seen intervening between right anterior rectum and vagina, image 121 series 3. Findings worrisome for abnormal extraluminal air/possible air containing colovaginal fistula. Small vaginal gas. No bowel obstruction delineated. PELVIS:UTERUS, ADNEXA: Linear relatively hyperattenuating tract with associated foci of air seen intervening between right anterior rectum and vagina, image 121 series 3. Findings worrisome for abnormal extraluminal air/air containing fistulous colovaginal connection. Small vaginal gas. No bowel obstruction delineated. BLADDER: Collapsed, making evaluation suboptimal.BONES, SOFT TISSUES: Nonspecific left greater than right sclerosis in regions of sacroiliac joints. Multilevel degenerative changes of spine, most pronounced at L1/2 level. | 1. Heterogeneous fluid containing collection with associated relative hyperdensity/soft tissue attenuation seen in the right posteroinferior perihepatic region with extension into Morison's pouch and into abdominal wall posterolaterally. Air containing component of collection or tract seen extending to junction of second and third portions of duodenum, underlying fistulous connection a consideration. Collection measures approximately 5.7 x 3.8 cm and may have subcapsular hepatic component or origin. Findings suspicious for infectious etiology/abscess formation and correlation with patient's clinical history and lab values recommended. Additional 1.6 x 1.4 cm focus seen inferior to region of ligamentum teres, may reflect additional small abscess. 2. Linear relatively hyperattenuating tract with associated foci of air seen intervening between right anterior rectum and vagina. Findings worrisome for abnormal extraluminal air/possible air containing colovaginal fistula. Evaluation suboptimal on current exam and correlation with patient's clinical history recommended and further assessment with dedicated fluoroscopy should be pursued as clinically warranted. 3. Mild abdominal adenopathy as above.4. Indeterminant 2.1-cm hypoattenuating lesion in spleen. |
Generate impression based on findings. | 39 -year-old female with history of upper extremity DVT and substernal chest pain PULMONARY ARTERIES: Multiple filling defects in bilateral lower lobe segmental pulmonary arteries. Filling defects are eccentrically located suggestive of chronic pulmonary emboli. There is a filling defect in the right lower lobe that appears more centrally located and may be subacute in nature. There is a pulmonary artery web at the takeoff of the right lower lobe pulmonary artery also suggestive of chronic pulmonary embolism. The pulmonary artery measures 2.8 cm suggestive of pulmonary artery hypertension.LUNGS AND PLEURA: There is bilateral lower lobe streaky groundglass opacities and subsegmental atelectasis with septal thickening. There are two small focal areas of peripheral consolidation along the major fissure in the mid and lower right lung (series 10, image 61 and image 79). These may represent focal areas of atelectasis, infection or infarcts. There is a micronodule in the right upper lobe measuring 3 mm (series 8, image 74).MEDIASTINUM AND HILA: Hypodense nodule in the left thyroid lobe. The heart size is normal. There is straightening of the interventricular septum suggestive of mild right heart strain. No pericardial effusion. There is no significant mediastinal or hilar lymphadenopathy.CHEST WALL: Bilateral prominent axillary lymph nodes measuring up to 13 mm in short axis (series 7, image 45). There is no significant retrocrural or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Small hiatal hernia. | 1.Subacute to chronic appearing pulmonary emboli in bilateral lower lobes as described above.2.Hypodense nodule in the right thyroid lobe. Follow-up with ultrasound if clinically warranted.PULMONARY EMBOLISM: PE: YesChronicity: Chronic appearingMultiplicity: BilateralMost Proximal: Right segmentalRV Strain: Mild. |
Generate impression based on findings. | There is minimal mucosal thickening within the left sphenoid sinus and right relatively greater than left maxillary sinuses. Small left maxillary sinus mucosal retention cyst. Trace mucosal thickening involving the anterior ethmoid air cells. The nasal cavity is clear. There is no significant nasal septal deviation. The ethmoid roofs are intact. There is focal dehiscence of the right medial orbital wall anteriorly which appears to be discontinuity with the right anterior ethmoidal canal. The carotid groove and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There are bilateral lens implants. | Minimal mucosal thickening involving the paranasal sinuses as above. No CT evidence of acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is no acute maxillofacial or orbital fracture. The globes are intact. Lens are in place. No retrobulbar hematoma. Visualized intracranial structures are unremarkable.There is minimal paranasal sinus mucosal thickening as well as minimal secretions within the sphenoid sinuses. There is no significant soft tissue swelling in the periorbital region. | No orbital fracture. No evidence of globe rupture. No retrobulbar hematoma. No evidence for foreign body. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: GSW to Left posterior neck History: trauma Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There are air bubbles tracking along the fascial planes in the left posteriolateral perivertebral musculature and underneath the trapezius along the left shoulder.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right A1 segment is smaller than the left A1 segment.CT head:There is right occipital depressed skull fracture associated with 4mm depression of the fracture fragment into the calvarium. There is adjacent punctate hyperdensity along the occipital lobe and a 3mm small extra-axial collection associated with some punctate extra-axial fat. There is adjacent scalp soft tissue swelling associated with puncate metallic density foreign objects.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. | 1.Right occipital depressed skull fracture associated with adjacent contusion and thin extra-axial hematoma. The possibility this is an open fracture cannot be excluded.2.Left posteriolateral neck penetrating injury involving the lower neck and uppershoulder musculature.3.No evidence for carotid or vertebral dissection. |
Generate impression based on findings. | Pain and swelling, check humerus prosthesis Shoulder: Long-standing humeral hemiprosthesis observed in gross anatomic alignment (patient lacks a a deltoid muscle which can appear with a humoral head projected more posteriorly). Without prior, subtle change cannot be identified however the humeral head appears properly positioned. Consider follow up imaging if there is concern for dislocation. Acromion and glenoid are otherwise also within expectation. Surgical clips located within the axilla and upper armHumerus: Longstem component extends into the distal diaphysis. Linear calcific densities observed along the upper soft tissues adjacent to multiple surgical staples and vascular clips. Although possibly heterotopic bone, comparison close lead with prior imaging would be important to exclude interval change given the potential of an abnormality within the surgical bed and presumed prior malignancy.In addition, the interface between the intermaxillary stem and native bone also demonstrates a collar of lucency which is of uncertain significance. This may represent a plastic radiolucent element, however resorbs an of bone cannot entirely be excluded given poor visualization of the osteotomy interface.Elbow: Diffuse demineralization without definite distinct focal additional abnormality not described previously above | No gross acute abnormality definitely identified, however there are upper arm soft tissue and prosthetic changes concerning for or long-standing potential abnormalities. Although remote, comparison with prior imaging is needed to exclude. Pager 1223 contacted |
Generate impression based on findings. | 19 year-old female with chest pain and shortness of breath PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Pulmonary artery measures 2.5 cm. There is collateralization and change in caliber of the left subclavian vein which may represent stenosis. LUNGS AND PLEURA: There is minimal dependent bibasilar atelectasis, left greater than right. There is a 5 mm groundglass nodule in the left upper lung (series 10, image 36). Streaky opacities in the left lung base likely represent subsegmental atelectasis.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Tracheostomy tube in position.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. The osseous structures are within normal limits.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. NG tube in the stomach. | 1.No evidence of pulmonary embolism.2.5-mm groundglass nodule in the left upper lung. Recent guidelines by the Fleischner society (Radiology 2005: 237:395-400) suggest that patients with low risk for lung cancer and nodules greater than 4 mm and less than or equal to 6 mm in diameter should have follow up in 12 months. In patients with a higher risk, such as smokers, follow-up is recommended in 6 months. Patients with a known malignancy are at increased risk for metastasis and should receive a three month follow-up.PULMONARY EMBOLISM: PE: None.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 32-year-old male with shortness of breath and hypoxia PULMONARY ARTERIES: Technically adequate examination. No evidence of pulmonary embolism. Pulmonary artery is enlarged measuring 3.0 cm suggestive of pulmonary artery hypertension.LUNGS AND PLEURA: Postoperative changes of bilateral lung transplantation. There is minimal improvement of bilateral upper lobe dominant groundglass opacities with architectural distortion and volume loss when compared to the prior exam, particularly in the left upper lobe. There are new focal areas of consolidation in the right upper lobe (series 8, image 8 and 44) that may represent infection or aspiration. There is a micronodule in the right lower lobe measuring 3 mm (series 8, image 85). No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: There is a right posterolateral paratracheal soft tissue density with centrally located focus of air density that appear smaller compared to the prior exam and may represent a tracheal diverticulum. The reference right paratracheal lymph node is unchanged measuring 13 mm (series 7, image 83). There is an additional right paratracheal lymph node superior to the reference lymph node that appears enlarged when compared to the prior exam measuring 12 mm, previously 8 mm (series 7, image 74). There are additional scattered non-pathologically enlarged mediastinal lymph nodes. No significant hilar lymphadenopathy.CHEST WALL: Right chest port with tip in the right atrium near the tricuspid valve is noted. Hemangioma of the T10 vertebral body is again noted. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left renal cyst is unchanged. Small gallstones are noted. Splenomegaly appears unchanged. Small hiatal hernia. | 1.No evidence of pulmonary embolism.2.No focal areas of consolidation in the right upper lobe may represent infection or aspiration. Mild interval increase in mediastinal lymphadenopathy may be reactive in etiology.3.Minimal improvement of bilateral upper lobe predominant fibrotic changes.PULMONARY EMBOLISM: PE: None.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Right lower extremity swelling and pain Pelvis: Bilateral mild hip osteoarthritis with more minimal degenerative changes of both SI joints and symphysis. Upper pelvis obscured by moderate gas and stool. No gross acute abnormality within this limitationHip and femur: Mild osteoarthritic changes of the hip with no acute femoral additional abnormality. Specifically no evidence of fracture-dislocation. Minimal atherosclerotic changes and diffuse stranding in the subcutaneous fat representing uncertain significance. Please correlate with patient's body appearance and physical exam. Soft tissues otherwise unremarkableKnee and lower leg: No radiographic abnormality of the knee observed of the and minimal degenerative changes. No effusion or malalignment. The proximal fibular demonstrates a healing proximal fibular fracture in gross alignment. The more distal tibia and fibula are otherwise unremarkable, see ankle description provided belowAnkle and associated single stress view: Mild to moderate asymmetry of the ankle mortise with surrounding moderate diffuse soft tissue swelling. Widening and minimal irregularity is observed medially raising the question of possible deltoid ligamentous injury. This abnormality is exaggerated and confirmed with the provided stress view. No definite underlying osseous acute fractures however are observed, however given diffuse demineralization limiting sensitivity, serial imaging may be indicated if concern remains high clinically.Foot: Diffuse demineralization with a prosthetic first MTP joint without prior for comparison. The distal component and stem of the proximal component appear well situated improperly anchored however mild under cutting and lucency involving the proximal component is of uncertain significance without prior exams. Correlation with old studies would be helpful to confirm however no distinct acute abnormality is otherwise identified. Diffuse mild soft tissue swelling as otherwise noted | Scattered degenerative changes and prosthetic first MTP arthroplasty, as described above. Acutely, asymmetry of the ankle with surrounding soft tissue swelling is concerning for ligamentous injury. Old healing proximal fibular fracture, within alignment |
Generate impression based on findings. | 57 year old female with metastatic papillary thyroid cancer presenting for restaging after 6 cycles of oral therapy and prior right neck dissection. HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild right maxillary sinus mucosal thickening. The imaged paranasal sinuses and mastoid air cells are otherwise clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.NECK: There are postoperative findings related to total thyroidectomy and right neck dissection. There is an unchanged centrally necrotic lymph node or mass inferior to the thyroid bed on the right measuring 18 x 20 mm as well as an unchanged right pretracheal lymph node measuring 15 x 17 mm. Additional mildly prominent scattered cervical lymph nodes appear unchanged. There is fatty atrophy of the parotid glands. The right submandibular gland is surgically absent and right IJ vein ligated. The left internal carotid artery has a retropharyngeal course. The internal carotid arteries are patent. The osseous structures are unremarkable. The airways are patent. There are numerous subcentimeter pulmonary nodules. | 1.Two unchanged masses/enlarged lymph nodes inferior to the right thyroidectomy bed and at the right upper paratracheal level. No new masses or lymphadenopathy.2.No evidence of intracranial metastases.3.Numerous subcentimeter pulmonary nodules which will be further described on the report from the CT chest performed concurrently.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Pain and swelling. Rule-out fracture.VIEWS: Left knee AP/lateral/oblique (3 views) 01/10/15 A joint effusion is not identified. The bones are normal in appearance. No fracture is seen. | Normal examination. |
Generate impression based on findings. | Intubated and head trauma. Tachypnea. Uncomfortable.VIEW: Chest AP (one view) 01/10/15, 1642 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in gastric antrum. Left central line tip is at junction of brachiocephalic veins.Cardiothymic silhouette is normal. Focal opacities are present in right upper and left lower lobes. | Bilateral opacities may be atelectasis or pneumonia. |
Generate impression based on findings. | Chest tube fell out. 24 day old former 25 week gestational age patient.VIEWS: Chest AP/lateral (two views) 01/10/15, 1830 and 1834 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in stomach with side port in lower esophagus. Left upper extremity PICC tip is in SVC. Right chest tube tip is located anteriorly.Complete atelectasis of the left lung is a new finding. Mediastinum is shifted even more to the left with herniation of lung anteriorly across midline. Multiple pneumatoceles of varying sizes with the largest approximately 3 cm in diameter in the base. No pneumothorax is seen. Cardiac silhouette size cannot be evaluated.Soft tissue edema persists. Changes from metabolic bone disease of prematurity continue. | Complete atelectasis of left lung. Pulmonary interstitial emphysema and pneumatocele formation. No pneumothorax. |
Generate impression based on findings. | Check for fracture-dislocation, leg length swelling and pain following fall Knee: Mild degenerative changes scattered throughout the knee with narrowing, sclerosis and minimal osteophytes. No effusion or evidence of acute distinct abnormality.Lower leg: Mild diffuse swelling with stranding in subcutaneous tissues of uncertain significance, please compare the opposite leg and physical exam. Specifically a more focal concentric soft tissue deformity is observed along the lateral upper lower leg, possibly a subcutaneous hematoma. Underlying osseous structures however are otherwise intact | Suspected diffuse swelling and possible focal hematoma involving the upper lateral lower leg. |
Generate impression based on findings. | Distention and tachycardia. Liver transplant. ABDOMEN:LUNG BASES: Consolidation is present in both bases right greater than left. Pleural effusions are better seen on sonogram from 01/10/15.LIVER, BILIARY TRACT: Liver appears slightly heterogeneous. A hypodense lesion in segment 5 measures 1.3 cm and formerly measured 0.9 cm. A fine track extends to the surface of the liver. Surgical clips, drain, and what appears to be mesh in the anterior abdominal wall deep grade visualization.SPLEEN: Mildly enlarged measuring 7 cm in length.PANCREAS: No definite abnormalityADRENAL GLANDS: No definite abnormalityKIDNEYS, URETERS: No calculi. No pelvicaliceal dilation.RETROPERITONEUM, LYMPH NODES: IVC stent continues in place.BOWEL, MESENTERY: No dilated bowel loops. Feeding tube tip at duodenojejunal junction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A moderate amount of free peritoneal fluid is noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Bladder catheter is in place and no fluid is seen in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No dilated bowel loops.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Free peritoneal fluid is noted. | Free peritoneal fluid increased in the interval. Hypodense lesion in segment 5 of the liver of unknown significance. |
Generate impression based on findings. | Knee pain following motor vehicle collision Minimal atherosclerotic changes without additional underlying acute osseous abnormality. Specifically no fracture or malalignment. No effusion, however minimal soft tissue swelling overlying the knee anteriorly cannot be excluded, please correlate with physical exam. | Minimal soft tissue swelling without underlying acute osseous abnormality |
Generate impression based on findings. | Female 24 years old; Reason: Evaluate for acute appendicitis History: rlq pain woken from sleep Paucity of abdominal fat makes assessment suboptimal.ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal/left paraaortic lymph nodes. BOWEL, MESENTERY: Mild right lower quadrant mesenteric stranding with multiple subcentimeter mesenteric lymph nodes. Segment of terminal ileal demonstrates mild to moderate wall thickening, likely due in part to underdistention, but appearance worrisome for underlying ileitis. Normal sized contrast and air containing appendix, image 70 series 3. Distalmost terminal ileum contains contrast and measures up to 1.2 cm in diameter, image 64 series 3. Proximal to this level is aforementioned apparent segmental ileal wall thickening.PELVIS:UTERUS, ADNEXA: Probable follicles in both ovaries. Small air and fluid in the vagina, correlate with menstrual history.BLADDER: Mild/moderate urinary bladder distention.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Findings suspicious for acute ileitis as described, infectious etiology a consideration but inflammatory etiology/Crohn's disease not entirely excluded and correlation patient's clinical history recommended.2. Normal appendix.3. Mild to moderate urinary bladder distention. |
Generate impression based on findings. | Heavy bag fell on leg. Pain and swelling, pain along medial side Moderate knee osteoarthritis, incompletely visualized without additional lower leg acute abnormalities. Specifically no fracture or malalignment involving the ankle. Soft tissues grossly unremarkable although mild diffuse soft tissue swelling cannot be excluded | Moderate knee osteoarthritis without additional acute abnormality |
Generate impression based on findings. | 24-year-old male with tachycardia and left-sided back pain. History demonstrates pathology proven anterior mediastinal teratoma. PULMONARY ARTERIES: Technically adequate examination. Equivocal filling defect within a right lower lobe subsegmental pulmonary artery (series 6, image 256) may represent a pulmonary embolism although the clinical significance of a small, distal embolus is uncertain.LUNGS AND PLEURA: Focal opacity along the major fissure in the left upper lung may represent atelectasis. Small focus of tree in bud opacities in the peripheral right middle lobe may be of infectious etiology (series 10, image 101).MEDIASTINUM AND HILA: There is a large, heterogeneous anterior mediastinal mass measuring 10.0 x 15.7 cm on transaxial image (series 7, image 153). CC dimension measures 10.6 cm (series 80648, image 49). There are foci of calcification within the mass. The mass demonstrates mild heterogeneous enhancement. There is mass effect on the heart superiorly and compression of the main and right pulmonary artery anteriorly. There is no fat plane in between the mass and pulmonary artery for which invasion or direct involvement cannot be entirely excluded. There is a 14mm right hilar lymph node. No significant mediastinal lymphadenopathy.CHEST WALL: No evidence of osseous erosion. The osseous structures are within normal limits. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Equivocal pulmonary embolism in a distal subsegmental right lower lobe pulmonary artery is of uncertain clinical significance.2.Known anterior mediastinal teratoma as described above.PULMONARY EMBOLISM: PE: Equivocal.Chronicity: Likely chronic.Multiplicity: Solitary.Most Proximal: Subsegmental right lower lobe.RV Strain: None. |
Generate impression based on findings. | Pain and swelling Hand: An oblique and minimally volar angulated fracture through the neck of the fifth metacarpal is observed with overlying mild swelling. Fracture does not extend into the articular surfaces. The remainder of the hand is otherwise unremarkable and intact.Wrist: No radiographic acute or chronic abnormality | Distal fifth metacarpal oblique neck fracture with minimal volar angulation |
Generate impression based on findings. | 85 year old female with T3N0 epiglottic SCC-mod diff. Pt completed FHX 5/4/2012. There are post treatment findings within the neck with unchanged mild edema within the hypopharynx and larynx. There is no evidence of discrete mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unchanged. There is a retropharyngeal course of the distal right internal carotid artery. There is atherosclerotic calcification at the origins of both internal carotid arteries without hemodynamically significant stenosis as well as involving the aortic arch. The major cervical vessels are patent. There is unchanged mild compression deformity of the T4 vertebral body. The osseous structures are otherwise unremarkable. The airways are patent. The imaged portions of the lungs are clear. There is 5-mm saccular aneurysm arising in a superior direction from the supraclinoid segment of the right internal carotid artery with focus of calcification and unchanged since 7/28/2013. The imaged intracranial structures are unremarkable. There are bilateral lens implants. | 1.No evidence of locoregional tumor recurrence or significant lymphadenopathy.2.Unchanged 5 mm aneurysm of the supraclinoid right internal carotid artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Pain and swelling An acute oblique fracture through the aseptic distal first phalanx extending to the articular surface with approximately 2mm displacement is observed. Overlying soft tissue swelling | Minimally displaced oblique fracture through the base of the distal first phalanx with distinct extension to the articular surface |
Generate impression based on findings. | Check for fracture. Patient in splint Detail obscured by extensive overlying splint material. Gross anatomic alignment is observed without clear identification of previously described fractures | Gross anatomic alignment |
Generate impression based on findings. | Bump on left lower shin.VIEWS: Left tibia fibula AP/lateral (two views) 01/10/15 The bones are normal in appearance. No fractures seen. No definite soft tissue mass is identified. | Normal examination. |
Generate impression based on findings. | Newborn 24 week gestational age patient with placement of lines.VIEWS: Chest and abdomen AP (two views) 01/10/15, 1822 Endotracheal tube tip is at carina. Umbilical venous line tip is in right atrium. Umbilical arterial line tip is at T6/7.Atelectasis in left lung has resolved. Focal opacities are seen in the right base. Cardiothymic silhouette is normal.Mildly dilated bowel loops are present in a disorganized pattern. | Atelectasis in left lung resolved. New opacity in right lung. Mildly dilated bowel. |
Generate impression based on findings. | Male 48 years old; Reason: sepsis History: sepsis Evaluation of organs of the abdomen and pelvis suboptimal without IV contrast.ABDOMEN:LUNGS BASES: Again visualized right greater than left small pleural effusions with underlying atelectasis/consolidation.LIVER, BILIARY TRACT: Upper abdominal drainage catheters. Status post orthotopic liver transplant. Evaluation and comparison difficult on this noncontrast study but appearing less pronounced than on prior exam is area of heterogeneous hypoattenuation in posterosuperior aspect of right hepatic lobe, image 19 series 3. Grossly unchanged additional sites of hypoattenuation in anterior right liver lobe and subcapsular left hepatic lobe. Mild interval decrease in size of posteriorly located presumed hematoma, measuring approximately 10 0.2 x 2 .9 cm, image 29 series 3, previously measured 10.3 x 5.2 cm. A drain is seen traversing this collection, with tip located in upper midline, beneath left hepatic lobe. Vasculature not well assessed on this noncontrast study. SPLEEN: Splenomegaly, spleen measures up to 18.7 cm. Vasculature not well assessed on this noncontrast study. Splenic varices and splenorenal shunting again seen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing right upper pole renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrojejunostomy tube with tip seen near duodenojejunal junction. Mild diffuse prominence of small bowel, measuring up to 2.6 cm, suggestive of postoperative ileus. Marked interval improvement in previously seen 18.7 cm postoperative hematoma in region of lesser sac, particularly when viewed in axial plane. Persistent hemorrhagic component seen alongside proximal greater curvature of stomach, measuring approximately 10.4 x 3.3 cm, coronal image 45, previously measured approximately 12.1 x 5.6 cm.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Underdistended bladder, making evaluation suboptimal. Previously seen gas in bladder not as well visualized.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Large ventral right abdominal wall defect, similar in appearance to prior exam. Ventral anteroinferior body wall edema. Bilateral gynecomastia. Incompletely imaged possible scrotal edema. Increasing ascites, now small to moderate. | 1. Postsurgical changes related to orthotopic liver transplant, see above.2. Improving hematoma in region of lesser sac/along greater curvature of stomach.3. Mild interval increase in ascites, now small to moderate.4. Bilateral pleural effusions. |
Generate impression based on findings. | 57-year-old female with multiple medical problems including ESRD, SLE with hypoxia, and shortness of breath PULMONARY ARTERIES: Technically adequate examination. Equivocal filling defect in the left lingular pulmonary artery (series 5, 130). No additional filling defects are noted. A small, distal filling defect is likely of no clinical significance.LUNGS AND PLEURA: Right greater than left pleural effusions appear slightly decreased when compared to the prior exam. There is atelectasis on the right. There is mucous plugging of the left lower lobe bronchus with associated atelectasis. Mucous plugging is increased when compared to 1/5/2015 and similar to 12/28/2014. MEDIASTINUM AND HILA: Mild aneurysmal dilatation of the ascending aorta measuring 3.4 cm. Severe atherosclerotic calcifications of the aorta and its branch vessels. Severe coronary artery calcifications.CHEST WALL: The osseous structures are unremarkable. There is diffuse chest wall edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Innumerable hypoattenuating lesions in the liver are too small to further characterize. There is a 14-mm hypodense lesion in the right lobe of the liver (series 6, image 231) that measures 5 Hounsfield units and likely represents a cyst. Calcified lesion in the dome of the left lobe of the liver may represent a granuloma and is unchanged. | 1.Equivocal filling defect in the distal lingular pulmonary artery is likely of no clinical significance.2.Right greater than left pleural effusions appear slightly decreased when compared to the prior exam.3.Mucous plugging of the left lower lobe bronchus with associated atelectasis appear similar to CT 12/28/2014.PULMONARY EMBOLISM: PE: Equivocal Chronicity: Unknown.Multiplicity: Solitary.Most Proximal: Distal lingular.RV Strain: None. |
Generate impression based on findings. | Check for right femur fracture. An extensive spiral fracture of the proximal right femur is observed with minimal displacement of and associated fragment medially. Gross anatomic alignment is observed regarding displacement, however the distal femur is exaggerated rotated extensively. Soft tissue swelling | Extensive comminuted proximal diaphyseal spiral fracture with extensive rotational abnormality |
Generate impression based on findings. | 60 year old male with T1N2b SCCA of the right palatine tonsil. He is s/p CRT completed 8/7/2014. There is no residual measurable tumor involving the right tongue base and right tonsillar pillar. There is decrease in previously described enhancement involving the pharyngeal and laryngeal mucosa. There is also interval decrease in size of a right level IIA lymph node, which now measures 4 mm in short axis, previously 6 mm. A right level IIB lymph node is unchanged, measuring 5 mm in short axis, previously 5 mm. A nonspecific nodule in the left upper neck posterior subcutaneous tissues is unchanged, measuring 1 mm and essentially resolved. The thyroid and major salivary glands are unchanged. The imaged intracranial structures are unremarkable. The paranasal sinuses are clear. The osseous structures are unremarkable, aside from degenerative changes in the cervical spine with moderate to severe left C5-C6 neural foraminal narrowing. There are bilateral lens implants. | No residual measurable tonsillar tumor or significant cervical lymphadenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Left foot pain and swelling. Slipped on stairs many months ago. Chronic pain Ankle: Questionable mild diffuse swelling, please correlate with physical exam and opposite leg. Otherwise underlying ankles unremarkable other than minimal degenerative changes, not incompatible with patient age.Foot: Minimal osteoarthritic changes of the first MTP. No foot acute abnormalities, specifically no fractures or malalignment. | Questionable mild diffuse swelling without underlying acute osseous abnormalities. Minimal osteoarthritic changes |
Generate impression based on findings. | Neck spasm The lateral projection demonstrates a mildly exaggerated extension which may represent minimal splinting, however no acute or underlying associated osseous abnormality. Specifically alignment preserved. Soft tissues are unremarkable. | Mild hyper extension cannot be excluded, and may represent muscle spasm however no associated underlying osseous or additional soft tissue abnormality is observed |
Generate impression based on findings. | Femur fracture An acute fracture through the distal stem of a right total hip arthroplasty is observed with moderate medial angulation and fragmentation of the surrounding cortical shaft. Extensive artifact from the metallic prosthesis limits sensitivity, however no definite associated discrete focal soft tissue abnormality is a identified in the immediate adjacent tissues. More proximally a 3 to 4-cm subcutaneous gas and fluid collection is observed overlying the right iliac crest, which is of uncertain significance and possibly related to either medication injections or potentially an old prior drain. Dedicated imaging may be indicated.No focal intrapelvic acute abnormality other than mild ascites. With incomplete visualized drainage/dialysis catheter observed proximally. | Acute fracture of the right femur overlying the distal stem of the right total hip arthroplasty |
Generate impression based on findings. | Check for osteomyelitis Extensive soft tissue swelling and deformity of the mid and hindfoot. Superimposed ulcerations, most pronounced involving the calcaneus along the plantar and posterior surfaces are also observed in largely unchanged when compared to prior exam. No gross interval underlying osseous change, however comparison is with a prior foot exam which decreases sensitivity. Specifically the lateral cortical margin of the talus is not clearly observed which raises concern for possible acute or subacute involvement with cortical loss and or periosteal changes. This nonspecific appearance can represent potential osteomyelitis and/or chronic osteomyelitis. Close serial imaging and/or axial imaging is recommended to exclude an underlying acute evolving process.The distal elements including postsurgical excision of the distal fifth metatarsal appears otherwise unchanged. Contractures and hammertoes are similar | Extensive soft tissue changes, ulceration and questionable appearance of the talus. See detail provided and recommendation above |
Generate impression based on findings. | Diabetic ketoacidosis and acute respiratory insufficiency. New intubation.VIEW: Chest AP (one view) 01/10/15, 1811 Cardiothymic silhouette is normal. No focal lung opacity is present. Few vertical linear lucencies are seen in the right apex extending superiorly.A vertically oriented density is noted in the midline at the superior aspect of the spinous process of C7. The stomach is moderately to markedly distended with gas. | Probable pneumomediastinum.If an endotracheal tube is present the tip is at or above C7. Increased distention of stomach may be related to bag mask ventilation or or-endotracheal tube. |
Generate impression based on findings. | 56 year old male with lymphadenopathy and SCC of unknown primary. There is bilateral cervical lymphadenopathy. For example, a conglomerated mass of nodes within the left level 1A region measures 38 x 38 mm, previously 36 x 34 mm, a left level IIB lymph node measures 21 x 17 mm, previously 20 x 14 mm, and a right level 2B lymph node measures 10x11x15 mm, previously 12x15x18 mm. There is unchanged slight asymmetry of the tonsillar pillars with the left being larger than the right. There is otherwise no evidence of mass lesions. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent with mild atherosclerotic calcification of the proximal internal carotid arteries. There is mass effect on the left jugular vein on the left without occlusion. There is cervical spondyloarthropathy as well as ossification of the posterior longitudinal ligament that results in multilevel spinal stenosis. The osseous structures are otherwise unremarkable. The airways are patent. There is a left temporal lobe developmental venous anomaly. The imaged intracranial structures are otherwise unremarkable. There is a left maxillary sinus mucosal retention cyst. The imaged portions of the lungs are clear. | 1.Compared to 10/4/2014, again seen is bilateral cervical lymphadenopathy with the left level IIA and IIB lymph nodes increased in size. The right level IIB lymph node measures slightly smaller. 2.Unchanged slight asymmetry of the tonsillar pillars with the left being larger than the right. Otherwise no evidence of mass lesions. 3.Cervical spondyloarthropathy and ossification of the posterior longitudinal ligament resulting in multilevel spinal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 54-year-old female with shortness of breath PULMONARY ARTERIES: Technically adequate examination. The pulmonary artery measures 2.3 cm. There is no evidence of pulmonary embolism.LUNGS AND PLEURA: Minimal bibasilar atelectasis in the right lung base. There is a calcified granuloma in the right upper lobe (series 8, image 24).MEDIASTINUM AND HILA: No significant hilar or mediastinal lymphadenopathy. Heart size is normal. No pericardial effusion. Soft tissue in the anterior mediastinum may represent recurrent or residual thymic tissue.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Degenerative changes affect the osseous structures.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is mild left adrenal gland thickening. Splenosis is noted. Diverticulosis without evidence of diverticulitis of the partially visualized colon is noted. Small hiatal hernia. Otherwise the intra-abdominal contents are within normal limits. | 1.No evidence of pulmonary embolism.2.Please note that a contrast extravasation occurred as detailed in the technique section.PULMONARY EMBOLISM: PE: None.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Gunshot wound to knee.VIEWS: Right femur AP/lateral (two views), right knee AP/lateral (two views), right tibia fibula AP/lateral (two views) 01/11/15 Projectile fragment is lodged in the medial aspect of the proximal tibial metaphysis. Air and fluid are present within the knee joint. Subcutaneous emphysema is identified. A vertically oriented lucency is present in the proximal tibia anterior to the tibial spines. No other possible fracture is identified. | Probable proximal tibial intra-articular fracture. |
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