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Generate impression based on findings. | 53-year-old female with history of slamming thumb in door. Evaluate for fracture. No acute fracture or malalignment. The soft tissues are unremarkable. | No acute fracture. or malalignment. |
Generate impression based on findings. | 28-year-old male with history of pain. No acute fracture or malalignment. The soft tissues are unremarkable. | No acute fracture or malalignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in paternal aunt at age 65. Two standard digital views of both breasts and an additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 64-year-old female history of swollen digits. Evaluate for osteomyelitis. Right hand: 02 sat monitoring overlies the distal second digit. There is been interval amputation of the distal third finger. There is moderate soft tissue swelling about the third digit without underlying osseous erosions to suggest osteomyelitis. Mild soft tissue swelling about the second digit. The tufts of the second through fifth digits are sclerotic. No acute fractures or malalignment.Left hand: A metallic ring overlies the fourth finger. There is significant soft tissue swelling of the third digit and mild soft tissue swelling of the second digit. The tufts of the second through fifth digits are sclerotic. No radiographic evidence of osteomyelitis. No acute fractures or dislocations. | 1.Soft tissue swelling as above without evidence of osteomyelitis.2.Interval amputation of distal third finger. |
Generate impression based on findings. | Reason: restaging scans s/p 6 cycles of oral investigational therapy; please provide bi-dimensional measurements History: as above CHEST:LUNGS AND PLEURA: Stable size and number of widespread bilateral pulmonary metastases.Reference left lung base nodule measures 28 x 15 mm (series 5, image 63), unchanged.MEDIASTINUM AND HILA: Postop change involving the neck.Intrathoracic lymphadenopathy unchange. Reference right paratracheal lymphadenopathy measures 16 x 13 mm (series 3, image 17), unchanged. Reference right cardiophrenic lymph node measures 28 x 24 mm (series 3, image 51), unchanged.CHEST WALL: Mild degenerative change.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensity left lobe of liver (image 71/142) too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nonobstructive left renal calculus 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. | Stable pulmonary nodules and intrathoracic lymphadenopathy. |
Generate impression based on findings. | Reason: r/o acute intraabdominal process History: abdominal pain Evaluation of solid organ pathology limited without intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nodular liver contour with ill-defined hypoattenuating diffuse hepatic lesions incompletely evaluated on noncontrast examination but highly suspicious for metastatic disease given comparison to previous. Hepatic dome lesion incompletely visualized but now measures approximately 6.0 cm in greatest axial dimension (series 3 image 24), previously 3.1 cm. No biliary ductal dilation. Collapsed gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic and periportal lymphadenopathy. Reference lymph node measures 2.3 x 1.8 cm (series 3 image 35).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Extensive ill-defined hypoattenuating hepatic lesions incompletely evaluated on noncontrast examination but highly suspicious for markedly progressed metastatic disease, most likely of a lung primary origin given comparison to PE protocol chest CT from 9/5/2014. 2.Gastrohepatic/periportal lymphadenopathy. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional right CC view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The tightly clustered calcifications in the right breast 12 o'clock position are unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable right calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 24-year-old female with history of pain. There is a small suprapatellar joint effusion. No acute fracture or malalignment. The soft tissues are unremarkable. | Small suprapatellar joint effusion without acute fracture. |
Generate impression based on findings. | Ms. Lisec is a 59 year old female with biopsy proven right breast papilloma with atypia. She presents today for needle localization of this area prior to surgery. On review of the prior studies, a wing clip with small associated focal asymmetry is identified in the right upper outer breast, 11 o'clock location. Target focal asymmetry with wing clip is located in the right breast in the upper outer quadrant region located anteriorly 11 o’clock. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure under direct supervision of Dr. Schacht, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the focal asymmetry, clip and spring wire to be within the specimen. | Successful needle localization of the right breast clip and focal asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female; 64 years old. Reason: r/o bronchiectasis, abnormal pulmonary process History: worsening SOB, DOE LUNGS AND PLEURA: Bibasilar bronchiectasis with mild bronchial wall thickening has slightly progressed since prior study. Mucous plugging and mild subsegmental atelectasis is noted in the left lower lobe. Mild clustered micronodules in the left upper lobe (image 130, series 4), which may be due to infectious bronchiolitis.MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications of the coronary arteries.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Slight progression in bibasilar bronchiectasis with mild bronchial thickening and mucous plugging, again suggestive of asthma or bronchitis.2. New mild clustered micronodules in the left upper lobe, which may be due to infectious bronchiolitis. |
Generate impression based on findings. | 58-year-old male with history of pain, especially with shoulder flexion. Mild degenerative disease affects the AC joint. There is no underlying fracture or malalignment. The soft tissues are unremarkable. | No acute fracture or malalignment. |
Generate impression based on findings. | Reason: r/o stone, hydronephrosis History: hx of UPJ obstruction, hx of drains, left flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Severe left UPJ obstruction with worsening hydronephrosis the prior study. The left collecting system now measures 25.4 cm in craniocaudal dimension (coronal series image 27) previously 16.3 cm, surrounded by a thin rim of atrophic left renal parenchyma which is more atrophied compared to previous.Moderate right hydronephrosis with abnormal rotation of the right kidney and punctate nephrolithiasis is not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral ovarian cysts. Suggestion of hydrosalpinx on the right is more conspicuous compared to the prior study. A coarse calcification is again noted in the right adnexa.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild pelvic ascites. | 1.Severe left UPJ obstruction has progressed since the prior study as described above. 2.Moderate right hydronephrosis without significant change. 3.Bilateral ovarian cysts with suggestion of hydrosalpinx on the right which is more conspicuous compared to the prior study. Pelvic sonography may be helpful for further evaluation. |
Generate impression based on findings. | 80 year-old male with history of anterior shoulder dislocation status post reduction. There has been interval reduction of an anterior shoulder dislocation. Alignment is now anatomic. There are no acute fractures. Mild degenerative disease affects the AC joint. | Interval reduction of anterior shoulder dislocation without acute fracture. |
Generate impression based on findings. | Male; 41 years old. Reason: eval for possible sarcoid History: dyspnea, lymphadenopathy, abnormal CXR LUNGS AND PLEURA: Mild central bronchial wall thickening, which may be due to bronchitis. Otherwise, no significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted. There are a few scattered prominent lymph nodes in the mediastinum but not significantly enlarged. No evidence of sarcoidosis.CHEST WALL: No significant abnormality noted. Old healed right lateral sixth rib fracture.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild central bronchial wall thickening, consistent with bronchitis. No specific evidence of sarcoidosis. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Stable thickening and calcification of the pleura. Linear atelectasis or scarring in right middle lobe. Unchanged right apical scarring. Unchanged calcified nodules consistent with prior granulomatous disease. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Punctate focus of air in the pulmonary outflow tract presumably related to power injection. Aspirated debris in central airways. Calcified nodes consistent with healed granulomatous disease. Moderate coronary calcification.CHEST WALL: Unchanged compression deformities at T4 T5. Healed right eighth rib fracture.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Small hepatic hypodensities are too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal thickening is unchanged.KIDNEYS, URETERS: Multiple bilateral renal hypodensities are unchanged with a right-sided parapelvic cyst and left-sided extrarenal pelvis.PANCREAS: Punctate hypodensity in pancreatic head (image 96/115) measures 3-mm, unchangedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.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. Incidental findings as above. |
Generate impression based on findings. | evaluate pleural effusionVIEWS: Chest and abdomen AP, abdomen cross table lateral ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left upper extremity PICC with tip in the left brachiocephalic vein. Left chest tube in place. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally minimally improved. Bilateral small pleural effusions left greater than right. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Marked body wall edema. | Bilateral small pleural effusions left greater than right minimally increased in the interval. |
Generate impression based on findings. | There is an anterior shoulder dislocation. There is no evidence of underlying fracture. Mild degenerative disease affects the AC joint. | Anterior shoulder dislocation without underlying fracture. |
Generate impression based on findings. | 27-year-old female history of fall. Evaluate for fracture. Lumber spine: No acute fracture or subluxation. Intervertebral disk spaces and vertebral body heights are well-maintained. Alignment is anatomic. Cholecystectomy and tubal ligation clips are present.Sacrum: No acute fracture or subluxation. Tubal ligation clips are present. | No acute fracture or subluxation. |
Generate impression based on findings. | Male 12 years old Reason: fracture VIEWS: Right ankle AP, lateral and oblique 1/12/15 (3 views) Interval removal of cast. Alignment is anatomic. No joint effusion. No periosteal reaction or callus formation noted. | Interval cast removal as described. |
Generate impression based on findings. | 53-year-old female with recently perforated ulcer with surgery and gastrojejunostomy. Abdominal pain, epigastric. Evaluate for acute abnormality. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in the liver. Patient is status post cholecystectomy with again slightly prominent extrahepatic bile duct but without intrahepatic dilatation to suggest obstruction.SPLEEN: No significant abnormality notedPANCREAS: No change in the pancreatic calcification seen in mid body. No other abnormalities are seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes about the stomach from prior gastric bypass surgery are again seen similar in appearance to prior CT examination. Orally administered contrast has rap Hadley emptied through the stomach into the small bowel and rapidly progressed through to distal small bowel and right lower quadrant without evidence of obstruction. Prior noted free air in the mesentery and prior CT is no longer visualized. No free mesenteric fluid is seen. No loculated collection seen to suggest abscess. See pelvis discussion below for anterior abdominal ventral wall hernia.BONES, SOFT TISSUES: Postoperative changes seen in anterior subcutaneous tissues in the midline with residual small fluid collections measuring up to 1.6 cm in diameter (series 3, image 54). While CT cannot characterize fluid collections common no air is seen in these or other findings seen to suggest infection and these most likely represent postoperative fluid collections of the benign nature. These only are seen in subcutaneous tissues and do not extend into the abdomen.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes about the stomach from prior gastric bypass surgery are again seen similar in appearance to prior CT examination. Orally administered contrast has rap Hadley emptied through the stomach into the small bowel and rapidly progressed through to distal small bowel and right lower quadrant without evidence of obstruction. Prior noted free air in the mesentery and prior CT is no longer visualized. No free mesenteric fluid is seen. No loculated collection seen to suggest abscess. Anterior abdominal ventral hernia is again seen containing small bowel loops but without complication.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Expected postoperative appearance about the stomach from prior remote gastric bypass surgery and recent gastrojejunostomy. 2. Resolution of prior noted pneumoperitoneum without visible complication. 3. Anterior abdominal wall ventral pelvic hernia without complication unchanged. |
Generate impression based on findings. | 32-year-old male with abdominal pain. Evaluate pancreatic pseudocysts. ABDOMEN:LUNG BASES: Interval improvement in bilateral pleural effusions with associated atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesions. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: Extensive peripancreatic inflammation is again seen. There has been interval increase in the size of the head of the pancreas and increased peripancreatic fluid about the head and the duodenum suggesting worsening pancreatitis in that region without loculated fluid collections. A cyst gastrostomy tube is present with similar appearance of the peripancreatic complex fluid collection with debris adjacent to the cyst gastrostomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously noted perihepatic fluid is decreased in size with possible relocation into the pelvis as detailed below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a loculated fluid collection with a thin wall in the cul-de-sac measuring approximately 4.4 x 3.2 centimeters (series 4, image 129). This may be a new fluid collection versus relocation of the previously described perihepatic ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings consistent with worsening pancreatitis involving the head as above. 2.Peripancreatic complex fluid with cyst gastrostomy tube appears simpler to the previous examination. 3.New pelvic loculated fluid collection with interval decrease in the perihepatic ascites as above.4.Interval resolution of bilateral small pleural effusions.Findings relayed to Dr. Laura Dickens over the phone at approximately 9:37 am |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral breast reduction surgery. Personal history of cervical cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of non-surgical architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Right middle lobe opacities have improved.MEDIASTINUM AND HILA: Mild coronary calcification.CHEST WALL: Interval removal left port catheter.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube tip in stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Male; 44 years old. Reason: evaluate for COPD, possible spontaneous pneumomediastinum, any other cause of chest pain History: 44yoM tobacco, cocaine abuse presenting with chest pain LUNGS AND PLEURA: Mild biapical paraseptal emphysema, right greater than left where there is a large bulla. Although evaluation of the lung parenchyma is mildly limited by respiratory motion, there is very mild diffuse groundglass opacity in both lower lobes, which is nonspecific and may be due to edema or hemorrhage.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Mild nonspecific diffuse ground glass opacity in both lower lobes, which may be due to the edema or hemorrhage.2. Paraseptal emphysema with a large right apical bulla. |
Generate impression based on findings. | Reason: h/o HNC and CRT History: none CHEST:LUNGS AND PLEURA: Mild nonspecific bronchial wall thickening. Punctate subpleural nodule in the lingula (image 63/110) is unchanged. No pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.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: Small exophytic left renal hypodensity unchanged and presumably a cyst.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: Degenerating involving spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Nine year old female, evaluate residual stone burden. History of prior bilateral nephrolithiasis. ABDOMEN:LUNG BASES: No focal air space opacity.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval placement of bilateral nephroureteral stents with the proximal tips within the bilateral calyceal systems and the distal tips within the urinary bladder. Multiple calcific densities are seen within the inferior pole collecting systems of both kidneys consistent with renal stones, the largest on the right measuring up to 10 mm, and the largest the left measuring up to 11 mm. Moderate right-sided hydronephrosis is evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube in place, with tip and bumper in the mid gastric body.BONES, SOFT TISSUES: Moderate levoscoliosis of the thoracolumbar spine. Superior and lateral translation of both femoral heads and shallow acetabuli consistent with bilateral hip dysplasia.OTHER: A ventriculoperitoneal shunt catheter is in place with the tip terminating in the midline hemipelvis, without evidence of complication.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small volume of free fluid within the pelvis.BONES, SOFT TISSUES: Moderate levoscoliosis of the thoracolumbar spine. Superior and lateral translation of both femoral heads and shallow acetabuli consistent with bilateral hip dysplasia.OTHER: A ventriculoperitoneal shunt catheter is in place with the tip terminating in the midline hemipelvis, without evidence of complication. | 1.Interval placement of bilateral nephroureteral stents, with persistent mild/moderate right-sided hydronephrosis.2.Multiple bilateral renal stones measuring up to 11 mm as detailed above.3.Levoscoliosis and bilateral hip dysplasia.4.Small volume ascites within the pelvis. |
Generate impression based on findings. | Reason: 57 y/o woman with metastatic breast cancer with clinical progression in her left breast. Evaluate for progression of disease. History: Ulcerated left breast mass. CHEST:LUNGS AND PLEURA: Stable to slightly increased pulmonary metastases, most evident in the superior left upper lobe (image 26/103).Referenced nodule measurements as follows:1. Right middle lobe nodule marginally increased measuring 20 x 16 mm on image 49/103 (19 x 17 mm on prior). 2. Left apex nodular septal thickening stable to marginally increased measuring 15 x 6 mm on image 13/103 (12 x 3 mm on prior).MEDIASTINUM AND HILA: Reference right hilar lymph node increased to 10 mm on image 37/132 (5 mm on prior).CHEST WALL: Right chest wall port with catheter tip in the SVC.Reference right axillary lymph node measures 9 mm on image 16/132, unchanged.Extensive left breast skin thickening and nodularity stable to marginally increased. Reference left breast mass has increased measuring 27 x 20 mm on image 50/132 (25 x 20 mm on prior).Reference soft tissue nodule involving the left pectoralis major muscle shows less no significant contrast enhancement and measures 15 x 15 mm on image 25/132.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Reference ill-defined hypoattenuating liver lesion measures 17 x 12 mm (series 4, image 73), unchanged. Other hypodense liver lesions are too small to characterize but stable. Right lobe vascular malformations redemonstrated.SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: Bone island in L1 vertebral body unchanged..OTHER: No significant abnormality noted.. | Stable to marginally increased breast, intrathoracic, and intrahepatic reference measurements. |
Generate impression based on findings. | 49-year-old female with evidence of infection, spiking fevers in patient with recent sphincterotomy, stenting and IR drain placement. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis. Left upper lobe nonspecific soft tissue nodule (series 7, image 47) measuring 0.7 x 0.6 cm and several smaller scattered nodules seen elsewhere. No other evidence of masses, airspace disease or pleural disease. In light of left anterior chest Port-A-Cath system, if this patient has a cancer history, these are worrisome for metastatic disease. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left anterior chest wall Port-A-Cath system with catheter tip at the vena cava/right atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Round hypoattenuating lesion with enhancing rim is seen in segment 7 dome (series 5 on image 70) measuring 1.3 x 1.8 cm. This is concerning for metastatic disease, although if infection is a possibility, small abscess cannot be differentiated.. Pneumobilia is seen with a large bore bile duct stent extending to the distal bile duct and bilateral left and right external biliary drainage catheters with the catheter is extending into the duodenum. No biliary duct dilatation is seen to suggest obstruction and air is seen in the large bore biliary stent.Gallbladder is collapsed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right ureteral stent is seen extending from the renal pelvis through to the bladder. No significant hydronephrosis is seen. Bilateral renal parenchyma shows no abnormal masses or other significant abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through the stomach and small bowel to the ileo--- transverse colon anastomosis from prior right hemicolectomy. No intrinsic abnormalities seen in the stomach, small bowel or otherwise in the:.Extensive amount of high density fluid is seen throughout the peritoneum particularly about the liver and in the right abdomen/pelvis. The high density is mottled and presence of either tumor, hemorrhage or diffuse infection cannot be differentiated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Small amount of air is seen in the anterior bladder (series 5, image 180) -- this may relate to recent instrumentation. No other abnormalities are seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through the stomach and small bowel to the ileo--- transverse colon anastomosis from prior right hemicolectomy. No intrinsic abnormalities seen in the stomach, small bowel or otherwise in the:.Extensive amount of high density fluid is seen throughout the peritoneum particularly about the liver and in the right abdomen/pelvis. The high density fluid is mottled and presence of either tumor, hemorrhage or diffuse infection cannot be differentiated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post right hemicolectomy. 2. Large amount of diffuse mesenteric fluid of high density raising question of metastatic disease, hemorrhage or infection. 3. Multiple lung nodules worrisome for metastatic disease. 4. Punctate air seen in bladder -- this may relate to recent instrumentation. 5. Right ureteral stent in expected position without hydronephrosis seen. 6. Large bile duct stent and bilateral percutaneous left and right biliary drains extending to duodenum with expected position and appearance and no evidence for biliary obstruction. 7. Hypoattenuating right lobe liver mass -- metastatic disease is most likely diagnosis, however if infection is of concern, small abscess cannot be differentiated. |
Generate impression based on findings. | Reason: r/o ileus History: n/v Non-obstructive bowel gas pattern. G-tube is again seen overlying the gastric body. Calcified fibroid uterus is noted. | Non-obstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetries in the upper, outer breast bilaterally are consistent with dense parenchyma. Grouped punctate calcifications are seen in the left retroareolar breast. No suspicious masses or areas of architectural distortion are present. | Grouped punctate calcifications are seen in the left retroareolar breast. Further evaluation with spot magnification films is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female; 67 years old. Reason: Fever, SOB, pleural effusion History: As above LUNGS AND PLEURA: Moderate consolidation right upper lobe, compatible with pneumonia. Trace right pleural effusion. Mild bibasilar dependent subsegmental atelectasis.MEDIASTINUM AND HILA: Calcified mediastinal and bilateral hilar lymph nodes, most compatible with prior granulomatous process. Mild cardiomegaly. Moderate coronary artery atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Moderate consolidation right upper lobe, compatible with pneumonia. |
Generate impression based on findings. | Ms. Antonesi is a 45 year old female with a personal history of right breast lumpectomy in December 2013 for atypical intraductal proliferation. She is currently on tamoxifen therapy. Family history of breast cancer in maternal great aunt and ovarian cancer in grandmother. Three standard views of both breasts with two right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are expected postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign intramammary lymph nodes are identified in the left upper outer breast. | Expected postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign bilateral breast biopsies. Family history of breast cancer in two maternal aunts. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the right breast. Linear markers were placed on scars overlying both breasts. Scattered calcifications in both breasts are progressing in a benign fashion. Percutaneously placed clip in the left breast is unchanged in position. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 years, Female. Reason: Evaluate progression of ileus History: vomiting. Nonobstructive bowel gas pattern. Right pelvic drain and bilateral common iliac stents again noted. Diffuse lucency over the right upper quadrant is again noted and likely represents post-procedural free air. Subcutaneous emphysema is present in the right abdominal and pelvic wall. | 1.Nonobstructive bowel gas pattern.2.Persistent postprocedural free air and subcutaneous emphysema as described above. |
Generate impression based on findings. | Male; 54 years old. Reason: characterize lung processes History: SOB, cough, h/o adenoid cystic CA LUNGS AND PLEURA: Multiple metastases as detailed below. Lesion along the right cardiophrenic angle measures 40 x 18 mm (image 56, series 5), previously 40 x 19 mm and is not significantly changed, though reproducible measurements at this site are inaccurate due to the orientation of this lesion.Lesion adjacent to the left cardiophrenic angle measures 24 mm (image 56, series 4), previously 22 mm and slightly increased. Lesion in the azygoesophageal recess measures 28 x 22 mm (image 33, series 4), previously 21 x 18 mm and mildly increased.Nodule along the right major fissure measures 18 x 14 mm, previously 17 x 12 mm and slightly increased. Additional pleural lesions on the right are increased since prior study, particularly at the posterior right costophrenic angle.Small right pleural effusion, slightly increased.MEDIASTINUM AND HILA: Right anterior cardiophrenic node measures 10 mm (image 52, series 4), previously 10 mm and unchanged.CHEST WALL: Right inferior chest wall mass measures 30 x 19 mm (coronal image 22, series 80272), previously 30 x 20 mm and not significantly changed.UPPER ABDOMEN: Please refer to report from dedicated CT abdomen/pelvis examination performed at the same time. | Increased metastatic disease in the chest. Please see dedicated CT abdomen/pelvis report. |
Generate impression based on findings. | 97-year-old female status post reduction of right forearm fractures. Overlying cast material limits fine osseous detail. There is a partially reduced fracture of the distal ulnar diaphysis with mild lateral angulation. Additionally, there is a partially reduced fracture of the proximal radial diaphysis with persistent mild lateral angulation of the distal fracture fragment. | Partially reduced right both bones forearm fracture. |
Generate impression based on findings. | 16-year-old male with history of ulcerative colitis and primary sclerosing cholangitis. Assess for progression of primary sclerosing cholangitis in setting of elevated liver function tests. LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Fusiform narrowing of the branch points of the left and right intrahepatic biliary ducts is again seen, with associated poststenotic dilatation of the common duct. There is multifocal dilatation/stricturing evident within the bilobar biliary system, which appears similar to the prior examination. The gallbladder is not identified, presumably contracted. These findings are consistent with primary sclerosing cholangitis without definite interval progression.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | Multifocal biliary dilatation and stricturing evident within both hepatic lobes, most consistent with primary sclerosing cholangitis, without significant interval progression. |
Generate impression based on findings. | Male 24 years old Reason: 24 male with acute promyelocytic leukemia, transaminitis. r/o parenchymal liver disease, PLEASE PERFORM DOPPLERS to r/o hepatic/portal vein thrombosis History: Transaminitis LIVER: The liver has a smooth contour. Liver measures 17 cm in length. The parenchyma is mildly echogenic . No suspicious hepatic lesions. Main portal vein is patent with normal directional flow.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 2mm in thickness. No pericholecystic fluid. Common duct measures 2mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 12.4 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 14.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.8 cm. in length. OTHER: No significant abnormalities noted. | 1.Patent hepatic vasculature with normal directional flow. |
Generate impression based on findings. | Reason: h/o SGL ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Minimal dependent edema and atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Interval removal of right chest port.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.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. | Asymptomatic female presents for routine screening mammography. Recalled from screening multiple times for calcifications and asymmetries. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Group of calcification in the right breast at the 12 o'clock position is unchanged. Group of calcification in the left central breast is unchanged. Stable focal asymmetries are present bilaterallyNo new masses, suspicious microcalcifications or areas of architectural distortion are present. | Stable calcifications and asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 41-year-old female with epigastric pain. Rule-out pancreatitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Focal fatty infiltration seen about the ligamentum teres and falciform ligament. No other focal parenchymal abnormalities seen.SPLEEN: No significant abnormality notedPANCREAS: Pancreas shows normal morphology for a patient of this age. No abnormal fluid collections are seen in or about the pancreas. Pancreatic duct is not dilated. No abnormal calcifications are seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating cortical lesions most of which are too small to characterize. Largest of these show near water attenuation typical of benign cysts. No other significant abnormalities seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Physiologic changes seen without significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large and small bowel appear normal. Small amount of free pelvic fluid is seen consistent with physiologic changes in a female patient of this age.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Normal morphology to the pancreas without evidence of complications from potential pancreatitis. Normal CT appearance does not exclude pancreatitis. 2. Multiple small bilateral low-attenuation lesions scattered throughout the kidneys while too small to characterize, most likely benign cysts I see above discussion. |
Generate impression based on findings. | Fall, evaluate for intracranial hemorrhage Head: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. There is advanced global parenchymal volume loss commensurate with age. No hydrocephalus. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes.There is a laceration involving the right parietal scalp. Underlying calvarium is intact.Cervical Spine:No evidence of acute fracture or subluxation in the cervical spine. There is prominence of the retro-odontoid soft tissues and mild narrowing of the spinal canal at the craniocervical junction. Scattered osseous lucencies are seen throughout the cervical spine which are nonspecific and may be related to osteopenia and renal osteodystrophy.There is loss of cervical lordosis. There is grade 1 anterolisthesis of C2 on C3 with vacuum disk phenomena and facet arthropathy compatible with degenerative disease. Alignment of the cervical spine is otherwise maintained. There is osseous fusion involving the left C3 and C4 facet joints on the left likely on a degenerative basis.There is moderate left neural foramina stenosis at C6-C7. No evidence of severe spinal canal or neural foramina stenosis at any level in the cervical spine.Limited evaluation of the lung apices demonstrates a nodular opacity at the right lung apex measuring up to 2 cm in the transverse dimension which can be further evaluated with a dedicated chest CT. Multinodular thyroid gland is also noted. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Right parietal scalp laceration with intact underlying calvarium.3. No acute fracture or traumatic subluxation in the cervical spine.4. Nodular opacification at the right lung apex measuring up to 2 cm in diameter is seen on the most inferior slice. Finding may be related to atelectasis but suggest dedicated chest CT for further evaluation.5. Scattered osseous lucencies are seen throughout the cervical spine which are nonspecific and may be related to osteopenia and renal osteodystrophy. 6. Multinodular thyroid gland. |
Generate impression based on findings. | Reason: h/o SGL ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: New patchy groundglass nodular opacities in the right upper lobe (images 21 and 31/114). Previously noted scattered punctate micronodules are unchanged.MEDIASTINUM AND HILA: Moderate coronary calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.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. | New patchy groundglass nodular opacities in the right upper lobe. These are more typical of aspirate or infection than metastatic disease though continued follow up is recommended. |
Generate impression based on findings. | Reason: abscesses or other pathology in buttock History: s/p injection into B buttock, now with recurrent infection UTERUS, ADNEXA: Small left adnexal cysts. Mild pelvic free fluid.BLADDER: Partially collapsedLYMPH NODES: Enlarged bilateral inguinal lymph nodes left greater than right. Reference left inguinal lymph node measures 2.9 x 1.7 cm (series 3 image 38). Enlarged left iliac lymph nodes, with reference node measuring 3.3 x 2.4 cm (image 34).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is subcutaneous soft tissue stranding in both buttocks left greater than right. In the left buttocks there is extensive inflammatory change which extends from the skin through the subcutaneous fat into the left gluteus musculature highly suspicious for a developing phlegmonous infectious process. This coalesced inflammatory change measures 8.0 x 3.2 cm in greatest axial dimension (series 3 image 34). A small relatively circumscribed component with a fat-fluid level measures 2.0 x 1.9 cm (series 3 image 23). There is left gluteal intramuscular low attenuation and abnormal enhancement consistent wtih myositis. However, there is no discrete walled abscess or drainable collection at this time.Comparatively mild soft tissue inflammatory changes on the right do not involve the gluteus musculature and may be reactive.OTHER: No significant abnormality noted | 1. Extensive inflammatory changes in the left gluteal subcutaneous soft tissues as described above are highly suspicious for developing phlegmonous infection with intramuscular extension/myositis. However, there is no discrete abscess or drainable fluid collection at this time.2. Bilateral inguinal and left iliac lymphadenopathy, which is nonspecific and may be reactive. Correlation and follow up with physical examination is recommended. |
Generate impression based on findings. | 62 year old male with abdominal pain, fever, concern for air under the diaphragm in the setting of recent G tube placement. Follow up left lateral decubitus film. History: Abdominal pain, G tube, fever. No free air is present. Lucencies seen along the diaphragm and right abdominal wall correspond to intraperitoneal fat seen on chest CT from December 2014. Gastrostomy tube projects over the gastric body. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. No free air. |
Generate impression based on findings. | 62 year old male with G tube and abdominal distention, constipation, vomiting. Assess for stool burden and free air. History: abdominal distention, mild tenderness on exam. Gastrostomy tube projects over the gastric body. Nonobstructive bowel gas pattern. No gross intraperitoneal free air. Probable residual contrast material is noted in right lower quadrant bowel loops. | Nonobstructive bowel gas pattern. While no gross free air is seen, supine films are insensitive for its detection, and upright or decubitus films can be obtained for further evaluation if clinically indicated. |
Generate impression based on findings. | Fracture.VIEWS: Right wrist PA/lateral (two views) 01/12/15 A cast obscures bone detail. Periosteal reaction around the distal radius has increased. Alignment is anatomic. | Healing distal radial fracture. |
Generate impression based on findings. | 76-year-old female with tachycardia, right lower quadrant pain. Rule-out infection. Within the limits of a non-IV contrast enhanced examination, which limits the ability to evaluate solid parenchymal organs and vascular structures the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Approximately 1 cm benign appearing calcified density is seen either exophytic off posterior right lobe or immediately adjacent to liver (series 4, image 36). While this is nonspecific on a most likely reflects old traumatic or post inflammatory abnormality. Within limits of no IV contrast, liver parenchyma appears normal. Patient is status post cholecystectomy with no other biliary tract abnormality.SPLEEN: No significant abnormality notedPANCREAS: Morphology and appearance the pancreatic parenchyma appears normal. There is slight haziness to the peripancreatic fat anterior and inferior to the uncinate process. This may reflect changes from focal pancreatitisADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderately large hiatal hernia seen without other complication in the stomach. Small bowel and colon appear normal other than uncomplicated sigmoid diverticulosis.. No free mesenteric fluid noted. There is slight haziness to the peripancreatic fat anterior and inferior to the uncinate process. This is nonspecific and may reflect changes from focal pancreatitis although changes in the mesentery from duodenitis or dramatic changes in the duodenum cannot be differentiated. Without old prior examinations, this could represent old scarring as well.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Post hysterectomy without other abnormality.BLADDER: Foley catheter in collapsed bladder without other abnormality.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderately large hiatal hernia seen without other complication in the stomach. Small bowel and colon appear normal other than uncomplicated sigmoid diverticulosis.. No free mesenteric fluid noted.BONES, SOFT TISSUES: Bilateral fat containing inguinal hernias.OTHER: No significant abnormality noted | 1. Large hiatal hernia without other complication. 2. Uncomplicated sigmoid diverticulosis. 3. Slight haziness to the surrounding fat anterior and inferior to the uncinate pancreatic process which is of uncertain age and/or significance. This may reflect focal pancreatitis in uncinate/head of pancreas although other etiologies cannot be discriminated. Please see above discussions in pancreas and mesentery sections above. 4. No other significant abnormality seen. |
Generate impression based on findings. | 81-year-old with history of right lumpectomy in 1992 for breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Postoperative distortion and density in the right upper breast with volume loss is unchanged from the prior study. A linear scar marker is seen in the right upper breast.Benign calcifications are seen bilaterally including arterial calcifications. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | No abnormal DWI signal to suggest acute infarct. Scattered periventricular and subcortical T2 hyperintensities are unchanged from the prior exam. Ventricles are normal in size and morphology. A focus of susceptibility immediately adjacent to the left occipital horn in the left temporal lobe with mixed central T1 and T2 signal intensity measures 15 mm (91/98), unchanged. No associated abnormalities are evident. No new foci of susceptibility are present.The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1.Focus of susceptibility in the left temporal lobe is unchanged and likely represents a cavernous malformation.2.Scattered periventricular and subcortical T2 hyperintensities are nonspecific but abnormal for age, possibly related to small vessel ischemic disease or migraines. |
Generate impression based on findings. | 69-year-old male with nasal blockage and history of sinonasal polyposis There is interval worsening of mucosal thickening within the bilateral maxillary sinuses including new bilateral superimposed air-fluid levels (right greater than left). Bilateral ostiomeatal units remain obstructed.Redemonstrated is scattered opacification within the ethmoid sinuses as well as mucosal thickening within the sphenoid and frontal sinuses. There are polypoid opacities adjacent to the nasal septum at the level of the middle turbinates bilaterally. There is mild S-shaped nasal septal deviation. These findings are relatively unchanged.The ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The intracranial structures are unremarkable. There are lens implants. | 1.There is interval worsening of mucosal thickening within the bilateral maxillary sinuses including new bilateral superimposed air-fluid levels (right greater than left). Bilateral ostiomeatal units remain obstructed.2.Persistent paranasal sinus opacification there in a sporadic pattern and sinonasal polyposis are relatively unchanged. |
Generate impression based on findings. | Routine screening mammography. Mole under right arm. History of benign right breast stereotactic core needle biopsy. History of breast carcinoma in maternal aunt diagnosed at the age of 40. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A round marker was placed on a skin lesion overlying the right upper breast. Stable calcifications are present bilaterally, including arterial calcifications. A percutaneously placed clip in the right breast is unchanged in position. Benign lymph nodes project over the axillae.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | A small solitary focus of mucosal thickening within the left maxillary sinus narrows the left ostiomeatal unit. The remaining paranasal sinuses are clear as are the bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. Note is made of bilateral air cells. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. Note is made of a left concha bullosa. The nasal septum is deviated rightward with a shallow rightward septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | A small solitary focus of mucosal thickening within the left maxillary sinus narrows the left ostiomeatal unit. The remaining paranasal sinuses are clear as are the bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. |
Generate impression based on findings. | Reason: 77 yo with newly dx pancreatic adneocarcinoma of body of pancreas (2 cm). Questionable vessel involvement of OSH CT Scan. Known 4.8cm AAA. History: weight loss ABDOMEN:LUNGS BASES: Patchy nonspecific bibasilar groundglass opacities with mild atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Soft tissue mass in the body of the pancreas measures 2.5 x 2.2 cm (series 10 image 53) with distal pancreatic atrophy/ductal dilation and is consistent with the patient's known pancreatic cancer. Mesenteric Arteries:Arterial anatomy: Small left gastric artery arises from the aorta. Otherwise conventional.Arterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: None, but see splenic artery abutment below. (2) Tumor abutment or encasement of additional arteries: There is 180 degree abutment of the proximal splenic artery (series 8 image 54) without involvement of the celiac trunk. Mesenteric Veins:Venous tumor abutment or encasement: patent without evidence of tumor invasionPortal venous system: patent without evidence of tumor invasionInferior vena cava (IVC): patent without evidence of tumor invasionADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts without hydronephrosis.RETROPERITONEUM, LYMPH NODES: Enlarged periportal lymph node measures 2.1 x 1.3 cm (series 10 image 49). Infrarenal abdominal aortic aneurysm measures up to 4.6 cm in maximal dimension on this study. Ectasia and aneurysmal dilation of the common iliac arteries measure up to 2.1 cm in diameter. Severe atherosclerotic calcification affects the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Pancreatic body mass as described above with short segment 180 degree abutment of the proximal splenic artery. 2. Enlarged periportal lymph node. 3. Infrarenal abdominal aortic and iliac artery aneurysms. |
Generate impression based on findings. | 32-year-old male with history of trauma. Left knee: No acute fracture or malalignment. Small well corticated density within the patellar tendon is likely the result of remote trauma. There is no joint effusion.Left hip: No acute fracture or dislocation. Alignment is anatomic. The soft tissues are unremarkable.Left hand: No acute fracture or malalignment. The soft tissues are unremarkable. | No acute fracture or malalignment. Findings suggestive of remote trauma to the patellar tendon are stable. |
Generate impression based on findings. | Status post fracture.VIEWS: Right hand AP, lateral and oblique 1/12/15 (3 views) Cast has been removed and two K wires are affixing the transverse healing fracture of the proximal metaphyses of the first metacarpal in near anatomic alignment and interval. | Postsurgical changes as described on first metacarpal healing fracture. |
Generate impression based on findings. | There are two, small, linear foci which appear as restricted diffusion involving the right posterolateral pons and left superior cerebellar peduncle (with matching ADC hypointensity), best seen series 50 on image 206. However, this is an area prone to artifact on diffusion imaging, and if patient symptomatology does not correlate with this, artifact would be favored. There is no restricted diffusion elsewhere to suggest the presence of acute ischemia.A previously identified CT abnormality involving the posterior limb of the left internal capsule demonstrates central T2 hyperintensity, central T1 hypointensity, surrounding gliosis, with susceptibility from presumed hemosiderin.There are scattered punctate foci of T2 hyperintensity within the white matter of the periventricular and subcortical white matter, as well as within the leftward pons. These are not associated with mass effect, restricted effusion, or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | 1.There are two, small, linear foci which appear as restricted diffusion involving the right posterolateral pons and left superior cerebellar peduncle (with matching ADC hypointensity). However, this is an area prone to artifact on diffusion imaging, and if patient symptomatology does not correlate with this, artifact would be favored. There is no restricted diffusion elsewhere to suggest the presence of acute ischemia.2.A previously identified CT abnormality involving the posterior limb of the left internal capsule demonstrates central T2 hyperintensity, central T1 hypointensity, surrounding gliosis, with susceptibility from presumed hemosiderin. The constellation of these features is most consistent with hemosiderin scar from prior hemorrhage.3.There are scattered punctate foci of T2 hyperintensity within the white matter of the periventricular and subcortical white matter, as well as within the leftward pons. These are not associated with mass effect, restricted effusion, or susceptibility abnormality. These are nonspecific in appearance yet abnormal for patient age. Differential diagnosis would most likely include small vessel disease, migraine sequelae, residua from previous head trauma, or demyelination. |
Generate impression based on findings. | BRAIN:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Myelination pattern appears appropriate for age. Cerebellar tonsils are normal in position without evidence of Chiari malformation.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. CSF flow study demonstrates normal biphasic flow.SPINE: Normal marrow signal within the vertebral bodies. Alignment is anatomic. No abnormal signal within the cord or conus which ends at L2. Anterior movement of the cauda equina and filum are noted on prone images. Specifically no syrinx is evident. No significant neural foraminal narrowing or narrowing of the central canal. A sacral dimple is is not well visualized. There are no sinus tracts or other abnormalities in the posterior subcutaneous tissues of the lumbar spine. No posterior fusion defects.Limited evaluation abdominal structures demonstrates a 8mm left adnexal cysts (2601/31), likely ovarian cysts. A vitamin E capsule is placed along the right skin at the level of the sacrum. Fetal lobulation of the kidneys bilaterally. | No evidence of Chiari malformation, syrinx, or tethered cord. |
Generate impression based on findings. | Female, 18 years old, newly diagnosed SLE, suspected orbital myositis. Presenting with periorbital edema and blurred vision right greater than left. The globes are symmetric and round and the lenses are normally positioned. The optic nerves demonstrate a normal CT appearance. The extraocular muscles are symmetric and of normal caliber and attenuation. No evidence of any significant orbital stranding, fluid or mass effect is seen. No pathologic orbital enhancement is detected. Likewise, the periorbital soft tissues are unremarkable.Incidental note is made of numerous calcifications within the parotid glands. The partially visualized intracranial and neck soft tissues are otherwise unremarkable. The osseous structures are intact. The visualized paranasal sinuses and mastoid air cells are clear. | 1. No definite orbital abnormalities are detected within the limits of CT.2. Numerous calcifications are evident through the parotid glands which is compatible with the diagnosis of SLE. |
Generate impression based on findings. | Male 65 years old; Reason: met prostate cancer, evaluation of disease after 12 cycles of investigational treatment History: met prostate cancer CHEST:LUNGS AND PLEURA: Right middle lobe pulmonary nodule measures 5 mm (image 63/series 5), unchanged. Other scattered micronodules are also unchanged.MEDIASTINUM AND HILA: Heart size is enlarged. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Small sclerotic bony foci in the thoracic spine compatible with metastatic disease. Healed T1 spinous process fracture.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar hepatic cysts. No definite solid hepatic lesion. The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Aorta caval lymph node measures 1.4 x 1.2 cm (image 130/series 3) previously, 1.5 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is small in size with fiducial markers.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable exam with no significant change in the size of the pulmonary nodules. 2.Small sclerotic foci in the thoracic spine suspicious for metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A focal asymmetry in the central left breast mid depth is unchanged dating back to 2007. Benign oil cysts are present in the right upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No interval change or mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 33 year old female with history of trauma. Cervical spine: No acute fracture or subluxation. There is loss of the normal cervical lordosis which may be secondary to patient positioning or muscle spasm. Anterior osteophytes are present at C5-6 and C6-7. Intervertebral disk spaces and vertebral body heights are well-maintained. The prevertebral soft tissues are within normal limits. The airway is patent.Thoracic spine: No acute fracture or subluxation. Intervertebral disk spaces and vertebral body heights are well-maintained. The prevertebral soft tissues are within normal limits. Lumbar spine: No acute fracture or subluxation. Intervertebral disk spaces and vertebral body heights are well-maintained. The prevertebral soft tissues are within normal limits. Coccyx: No acute fracture or subluxation. The prevertebral soft tissues are within normal limits. | No acute fracture or subluxation. |
Generate impression based on findings. | 35-year-old female with history of right knee pain status post fall. No acute fracture or dislocation. Alignment is anatomic. There is no joint effusion. The soft tissues are unremarkable. | No acute fracture. |
Generate impression based on findings. | Female 57 years old; Reason: anal cancer completed chemotherapy and radiation therapy in April 2014. evaluate for disease recurrence History: anal cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent.The gallbladder contains multiple calculi. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes. Reference left para-aortic lymph node measures 1.6 x 1.0 cm (image 123/series 3) previously, 1.5 x 0.9 cm.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Pessary device in the vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild anorectal thickening.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Stable exam with no significant change in size of the small retroperitoneal lymph nodes. No new sites of disease. |
Generate impression based on findings. | Male, 31 years old, with hypertension and headache. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The ventricular system is normal in size and morphology. The visualized paranasal sinuses and mastoid air cells are clear. Soft tissue debris is present within the right external auditory canal. The bones of the calvarium and skull base are intact. | No evidence of ischemia or any other acute intracranial abnormality. |
Generate impression based on findings. | 55-year-old female with history of left total hip arthroplasty 6 weeks prior. Left hip: Hardware components of a left total hip arthroplasty are situated in anatomic alignment without radiographic evidence of hardware complication. Orthopedic fixation of the left acetabulum and lumbosacral spine appears similar to prior. There is mild cortical thickening along the lateral aspect of the left proximal femur.Pelvis: Hardware components of a left total hip arthroplasty are situated in anatomic alignment without radiographic evidence of hardware complication. Orthopedic fixation of the left acetabulum and lumbosacral spine appears similar to prior. Mild osteoarthritis affects the right hip. | Left total hip arthroplasty and other findings as above. |
Generate impression based on findings. | Ankle fractureVIEWS: Right ankle AP, lateral and oblique 1/12/15 (3 views) Healing distal tibia fracture with periosteal reaction is seen in the alignment. Cast material obscures fine bone details. | Healing fracture in anatomic alignment. |
Generate impression based on findings. | Male, 60 years old, with extensive alcohol and tobacco abuse presenting with stridor from a new laryngeal mass, likely cancer status post biopsy. CT for staging. Diffuse mucosal thickening and hyper-enhancement is evident involving the bilateral base of tongue, the preepiglottic space, the epiglottis and epiglottic root, the aryepiglottic folds, and the false vocal folds. The true vocal cords are likely also involved with thickening at the level of the anterior commissure, and with perhaps an exophytic component extending slightly below the level of the cords on the right. The supraglottic airway is completely effaced.The paraglottic space is infiltrated and thickened as well. The thyroid cartilage is irregularly calcified but symmetrically so which can be normal. No definite evidence of cartilaginous invasion is seen at the level of the thyroid, arytenoid or cricoid cartilages.Bulky adenopathy is identified on both sides of the neck involving levels 2 and 3. For reference, a node at level 3 on the right measures 18 x 13 mm (image 155 series 4), and a node on the left at level 2 measures 25 x 22 mm (image 134 series 4). Numerous smaller nodes are also evident distributed widely through both sides of the neck, but these do not meet imaging criteria for pathologic enlargement.A tracheostomy is in place. The salivary glands are free of focal lesions. However, the fat planes separating the submandibular glands from adjacent adenopathy are not well seen and therefore some degree of submandibular invasion cannot be excluded. The thyroid is within normal limits. Cervical vessels opacify normally. No destructive osseous lesions are seen. | Extensive infiltrative mucosal space tumor with suspected involvement of the bilateral base of tongue, epiglottis, aryepiglottic folds, paraglottic space, false and true vocal cords. Within the limitations of CT, no definite evidence of cartilaginous invasion or extralaryngeal spread is detected.Bulky adenopathy is seen on both sides of the neck at levels 2 and 3 with reference measurements as above. Numerous smaller nodes are scattered more widely through the neck but these do not meet imaging criteria for pathologic enlargement. |
Generate impression based on findings. | Newly diagnosed epiglottic cancer, hoarseness. There are focal nodular thickening at the inferior aspect of the of the epiglottis along the laryngeal surface anteriorly at the midline presumably represent site of known tumor. Preepiglottic fat appears preserved. Laryngeal cartilages are intact. No masses are seen involving at the level of the glottis, subglottic region, or hypopharynx.There is slightly prominence at the left base of tongue involving the left lingual tonsils without discrete mass. No other enhancing masses are appreciated within the oral cavity, pharyngeal, parapharyngeal soft tissues. Right-sided tonsilliths.There are multiple scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. Left level IIb lymph node measures up to 10 mm in the short axis. The airway remains patent. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. Mild degenerative changes in the cervical spine. No suspicion osseous lesions are seen. The imaged intracranial structures are unremarkable. There are emphysematous changes in the lungs with micronodules at the right lung apex. | 1. 10-mm nodular lesion involving the laryngeal surface of the epiglottis in its inferior aspect presumably corresponding to the known tumor. Correlate with endoscopic findings. Preepiglottic fat appears preserved. Laryngeal cartilages are intact. No evidence of glottic or subglottic extension. Slight prominence of the left lingual tonsils without discrete underlying mass.2. Multiple small lymph nodes throughout the neck which are nonspecific and not suspicious by CT criteria. The relatively most prominent left level IIb lymph node measures up to 10 mm in the short axis and borderline prominent.3. Emphysematous changes in the lungs with micronodules noted in the right upper lobe and can be evaluated with dedicated chest CT. |
Generate impression based on findings. | Reason: Stage IV HCC please provide index lesions to include repeat measurement of enhancing component of the liver as previously captured as image number 30, series number 8 in the lateral aspect of the mass History: As above CHEST:LUNGS AND PLEURA: Basilar scar/atelectasis without suspicious nodule or mass.MEDIASTINUM AND HILA: Nonspecific hypoattenuating thyroid lesions. Mild coronary artery calcifications. Mild enlargement of the main pulmonary artery.CHEST WALL: Intramuscular lipoma adjacent to the left humeral head unchanged.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. The previously hypoattenuating reference segment 4 liver lesion is not significantly changed in size measuring 6.0 x 4.6 cm (series 9 image 33). On axial images the inferior nodular enhancing component appears more conspicuous compared to the prior study, however does not appear significantly changed on coronal images. The previously reference arterial enhancing nodule along the superolateral aspect of the lesion measures 2.2 x 1.7 cm (series 9 image 29) unchanged. The left portal vein is again attenuated by this lesion.Calcification in the gallbladder fossa with rim enhancing collection measuring 2.5 x 1.5 cm (series 9 image 46) unchanged. The previously seen loculated fluid collection adjacent to the gastric antrum with a surgical clip now has nearly resolved. However there remains extensive inflammatory changes in this region and suggestion of a soft tissue tract connecting these collections suggesting a fistulous connection.SPLEEN: Small accessory spleen anteriorly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged appearance of bilateral hypoattenuating renal lesions. Nonobstructing nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric antral thickening and question of fistulous connection at the gastric antrum as described above.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No significant interval change in hepatic mass with nodular peripheral enhancement consistent with the given history of hepatocellular carcinoma.2.Persistent rim enhancing fluid collections along the gallbladder fossa. The enhancing component near the gastric antrum surgical clip has slightly decreased in size but there remains suspicion of a fistulous tract connecting these collections. |
Generate impression based on findings. | 72-year-old female with history of breast cancer. Evaluate for systemic metastasis. CHEST:LUNGS AND PLEURA: There are multiple bilateral pulmonary nodules highly suspicious for metastatic disease. Reference right upper lobe nodule measures 1.0 x 0.8 cm (series 4, image 59). Moderate to severe upper lobe predominant centrilobular and paraseptal emphysema. Mild pulmonary opacities posteriorly in the upper lobes bilaterally (series 4, image 40), most likely scarring. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Mild to moderate coronary artery atherosclerotic calcifications. Nonspecific mildly prominent precarinal lymph nodes. CHEST WALL: There is a large soft tissue mass which encases the sternum throughout its length with associated significant osseous erosion of the sternum. This mass measuring approximately 6.2 x 5.1 cm (series 3, image 44) at the level of the main pulmonary artery. Sclerosis affects the left scapula suggestive of metastatic involvement.Bilateral saline breast implants noted. Postsurgical clips in the right breast posterior to the saline implant.ABDOMEN:LIVER, BILIARY TRACT: There are diffuse hepatic hypoattenuating lesions, some of which are well defined and some of which are ill-defined and infiltrative. Reference segment 5 lesion measures approximately 1.2 x 1.2 cm (series 3, image 133). These most likely are metastatic disease; however, underlying focal fat is a consideration and if there is clinical concern over differentiating focal fat versus tumor burden, MRI examination may be considered for further evaluation.SPLEEN: Splenic granulomata are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of colitis or small bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of colitis or small bowel obstruction. Hypoattenuation in the external iliac veins bilaterally is likely related to mixing rather than thrombus given that the finding is bilateral.BONES, SOFT TISSUES: There is sclerosis about the right superior and inferior pubic rami as well as the right acetabulum with underlying cortical disruption highly suggestive of nondisplaced pathological fractures.OTHER: No significant abnormality noted. | 1.Multiple bilateral pulmonary nodules compatible with metastatic disease.2.Soft tissue mass encasing the sternum compatible with metastatic disease.3.Multiple osseous lesions consistent with metastatic disease including right pubic ramus and acetabulum which also demonstrates underlying nondisplaced pathological fractures.4.Diffuse hypoattenuating hepatic lesions are most likely tumor. If there is clinical concern to differentiate between underlying focal fat versus tumor burden, MRI may be considered for further evaluation.Findings relayed to Dr. Jin Choi over the phone at approximately 10:40 a.m. Per Dr. Choi, patient has been evaluated by orthopedic surgery for the right pubic ramus/acetabular pathological fractures. |
Generate impression based on findings. | 34-year-old female with history of cirrhosis of unknown etiology and refractory hypoxia. Evaluate for pneumonia and liver pathology. CHEST:LUNGS AND PLEURA: Diffuse multifocal air space opacities predominately groundglass in nature particularly in the upper and mid lung zone regions although bibasilar consolidation/atelectasis is seen. These are nonspecific and can be seen with pulmonary edema, diffuse infection, hemorrhage and ARDS. Bibasilar bronchiectasis is seen. No pleural effusions.MEDIASTINUM AND HILA: NG tube traverses through the esophagus into the stomach. No adenopathy is seen. Central venous catheter line is seen with tip of catheter in the right atrium. No significant abnormality noted otherwise.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology to liver with atrophy of the right lobe and relative predominance of the left lobe. No parenchymal mass lesions are seen, the lack of arterial phase imaging limits ability to detect small hepatocellular carcinomas. Vascular structures are patent and normal in the liver, however extensive portosystemic collaterals are seen consistent with portal hypertension. Gallstones are seen. No intrahepatic or extrahepatic biliary tract abnormalities are otherwise seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of ascites is seen throughout the abdomen and pelvis without loculation or other abnormality. Proximal small bowel appears normal. There are dilated loops of ileum without definite zone of transition to collapsed distal small bowel the terminal ileum is slightly smaller in caliber and partial small bowel obstruction cannot be excluded. Colon appears normal.OTHER: Diffuse subcutaneous edema seen suggestive of anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse subcutaneous tissue edema consistent with anasarca. Large mass involving the left gluteal muscles (series 8, image 157) measuring 12.9 x 6.8 cm. while this is nonspecific it is heterogeneous and slightly high density appearance -- in light of history of prior fall and suspected hematoma, this would be most compatible with a hematoma.. if further imaging characterization would be helpful, MR could better evaluate the soft tissue characteristics of this mass. OTHER: No significant abnormality noted | 1. Diffuse multifocal airspace pulmonary parenchymal opacities predominately groundglass in nature but with some foci of consolidation/atelectasis in the bases -- nonspecific in nature. 2. Cirrhotic liver morphology with evidence of portal hypertension.. 3. Gallstones without other biliary tract complication. 4. Dilated mid ileal bowel loops -- this may represent focal ileus, however partial small bowel obstruction cannot be excluded. 5. Large heterogeneous mass involving the left gluteal muscles -- most likely hematoma -- if tissue characterization with imaging would be helpful, MR could better evaluate this.findings discussed with Dr. Savage in the MICU at 1:18 PM. |
Generate impression based on findings. | 25-year-old male with history of kyphoscoliosis. There is approximately 30 degrees of dextroscoliosis in the thoracic spine measured from the superior endplate of T5 to the inferior endplate of T9. Hyperkyphosis of the thoracic spine is also appreciated, appearing similar to prior. There is approximately 23 mm of positive sagittal balance (the previous study was inadvertently measured from C6 and when corrected to C7 it measured 21mm). There is 9 mm of rightward pelvic tilt. | Scoliosis as above. |
Generate impression based on findings. | 54-year-old male with history of head and neck cancer. Reason: h/o SGL ca and CRT, compare to previous. Persistent posttreatment changes, including diffuse supraglottic mucosal thickening and edema.Diffuse hyperenhancement of the supraglottic mucosa, similar in appearance to prior exam. However, no areas of discrete nodularity, or easily measured mass/lesion. No significant associated airway narrowing. No significant lymphadenopathy by size criteria. The thyroid and salivary glands are unremarkable. The major cervical vessels appear intact. Atherosclerotic calcification is noted at the carotid bifurcation.There is redemonstration of mild cervical spondylosis, most significant at C6-C7 level. The previously described subcutaneous nodules in the posterior neck are no longer visualized. No destructive osseous lesion is identified. | Redemonstration of posttreatment changes in the neck, without convincing evidence of progression/recurrence of disease. No significant lymphadenopathy by size criteria. |
Generate impression based on findings. | 10-year-old male with pain over cuneiform with ambulation.VIEWS: Right foot AP, lateral and oblique (3 views) 1/12/2015 No acute fracture or malalignment evident. Normal appearing cuneiforms. | Normal exam. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of aspiration of a cyst in the left breast upper outer quadrant. Family history of mother diagnosed with ovarian cancer at unknown age. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable, multiple circumscribed masses in the left breast upper outer quadrant represent benign intramammary lymph nodes.No new masses, suspicious microcalcifications or areas of architectural distortion in either breast. Benign lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 25 year old female with abdominal pain, nausea, and vomiting. Assess for SMA syndrome. Incidental note is made of mild reversal of the cervical lordosis. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild proximal escape of contrast after the primary peristaltic wave, with a strong secondary peristaltic wave. Double contrast evaluation of the hypopharynx demonstrated no Zenker's diverticulum, esophageal web, or cricopharyngeal bar (see AP and lateral fluoroscopy capture series 5 and 6 respectively). The stomach was normal in size, shape, and position. The gastric mucosal surface was normal. Spontaneous emptying of contrast into the duodenal sweep was observed. The duodenal bulb and sweep were within normal limits. Contrast traversed the duodenum and entered the jejunum without evidence of obstruction or duodenal compression to suggest SMA syndrome. TOTAL FLUOROSCOPY TIME: 4:10 mm:ss | 1.Unremarkable examination of the stomach and duodenum, without evidence of SMA syndrome as clinically questioned. 2.Findings compatible with minor esophageal motility disorder as described above, which is of doubtful clinical significance. |
Generate impression based on findings. | 44 year old asymptomatic female presents for routine screening mammography. Prior mammogram in early 30s. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 45-year-old female history of left total hip arthroplasty. Hardware components of a left total hip arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication. The femoral head component has not yet been installed. Soft tissue defect about the lateral proximal thigh is likely postsurgical in etiology. Electric leads overlie the pelvis. | Left total hip arthroplasty as above. |
Generate impression based on findings. | Female 35 years old; Reason: 34 F with stage IIIC colon cancer, please eval for evidence of disease recurrence. History: none CHEST:LUNGS AND PLEURA: Few scattered left pulmonary micronodules are unchanged. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. Right-sided aortic arch. Left ventricle feeds the pulmonary artery and right ventricle feeds the aorta. Compatible with transposition.There are postsurgical changes in the mediastinum.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes in the colon. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged, heterogeneous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable exam. No new sites of disease. |
Generate impression based on findings. | 46-year-old female with history of pain. Thoracic spine: No acute fracture or subluxations. Alignment is anatomic. Intervertebral disk paces and vertebral body heights are well-maintained. The soft tissues are unremarkable.Lumbar spine: Mild leftward curve of the lumbar spine. No acute fracture or subluxation. Intervertebral disk spaces and vertebral body heights are well-maintained. Tiny anterior osteophytes are present at L3 and L4. The soft tissues are unremarkable. | No acute fracture or subluxation. Mild degenerative disc disease of the lumbar spine. |
Generate impression based on findings. | Reason: eval for kidney stone History: right flank pain Evaluation of solid organ and bowel pathology is limited without oral/IV contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate left nonobstructing renal calculus unchanged. No evidence of new obstructing stone or hydronephrosis in either kidney.. lack of IV contrast limits ability to evaluate for pyelonephritis, however no perinephric stranding or associated inflammatory changes are seen to suggest any inflammation. No mass lesions seen, however lack of IV contrast limits ability to evaluate renal parenchyma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal bowel caliber. Suggestion of a normal appendix on coronal series images 58-59. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Calcified phleboliths in the pelvis are unchanged. | No specific findings to account for the patient's right flank pain. No significant interval change since 1/4/15. |
Generate impression based on findings. | 66-year-old male with history of thumb abscess. Evaluate for osseous involvement. No acute fracture or malalignment. Mild soft tissue swelling about the distal volar aspect of the thumb. There is no evidence of underlying osseous involvement. | Soft tissue swelling without radiographic evidence of osteomyelitis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast carcinoma in two maternal aunts and ovarian carcinoma in a sister. Two standard digital views of both breasts were performed with an additional right MLO view and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was also performed. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 18 year-old male with history of healing fracture. A single orthopedic screw affixes a transverse fracture of the fifth metacarpal in near-anatomic alignment. There is no evidence of hardware complication. There has been minimal interval healing. Mild soft tissue swelling about the fracture. | Orthopedic fixation of 5th metatarsal fracture as above. |
Generate impression based on findings. | PHARYNX/LARYNX: Posttreatment changes with decreased subglottic edema. The airway is clear. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: For findings in the lungs, including right upper lobe opacity, please refer to dedicated CT chest. Mild intramural thrombus of the bilateral common carotid arteries. Mild mucosal thickening of the right sphenoid sinus. Mild degenerative changes of the visualized spine. | 1.Posttreatment changes without evidence of tumor recurrence.2.For findings in the chest, please see dedicated chest CT. |
Generate impression based on findings. | Male; 41 years old. Reason: bilateral consolidation with LLL sparing, hypoxia History: as above LUNGS AND PLEURA: Severe, diffuse groundglass opacity with scattered areas of denser atelectasis/consolidation in a predominantly perihilar distribution, upper lobes greater than lower lobes. Moderate bilateral pleural effusions. Moderate subsegmental atelectasis in both lower lobes.Interval development of mild bronchiectasis bilaterally, with areas of architectural distortion and volume loss.MEDIASTINUM AND HILA: Mild cardiomegaly. Decreased attenuation of the cardiac blood pool, suggestive of anemia. Large pericardial effusion. Left PICC tip in the SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenomegaly and hypoattenuating focal splenic lesion, unchanged. Ascites. | Severe, diffuse airspace disease as detailed above, most suggestive of ARDS and/or pulmonary edema. Interval development of mild bronchiectasis bilaterally, with areas of architectural distortion and volume loss consistent with proliferative phase of ARDS. |
Generate impression based on findings. | 62 year-old female history of right total hip arthroplasty. Six-week follow-up. Right hip: Hardware components of a right total hip arthroplasty are situated in anatomic alignment without radiographic evidence of hardware complication. There is scattered heterotopic bone about the right hip. The soft tissues are otherwise unremarkable. Surgical drain has been removed.Pelvis: Again seen are the post surgical changes in the right hip. Mild osteoarthritis affects the left hip and visualized lumbosacral spine. | Right total hip arthroplasty as above. |
Generate impression based on findings. | 42 year-old female with altered mental status and hyperglycemia who presents for evaluation for perforated viscera versus mesenteric ischemia versus pancreatitis. Motion artifact limits evaluation.ABDOMEN: LUNG BASES: Mild bilateral basilar atelectasis. Bilateral breast calcifications and nonspecific haziness in the right breast. LIVER, BILIARY TRACT: Diffuse hepatic fatty infiltration without focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. There is high density material within the gallbladder which may be high density bile versus cholelithiasis. No gallbladder wall thickening or pericholecystic fluid to suggest cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: The pancreas is enlarged with loss of normal pancreatic contour. There is mild to moderate peripancreatic fat infiltration and fluid. Findings consistent with acute pancreatitis. No loculated peripancreatic fluid collections to suggest abscess.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No findings to suggest bowel obstruction or colitis. Limited examination for evaluation of mesenteric ischemia given lack of contrast enhancement. No pneumoperitoneum as clinically questioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Bladder Foley catheter is noted. Gaseous foci within the bladder most likely iatrogenic from Foley catheter placement.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest bowel obstruction or colitis. Limited examination for evaluation of mesenteric ischemia given lack of contrast enhancement. No pneumoperitoneum as clinically questioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings consistent with acute pancreatitis. 2.No pneumoperitoneum as clinically questioned. 3.Examination is limited for evaluation of mesenteric ischemia given lack of contrast enhancement; however, no evidence of colitis or small bowel obstruction. 4.Diffuse hepatic steatosis. 5.High-density within the gallbladder may be high density bile versus cholelithiasis without specific CT findings to suggest cholecystitis.6.Bilateral breast calcifications and nonspecific haziness in the right breast. When patient is able to obtain a mammogram, correlation with mammography is recommended. |
Generate impression based on findings. | Ms. Roundtree is a 50-year-old female with biopsy proven ADH in the right breast. She presents today for seed localization prior to surgery on 1/15/2015. On review of the prior studies, there is a focal asymmetry along with an X-shaped clip at the 9 o'clock position of the right breast which was biopsied. PROCEDURE: The procedure, risks including bleeding, mistargeting and infection, and benefits of radioactive seed placement were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. Using aseptic technique, continuous ultrasound guidance and an lateromedial approach, an IsoAid preloaded breast localization needle was placed in the mass and adjacent to the clip. The I-125 seed was then deployed. The skin entry site was closed with a Band-Aid. A bracelet was placed on the right breast wrist labeled with the patient's name, MRN, number of seeds placed, right breast and surgical date (01/15/2014).Post-procedure digital right breast CC and ML views revealed the percutaneously placed seed to be in the expected location in the just medial to the asymmetry and clip. No evidence of hematoma or other complication was present. Post seed placement instructions were given to the patient. Patient tolerated the procedure well and left the breast imaging center in stable condition. Drs. Sheth and Schacht performed the procedure. | Successful radioactive seed localization of the right breast clip and asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male; 60 years old. Reason: 60 yo male w/ extensive etoh abuse and tobacco abuse p/w large neck mass causing stridor s/p trach and biopsy - concern for head and neck cancer. CT for staging so please do to adrenals. History: neck mass - staging of likely H/N cancer CHEST:LUNGS AND PLEURA: Moderate bibasilar dependent atelectasis/consolidation, for which underlying infection cannot be excluded. Trace bilateral pleural effusions, right greater than left. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: S/P tracheostomy. No enlarged mediastinal or hilar lymph nodes. Normal heart size. No significant coronary artery atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Feeding tube tip in stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Moderate bibasilar atelectasis/consolidation, presumably secondary to aspirate or infection.2. No specific evidence of metastatic disease in the chest and abdomen. |
Generate impression based on findings. | 73-year-old female, evaluate fracture healing Mildly impacted fracture of the surgical neck of the humerus with interval increase in callus formation indicating some interval healing. Near severe osteoarthritic changes affect the glenohumeral joint. | Healing proximal humerus fracture. |
Generate impression based on findings. | A few scattered pericallosal T2 hyperintensities are unchanged and compatible with stated history of multiple sclerosis. No new lesions are evident.No evidence of parenchymal edema or mass effect. A pineal cyst is unchanged in size. Ventricles are normal in size and morphology. No extra-axial fluid collections. | Stable white matter lesions compatible with history of multiple sclerosis. No new lesions are evident. |
Generate impression based on findings. | 55 year-old female, preoperative evaluation for right total hip arthroplasty. Moderate joint space narrowing of the right hip with subchondral cysts in the femur and acetabulum consistent with osteoarthritis. Osteoarthritis affects the visualized portions of the SI joints. Conglomerate density within the pelvis likely represents uterus and adjacent bowel loops and adnexa, poorly evaluated on noncontrast CT. If the patient is postmenopausal and further evaluation of the pelvis is clinically warranted, dedicated ultrasound may be considered. | Osteoarthritis and additional findings as described above. |
Generate impression based on findings. | 21-year-old male with finger pain Three orthopedic screws transverse an oblique fracture of the proximal phalanx in near-anatomic alignment. There is mild lucency surrounding the distal orthopedic screw without clear engagement of the threads. Interval removal of cast. Sclerosis about the fracture line indicates some interval healing. | Orthopedic fixation of healing proximal phalanx fracture as described above. |
Generate impression based on findings. | 49-year-old male, postoperative evaluation Interval removal of surgical drain. Postoperative changes of bilateral total hip arthroplasties are identified in near-anatomic alignment. Lucency about the acetabular component of the right hip arthroplasty is unchanged from the prior exam. Cortical defects along the proximal cortex of the right femur appear unchanged from the prior exam. | Total hip arthroplasty as described above, appearing similar to the prior exam. |
Generate impression based on findings. | 70-year-old male with history of right total knee arthroplasty. Six-week follow-up. Hardware components of a right total knee arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication. Surgical clips are present within the medial soft tissues of the visualized left leg. Moderate osteoarthritis affects the left knee as seen on the frontal view. | Right total knee arthroplasty as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 65-year-old male with multiple myeloma, status post stem cell transplant The bones are diffusely demineralized.SKULL: Lucency within the right skull adjacent to the midline is unchanged and may represent a venous lake.CERVICAL SPINE: Moderate degenerative arthritic changes affect the mid to lower cervical spine.THORACIC SPINE: Status post kyphoplasty at T9 and T11 with multiple additional vertebral body compression fractures, including moderate loss of height at T12 and T8, marked loss of height at T7 and mild loss of height at T6.LUMBAR SPINE: Multiple endplate deformities throughout lumbar spine appears similar to the prior exam..RIBS: No discrete lytic lesion.PELVIS: The upper pelvis and SI joints are obscured by bowel gas and stool.UPPER EXTREMITY: No new discrete lytic lesion. Moderate osteoarthritis affects the shoulders.LOWER EXTREMITY: No new discrete lytic lesion. | No new discrete lytic lesion and additional findings as described. |
Generate impression based on findings. | 37-year-old female with history of perianal Crohn's disease. Evaluate for new abscess or fistula. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Partially visualized postoperative changes at the ileocolonic anastomosis. No abdominal or pelvic fluid collections are present.BONES, SOFT TISSUES: There are multiple complex fistulous tracts in the perirectal/anal region, specifically on the left, terminating into abscesses. Comparison made to CT enterography 3/5/2014. Interval placement of perirectal transsphincteric seton.New left air and fluid filled collection in the left ischioanal fossa (series 3, image 62) compatible with an abscess. There is a fistulous track extending from this collection extending to the anus. New fluid collection with rim enhancement measuring 3.4 x 2.3 cm at the left deep buttock posteriorly compatible with an abscess (series 3, image 80); superior to and communicating with this left buttock abscess, there is an air and fluid-filled fistulous tract extending to the anus. New contrast enhancement within the anal region at approximately 10 o'clock position with internal gaseous focus (series 3, image 36) suggestive of an additional abscess/fistula.Interval increase in size of the air and fluid-filled collection at the left gluteal cleft (series 3, images 58 through 67), compatible with an abscess.Again noted is mild stranding at the right gluteal cleft suggestive of phlegmon.OTHER: No significant abnormality noted | Multiple new complex fistulous tracts in the perirectal/anal region, specifically on the left, terminating into abscesses as detailed above. |
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