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Generate impression based on findings. | 65-year-old male with fifth digit pain Deformity and callus formation consistent with a healing fifth metacarpal fracture. There is mild volar angulation of the distal fragment. | Healing fifth metacarpal fracture. |
Generate impression based on findings. | 50-year-old male with history of third digit injury. No acute fracture or malalignment. The soft tissues are unremarkable. | No acute fracture or dislocation. |
Generate impression based on findings. | History of left lumpectomy in 2012 for DCIS. Patient received radiation and is currently on tamoxifen. Known bilateral breast calcifications. Personal history of basal cell carcinoma of the left arm. History of breast cancer in maternal grandmother diagnosed at the age of 54. Three standard views of both breasts, a left medially exaggerated CC view and 2 left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on a scar overlying the left breast. Stable architectural distortion and surgical clips are present in the lumpectomy bed. A percutaneously placed clip is present in the central left breast. Stable benign calcifications are present in both breasts.No new masses or suspicious microcalcifications are present in either breast. | Stable post surgical changes of the left breast and stable bilateral 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. | 71-year-old male status post right TKA Hardware components of a total knee arthroplasty are situated in near anatomic alignment without evidence of complication. Interval removal of drain and surgical staples. There is a moderate joint effusion. Ossification projecting anterior to the distal femur is again noted. Anterior soft tissue swelling limits evaluation of the extensor mechanism. Severe medial joint space narrowing affects the contralateral knee as seen on the frontal view. | Status post total knee arthroplasty in near anatomic alignment. |
Generate impression based on findings. | Female; 73 years old. Reason: Assess mass seen on CXR History: mass on CXR LUNGS AND PLEURA: Stable scattered nonspecific pulmonary micronodules. Stable 1.2 x 0.5 cm nodular opacity in the right upper lobe (image 45, series 6), which may reflect scarring and which previously measured 1.1 x 0.6 cm. Grossly stable ovoid opacity in the right lower lobe with mild adjacent pleural thickening and an appearance typical for rounded atelectasis. Trace pleural effusions.MEDIASTINUM AND HILA: Small hiatal hernia. Trace pericardial effusion. Mild atherosclerotic calcifications of the coronary arteries.CHEST WALL: Stable borderline enlarged cardiophrenic node measuring 1.8 x 0.5 cm (image 66, series 4), previously 1.8 x 0.5 cm.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Percutaneous biliary drain, partially visualized. Splenomegaly, partially visualized. | No significant interval change. Grossly stable subpleural opacity in the right lower lobe which is most likely rounded atelectasis though continued follow up is recommended to exclude growth. |
Generate impression based on findings. | Ms. Alfred is a 61 year old female with a personal history of left breast lumpectomy in November 2008 for IDC/DCIS followed by radiation and hormonal therapy. Additional history of benign right breast biopsy in 2007. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There are stable postsurgical changes including architectural distortion, oval-shaped seroma, dystrophic benign calcifications and surgical clips present within the left lumpectomy site. Surgical clips are also identified in the left axilla. Biopsy marker clip from prior benign biopsy identified in the right medial breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes in the left 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. | Reason: h/o SGL ca, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.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: Stable presumed renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative change involving the spine, slightly increased at L3 -- 4.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: hx H\T\N ca, post CRT, evaluate dx and compare measurements to previous scans History: as above CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. No pleural effusions.Mild scarring/discoid atelectasis in the lingula unchanged.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion. Minimal coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.No Axley lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change without evidence of metastatic disease. |
Generate impression based on findings. | 60 year-old female with history of renal cell carcinoma, post partial nephrectomy. Evaluate. ABDOMEN:LUNG BASES: Stable trace pericardial effusion. Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesions. High-density material within the gallbladder likely represents bile. No intra-or extrahepatic or ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Post-operative changes of left partial nephrectomy without specific findings to suggest recurrence. No hydroureteronephrosis.Left upper pole hypoattenuating lesion is too small to characterize (coronal series, image 58) and was likely seen on the prior outside examination as noted on series 11, image 90. Right upper pole hypoattenuating lesion with focus of fat may represent a small angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant interval change in the nonspecific mildly enlarged retroperitoneal lymph nodes. Prominent periportal lymph node is stable.BOWEL, MESENTERY: Mild peritoneal nodularity posteriorly (series 3, image 73 and 80) not significantly changed. Small hiatal hernia is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant interval change in the nonspecific mildly prominent iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postoperative changes of partial left nephrectomy without specific findings to suggest tumor recurrence.2.Too small to characterize left upper pole hypoattenuating lesion.3.Subcentimeter right upper pole lesion may represent a small angiomyolipoma. |
Generate impression based on findings. | 12 month old male with known hydronephrosis secondary to extrinsic compression from a known adrenal mass. History of retroperitoneal neuroblastoma. BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 2 Length*** Right: 7.7 cm Left: 6.3 cm Mean for age: 6.2 cm Range for age: 5.0 - 8.5 cmADDITIONAL OBSERVATIONS: None | Grade 2 left hydronephrosis, not significantly changed from the prior examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Reason: evaluate pulm nodule History: smoking hx, seen on CXR LUNGS AND PLEURA: There is no correlate for the nodule noted on chest radiograph. It may have represented a pulmonary vessel on end.Calcified granuloma on the right. No suspicious pulmonary nodules. There is mild nonspecific bronchial wall thickening.MEDIASTINUM AND HILA: Calcified thyroid nodules. Small hiatal hernia. Aberrant right subclavian artery, normal anatomic variant.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. There is no correlate for the nodule noted on chest radiograph. It may have represented a pulmonary vessel on end. No suspicious pulmonary nodules. 2. Mild bronchial wall thickening which is nonspecific but most commonly seen with asthma or bronchitis. |
Generate impression based on findings. | 30 year-old male with history of clavicle ORIF. A screw and plate device is appreciated affixing a right midclavicular fracture without evidence of complication. The fracture lines are nearly completely indistinct compatible with continued healing. | Healing clavicle ORIF without evidence of complication. |
Generate impression based on findings. | History of left lumpectomy 3/2013 for DCIS. Patient received adjuvant radiation therapy. History of right mastopexy. History of ovarian cancer in sister. No new breast complaints. Three standard views of both breasts, an additional left ML view and 2 left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear marker was placed on a scar overlying the left breast. Postsurgical architectural distortion and surgical clips are present in the lumpectomy bed. New calcifications are associated with a lucency in the lumpectomy bed, most likely developing dystrophic calcifications in fat necrosis/oil cysts. A stable focal asymmetry is present at the 9 o'clock position of the left breast.No new masses are present in either breast. | Developing calcifications in the left lumpectomy bed are most likely benign dystropic calcifications in fat necrosis/oil cyst formation. A left unilateral mammogram in 6 months is recommended. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Reason: NSCLC please compare to prior exam. History: NSCLC CHEST:LUNGS AND PLEURA: Right upper lobe nodule (image 31 series 5) demonstrates significant decrease in size now measuring 15 mm x 13 mm previously measuring 21 mm x 19 mm.No additional suspicious nodules can be identified.No pleural effusions.MEDIASTINUM AND HILA: Interval reduction size of previously noted prominent mediastinal and right hilar lymph nodes.Reference precarinal lymph node (image 34 series 3) now measuring 5 mm in short axis previously measuring 9 mm.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.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval decrease in size of the known right upper lobe nodule and clearing of the diffuse pulmonary nodules.2.Interval decrease in right hilar and mediastinal lymphadenopathy. |
Generate impression based on findings. | Reason: mets lung cancer, on Nivolumab now. Pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Postsurgical changes of left lower lobectomy. Mild upper lobe predominant centrilobular emphysema is unchanged. New cluster of punctate subcentimeter nodules in the posterior right upper lobe (image 49/112) more typical of infection or aspirate than metastatic disease, though continued CT follow up is recommended. Other scattered pulmonary nodules, one of which is calcified and are unchanged. MEDIASTINUM AND HILA: Reference measurements as below:1.Right supraclavicular lymph node measures 8 x 6 mm (image 3/147) unchanged.2.Right lower paratracheal lymph node measures 8 mm (image 27/147), unchanged.3.Subcarinal lymph node measures 8 mm (image 41/147), unchanged.Severe coronary artery and mild aortic calcifications again noted. CHEST WALL: Multilevel anterior wedging and degenerative changes, not significantly changed. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small subcentimeter hypoattenuating foci in the liver are too small to characterize, although unchanged and likely benign. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: Small subcentimeter hypoattenuating foci in both kidneys are too small to characterize, although unchanged and likely benign. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter again noted. Atherosclerotic calcification of the abdominal aorta and its branches. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small focal hernia containing fat.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New cluster of punctate subcentimeter nodules in the posterior right upper lobe more typical of infection or aspirate than metastatic disease, though continued CT follow up is recommended. Otherwise stable CT. |
Generate impression based on findings. | Reason: met prostate cancer, evaluation of disease after 12 cycles of investigational treatment. Please complete PCWG2 form History: prostate cancer Degenerative arthritic symmetric radiotracer uptake is again noted. Stable foci of activity in the T1 spinous process and posteriorly in T7-T8 likely represent additional degenerative changes versus osseous metastasis. No new abnormal foci of activity. | Stable exam. No evidence of progression of bone metastases. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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. Deodorant artifact projects over both axillae.Stable benign masses are present in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable benign bilateral masses. 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. | Ms. Dean is a 76 year old female with a personal history of right breast lumpectomy in June 2014 for IDC/DCIS treated with radiation and hormonal therapy. Three standard views of both breasts with two right spot compression view is were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. 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. Surgical clips are also identified in the right axillary region. There is minimal skin thickening, likely related to radiation-related changes. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either 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. | Reason: Evalute for interstitial lung disease History: Wheezing and crackles on exam with reported history of previous pneumonia LUNGS AND PLEURA: Patchy groundglass and mild linear interstitial abnormality diffusely distributed bilaterally. No significant honeycombing or traction bronchiectasis. Minimal airtrapping on expiratory phase imaging.MEDIASTINUM AND HILA: Mild intrathoracic lymphadenopathy unchanged. Severe coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Residual enteric contrast material. Severe degenerative change involving the upper lumbar spine, incompletely visualized. | 1. Persistent patchy groundglass and mild linear interstitial abnormality diffusely distributed bilaterally. No significant honeycombing or traction bronchiectasis. Presuming the patient does not have pulmonary edema, this may represent a more chronic interstitial abnormality such as NSIP.2. Stable mild nonspecific intrathoracic lymphadenopathy. |
Generate impression based on findings. | 66-year-old female with history of pubic rami fractures. There are fracture deformities of the superior and inferior pubic rami with adjacent callus formation indicating healing. Moderate osteoarthritis affects the hip joints and visualized lumbar spine. Mild osteoarthritis affects the SI joints. Surgical clips project over the pelvis. | Chronic right pubic rami fracture deformities and degenerative arthritic changes as described above. |
Generate impression based on findings. | 79-year-old female, assess prosthetic Hardware components of a total knee arthroplasty are situated in near-anatomic alignment without evidence of complication. Vascular calcifications project over the soft tissues. | Postoperative total knee arthroplasty without evidence of complication. |
Generate impression based on findings. | 65-year-old female, postoperative assessment Hardware components of a total right hip arthroplasty are situated in near-anatomic alignment without evidence of complication. Lucency about the acetabular component appears unchanged. Surgical clips project over the soft tissues. | Postoperative changes of total right hip arthroplasty in near-anatomic alignment. |
Generate impression based on findings. | Ms. Robinson is a 87 year old female with a personal history of right breast lumpectomy in November 2009 for IDC/DCIS treated with radiation therapy. Family history of breast cancer in sister. 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 patient had a small amount of right non-bloody nipple discharge in mammographic compression. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear markers were placed on scars overlying both breasts. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also identified in the right axillary region. Stable calcified lesion in the right retroareolar region which may be a papilloma and could account for the patient's clear nipple discharge. Scattered benign calcifications are seen bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes in the right breast. No mammographic evidence of malignancy. Suggest clinical correlation for any further nipple discharge. 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. | 10-year-old male with known humeral fractureVIEWS: Right humerus AP and lateral (two views) 1/12/2015 Again seen is a transverse fracture through the proximal humeral metadiaphysis with increased callus formation and indistinctness of the fracture plane consistent with healing. Persistent and unchanged lateral displacement of 5 mm and medial angulation of the distal fracture fragment is again evident. | Healing transverse fracture of the proximal humeral metadiaphysis as detailed above. |
Generate impression based on findings. | Reason: 77 y/o F with dysphagia to solids and liquids, evaluate etiology; history of breast and lung cancer Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Surgical clips are noted in the right axilla. Mild scoliosis is noted.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed 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 a normal primary peristaltic wave. There is extrinsic compression on the left cervical esophagus, likely from enlarged thyroid lobe containing a nodule as seen on prior CT study (series 10). Small parapharyngeal and duodenal diverticula were noted. TOTAL FLUOROSCOPY TIME: 6:43 minutes | 1.Extrinsic compression on the left cervical esophagus from enlarged left thyroid lobe.2.Hypopharyngeal and duodenal diverticula of doubtful clinical significance. |
Generate impression based on findings. | Multiple myeloma, follow-up Diffuse demineralization limits sensitivitySKULL: No significant abnormality noted other than extensive dental caries.CERVICAL SPINE: Mild degenerative changes most pronounced involving the lower cervical spine including disk base narrowing and osteophytes.THORACIC SPINE: Posterior fixation of the lower T and L spine extending from T7 to L3 with preservation of alignment. No distinct lesions observed within this limitation. LUMBAR SPINE: The remainder of the lumbar spine other than mild degenerative changes of the lower levels L5-S1 disk space, are free of discrete myelomatous lesions. IVC filter.RIBS: The ribs appear grossly lesion free however the left scapula, specifically the distal tip demonstrates a mottled appearance of the probable lesion, best appreciated on the left humerus imagesPELVIS: Upper pelvis obscured by gas and stool. Scattered mild degenerative changes involving the hips, SI joints and symphysis. No discrete lesions to suggest myelomatous involvementUPPER EXTREMITY: Mild mottled appearance involving the diaphysis and mid humerus on the right with similar changes involving the left diaphysis. Mild endosteal scalloping all suspicious for myelomatous involvement. Forearms are unremarkableLOWER EXTREMITY: A mottled appearance is again observed involving the proximal right femur as well as distal diaphysis and metaphysis again with endosteal irregularity. Appearance is also identified on the left again with distal metaphyseal lesions. The lower legs are free of myelomatous lesions, however post fracture repair and multiple screws with deformity in the mid right tibia and more distal fibula are observed. Moderate knee osteoarthritis | Scattered numerous lesions largely observed in the extremities concerning for myelomatous involvement. See detail provided above |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with 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. Mammography is most sensitive when assessing for interval changes. If outside mammogram is submitted, an comparison can be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 66 years old; Reason: metastatic head and neck cancer, evaluate for treatment. History: as above There is slight focal uptake in the left eighth rib along the lateral aspect. There is heterogeneity along the proximal aspect of the left humerus is of uncertain significance, however this is not suspicious for metastatic disease. Three focal foci seen only on the anterior projection views overlying the lower spine and sacrum likely related to contamination presumably artifact.Hypermetabolic activity noted on prior PET/CT study in left posterior aspect of the T12 vertebral body is not seen on current study. | No suspicious uptake to suggest metastatic disease.Uptake in the left eighth rib along the lateral aspect is of uncertain significance. In the absence of additional osseous metastatic disease, this is presumably posttraumatic in nature. |
Generate impression based on findings. | 16 year old female with left leg pain for two months with thick bump over inner mid left shin.VIEWS: Left tibia/fibula AP and lateral (two views) 1/12/2015 No acute fracture or malalignment is evident. No soft tissue mass is seen. 2-mm bone excrescence arising off the medial aspect of the proximal tibial diaphysis is of uncertain clinical significance. | 1.No soft tissue mass, fracture or malalignment evident.2.2-mm bone excrescence arising off the medial aspect of the proximal tibial diaphysis of uncertain clinical significance. |
Generate impression based on findings. | 57-year-old presents for 6-month follow-up of left breast calcifications. Three standard views of the left breast, laterally exaggerated CC view and spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Multiple microcalcifications in the left upper outer quadrant remain highly likely benign. | Probably benign calcifications in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Female 49 years old; Reason: hematuria and right flank pain. evaluate for nephrolithiasis History: flank pain, hematuria ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: A focal hypodensity in the inferior right liver (3:37) and is grossly stable, and likely represents a small hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nephrolithiasis, or hydronephrosis. Clips likely related to postsurgical changes of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Previously seen dissection is not evaluable given the noncontrast nature of this exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Compared to 2011 at which point there is a bulky fibroid uterus, the uterus is not as well visualized, and likely secondary to interval hysterectomy. However, in the area of the right adnexa, there is a 4.6 x 2.8 cm incompletely characterized lesion.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. | No evidence of obstructive uropathy.Patient is likely status post interval hysterectomy compared to images from 2011. An incompletely characterized lesion is seen in the right adnexa, measuring up to 4.6 cm. While this could represents a physiologic cyst if the ovaries were not removed, further characterization with US and/or MRI is recommended, along with correlation with surgical history. |
Generate impression based on findings. | Hip pain Pelvis and right hip: Marked interval progression with increased destruction and loss of the superior margin and collapse of the right femoral head. Bone-on-bone narrowing is also increased with extensive sclerosis and subchondral cysts.Less pronounced changes of the left hip with preservation of femoral head shape but increased density and suggestion of moderate AVN with moderate superimposed osteoarthritis observed.Mild degenerative change of both SI joints with a bridging osteophyte involving the symphysis.Surgical hernial clips overlie the upper superior margin of the image, suggesting a ventral hernial repair | Marked interval progression since May 2014 with partial collapse and increased and now moderate to pronounced AVN of the right hip. Less pronounced interval change of the left hip. See detail provided |
Generate impression based on findings. | Pain and swelling, patient fell yesterday with left-sided weakness. Pain specifically involving anterior left knee Mild diffuse demineralization and mottled appearance appears similar to prior exams and prior previously described infarcts. Within this limitation, minimal degenerative changes of the knee are again identified without significant alteration. Specifically no acute superimposed abnormalities involving the anteromedial aspect of the knee, specifically underlying the marker provided.No knee effusion. Alignment preserved | Scattered infarcts without evidence of superimposed acute abnormality |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional bilateral CC views and a left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the left breast.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: NSA - Screening Mammogram. |
Generate impression based on findings. | Supracondylar fracture.VIEWS: Right elbow AP/lateral (two views) 01/12/15 Cast remains in place. Supracondylar fracture is in near-anatomic alignment. There may be some periosteal reaction. | Early healing of supracondylar fracture. |
Generate impression based on findings. | Crushing injury yesterday, tenderness No radiographic abnormality of the minimal soft tissue swelling on the dorsal aspect. Specifically alignment preserved | Mild soft tissue swelling without underlying osseous abnormality |
Generate impression based on findings. | Pain Detail obscured by overlying cast material. Postsurgical fixation of the distal radius with two K wires affixing the scapholunate and scaphocapitate articulations. Osseous structures in gross anatomic alignment. Mild underlying degenerative changes of the radiocarpal joint incompletely visualized | Surgical fixation and gross alignment preserved |
Generate impression based on findings. | Reason: Intracranial stenosis. Recurrent right hemispheric infarction. Left hemiparesis and numbness. Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection. A right internal artery was relatively small and has delayed flow.Right internal carotid artery: There is opacification of the right internal carotid artery up to be level of the ophthalmic artery, distal to which there is no opacification of the ophthalmic segment. Choroidal blush is identified.Right external carotid artery: There is no evidence for stenosis, dissection or atherosclerotic disease involving the right external carotid or any of its major branches.Left subclavian artery: There is no evidence for vertebral dissection. There is no significant stenosis at the origin of the left vertebral arteryLeft vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is an in flow jet of unopacified blood entering the basilar artery from the distal right vertebral artery. There is reverse filling of the right posterior communicating artery with associated opacification of the right anterior and middle cerebral arteries. There is delay in opacification of the anterior circulation relative to the posterior circulation.His of the right anterior cerebral artery distally are somewhat irregular. The right posterior inferior cerebellar artery is somewhat irregular.Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissectionLeft internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. Aortic arch injection for the intracranial vasculature: There is delay in opacification of the right MCA territory with M5 arterial branch arrival time within 1.16 seconds of each other. Right common iliac artery: There is no contraindications for the deployment of a closure device. | 1.Occlusion of the right internal carotid artery at the ophthalmic segment. The right internal artery is the supply to the right ophthalmic artery.2.Delayed arterial arrival time of the right middle and anterior cerebral artery circulations relative to the left hemisphere as well as the posterior circulation.3.Mild atherosclerotic changes are present in the distal right anterior cerebral artery branches. |
Generate impression based on findings. | Ankle fracture.VIEWS: Right ankle AP/lateral/oblique (3 views) 01/12/15 Two screws remain in place in the tibial epiphysis. Alignment is anatomic. Increased callus formation is noted along the posterior lateral aspect of the tibia. Demineralization continues. | Continued healing of distal tibial fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right breast biopsies. Three 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. Two biopsy clips are present in the left upper outer quadrant. Stable benign calcifications are present bilaterally, including arterial calcifications. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable left breast 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. | Ms. Boffman is a 82 year old female with a personal history of right breast mastectomy 1999 followed by radiation and chemotherapy. No current breast related complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are seen in the left breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. A left unilateral diagnostic mammogram can be performed annually as long as the patient's overall medical condition allows. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 7-week-old former 27 week gestational age patient with chylothorax.VIEW: Chest AP (one view) 01/12/15, 1202 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is distal to GE junction and not included on image. Left upper extremity PICC tip is in left brachiocephalic vein. Left chest tube remains in place.Soft tissue edema continues.Bilateral pleural effusion persists, left larger than right. Mild enlargement of the cardiac silhouette persists. | Unchanged bilateral pleural effusion. |
Generate impression based on findings. | 59-year-old male with metastatic colon cancer status post hepatic resection in February, 2014. Evaluate for interval recurrence of disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No parenchymal lung masses or nodules seen. No pleural disease.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Morphology and appearance the liver is unchanged status post right hepatectomy without evidence of abnormal lesions in the remaining liver. Vascular structures are normal. Patient is status post cholecystectomy with no other biliary tract abnormality seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild hydronephrosis of left kidney unchanged. Ureter is not dilated. No parenchymal mass abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No adenopathy.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. Status post right hepatectomy with left lobe of liver remaining normal in appearance without evidence for metastatic disease. 2. No other sites for recurrent or metastatic disease seen. 3. Stable mild left hydronephrosis without other associated abnormality seen. |
Generate impression based on findings. | 41-year-old male with history of end-stage renal disease, exploratory laparotomy for pancreatic necrosectomy. Now leaking copious amounts of bilious fluid from incision site. Rule-out fistula, leakage of bile. ABDOMEN:LUNG BASES: Small left pleural effusion and bibasilar atelectasis. No other abnormalities.LIVER, BILIARY TRACT: No significant abnormality noted within limits of non-IV contrast enhanced examination. Gallbladder is moderately distended and shows no abnormal wall thickening. Immediately adjacent medially to the gallbladder (series 3, image 70) is a low density collection measuring 1.9 x 2 .8 cm -- in light of history questioning bile leak, and in light of lack of oral contrast that could opacify bowel loops, it is uncertain whether this represents a portion of duodenum or a potential adjacent fluid collection.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing small calyceal stones bilaterally. No other renal abnormalities are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes about the stomach are seen. Immediately inferior to the stomach and more lateral extending towards the hepatic flexure of the colon and extending to the open wound is a linear tract with mottled debris and containing some high density material that appears to be a wide fistulous tract measuring approximately 1.1 cm in diameter (series 3, image 90. This tract appears to be continuous with a second component of the tract that exits separately more laterally through the subcutaneous fat to the skin surface (series 3, image 91). A posterior extension of these tracts appears to extend and communicate with the hepatic flexure of the colon (series 3, images 84 and 83). As the transverse colon anteriorly appears to come very close to the open anterior abdominal wound and the right subcutaneous fistula tract, and there is no orally administered contrast to help delineate the course of the intestinal tract, it cannot be ascertained whether whether these tracts could represent the normal colon brought to the skin surface for an ostomy, or whether these are fistulous tracts extending from the colon and the colon is collapsed anteriorly adjacent to anterior abdominal wall. More inferiorly, the visualized small bowel does not appear dilated to suggest any obstructions. More inferiorly the mesentery looks normal with no free or loculated fluid collection seen.Within limits of no oral or iv contrast there does appear to be infiltration of the fat surrounding the descending colon and postoperative or inflammatory changes extending to the anterior abdominal wall and posterior abdominal wall (series 3, image 76 through 109). Posterior to the left kidney at its inferior pole this is continuous to the posterior pararenal space to the left psoas inferiorly this process extends to the iliopsoas muscle in the pelvis. This may represent old hematoma or other post surgical scarring changes. More distally beyond this the sigmoid colon has a more normal appearance.There is in the left anterior lower abdominal subcutaneous fat a linear soft tissue tract extending to the skin surface -- this was explained to Dr. Van Beek, radiologist supervising the examination, as the site of a left lower quadrant intestinal ostomy. However there does not appear to be visualized in the bowel loops traversing through this and this remains of uncertain significance and may represent another fistulous tract if this is not the site of an intestinal ostomy. BONES, SOFT TISSUES: Open anterior midline abdominal wall wound.OTHER: 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: Changes of avascular necrosis is seen the femoral heads of both hips.OTHER: No significant abnormality noted | 1. Open anterior abdominal wound. 2. Apparent fistulous connections from the open wound to the right lower abdomen which appears to connect with: And a second tract through to the right lateral abdominal wall. Lack of orally administered contrast limits ability to definitively evaluate adjacent bowel loops and the potential course of the colon and these tracts. 3. Left lower abdominal quadrant tract through subcutaneous tissues to skin -- by history provided this is an intestinal tract ostomy, however no definite connection with bowel loops are seen and this remains of uncertain etiology in light of that history. 4. Small fluid collection adjacent gallbladder which may represent redundant residual duodenum, although in light of concern over bile leak, bile collection there cannot be excluded. |
Generate impression based on findings. | Abdominal pain. Constipation etiology?VIEW: Abdomen AP (one view) 01/12/15, 1227 A small amount of feces is seen in the rectosigmoid. No significantly dilated bowel loops are present. Bowel gas pattern is normal. No abnormal calcification is identified. | Normal examination. |
Generate impression based on findings. | Female 77 years old; Reason: rule out renal recurrence, special attention to left adrenal History: hx of renal cell carcinoma ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy with stable mild intra-and extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nodular thickening of the left adrenal gland.KIDNEYS, URETERS: Status post partial left nephrectomy. Mild unchanged prominence of both collecting systems. No new mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic/not well seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine, particularly in the lower lumbar spine.OTHER: No significant abnormality noted. | 1.Status post left partial nephrectomy with no evidence of recurrence. Stable left adrenal nodularity. |
Generate impression based on findings. | Female 35 years old; Reason: hx of left radical nephrectomy - US from 5/2014 reveals 2 likely AML's in righ kidney please evaluate History: hx of left radical nephrectomy - US from 5/2014 reveals 2 likely AML's in righ kidney please evaluate ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 1 cm enhancing focus in the dome of the left hepatic lobe is stable, likely a flash filling hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Previously seen echogenic lesions on sonogram as no direct correlate on today's contrast enhanced CT.. No obvious mass lesions are seen. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left corpus luteal cyst. Other likely physiological cysts in the ovaries, measuring up to 3.5 cm on the right. Compared to prior study, these are likely new physiological cysts, given the decrease in size and timeframe.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. | 1.Previously seen sonographic echogenic lesions have no direct CT correlate. No suspicious renal mass lesion is noted on today's contrast enhanced CT scan. |
Generate impression based on findings. | Male, 82 years old, history of squamous cell carcinoma of the larynx, follow up exam status post CRT. Subtle asymmetric attenuation and contour persists along the right true vocal cord without significant interval change. No discrete or measurable mass is evident at this location. The left laryngeal ventricle and left piriform sinus are mildly prominent which may reflect left vocal cord dysfunction.Elsewhere, the mucosal surfaces are unremarkable. No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are free of focal lesions. No destructive osseous lesions are seen. Redemonstrated is multilevel cervical spondylosis with some degree of spinal canal stenosis suspected at C3-4, C4-5 and C5-6. | Mild asymmetric attenuation and contour of the right vocal cord is unchanged and compatible with sequelae of prior therapy. No findings to suggest local tumor recurrence or pathologic adenopathy are seen. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast cyst removal. History of breast cancer in maternal great aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. 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. | 46-year-old female with rectal pain. Rule out rectal abscess. History provided to CT examination 2005 states ulcerative colitis status post proctocolectomy with ileoanal anastomosis and 2003. UTERUS, ADNEXA: No significant abnormality noted in the uterus. Post procedure changes seen in the fallopian tubes bilaterally.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Evidence of prior proctocolectomy with ileal anal pouch -- the pouch is distended with similar appearance compared to 2005 examination well distended with orally administered contrast. No wall thickening of the pouch is seen. Just past the anal verge in the subcutaneous tissues about the right buttock and extending towards the right proximal 5 are inflammatory changes including subcutaneous emphysema predominately appearing as infiltrative soft tissue stranding in the fat but with small localized collections measuring up to 1.4 x 2.6 cm. No definite fluid collections are seen and whether this represents phlegmon versus small early developing fluid collection cannot be ascertained but there does not appear to be a sizable fluid collection that could be percutaneously drained.. these findings are all new since 2005.BONES, SOFT TISSUES: Left inguinal hernia containing only mesenteric fat.OTHER: No significant abnormality noted | 1. Status post proctocolectomy with ileoanal pouch with similar appearance to 2005 CT examination. 2. Phlegmonous changes, subcutaneous fat infiltration and emphysematous changes in the right perianal fat consistent with perianal inflammatory disease. No sizable fluid component is seen for drainage at this time. These are new since 2005. |
Generate impression based on findings. | 67 year-old female with metastatic esophageal cancer status post 12 cycles of chemotherapy. Compare with previous study and evaluate treatment response. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary and nodules/masses are again seen, predominantly unchanged or minimally changed. Measurements are provided as follows:1. Cavitary left upper lobe nodule (series 4, image 43) measures 1.6 x 1 .3 cm, previously 1.6 x 1.3 cm. 2. Cavitary left lower lobe nodule (series 4, image 57) measures 1.9 x 1 .0 cm, previously 2.0 x 0.8 cm.3. Solid right middle lobe mass (series 4, image 58) measures 2.7 x 1 .5 cm, previously 2.2 x 1.5 cm.No new nodules or masses are seen. Left apical scarring unchanged. No pleural disease.MEDIASTINUM AND HILA: Right anterior chest wall Port-A-Cath with tip of catheter in the superior vena cava unchanged. Scattered small normal sized mediastinal lymph nodes are seen unchanged. Extensive severe coronary artery calcification again seen. Diffuse mid to distal esophageal wall thickening again seen unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Lytic lesion in the left fifth rib is unchanged (series 3, image 34 and coronal series image 35). Left sixth rib proximal healed rib fracture is unchanged. No other skeletal lesions are seen.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 significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Several small fibroids in the uterus. No other abnormality seen.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. | 1. Stable appearance to mild thickening of the mid/distal esophagus. 2. Stable pulmonary mass lesions most consistent with pulmonary metastases. 3. Stable appearance to the lytic left fifth rib lesion. Left sixth posterior rib lesion appears to represent healed rib fracture which appeared acute on the 6/12/14 CT examination. |
Generate impression based on findings. | Pain following fall Moderate effusion with underlying moderate degenerative changes similar and less pronounced in the left knee. Changes are tricompartmental yet largely and more pronounced in the medial compartment. There is however a small somewhat linear calcific density projected lateral to the tibial plateau, possibly a calcification within the collateral ligament given the absence of a clear donor site or underlying associated abnormality and soft tissue swelling. If patient has pain in the specific site however serial imaging may be prudent. | Moderate osteoarthritic changes without a definite superimposed acute abnormality, however small knee effusion is observed with a lateral linear calcific density. See recommendation and description above |
Generate impression based on findings. | Reason: brca - eval disease control on therapy History: breast ca CHEST:LUNGS AND PLEURA: Reference right lower lobe pulmonary nodule measures 5 x 4 mmon image 40/80, unchanged. Additional scattered pulmonary micronodules unchanged. No new suspicious lesions. Minimal basilar scarring/atelectasis. MEDIASTINUM AND HILA: Reference right paratracheal lymph node measures 5 mm, unchanged (series 3, image 29). Patulous esophagus. CHEST WALL: Left breast mass measures 3.6 x 2.2 cm on image 45/143 (previously 3.1 x 2.2 cm). A nodular component along the inferior margin (image 48/143) is hyperdense and has also increased in size.Reference left axillary lymph node measures 6 mm, unchanged (series 3, image 25). Left breast skin thickening and nipple retraction. Mixed lytic and sclerotic lesions in the sternum unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Fatty liver infiltration. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy. Mild aortic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable to slightly increased left breast mass, especially along the inferior margin.2.Stable osseous metastases |
Generate impression based on findings. | Left leg pain, lumbago L-spine: Scattered moderate degenerative changes with narrowing, sclerosis and osteophytes with relative sparing of L4 through S1. Alignment and vertebral body heights are both preserved. Neural foramina appear patent. Posterior elements appear intactHip: Moderate hip osteoarthritis with narrowing, sclerosis and osteophytes. Preservation of femoral head shape | Scattered moderate degenerative changes involving both the upper lumbar spine and hip, as described. |
Generate impression based on findings. | Femur fracture, check rod Continued healing of the distal right femoral diaphyseal fracture with associated IM rod and gross anatomic alignment. The intramedullary rod appears unchanged in position with fractured distal screws, all unchanged | Continued gross stability and to minimal healing of the distal femoral fracture |
Generate impression based on findings. | Female, 41 years old, with history of esophageal cancer and subsequent lymph node in the neck with CRT to the neck. The partially visualized gastric pull-up is not significantly changed from prior. No evidence is seen to suggest locally recurrent disease along that portion of the pull-up which is visualized on this exam.No evidence of pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally. No destructive osseous lesions are detected. | Redemonstration of postoperative findings without evidence to suggest recurrent primary tumor or pathologic adenopathy. |
Generate impression based on findings. | "Pain" Femur: Proximal small infarct unchanged. Otherwise no discrete femoral abnormality. Soft tissues remain unremarkable.Lower leg: Marked abnormal soft tissue gas involving the lower leg extending from the proximal diaphysis to the overlying accentuated soft tissues and swelling of the ankle. Extensive gas is largely within the posterior compartment and surrounding/involving the calf muscles and centered upon marked destruction of the proximal and fibular fracture. Without prior exams for comparison it is difficult to exclude acute osteomyelitis in what may represent a surgical osteotomy. Correlation with history would be helpful | Concern for necrotizing fasciitis given the appearance or a marked abscess with probable osteomyelitis of the underlying fibula. |
Generate impression based on findings. | Reason: esophageal cancer on chemotherapy, check response History: dysphagia CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules are unchanged.Left apical nodule (image 15/106) is stable measuring 7 mm./Right lower lobe nodule (image 59/106) stable measuring 5 mm.Interval increase in right pleural effusion. New right upper lobe linear scarring or atelectasis anteriorlyLeft pleural thickening and trace pleural effusion unchanged.MEDIASTINUM AND HILA: Ill-defined mass involving the distal esophagus stable measuring 19 mm x 14 mm on image 67/145, there has been interval placement of an esophageal stent which is filled with debris. Trace pericardial fluid stable. Hypodense right thyroid nodule.CHEST WALL: Stable right anterior chest wall mass measuring 19 mm on image 54/145. Right chest wall port with tip in the SVC.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodensity in segment IV presumably related to perfusion artifact or focal fat. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Poorly defined gastrohepatic lymph node (image 78/145) stable at 11 mm.Reference periaortic lymphadenopathy stable at 17 mm on image 100/145 and 16 mm on image 105/145.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities notedBONES, SOFT TISSUES: Small nonspecific lucency in L1 is unchanged but too small to characterize. Sclerosis in left lateral aspect of L4 nonspecific but unchanged. It could be degenerative of metastatic in nature.OTHER: No significant abnormality noted.. | 1. Stable esophageal mass and upper abdominal lymph nodes. 2. Stable pulmonary nodules. Increased right pleural effusion.3. Stable right chest wall mass. 4. Other findings as above. |
Generate impression based on findings. | Female 76 years old Reason: AST/ALT >1000 c/w ALF, unknown baseline, please eval with Dopplers for blood flow History: as above, sepsis LIVER: The liver has a smooth contour. Liver measures 10.8 cm in length. The parenchyma is mildly coarse and echogenic. BILIARY TRACT: Gallbladder is not identified; patient is status post cholecystectomy.Common duct measures 8mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.1 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Small cyst at the lower pole.SPLEEN: The spleen measures 6.1 cm. in length. OTHER: No ascites. | 1.Findings suggestive of chronic liver disease.2.Patent hepatic vasculature with normal directional flow |
Generate impression based on findings. | Female; 33 years old. Reason: History of breast cancer, evaluate for pulmonary embolus (pt is s/p long car ride and on anti-estrogen therapy), rib fracture History: Right sided pleuritic chest pain PULMONARY ARTERIES: No evidence of pulmonary embolism. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Few scattered small and somewhat linear opacities in the right upper lobe are nonspecific and may be due to subsegmental atelectasis and/or scarring. 8mm nodular opacity in the right upper lobe may be post infectious or inflammatory in etiology. Few scattered micronodules are seen in the right lower lobe. Trace right pleural effusion. These findings are all new since prior study. MEDIASTINUM AND HILA: Normal heart size. Small amount of pericardial fluid. No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post right mastectomy. Surgical clips in the right axilla.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism. Scattered small opacities in the right lung, some of which are nodular and others more ill-defined, may be post infectious or inflammatory in etiology. However, follow-up to resolution is advised given the patient's history of breast cancer.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Ms. Logan is a 38 year old female with a personal history of known right breast cancer currently on chemotherapy. She recently had an excisional biopsy of the left breast in July 2014 with results of focal ALH/PASH. She also had a biopsy of the left lateral breast in Nov 2014 with results of focal ALH/sclerosing adenosis. Family history of breast cancer in sister and paternal aunt. Three standard views of the left breast with additional left MLO film 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. Linear marker is placed overlying a scar in the left superior breast. A biopsy marker clip is identified in the left lateral breast. There is surgical distortion identified in the left superior breast, from prior surgical excisional biopsy. Multiple scattered calcifications identified in the left breast, which appear similar to prior exams. There is no new mass or areas of nonsurgical architectural distortion identified. A vascular port is seen overlying the left axilla. | Expected postsurgical changes and stable benign calcifications on the left. Per patient, she is scheduled for a bilateral mastectomy on 1/29/2015. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: PE? Re-expansion pulmonary edema s/p L-sided thora? Pleural disease? History: hypoxemia PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: Interval decrease in the moderate left-sided pleural effusion post thoracentesis.Interval increase in the moderate to large right pleural effusion.Underlying compressive atelectasis in the right lung identified.Air space opacities in the left lower lobe compatible with consolidation/atelectasis and edema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy identified.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence for pulmonary embolus.2.Bilateral pleural effusions.3.Interval decrease on the left post thoracentesis and interval increase on the right.4.Left basilar consolidation/atelectasis and edema. PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Pain Detailed secured by overlying cast material. Gross anatomic alignment and deformity of the distal ulna identified without a discrete fracture plane consistent with interval continued healing.Scapholunate widening is now observed and difficult to determine if new or previously present due to differences in positioning. The appearance suggest ligamentous injury. | Continued healing of a distal ulnar fracture with preservation of gross anatomic alignment |
Generate impression based on findings. | 12-year-old male status post ureteral reimplantation with history of megaureter/hydronephrosis. BLADDER Wall Thickness: Normal Contents: Distal aspect of the nephroureteral stent is identified within the bladder. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 9.1 cm Left: 9.5 cm Mean for age: 10.0 cm Range for age: 8.5 - 11.2 cmADDITIONAL OBSERVATIONS: A nephroureteral stent is identified within the left renal collecting system, with the distal tip present within the bladder. | Nephroureteral stent in place, without evidence of hydronephrosis or hydroureter.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Stenting tongue cancer status post chemoradiation, last 10/2014.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates posttherapy changes and borderline enlarged lymph nodes in the left neck. Right chest Port-A-Cath with tip in the SVC.Today's PET examination demonstrates complete interval resolution of previous hypermetabolic lymph nodes in the left neck without suspicious FDG avid lesion currently in the neck, chest, abdomen or pelvis. | Complete interval resolution of previous hypermetabolic left jugular lymph nodes without suspicious FDG avid lesion currently in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | Line placement.VIEW: Chest AP (one view) 01/12/15, 1337 The left central line has its tip at junction of superior vena cava and right atrium. Right upper extremity PICC tip is at junction of inferior vena cava and right atrium.Cardiothymic silhouette is normal in size. No focal lung opacity is present. No pleural effusion or pneumothorax is identified.The hepatic flexure of the colon is at the level of the diaphragm. | Right PICC tip at junction of right atrium and inferior vena cava. Left central line tip in superior vena cava. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: Postsurgical changes of endoscopic sinus surgery with interval resection of the bilateral uncinates, increasing the maxillary outflow pathways. Small right maxillary mucus retention cyst/polyp (80232/27) is unchanged. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is no septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Calcification of the posterior globes bilaterally likely represent optic disk drusen and are unchanged from the prior exam. Cavum septum pellucidum. | Postsurgical changes of endoscopic sinus surgery without evidence of acute sinus disease. |
Generate impression based on findings. | Female, 70 years old.Status post lysis of adhesions and ventral hernia repair. Evaluate for radiopaque foreign object. No evidence of unexpected radiopaque foreign objects. Right and left-sided abdominal drains are present. Enteric tube with tip projecting over the proximal gastric body. Multiple surgical clips scattered over the abdomen. Nonobstructive bowel gas pattern. Left basilar opacity may represent atelectasis/consolidation. | 1.No unexpected radiopaque foreign objects. 2.Postoperative changes as above. 3.Left basilar opacity may represent atelectasis/consolidation.Findings relayed to Dr. Lee, attending surgeon, in the operating room at approximately 1:43 p.m. |
Generate impression based on findings. | 60 year-old male with history of nontraumatic middle finger pain. There is moderate to severe osteoarthritis affecting the third PIP joint, which may be secondary to remote trauma. Additional arthritic changes affect the visualized MCP joints. There is soft tissue swelling about the third PIP joint. There are no acute fractures. | Soft tissue swelling and degenerative arthritic changes as above. |
Generate impression based on findings. | CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. Diffuse septal thickening and trace pleural effusions. Minimal dependant subsegmental atelectasis. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Small prevascular, paratracheal and subcarinal lymph nodes are present. Otherwise, no significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: Degenerative change. Hemangioma in T9. | Mild pulmonary edema and small pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There has been interval left parietal craniotomy and partial resection of the parietal calvarium. There is an expected amount of pneumocephalus. There is persistent extensive confluent cerebral white matter hypoattenuation with regional sulcal effacement, but no significant midline shift. There is no evidence of intracranial hemorrhage or definite evidence of residual intracranial tumor. There is diffuse mild cerebellar volume loss. The imaged paranasal sinuses and mastoid air cells are clear. There is a scalp drain and skin staples. | 1. Interval left parietal craniotomy and partial resection of the parietal calvarium for resection of a meningioma. Although there is no definite evidence of residual intracranial tumor, non-contrast CT is relatively insensitive for assessment of this. 2. Persistent left cerebral hemisphere vasogenic edema, but no significant midline shift.3. No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Reason: 56 yo M with h/o fungal pna; f/u resolution on posa History: 56 yo M with h/o fungal pna; f/u resolution on posa LUNGS AND PLEURA: Stable scattered calcified and noncalcified micronodules.No focal areas of consolidation or air space opacities.Mild scarring/discoid atelectasis in the right middle lobe.Minimal upper lobe centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute cardiopulmonary abnormalities identified. No specific evidence of acute infection. |
Generate impression based on findings. | 57 year-old Male with head CT in China with left sided lesions reported, please evaluate. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No suspicious mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of bilateral hypoattenuation in the subcortical white matter which are nonspecific, but favored to represent chronic small vessel ischemic changes.There is thickening of the bilateral maxillary sinuses, suggestive of chronic sinusitis. Mastoid air cells are clear. Calvarium is intact. | No evidence of intracranial hemorrhage or mass effect. Given patient's age, the scattered subcortical white matter hypoattenuation likely represents small vessel ischemic disease which could be confirmed with MRI. |
Generate impression based on findings. | Reason: pt with hx of esoph cancer s/p chemo rads and surg ck response, History: anemia CHEST:LUNGS AND PLEURA: Punctate micronodules are unchanged and presumably benign. No new pulmonary nodules.MEDIASTINUM AND HILA: Postop gastric pull-up. No pathologically enlarged nodes. Stable soft tissue density along superior right trachea, presumably scarring or fibrosis.CHEST WALL: Fused T8/T9 hemivertebral bodies with associated thoracic dextroscoliosis. Scattered areas of lucency are unchangedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: S/P cholecystectomy.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: Small sclerotic focus in L3 is presumably a bone island.OTHER: No significant abnormality noted. | No significant interval change or evidence of metastatic disease. |
Generate impression based on findings. | 70 year-old female with history of breast cancer. BRCA. Evaluate disease control on therapy. Abnormal osseous uptake of tracer in the sternum is not significantly changed, compatible with metastatic disease. No new suspicious sites of activity are present. | Stable sternal metastatic disease without evidence of new sites of disease or progression. |
Generate impression based on findings. | 55-year-old female with pain and stiffness, evaluate for rheumatoid arthritis There is mild pes cavus deformity bilaterally. Small talonavicular osteophytes indicate mild osteoarthritis. Mild osteoarthritic changes also affect the first metatarsophalangeal joint bilaterally. No erosions or other specific radiograph features of rheumatoid arthritis. | Degenerative arthritic changes without specific radiographic features of rheumatoid arthritis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Prior mammograms at an unknown outside facility 1-1.5 years ago. Three maternal aunts with breast cancer. A total of 19 digital images had to be performed to completely cover the parenchyma of both breasts in two views, limiting the study. The examination was reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. 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: NSA - Screening Mammogram. |
Generate impression based on findings. | BRAIN:There is a single punctate T2 hyperintensity in the right centrum semiovale (801/18) which is new from the prior exam. The remaining moderate quantity of T2 hyperintense lesions are unchanged. T2 hyperintense lesion in the left cerebellum is unchanged. T2 hyperintense lesions in the pons are stable.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. No abnormal diffusion weighted signal to suggest acute ischemia. No abnormal susceptibility. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Cervical spine:Marrow signal is normal. There is multilevel disk desiccation. Vertebral body heights are intact. Alignment is anatomic. No significant its neural foraminal stenosis or central canal narrowing.Multiple foci of abnormal T2 signal scattered throughout the cord are overall unchanged. For example, increased T2 signal within the right posterior cord at C3-C4 is unchanged, left lateral cord at C4-C5 is unchanged, and centrally on the right at the C5-C6 levels are unchanged.Right thyroid nodule is unchanged. | 1. Multiple white matter lesions throughout the brain and cerebellum compatible with patient's known MS. There is a single new punctate lesion in the right centrum semiovale, otherwise lesions are unchanged.2. Scattered cervical spinal cord lesions are unchanged. |
Generate impression based on findings. | Left-sided abdominal pain. Evaluate for renal stone ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver without focal hepatic lesions. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a 3-mm stone in the proximal left ureter with mild proximal hydroureteronephrosis and mild proximal ureteral and perinephric fat stranding. Additional non-obstructing punctate nephrolithiasis at the left lower pole identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No findings to suggest colitis or small bowel obstruction.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 findings to suggest colitis or small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings consistent with an obstructing 3 mm stone at the proximal left ureter resulting in mild proximal hydroureteronephrosis.2.Diffuse fatty infiltration of the liver. |
Generate impression based on findings. | Right-sided gingival/mouth cancer status post reconstruction and chemoradiotherapy. History of alcohol abuse and previously had a positive urine drug screen in pain clinic for marijuana. There are postsurgical findings related to partial right hemimandibulectomy with sideplate and screw fixation and graft augmentation. There is an unchanged displaced fracture of the sideplate. There is unchanged deformity of the left mandibular condyle, which is anteriorly and medially dislocated. There is persistent obscuration of the fascial planes in the region of the treatment bed. However, no definite mass lesion is identified to suggest locoregional tumor recurrence. Likewise, there is no definite significant cervical lymphadenopathy. There is persistent effacement of the left fossa of Rosenmuller likely secondary to secretions. The upper aerodigestive track is patent. There is unchanged asymmetric volume loss of the right vocalis muscle. The remaining salivary glands are unremarkable. There is an unchanged punctate hypoattenuating lesion in the thyroid gland. The right internal jugular vein does opacify for most of its course and may be chronically thrombosed or absent, but this is unchanged. The left internal jugular vein and carotid and vertebral arteries are intact. There is no subluxation and deformity of the left mandibular condyle. There is an unchanged small disc osteophyte complex at C5-C6. The imaged portions of the intracranial structures are orbits are unremarkable. The imaged portions of the lungs are clear. | 1. Extensive postsurgical findings in the neck without definite evidence of locoregional tumor recurrence or significant lymphadenopathy.2. Unchanged right mandibular plate fracture with anteromedial dislocation of the left mandibular condyle.3. Persistent effacement of the left fossa of Rosenmuller likely secondary to secretions adn perhaps treatment effects. |
Generate impression based on findings. | 72-year-old male with history of recurrent hyperparathyroidism after two prior parathyroid operations. Also s/p thyroidectomy (per EMR: subtotal right and subtotal left thyroidectomies in the late 60s and early 70s). Please evaluate for any adenomas. There is physiologic distribution of the radiopharmaceutical. On early imaging, there are two foci of radiotracer uptake in the low neck, larger and more intense on the left. On delayed images, only the left-sided focus persists and is localized on delayed SPECT/CT imaging at the posteroinferior aspect of the thyroidectomy bed anterior to the T1 vertebral body. No delayed focus is definitely present on the right, and the focus seen on early imaging (mentioned above) likely represents residual functioning thyroid tissue.Radiotracer uptake is also seen in the vascular access catheter. | Focus of abnormal delayed radiotracer uptake posteroinferior to the left thyroidectomy bed, compatible with left parathyroid adenoma. |
Generate impression based on findings. | Reason: metastatic disease? History: renal mass LUNGS AND PLEURA: Basilar scarring and atelectasis. No evidence of pulmonary metastases. Calcified granuloma on the right.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small axillary lymph nodes bilaterally.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. See recent abdominal CT report for details regarding the known right renal mass. | No evidence of pulmonary metastases. |
Generate impression based on findings. | Recurrent breast cancer left chest wall. Restaging exam for other recurrent sites.RADIOPHARMACEUTICAL: 13.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 78 mg/dL. Today's CT portion grossly demonstrates surgical clips in the left axilla. Sclerotic lesions are seen in the right medial iliac wing and medial left superior pubic ramus. Healing left lateral 9th and 10th rib fractures are seen. Vertebral compression deformities are present most notably at T11 and L1.Today's PET examination demonstrates a small mild to moderately hypermetabolic subcutaneous soft tissue focus in the inferomedial left breast (SUV max = 3.1) which likely correlates with the patient's history of recurrent tumor. A smaller subcutaneous focus somewhat more supero-medial to this (SUV max = 2.5) may represent a second recurrent focus in this region or represent inflammation.A punctate subcentimeter but slightly hypermetabolic left supraclavicular lymph node (SUV max = 1.3) is of some suspicion for a regional metastasis although given its location could also represent inflammation.Hypermetabolic activity in the left posterior neck corresponds to fat density and is most likely residual benign brown fat hypermetabolism. Focal hypermetabolic activity (SUV max = 2.9) corresponding to the benign-appearing left rib fractures is noted. Hypermetabolic activity corresponds with vertebral compression deformities most notably at T11 without convincing underlying lesion. This likely represents a benign healing compression deformity at the site.However, at the right medial iliac wing, a moderately hypermetabolic focus corresponds to the regional sclerosis on CT (SUV max = 4.3), and is highly suspicious for an osseous metastasis. Similarly, the left superior pubic ramus sclerotic region on CT is also moderately hypermetabolic (SUV max = 3.4), highly suspicious for an additional osseous metastasis. | 1.Hypermetabolic subcutaneous soft tissue focus in the left inferomedial breast, compatible with the patient's history of recurrent tumor. A punctate hypermetabolic focus slightly more superior and medial in the left subcutaneous breast may represent a second recurrent tumor focus versus inflammation.2.Punctate hypermetabolic left supraclavicular lymph node is of some suspicion for a regional metastasis although could also represent inflammation.3.Two moderately hypermetabolic sclerotic lesions in the pelvis, highly suspicious for osseous metastases.4.Healing benign appearing fractures involving the left 9th and 10th lateral ribs and two vertebral bodies at the thoracolumbar junction. |
Generate impression based on findings. | Female 22 years old Reason: Assess small bowel abnormality History: abd 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Normal appearance of aorta and celiac artery. No evidence of median arcuate ligament syndrome. All vessels enhance normally.No adenopathy.BOWEL, MESENTERY: No evidence of bowel wall thickening or abnormal enhancement. Normal mucosal fold pattern. Greater than average stool burden.No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel wall thickening or abnormal enhancement. Normal mucosal fold pattern. Greater than average stool burden.No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No abnormal findings to explain abdominal pain except possibly for greater than average stool burden which might explain constipation. Specifically no evidence of median arcuate ligament syndrome or small bowel abnormality. |
Generate impression based on findings. | Female; 64 years old. Reason: nsclc, previous therapy. History: nsclc CHEST:LUNGS AND PLEURA: Reference right upper lobe pulmonary nodule 14 x 9 mm (image 27, series 5), not significantly changed compared to prior study when it measured 13 x 9. Multiple additional nodules are also not significantly changed. Bilateral lower lobe masslike consolidation is not significantly changed.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Mild atherosclerotic calcifications of the coronary arteries. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. The hepatic vasculature are patent.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: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant interval change in pulmonary nodules and bilateral basilar masslike consolidations, all most compatible with multicentric mucinous adenocarcinoma. |
Generate impression based on findings. | Recent DVT's with lovenox treatment, worsening lethargy, subarachnoid hemorrhage from ruptured ACOM aneurysm that was coiled on 7/20/14. There are post-treatment findings related to ACOM aneurysm coiling. Streak artifact from the metal hardware partially obscures surrounding structures. Within this limitation, there is no evidence of large acute intracranial hemorrhage. There is encephalomalacia in the right inferior frontal lobe. There are unchanged multiple hypoattenuating foci in the basal ganglia, thalami, pons, and left centrum semiovale, as well as patchy hypoattenuating areas in the cerebral white matter. There is a right transparietal ventricular shunt in unchanged position. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The left ethmoid air cells are partially opacified. The imaged mastoid air cells are clear. The skull and scalp soft tissues are unchanged. There are bilateral lens implants. | 1. Post-treatment findings related to ACOM aneurysm coiling without evidence of large acute intracranial hemorrhage. 2. Unchanged appearance of the shunted ventricular system. 3. Chronic-appearing right inferior frontal lobe infarcts and multiple lacunar infarcts, as well as small vessel ischemic disease. |
Generate impression based on findings. | Reason: PANCREATIC NEUROENDOCRINE TUMOR EVALUATE FOR DISEASE PROGRESSION History: PANCREATIC CANCER CHEST:LUNGS AND PLEURA: Interval development of patchy ground glass opacities with a basilar predominant distribution, left greater than right. There are no discrete solid masses or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Severe coronary arterial calcifications.CHEST WALL: Right axillary surgical clips. Status post right mastectomy. ABDOMEN:LIVER, BILIARY TRACT: Numerous arterially enhancing hepatic lesions are again identified. Comparison is made to the examination from 6/5/2014 as arterial phase contrast was given on that examination. Comparison reference measurements are as follows:Anterior right hepatic lobe arterially enhancing lesion measures 1.3 x 0.8 cm (series 6 image 27) previously 1.3 x 0.9 cm.Posterior right hepatic lobe arterially enhancing lesion posterior-superior to a larger hypoattenuating lesion measures 1.4 x 1.2 cm (series 6 image 39) previously 1.4 x 1.2 cm.Inferior right hepatic lobe arterially enhancing lesion measures 1.3 x 1.3 cm (series 6 image 57) previously 1.3 x 1.3 cm.Other arterially enhancing foci are also not significantly changed in size. Multiple other hypodense lesions with no active arterial enhancement representing treated lesions with successful necrosis have also not changed in size. No discrete new lesions are identified.SPLEEN: Status post splenectomyPANCREAS: Status post distal pancreatectomy. The head and the neck of the pancreas appear unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal hypodensities unchanged.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes unchanged. No new lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fluid-filled endometrial cavity is unchanged in appearance and further evaluation with pelvic ultrasound is recommended if not recently performed.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. | 1.Stable appearance of arterially enhancing hepatic lesions as described above. Stable appearance also to postnecrotic treatment scars and hypovascular prior treated lesions.2.Interval development of patchy bilateral pulmonary groundglass opacities which are nonspecific and could represent drug reaction or atypical infection/edema. 3.Postoperative changes of distal pancreatectomy and splenectomy. |
Generate impression based on findings. | 71 year-old female with left adrenal mass noted on the outside hospital CT. Evaluate. ABDOMEN:LUNG BASES: Left basilar bronchial mucous plugging is again noted. Cystic lesion in the left base with a thin wall, unchanged.LIVER, BILIARY TRACT: Multiple hepatic hypoattenuating lesions with peripheral nodular discontiguous enhancement with subsequent filling in on the delayed imaging compatible with hemangiomas ranging in size from 1 to 5 cm. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a left adrenal well-defined homogeneous soft tissue mass measuring approximately 4.0 x 2.7 cm ( series 4, image 59). This lesion measures approximately 5 Hounsfield units on the precontrast images, measuring approximately 70 Hounsfield units postcontrast with rapid de-enhancement on 15 minute delayed phase with attenuation of 15 Hounsfield units. Findings compatible with a lipid rich adrenal adenoma. This lesion also demonstrated homogeneous dropout of signal on the out of phase on the MR examination and consistent with a lipid rich adenoma.There is additionally mild thickening of the medial limb of the right adrenal gland, nonspecific.KIDNEYS, URETERS: Bilateral renal hypoattenuating lesions consistent with cysts. Kidneys enhance and excrete contrast symmetrically. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality identified.BOWEL, MESENTERY: No findings to suggest colitis or small bowel obstruction. Appendix is normal.BONES, SOFT TISSUES: Mild anterior abdominal wall inflammatory changes (series 6, images 90, 93 through 101) are nonspecific.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest colitis or bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Left adrenal mass compatible with a lipid rich adenoma.2.Multiple hepatic hemangiomas. |
Generate impression based on findings. | Reason: 86 yo with CXR showing L perihilar opacity. Pls evaluated. Mild cough History: cough, abnl cxr LUNGS AND PLEURA: Small left pleural effusion. Subpleural reticulation with areas of consolidation traction bronchiectasis in the lingula (image 47/101) likely accounts for the abnormality noted on chest radiograph. This is presumably secondary to radiation pneumonitis. An underlying mass could be obscured by this opacity and therefore a follow-up CT in 3 to 6 months is recommended to confirm stability. On 2008 CT there are early changes of XRT pneumonitis at this location. Calcified granuloma on the right.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Deformity and a radiating scarlike lesion noted medial to the left nipple-areolar complex (image 48/101), unchanged and presumably postoperative. Heterogeneous nodular thyroid.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left adrenal thickening. | Abnormality on CXR represents a small left pleural effusion and subpleural reticulation with areas of consolidation and traction bronchiectasis in the lingula. This is presumably secondary to radiation pneumonitis. An underlying mass or pneumonia could be obscured by this opacity and therefore a follow-up CT in 3 to 6 months is recommended to confirm stability. On 2008 CT there are early changes of XRT pneumonitis at this location. |
Generate impression based on findings. | Ms. Rudall is a 72 year old female with a personal history of right breast lumpectomy in 2010 for IDC followed by radiation and hormonal therapy. Family history of breast cancer in maternal aunt, maternal niece, and paternal cousin. Three standard views of both breasts 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 stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also identified in the right axilla. Scattered benign calcifications are seen bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable 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. | 57 years old, Male, Reason: follow up liver with suspected iron deposition. LIVER: The liver is normal in size and measures 15.2 cm in length. Significantly increased echogenicity in the parenchyma consistent with iron deposition. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of velocity 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen is at the upper limits of normal in size measuring 14.2 cm in length. RIGHT KIDNEY: Kidney measures 12.9 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted. | 1. Spleen at the upper limits of normal in size.2. Increased echogenicity of the hepatic parenchyma. |
Generate impression based on findings. | Reason: perforated duodenal ulcer s/p gram patch on 1/10/2015 History: same Injection of diluted Omnipaque 350 showed good opacification of the duodenum without evidence of contrast extravasation. The visualized stomach and proximal jejunum were unremarkable.TOTAL FLUOROSCOPY TIME: 3:14 minutes | No evidence of contrast extravasation. |
Generate impression based on findings. | Female; 60 years old. Reason: s/p left pneumonectomy, smal cell lung cancer History: follow-up CT CHEST:LUNGS AND PLEURA: Postsurgical changes from left pneumonectomy with stable expected postoperative changes and fluid in the left hemithorax. The right lung again demonstrates mild emphysema and minimal bronchial wall thickening. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Old left-sided rib fractures are likely postsurgical in etiology.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: Stable adrenal adenomas.KIDNEYS, URETERS: Focal cortical thinning in the left renal midpole, most compatible with scarring and similar to prior study when it was partially visualized.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 postsurgical changes in the chest. No evidence of recurrent or metastatic disease in the chest and abdomen. |
Generate impression based on findings. | Male 80 years old; Reason: metastatic prostate cancer, evaluation of disease during treatment with investigational therapy. please complete PCWG2 form History: metastatic prostate cancer, Again seen is widespread osseous metastatic lesions involving the axialskeleton including the spine, ribs, sternum, and pelvis unchanged from prior study.There are no new lesions identified. Interval placement of left nephroureterostomy tube with improvement in the degree of left hydronephrosis. | Unchanged multifocal osseous metastases without new lesions. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left cyst aspiration in 2004. History of breast cancer in mother at age 55 and sister. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The calcifications have progressed in a benign fashion bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Benign progression of bilateral 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Ms. Slazas is a 44 year old female with a personal history of right breast mastectomy in 2008 for poorly differentiated IDC followed by chemotherapy. History of left breast implant. No current breast related complaints. Three standard views of the left breast along with three implant displaced 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. Retropectoral silicone implant is unchanged in position and contour. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Granulation tissue left anterolateral trachea. Posterior compression on trachea distal to tracheostomy tube. Significant compression of left mainstem bronchus by a bulge of posterior tracheal wall.EXAMINATION: CT angiogram chest without and with IV contrast material 01/12/15 The heart is in the right chest. The right ventricle and right atrium are to the right and the left atrium and left ventricle are to the left. The main pulmonary artery courses from right to left, anterior to the aorta The left pulmonary artery has a diameter of 1.01 cm and the right, 0.5 cm. A small segment of non-aerated right lung is noted posteriorly. The aortic arch has a normal branching pattern. The descending aorta passes along the right side of the spine. The two pulmonary veins are seen on the left. The pulmonary veins cannot be identified on the right.The tracheostomy tube tip is just superior to the level of the aortic arch. The anterior and left lateral wall of the trachea just inferior to the tracheostomy tube tip has a slightly nodular appearance. At the level of the aortic arch, the trachea is flat with and AP diameter of 0.5 cm. Inferior to the level of the aortic arch, the trachea is completely flattened and has a diameter of less than 0.3 cm. This portion of the trachea continues into the left mainstem bronchus with a diameter of 0.4 - 05 cm. The left bronchus passes between the left pulmonary artery and descending aorta. Inferior to this the left bronchus passes between the pulmonary veins and the aorta. No right mainstem bronchus is identified. The trachea has a crescent shape with posterior indentation by the esophagus. The esophagus is patulous and dilated. An air-fluid level is present in the distal esophagus.The left lung volume is large. It crosses the midline to the right.A left thoracic curve is present. T10 is composed of two hemivertebra. A gastrostomy tube is present. | Hypoplastic right lung. No right bronchus or right bonchi containing mucus. Compression of trachea and left bronchus at multiple levels, with stenosis/narrowing at the left mainstem bronchus. |
Generate impression based on findings. | 65 years, Female. Reason: post op ileus History: hypoactive bowel sounds, nausea/vomiting Right chest tube and epicardial leads are again seen. Patient is status post sternotomy. Pelvic phleboliths noted.Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 18 year-old female with history of right thumb pain. No acute fracture or malalignment. The soft tissues are unremarkable. | No radiographic findings to account for the patient's pain. |
Generate impression based on findings. | The colon is adequately cleansed of stool and adequately distended. There is a small to moderate amount of retained liquid and liquid feces which is well tagged with oral contrast.The descending colon is a markedly redundant sigmoid and right colon. The colon in the distribution of the expected "transverse colon" is actually ascending colon with the cecum in the right mid-abdomen. This is a distal midgut under rotation. There is also proximal midgut malrotation with abdominal SMA/SMV relationship and the duodenum does not cross the midline. The jejunum is located in the right upper quadrant.No significant size polyps masses anywhere in the colon.Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC | Proximal and distal midgut malrotation. Nephrolithiasis. Severe diffuse fatty liver; correlate with LFTs.No significant sized colonic polyps or masses.*OPTIONAL C-RADS CLASSIFICATION:C-1E-3*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant. |
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