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Generate impression based on findings. | Male, 43 years old, with cervical spondylosis and history of some type of cervical spine surgery at C5-6, assess cervical stenosis. L Anterior instrumented fusion of the cervical spine is seen with a plate and screw device bridging C5 and C6. The screws are well seated. No instrument complication is suspected. A wedge of material which may represent bone graft or some synthetic material has been placed within the anterior aspect of the C5-6 intervertebral disk space.A mild reversal of the normal cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Aside from surgical findings at C5 and C6, vertebral body morphology is within normal limits. No fractures are suspected. The posterior elements are normally formed and intact.The spinal canal is congenitally slender. Superimposed upon this are the following level specific findings:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Right greater than left uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left and moderate right neuroforaminal narrowing. C4-5: Broad disk osteophyte complex. Mild spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C5-6: Broad disk osteophyte complex with a probable right paracentral herniation. Moderate spinal canal stenosis with impingement of the right ventral cord. Moderate to severe bilateral foraminal narrowing. C6-7: Broad disk osteophyte complex. No significant spinal canal stenosis. Mild left neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. | 1. Evidence of instrumented anterior spinal fusion at C5-6. No instrument complications are suspected2. Multilevel cervical spondylosis, most severely affecting C4-5 where there is a mild generalized spinal canal stenosis, and C5-6 where there is a moderate generalized canal stenosis as well as impingement of the right ventral cord.3. Scattered foraminal narrowing is also seen most significantly affecting C4-5 and C5-6. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt. Personal history of leukemia diagnosed at the age of two and benign left breast biopsy in 2007. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy clip identified in the left superior breast. Focal asymmetry in the right upper outer breast is present. No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. | Focal asymmetry in the right upper outer breast. Additional imaging, including spot compression views and possible ultrasound, is recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Postoperative changes are again seen involving the left floor of mouth and submandibular region related to prior left neck dissection. There is no discrete enhancing mass to suggest locoregional tumor recurrence. PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The left submandibular gland is absent. Left parotid gland is slightly smaller than the right. The postcontrast appearance of the salivary glands is otherwise unremarkable. There is a tiny stable nonspecific hypodensity in the right thyroid lobe.ORAL CAVITY: The oral tongue and floor of mouth are otherwise unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes. The previously reference right submandibular region lymph nodes have decreased in size, the largest of which now demonstrates a fatty hilum. The previously reference right level Ib lymph node now measures 8 mm in short axis on 6/39, compared to previous 10 mm. There is continued mild thickening of the overlying platysma which is felt to be posttreatment related.OTHER: Atherosclerotic calcification is present along the carotid bulbs, left greater than right side. The esophagus remains patulous at levels. Spondylotic changes are seen along the cervical spine | 1. No CT evidence of local regional tumor recurrence.2. No cervical lymphadenopathy. Interval decreased size of previously noted benign-appearing right submandibular region lymph nodes, likely reactive.3. Stable nonspecific punctate hypodensity in the right thyroid lobe. |
Generate impression based on findings. | Ms. Young is a 71 year old female with known left breast cancer. Dr. Chhablani palpated an enlarged left axillary lymph node which underwent in-office FNA (which was nondiagnostic.). She presents today for formal ultrasound guided biopsy of enlarged left axillary lymph node. Left axillary ultrasound identified the target lymph node for biopsy. It was in the inferolateral axilla. Bipolar maximum dimension was 2.8 cm, cortical thickness was 1.3 cm, and moderate non-hilar cortical blood flow was seen on color flow imaging. The target node was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy of an axillary lymph node were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure. The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and inferolateral to superomedial approach, a 14-gauge core needle (Achieve) was directed into the target node and three specimens were obtained, using the open-trough technique. Samples were obtained centrally through the hypoechoic cortex and at the periphery. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Whitish tissue was noted throughout all specimens.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the enlarged lymph node. Pressure was held over the biopsy site until all bleeding subsided. No evidence of hematoma or other complication on post procedure ultrasound. The skin incision was closed with a Steri-Strip. A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing.A post-procedure mammogram (left MLO view) was obtained to document the presence of biopsy clip within the biopsied left axillary lymph node. No evidence of hematoma or other complication.Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy with clip placement of an abnormal left axillary lymph node. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 52-year-old male with history of knee pain. Tiny osteophytes indicate mild osteoarthritis. There is a small joint effusion. Mild osteoarthritis affects the left knee as seen on the frontal view. Scattered vascular calcifications are present. | Mild osteoarthritis as described above. |
Generate impression based on findings. | 66 year old female who was recalled from screening mammogram for left breast calcifications. History of benign bilateral breast biopsies. A ML view and two spot magnification 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. A group of calcifications is again noted in the left lower inner quadrant, some of which are linear, and may be vascular in origin. No suspicious masses or areas of architectural distortion are present. | High probability benign calcifications in the left lower inner quadrant, likely vascular in origin. As long as the patient's physical examination remains normal, left unilateral 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. | CT HEAD:.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. Chronic right basal ganglia lacunar infarct is unchanged. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Lenses are thin bilaterally.CT NECK:Posttreatment findings again seen without discrete mass in the right tonsillar fossa. Right level 4 lymph node measures 7 mm in short axis, previously 8 millimeters. No significant neck lymphadenopathy by CT criteria. Right paratracheal node is not completely included within the field of view and better evaluated on dedicated chest CT. Thyroid and submandibular glands are normal. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged portions of the lungs are clear. Severe degenerative changes of the cervical spine, particularly at C5-C6, with multilevel spondylolithesis is unchanged. For findings in the chest, please see dedicated chest CT. | Posttreatment changes in the neck. No discrete mass in the right tonsillar fossa is appreciated. No significant residual lymphadenopathy seen. |
Generate impression based on findings. | Neck pain, occipital pain, pain on range of motion. Evaluate for cervical pannus. There is osseous assimilation involving the bilateral occipital condyles and lateral masses of C1. There is also osseous fusion involving the left anterior aspect of the C1 arch with the basiocciput. Anterior arch of C1 is thick. Left posterior C1 arch is assimilated with the occiput with right posterior arch unfused to the left.There is also evidence of basilar invagination with the odontoid tip projecting superiorly 9 mm and 11 mm above McGregor's and Chamberlain's lines respectively. Effacement of the ventral subarachnoid space at the craniocervical junction better seen on recent MRI. No osseous erosions or retro-odontoid pannus formation.Trace anterolisthesis of C3 on C4. Remainder of the vertebral body heights and alignment in the cervical spine are normal. No significant spinal canal or neural foramina stenosis seen at any level. | 1. Atlanto-occipital assimilation (incomplete) as detailed above, greater on the left than the right.2. Evidence of basilar invagination. Partial effacement the ventral subarachnoid space at the cervicomedullary junction better seen on prior MRI studies. |
Generate impression based on findings. | 58-year-old female with history of osteoarthritis and fracture. Shoulder: Small osteophytes at the AC joint indicate mild osteoarthritis. There is no evidence of fracture.Right wrist: There is mild narrowing of the radioscaphoid articulation but otherwise the wrist appears normal. There is no evidence of fracture. | Minimal osteoarthritis as above. |
Generate impression based on findings. | Two year-old male who fell 3 weeks ago, not using arm well for a couple weeksVIEWS: Right forearm AP/lateral (two views) 01/13/15 Periosteal reaction is seen along the radial and posterior aspects of the distal radius. There is a torus fracture of the distal radial metaphysis. A band of sclerosis in the ulna is present at the same level. No malalignment is evident. | Healing torus fracture of the distal radial and ulnar metaphysis. |
Generate impression based on findings. | 77-year-old female with history of right total hip arthroplasty. Right hip: Hardware components of a right total hip arthroplasty are situated in anatomic alignment without radiographic evidence of hardware failure. Scattered foci of gas density within the soft tissues and a surgical drain indicate recent surgery.Pelvis: Mild osteoarthritis affects the left hip. There are severe degenerative arthritic changes affecting the lower lumbar spine. | Right total hip arthroplasty and degenerative changes as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of bilateral breast reduction. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple benign dystrophic calcifications are seen in both breasts (left greater than right), related to breast reduction surgery. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Bilateral benign dystrophic 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. | 60-year-old male with history of fifth finger dislocation. Evaluate for healing. The fifth PIP joint is held in slight flexion. There is a 3-mm ossific density noted along the ulnar aspect of the fifth PIP joint which likely represents a small fracture fragment from the base of the middle phalanx. | Fracture fragment adjacent to the fifth PIP joint as described above |
Generate impression based on findings. | 42 year-old female with thyroid cancer status post thyroidectomy and RAI. Evaluate RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT BED: No significant abnormality noted.LEFT BED: Previously seen ovoid soft tissue in the anterior bed is noted to be benign-appearing lymph node measuring approximately 4 x 3 x 6 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are noted.OTHER: No significant abnormality noted. | No specific evidence of recurrent or residual disease. |
Generate impression based on findings. | 67 year old female with history of kidney neoplasm, with metastases, evaluate for progression of disease. CHEST:LUNGS AND PLEURA: Moderate right pleural effusion and associated atelectasis, similar to prior.Multiple bilateral foci of peripheral air space consolidation, some of which have a wedgelike configuration, most likely due to prior thromboembolic disease. No new nodules or lesions.MEDIASTINUM AND HILA: Large right pulmonary artery embolus has decreased in size slightly from prior. No new pulmonary emboli are seen. The main pulmonary artery measures approximately 2.7 cm, within normal limits. Heart size within normal limits, and no pericardial effusion. No significant mediastinal lymphadenopathy. Right chest Port-A-Cath tip at the superior cavoatrial junction. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuation in the hepatic dome may represent altered hepatic perfusion. The previously seen segment 8 hypoattenuating focus (3/79) is unchanged in size at 1.47 cm. Hepatic and portal vasculature are patent, without additional significant normality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland within normal limits. The right adrenal gland is not visualized.KIDNEYS, URETERS: Postoperative findings of right nephrectomy. Left kidney 2.5 x 2.3 cm hypoattenuating lesion (3/95) is unchanged in appearance from prior, and appeared more cystic on recent ultrasound.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: 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.Post operative findings of right nephrectomy without local disease recurrence.2.Left kidney hypoattenuating focus is unchanged in size and may be followed on subsequent exams.3.Stable pulmonary infarcts and moderate right pleural effusion, with improving right pulmonary artery embolus.4.Hypoattenuating hepatic focus is unchanged, and in the setting of additional abnormal areas of perfusion this may be vascular in etiology, although nonspecific. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Mild ductal ectasia is noted bilaterally. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | The bilateral external auditory canals, middle ear cavities and mastoid air cells are clear. There is no evidence for congenital atresia of the external auditory canals or middle ear cavities. The scuta and ossicles are intact bilaterally. No erosive changes are identified. There are no soft tissue masses identified within either middle ear cavity. The roofs of the attic are intact on both sides. The oval and round window niches are patent bilaterally. The course of the seventh nerves are well defined bilaterally without positional anomalies identified on either side. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. The cochlea and vestibules are patent bilaterally. There are no dehiscences or fenestrations of the semicircular canals on either side. The cochlear and vestibular aqueducts and internal auditory canals are symmetric bilaterally. The carotid and jugular plates are intact on both sides. Minimal mucosal prominence is noted of the maxillary sinuses. Incidental note is made of a supernumerary tooth just lateral to tooth #8. The basal cisterns are prominent for the patient's age which are only partially visualized but may suggest global volume loss. | 1.Normal examination of the temporal bones bilaterally.2.Partially visualized prominent basal cisterns for the patient's age, which may suggest global volume loss. Dedicated brain imaging may provide further information if clinically warranted. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Strong family history of breast cancer in maternal grandmother, paternal grandmother, four maternal aunts, and two maternal cousins. Two standard digital views of both breasts (total of 8 images) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Two focal asymmetries are identified in the right breast (medial and lateral). No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. | Right focal asymmetries. An attempt to obtain patient's prior mammograms will be made first. If not possible, then additional imaging including spot compression views and possible ultrasound, is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | Male; 84 years old. Reason: h/o R ear mucoep ca, s/p crt, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Centrilobular emphysema. Minimal bibasilar or dependent subsegmental atelectasis. Stable scattered, punctate calcified and noncalcified micronodules measuring up to 3 mm (right lower lobe image 73/series 5). No new or suspicious pulmonary nodules or masses. Trachea debris noted.Interval resolution of small left hydropneumothorax. Stable mild left pleural calcifications.MEDIASTINUM AND HILA: Status post CABG/median sternotomy. Severe coronary calcifications. Scattered small subcentimeter lymph nodes.CHEST WALL: Multilevel degenerative change involving the spine. Left chest Port-A-Cath tip near the superior cavoatrial junction.ABDOMEN: Residual high density contrast material from precede ing swallow study causes streak artifact which moderately limits evaluation of the abdomen.LIVER, BILIARY TRACT: Scattered subcentimeter hepatic hypodensities are stable but too small to characterize.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 markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval resolution of small left hydropneumothorax.2. No evidence of metastatic disease in the chest and abdomen. |
Generate impression based on findings. | No abnormal diffusion signal. There is a focus of sulcal T1 shortening along the posterior limb of the right sylvian fissure and right inferior parietal lobule seen on axial and sagittal T1-weighted images and may represents laminar necrosis. No associated susceptibility effect, gliosis or enhancement is associated with this region. The ventricles are of normal morphology. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. No abnormal parenchymal or meningeal enhancement is appreciated. There is heterogeneous signal involving the calvarial marrow including small lesions with enhancement. No destructive osseous lesions appreciated. | 1.No acute infarct, mass, or mass effect. No gross MR evidence of intracranial infection; suggest lumbar puncture if there is continued suspicion for intracranial infection. 2.Focus of T1 shortening in the right inferior parietal lobule along the posterior limb of the right sylvian fissure may represent laminar necrosis; possibly from prior ischemia or other chronic cortical injury.3.Heterogenous marrow signal involving the calvarium which is nonspecific and can be seen with entities such as chronic anemia. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother and maternal grandmother. 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. | 44-year-old female with pain and nausea. Evaluate for diverticulitis. ABDOMEN: Lack of intravenous contrast limits evaluation of the solid organs.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic fatty infiltration without focal hepatic lesions. Status post cholecystectomy. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Asymmetric right perinephric fat stranding again noted. No nephrolithiasis or ureteral calculus. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Mild calcifications affect the abdominal aorta.BOWEL, MESENTERY: No findings to suggest diverticulitis, colitis or small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest diverticulitis, colitis or small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Asymmetric right perinephric fat stranding again noted. Early infectious/inflammatory process cannot be excluded. 2.No specific findings to suggest diverticulitis or colitis.3.Diffuse fatty liver. |
Generate impression based on findings. | 86 years, Female. Reason: r/o obstruction History: abdominal pain No evidence of free air. Non-obstructive bowel gas pattern. Right hip arthroplasty. | No evidence of free air. Non-obstructive bowel gas pattern. |
Generate impression based on findings. | 78 year old male with unexplained iron deficiency anemia. Scout radiograph demonstrates a nonobstructive bowel gas pattern. Postoperative changes are noted in the chest and a small vascular stent projects over the left upper quadrant near the spinal border. Transit time to the colon was approximately 2 hours. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, without ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. No filling defects, polyps, or large masses were noted. Several diverticula were identified extending from the terminal ileum, to the level of the ileocecal valve. The terminal ileum demonstrated normal caliber. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 7:58 mm:ss | 1.Several terminal ileal diverticula, extending to the level of the ileocecal valve, which may represent a source of bleeding. 2.No filling defects, polyps, or large masses seen. |
Generate impression based on findings. | Colon carcinoma CHEST:LUNGS AND PLEURA: Emphysema again noted. Stable peripheral lingular micronodule. Interval decrease in size of right lower lobe peripheral mass best seen on image 57 of series 5 now measuring 4.5 x 6.4 cm; this is in comparison to 5.5 x 8.1 cm on 7/30/2014MEDIASTINUM AND HILA: Interval decrease in size of right hilar adenopathy best seen on image 64 series 3 now measuring 1.6 x 1.1 cm; this compares to 2.1 x 1.5 cm on 7/30/2014.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable bilobar subcentimeter low attenuation foci. Cholelithiasis without acute inflammation or ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Hyperplasia left adrenal gland.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval decrease in size of peripheral right lower lobe lung mass associated with interval decrease in size of right hilar adenopathy. No new metastatic focus. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts (with an additional left MLO view) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 2-year-old male with left paraspinous asymmetry.VIEWS: Pelvis AP and frog leg (two views) 1/13/2015 Lateral uncovering of the femoral heads by approximately 50 to 60% is seen on the AP view. The femoral heads are seated within the acetabula on the frog leg view. There is bilateral acetabular dysplasia. No acute fracture is evident. | Dysplastic acetabula with lateral uncovering of both femoral heads. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts (total of 8 images) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign left breast biopsy. Family history of breast cancer in mother. Two standard digital views of both breasts with tomosynthesis 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. Biopsy clip identified within the central 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: NSC - Screening Mammogram. |
Generate impression based on findings. | 31 year old woman with palpable periareolar abnormality for past 4-6 months. History of NF1. Three standard views of both breasts were performed digitally with 2 additional left spot compression views and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A triangular marker is noted near the left nipple, without underlying abnormality evident. No discrete masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Benign intramammary and axillary lymph nodes are present bilaterally.LEFT BREAST ULTRASOUND | No mammographic or sonographic abnormality to correspond with the palpable area of concern which should be managed clinically. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral annual screening mammogram is recommended once the patient is 40 years of age. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother. 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. | Female; 85 years old. Reason: h/o right tongue cancer History: r/o lung mets LUNGS AND PLEURA: No significant interval change in widespread nodules, many of which are calcified, as well as right middle lobe and lingular atelectasis and bronchiectasis. These findings are compatible with atypical mycobacterial infection and have been present back to multiple previous scans. No new pulmonary nodules to suggest metastases.MEDIASTINUM AND HILA: Stable calcified and noncalcified nodes. Mild coronary artery atherosclerotic calcification.CHEST WALL: Degenerative change in spine. Healed rib fractures.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant interval change or evidence of pulmonary metastases. |
Generate impression based on findings. | Opacification of the uterine cavity revealed a retroverted uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Left tube was freely opacified with free spillage, indicating tubal patency. Right fallopian tube is not dilated and is indeterminant. This might be due to preferential flow to the left side. TOTAL FLUOROSCOPY TIME: 2:41 minutes | Normal retroverted uterine cavity. Patent left fallopian tube. Right fallopian tube is non-dilated but without free spill and is thus indeterminant. |
Generate impression based on findings. | 66-year-old male with history of urothelial cancer status post radical cystectomy and chemotherapy. Patient now with blood in urine. Evaluate upper urinary tract. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophy of the right kidney with nonspecific right perinephric fat stranding is unchanged. No hydroureteronephrosis. The kidneys enhance symmetrically. The right ureter in its entirety and the left mid to distal ureter are not opacified; however, no specific findings to suggest disease recurrence or tumor.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease affects the abdominal aorta and its branches.BOWEL, MESENTERY: Postoperative changes in the small bowel.BONES, SOFT TISSUES: Right mid anterior abdominal wall ileal conduit.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with ileal conduit formation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative in the small bowel.BONES, SOFT TISSUES: Postoperative changes from a right iliofemoral bypass graft.OTHER: No significant abnormality noted | No evidence of recurrent or metastatic disease. Postoperative changes of cystoprostatectomy with ileal conduit formation. |
Generate impression based on findings. | Fall No acute intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. Again seen is prominence of the extra-axial spaces along the bilateral convexities which is likely related to volume loss and stable to less prominent compared to 12/7/2014. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. No hydrocephalus. No midline shift or uncal herniation.There is mild soft tissue swelling in the forhead scalp. Underlying calvarium is intact. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Bilateral extra-axial low density collections without associated mass effect are stable to slightly less prominent than prior. These are likely related to volume loss or possibly represent chronic subdural hematomas. MRI can be obtained for differentiation if clinically indicated. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Interval decrease in size of the multiple pulmonary nodules.Reference right lower lobe nodule (image 46 series 4) now measures 13 mm x 13 mm previously measuring 17 mm x 16 mm.Additional nodules demonstrate interval decrease in size.Left basilar scarring/discoid atelectasis unchanged.No pleural effusionsMEDIASTINUM AND HILA: Status post thyroidectomy.No hilar or mediastinal lymphadenopathy.Cardiac size is normal evidence of the pericardial effusion.Mild coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.No evidence of axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable 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: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in size of multiple pulmonary nodules. |
Generate impression based on findings. | Female 57 years old; Reason: Lung Transplant Evaluation History: SOB The comparison chest radiograph performed on 1/13/2015 and demonstrates prominence of the main pulmonary artery. There is matched decreased ventilation and perfusion activity in the left lower lobe. Otherwise the ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 49.84 % (upper lung 16.4%; middle lung 19.87; lower lung 13.57%)Right lung: 50.16% (upper lung 19.10%; middle lung 24.92; Lower lung 6.14%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 48.58% (upper lung 20.49%; middle lung 20.38; lower lung 7.71%)Right lung: 51.42% (upper lung 20.24%; middle lung 27.87; lower lung 3.31 %) | 1. No suspicious findings to suggest pulmonary embolism. 2. Matched decreased ventilation and perfusion activity in the right lower lobe which may be related to elevation of the right hemidiaphragm noted on same day chest x-ray. |
Generate impression based on findings. | Female 85 years old; Reason: 85 y/o new dx colon ca. compare to prior CT History: colon ca CHEST:LUNGS AND PLEURA: Scattered micronodules. For example, 4 x 3 mm right upper lobe lung nodule, image 37 series 6, stable from December 15, 2014 CT chest study. No pleural effusion. Emphysematous disease.MEDIASTINUM AND HILA: Atherosclerotic thoracic aorta. Moderate calcified coronary artery disease. Small hiatal hernia. Heterogeneous thyroid gland, greater in right lobe, exophytic nodularity suggested in isthmus area as well..CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided nephroureteral stent. No significant hydronephrosis on either side. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Enlarged portacaval (measuring 2.8 x 1.4 cm, image 85 series 401, previously measured 1.7 x 0.6 cm) and retroperitoneal adenopathy. Enlarging left common iliac lymph node submitted for reference, measuring 2.3 x 1.5 cm, image 131 series 401, previously measured 1.8 x 1 cm.BOWEL, MESENTERY: Status post right hemicolectomy with presumed resection of previously seen heterogeneous mixed solid and fluid mass seen in right lower quadrant. Lobulated right lower quadrant soft tissue mass with curvilinear rim and internal enhancement, appearance suspicious for metastatic lymphadenopathy. This conglomerate nodal mass measures approximately 4.8 x 3.6 cm, image 136 series 401, is located inferolaterally in relation to postsurgical anastomotic site, near distal ileal loops. Located closer to the postanastomotic site inferomedially is another necrotic lymph node on image 125 series 401, measuring 1.3 x 0.9 cm. No bowel obstruction. Left-sided colon diverticulosis without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Soft tissue fullness seen in perineal area, may reflect a component of underlying pelvic floor laxity/prolapse. Correlation with patient's clinical history recommended. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine, scattered subcentimeter sclerotic foci seen without significant change. OTHER: New from prior study is right common femoral venous thrombosis with thrombus seen in the superficial femoral artery and in the profunda femoris as well. Findings discussed with Dr. B. Polite at 3:15 p.m. on 1/13/15. | 1. Status post right hemicolectomy. 2. Metastatic mesenteric, retroperitoneal and portacaval lymphadenopathy.3. Right sided deep venous thrombosis. 4. Please refer to concomitant PET exam from same day for additional findings. |
Generate impression based on findings. | Recurrent papillary thyroid carcinoma Questionable hypoechoic focus with echogenic foci within the inferior right central neck. The skin overlying this lesion was marked.Abnormal appearing right level 2 and level 3 lymph nodes were localized under ultrasound and methylene blue injected within the lymph nodes for localization.Abnormal appearing left level 2 lymph node localized under ultrasound and methylene injected within the lymph node for localization. | Intraoperative ultrasound guided cervical lymph node and right central compartment lesion localization as described. |
Generate impression based on findings. | 55 year old female with bruise on left arm, history of fall Shoulder: Glenohumeral alignment is within normal limits. No fracture is identified.Humerus: No fracture or malalignment. Forearm: No fracture or malalignment. | No fracture or dislocation. |
Generate impression based on findings. | 16-month-old male with pain of unclear etiology, evaluate for toddler's fracture or otherVIEWS: Right femur and tibia-fibula AP/lateral (two views each) 01/13/15 Femur: No acute fracture or malalignment.Tibia-fibula: No acute fracture or malalignment. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | Headache No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | No evidence of acute intracranial hemorrhage or mass effect. |
Generate impression based on findings. | 77 year old female with history of cholangiocarcinoma. Compare with prior imaging. Mid-chemotherapy scans and transaminitis. ABDOMEN:LUNG BASES: New small left greater than right pleural effusion with associated atelectasis. Cardiomegaly, with partially visualized cardiac assist device.LIVER, BILIARY TRACT: Multiple focal enhancing liver lesions are again seen, representative foci as follows:Segment 5 lesion (10/56) measures approximately 2 x 2 cm in the arterial phase, unchanged.Segment 8 lesion (10/34) measures approximately 2.3 x 2.6 cm in the arterial phase, unchanged.Hepatic dome/segment 8 lesion (12/27) measures approximately 1.9 x 1.5 cm on the venous phase images, arterial phase images in this area are limited by beam hardening artifact. Although this lesion measures smaller on the current venous phase CT, differences in measurement may be accounted for by the precontrast phase.Additional small cysts and transient perfusion differences are also seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing right renal calcifications. RETROPERITONEUM, LYMPH NODES: Multiple enlarged retrocrural/retroperitoneal lymph nodes are seen, with the previously measured periaortic reference lymph node on MRI now not accurately measurable due to interval development of lymph node conglomeration. However, an approximation of the lymph mass size in this area (12/58) is 2 cm, increased from prior 1.3 cm.BOWEL, MESENTERY: No small bowel destruction or free air. Moderate amount of ascites and mesenteric edema.BONES, SOFT TISSUES: Multiple tiny foci of sclerosis are seen in the spine and pelvis, which are new from prior and although nonspecific may represent metastatic foci.OTHER: Interval increased ascites and although no definite nodularity is seen cannot exclude carcinomatosis in the setting of ascites. Small upper quadrant varices.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymphadenopathy has increased from prior. Right iliac lymph node (12/104) measures 1 cm. | 1.New abdominal/pelvic ascites, and left greater than right pleural effusion with associated atelectasis.2.Multiple enhancing liver lesions are again seen and although there is no difference in size from prior imaging, the segment 8 lesions are nonspecific and should be followed.3.Marked increased abdominal, pelvic and retroperitoneal lymphadenopathy as above.4.New scattered small sclerotic foci in the spine and pelvis, may represent metastatic foci. |
Generate impression based on findings. | Evaluation is limited due to lack of intravenous contrast, due to iodinated contrast allergy. Extensive dental amalgam streak artifact again obscures most of the oral cavity contents, thus limiting the evaluation of the area of reported right tongue tumor. There are interval right-sided surgical clips along the right anterolateral oral tongue with associated volume loss consistent with partial glossectomy. The affected portion of the right oral tongue was not included within the field of view of previous angled images. Additional surgical clips are seen along the right neck, related to neck dissection. There is relative loss of fat planes along the right neck, likely postoperative in nature.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass.GLANDS: The submandibular, sublingual, and parotid glands have an unremarkable noncontrast appearance. The thyroid gland is unremarkable. CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: Scattered atherosclerotic calcifications are seen along the origin of the great vessels. There is biapical pleuroparenchymal scarring. Significant degenerative changes are seen along the cervical spine, with grade 1 anterolisthesis of C2 on C3, C4 on C5, and C6 on C7, as well as trace grade 1 retrolisthesis of C5 on C6. There are multiple levels of left foraminal narrowing that appear moderate-severe in degree. | Interval expected postoperative changes following right partial glossectomy and right neck dissection. Limited evaluation due to lack of contrast and dental amalgam streak artifact within the oral cavity, without definite evidence of mass lesion or lymphadenopathy. |
Generate impression based on findings. | 8 year-old male with history of distal radius and ulnar fracture. Overlying cast material limits fine osseous detail. There is a transverse band of sclerosis along the distal ulna compatible with a healing/healed fracture. Again seen is a Salter-Harris II fracture of the distal radius with fracture fragments in near anatomic alignment. The fracture line is visible on the oblique view with what we expect is a small amount of callus formation compatible with healing. | Healing distal radius and ulnar fractures as above. |
Generate impression based on findings. | Renal cell carcinoma CHEST:LUNGS AND PLEURA: 0.7 x 0.7 lingular lung nodule best seen on image 83.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: 2.7 x 1.7 cm right chest wall subcutaneous nodule best seen on image 52.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy site clear. Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Peripheral left lingular lung nodule best considered indeterminant; would pay special attention to this nodule on future exams. Right chest wall subcutaneous soft tissue nodule, again best considered indeterminate. |
Generate impression based on findings. | Depressed skull fracture, postop follow-up. Again seen are postsurgical changes of right parietal craniotomy and plate and screw fixation. Calvarium is well aligned without depressed bony fragments.Interval evolution of postoperative changes seen with resolution of previously seen mild parenchymal edema in the right parietal lobe. No new hemorrhage. No midline shift or uncal herniation. No hydrocephalus. Nondisplaced left parietal fracture also again seen. Interval decrease in edema involving the soft tissues. | 1. Status post right parietal craniotomy for repair of previously seen comminuted depressed fracture. Calvarium is well aligned without depressed bony fragments.2. Previously seen right parietal edema and hemorrhage have resolved. No new hemorrhage or mass effect. |
Generate impression based on findings. | 34-year-old male status post total abdominal colectomy for ulcerative colitis complicated by Clostridium difficile toxic megacolon. Patient now with leukocytosis and distention. Evaluate for abscess. ABDOMEN:LUNG BASES: Bilateral small to moderate-sized pleural effusions with mild overlying atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderately dilated loops of small bowel with collapsed distal ileum and transition point at the distal ileum; findings compatible with partial small bowel obstruction. Moderate abdominal and pelvic ascites as well as pneumoperitoneum likely secondary to recent postoperative state. Status post total colectomy with right lower quadrant ostomy. No specific findings to suggest abscess.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: Moderately dilated loops of small bowel with collapsed distal ileum and transition point at the distal ileum; findings compatible with partial small bowel obstruction. Moderate abdominal and pelvic ascites as well as pneumoperitoneum likely secondary to recent postoperative state.Status post total colectomy with right lower quadrant ostomy. No specific findings to suggest abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings consistent with partial small bowel obstruction as above.2.Postoperative changes of total colectomy, small to moderate pneumoperitoneum and ascites. No specific findings to suggest abscess.3.Bilateral small to moderate-sized pleural effusions. |
Generate impression based on findings. | 37 year old female who has a complaint of painful left breast mass x 5 months. No family history of breast cancer. Bilateral Diagnostic Mammogram: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density.Within the upper outer quadrant of the left breast, there is a 9.4 x 7.2 x 9.0 cm mass, corresponding to the area of palpable abnormality. Approximately 3 cm posterior lateral to the index lesion, there is a 2.2 x 2.8 x 2.0 cm asymmetry. Multiple enlarged left axillary lymph nodes are identified, with the largest measuring 4.8 cm in greatest dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing right axillary lymph nodes are identified.Left Breast Ultrasound: On physical examination, there is a large, approximately 10 cm firm palpable mass at the approximate one o'clock position of the left breast, 10 cm from the nipple. Additionally, enlarged left axillary lymph nodes are noted on physical examination, with the largest measuring approximately 3 cm. A targeted left ultrasound was performed for the palpable and mammographic areas of concern. At the one o'clock position of the left breast, 10 cm from the nipple, is a large, ill-defined, hypoechoic mass which spans a distance greater than the footplate of the ultrasound probe, with largest maximal dimension by ultrasound measuring 3.7 cm. Increased vascularity is noted within this mass. At the one o'clock position of the left breast, 12 cm from the nipple, there is a 1.7 x 1.5 x 1.8 cm ill-defined hypoechoic mass with hyperechoic rim corresponding to the asymmetry visualized on mammogram. Within the low left axilla, there are several abnormal morphology, enlarged lymph nodes with no visualized fatty hilum. The largest identified node measures approximately 3.8 cm in greatest dimension, and demonstrates non-hilar flow. | 1.Large, ill-defined, hypoechoic mass measuring approximately 9 cm by mammogram, at the one o'clock position of the left breast, 10 cm from the nipple, corresponding to the patient's palpable abnormality. This finding is highly suspicious for malignancy, and core needle biopsy of this mass is recommended.2. Ill-defined hypoechoic mass at the one o'clock position of the left breast, 12 cm from the nipple, concerning for satellite lesion.3. Enlarged, abnormal morphology left axillary lymph nodes, with the largest identified measuring 4.8 cm in greatest dimension by mammogram. Tissue sampling of this lesion may be performed as indicated.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: There is trace mucosal thickening in several right anterior ethmoid air cells.Maxillary sinuses: There is mild mucosal thickening in both maxillary sinuses. The ostiomeatal units are clear. There is redemonstration of a rounded area of fluid density in the superomedial left maxillary sinus measuring 1.7 x 1.4 cm in greatest axial dimensions, by 1.4 cm CC, just posterior to the left ostiomeatal unit. There is associated osseous expansion of presumed underlying air cell which could relate to a Haller cell given its location. An accessory ostium is incidentally noted on the left side.Posterior ethmoids: There is scattered trace mucosal thickening in bilateral posterior ethmoid air cells.Sphenoid sinus: The sphenoid sinuses are clear. There is opacification along the sphenoethmoidal recesses bilaterally.There is minimal rightward nasal 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. | No significant interval change in size or appearance of a fluid density oval structure projecting just posterior to the left ostiomeatal unit with osseous remodeling. This could represent a chronic mucous retention cyst relating to the ethmoids or possibly a mucocele relating to a left-sided Haller cell. Correlation with surgical findings is recommended. |
Generate impression based on findings. | Reason: saccular thoracic aneurysm - no contrast ct History: aneurysm LUNGS AND PLEURA: Mild upper lobe predominant paraseptal and centrilobular emphysema.Bronchial wall thickening with interval improvement in the previously noted bronchial plugging involving the right lower lobeno suspicious nodules or masses.No pleural effusions..MEDIASTINUM AND HILA: Marked atherosclerotic changes of the thoracic aorta with focal dilatation and calcification of the wall at the level of the aortic arch measuring 38 mm, similar to the prior exam.Cardiac size is normal evidence of the pericardial effusion.Marked coronary calcification.No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable exam with severe atherosclerotic changes of the aorta and extensive calcification of its wall. Focal aortic dilatation at the level of the aortic arch is unchanged. |
Generate impression based on findings. | 2-year-old male with right testicular tenderness and mild swelling RIGHT TESTIS: Inguinal canal location. There is normal echotexture. The right testicle measures 1.6 x 0.7 cm. Normal demonstrable spectral and color Doppler flow is present.LEFT TESTIS: Inguinal canal location. There is normal echotexture. The left testicle measures 1.8 x 0.7 cm. Mildly high resistance waveform on spectral doppler flow. RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted. | The left testicle is normal in appearance with mildly high resistance waveform. Testicular torsion may be considered if the physical exam correlates. |
Generate impression based on findings. | 48 year old female who has a complaint of left axillary discomfort x 3 months. History of benign right breast excisional biopsy. History of known multiple fibroadenomata. No family history of breast cancer. Bilateral Diagnostic Mammogram: 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. Multiple benign morphology masses are present bilaterally, and are unchanged from prior examination. A linear marker has been placed on a scar overlying the upper outer right breast with underlying postsurgical architectural distortion, unchanged. No new dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.Left Breast Ultrasound: On physical examination, no palpable abnormality is identified within the left axilla. A targeted left ultrasound is performed for the patient's area of concern. Within the low left axilla, at the patient's area of focal pain, there are multiple benign morphology lymph nodes which demonstrate normal hilar blood flow. | Benign morphology left axillary lymph nodes at the site of the patient's focal pain. Stable bilateral benign breast masses. 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. | 61 year old woman with mitral valve regurgitation referred for evaluation of cardiovascular anatomy prior to possible robotic mitral valve surgery. CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic calcification, dissection or aneurysm is noted. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. Aortic Valve: There aortic valve is trileaflet and with normal leaflet excursion. Mitral Valve: No mitral annular calcification is noted. There is prolapse of the posterior mitral valve leaflet. Left Ventricle: The left ventricular end-diastolic size is normal. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Right Ventricle: Visually the right ventricle is mildly dilated.Left Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is moderately dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is no calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is no calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is no calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Normal thoracic aortic anatomy with mild tortuosity. 2. Posterior mitral valve leaflet prolapse. 3. Normal LV size. 4. Mild RV dilation. 5. Moderate biatrial dilation. 6. No coronary calcification noted. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvis CTA will be interpreted separately by radiology. |
Generate impression based on findings. | There are multiple heterogeneously enhancing soft tissue nodules throughout the right neck, consistent with lymphadenopathy. These appear in almost near confluent nodal conglomerates. These are located in 1 through 4 nodal stations, with additional abnormal appearing right posterior cervical nodes. There also supraclavicular lymph nodes bilaterally, larger on the right side, most conspicuous just dorsal to the proximal right common carotid artery which is displaced anteriorly. A reference largest node on the right measures 2.2 cm in long axis on 8/28 in the right level 2a nodal station. A few of the nodes demonstrate central hypoenhancement suggestive of possible necrosis. Associate mass effect is noted upon the right submitted to the gland which is displaced anteriorly. There is a prominent right intraparotid lymph node along the inferior aspect of the gland, likely corresponding to the palpable abnormality. There is also partially visualized right axillary and subpectoral lymphadenopathy. There is also an abnormal appearing small left subpectoral lymph node on 8/59.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. There are nonspecific hypoenhancing lesions in the left lobe of the thyroid gland.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.OTHER: There is only partial visualization of the upper breast tissue, with asymmetric ill-defined increased density in the visualized fat of the right upper breast. Please see concurrent CT chest for further details regarding right breast masses out of the field of view. | 1. Extensive right cervical lymphadenopathy consistent with metastatic disease from suspected primary breast cancer, as well as partially visualized axillary and subpectoral lymphadenopathy.2. Tiny nonspecific low densities in the thyroid gland. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated. |
Generate impression based on findings. | 64-year-old female, preoperative planning There is marked degenerative disk disease, particularly affecting C4/5 and C5/6 with anterior osteophytes and loss of the normal cervical lordosis.Median sternotomy wires are partially visualized. | Degenerative arthritic changes as described above. |
Generate impression based on findings. | 4-year-old male with pain after fall.VIEWS: Left wrist PA lateral and oblique (3 views) 1/13/2015 No acute fracture or malalignment evident. Mild soft tissue swelling is seen about the wrist. | Mild tissue swelling about the wrist without underlying fracture or malalignment. |
Generate impression based on findings. | 75-year-old male with metastatic prostate cancer status post 4 cycles of treatment. Abnormal increased activity is again seen in the ribs, spine, and right acetabulum. These findings are not significantly changed from the prior study and are consistent with osseous metastatic disease. No new lesions or evidence of disease progression are present. | Diffuse osseous metastases without evidence of disease progression. |
Generate impression based on findings. | 71 years old female presents with lung nodule in the right upper lobe. This study was performed for the diagnosis of the nodule. RADIOPHARMACEUTICAL: 11.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 160 mg/dL. Today's CT portion grossly demonstrates demonstrates a nodule in the right upper lobe, no significant change as compared with prior CT. There is a calcified nodule in the right lobe of thyroid gland.Today's PET examination demonstrates abnormal FDG uptake in the right upper lobe lung nodule. There is a focus of increased activity in the right lobe of thyroid, which correlates with calcified nodule seen on CT portion of the study.There is a focus of increased activity in the anterior segment of the left eighth rib, which can be due to trauma.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. Diffuse FDG uptake is seen in the shoulders, which is most likely due to arthritis. | 1.No abnormal FDG uptake in the lung nodule in the right upper lobe, which has no significant change in size as compared with prior CT scan from 2003. This finding is most likely benign. Suggest follow-up if clinically indicated.2.Calcified thyroid nodule with increased FDG uptake, which can be due to adenoma or carcinoma. Suggest follow-up with ultrasonography. |
Generate impression based on findings. | 10-year-old female with right neck swelling, pain, fever A lymph node in the right neck measures 2.9 x 1.9 x 3.9 cm and demonstrates increased color doppler flow. There are additional enlarged lymph nodes in the right side of the neck. There also prominent lymph nodes in the left side of the neck measuring 2.3 x 0.7 x 2.0 cm. No fluid collection is identified. | Lymphadenitis without evidence of abscess. |
Generate impression based on findings. | Evaluate pneumothoraxVIEW: Chest AP and abdomen AP ET tube tip at the level of the thoracic inlet. Umbilical lines unchanged. There are three chest tubes on the right. The moderate right pneumothorax has decreased in size. Cardiothymic silhouette normal. Patchy atelectasis left lower lobe. Absent bowel gas without pneumoperitoneum. | Interval improvement in the moderate size right pneumothorax. |
Generate impression based on findings. | 7-month-old male for ET tube placementVIEW: Chest AP (one view) 01/13/15 Right internal jugular central venous catheter tip is at the confluence of the brachiocephalic veins. ET tube tip is at the thoracic inlet. Enteric tube tip is in the second portion of the duodenum. Epicardial pacing leads are noted. Two mediastinal chest tubes and a catheter is present.Cardiothymic silhouette is normal. There is a small amount of subcutaneous emphysema in the right lateral chest wall. No pleural effusion or pneumothorax. Interval improvement of central vascular engorgement/pulmonary edema. Right lower lung opacity may represent atelectasis. | ET tube tip is at the thoracic inlet. |
Generate impression based on findings. | Evaluate ET tubeVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. Umbilical lines unchanged. There are three chest tubes on the right. The moderate size right pneumothorax has improved in the interval. Cardiothymic silhouette normal. Diffuse lung haziness bilaterally without pleural effusion. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | ET tube tip below thoracic inlet and above the carina. |
Generate impression based on findings. | Male 83 years old; Reason: please eval for PE History: RV failure of unclear etiology The comparison chest radiograph performed on 1/13/2015 demonstrates mild cardiomegaly with low lung volumes. Please refer to final chest x-ray report for additional findings. There is matched decreased ventilation perfusion activity in the posterior segment of the right upper lobe only seen on posterior images likely due to artifact.Otherwise the ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion. | 1. No evidence of pulmonary embolism.2. Matched decreased ventilation-perfusion activity in the posterior segment of the right upper lobe likely due to artifact.Findings were discussed with Dr. Maureen Willcox in person in nuclear medicine reading room on 1/13/2015 at 4:05 PM. |
Generate impression based on findings. | 50 year-old female with shoulder pain, evaluate rotator cuff Intra-articular contrast is noted extending across a full-thickness defect through the distal supraspinatus tendon at its insertion on the greater tuberosity consistent with a full-thickness distal rotator cuff tear. Several additional contrast-filled linear tracts extending across the supraspinatus tendon slightly more proximally are consistent with additional tearing. Contrast fills the subacromial-subdeltoid bursa. There is mild adjacent tendinous retraction and significant atrophy of the rotator cuff muscles. | Full thickness distal supraspinatus tear as described above |
Generate impression based on findings. | 65-year-old female status post right TKA Hardware components of a right total knee arthroplasty are situated in near-anatomic alignment without evidence of hardware complication. Foci of gas, drain and surgical clips in the soft tissues reflect recent surgery. | Status post TKA in near anatomic alignment. |
Generate impression based on findings. | 71 year-old female with history of left ring finger DIP mass. There is focal soft tissue prominence dorsal to the DIP joint which is nonspecific. There is no evidence of underlying osseous erosion. Mild osteoarthritis affects the DIP joint. There is a deformity of the proximal fifth metacarpal likely from an old healed fracture. | Focal soft tissue prominence about the DIP joint is nonspecific. |
Generate impression based on findings. | 52 year woman with left breast calcifications seen on screening mammogram. Three views of the left breast, including spot compression views, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Segmentally distributed calcifications are again seen in the left upper outer quadrant. No dominant mass or areas of architectural distortion are present in the left breast. LEFT BREAST ULTRASOUND | Segmentally distributed calcifications and vague hypoechoic soft tissue in the left breast upper outer quadrant, without distinct mass identified. Stereotactic biopsy is recommended for further evaluation. Finding and recommendation were discussed with the patient. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 85 year-old female with large left breast cancer status post chemotherapy. Sentinel lymph node biopsy scheduled for 1/14/2014.RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 1.05 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Three foci increased activity are noted superior to the sites of injection, situated in an intramammary location, medially in the left outer breast/axilla, and superiorly in the left clavicular region. These likely all represent sentinel node(s). Only the region of the intramammary node was marked with an indelible marker. | Left intramammary sentinal lymph node and sentinal nodes in the left outer breast/axilla, and left clavicular region were identified. |
Generate impression based on findings. | Female 65 years old; Reason: 65 y.o. with HPT. Please assess for parathyroid adenomas There is physiologic distribution of the radiopharmaceutical. There is absence of right submandibular gland activity compatible with patient's known history of submandibular gland resection. There is uptake in the region of the sella turcica. There is uniform uptake of the bilateral thyroid glands on early images. On delayed images there is foci of increased activity in the lower poles of the bilateral thyroid lobes.The right thyroid lobe appears to measure 4.0 cm and the left lobe 2.8 cm in length.There is nonspecific uptake in the upper middle chest. | 1. Foci of increased activity in the lower poles of the bilateral thyroid lobes seen on delayed images. Findings may represent parathyroid adenoma or hyperplasia.2. Uptake in the region of the sella turcica may represent a pituitary adenoma. Correlate with brain MRI if clinically indicated.3. Nonspecific uptake in the upper middle chest. |
Generate impression based on findings. | 59-year-old male with history of esophageal carcinoma. Receiving therapy on clinical trial.RADIOPHARMACEUTICAL: 13.37 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 117 mg/dL. Today's CT portion of the neck demonstrates ethmoid air cells and left maxillary sinus mucosal thickening as well as small bilateral nonenlarged level 2 lymph nodes. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates moderate tubular increased metabolic activity in the distal esophagus with maximal SUV of 11.2 (previously 11.2), compatible with known primary esophageal carcinoma. There has been resolution of the lingular and near resolution of curvilinear right lower lobe paraspinal radiotracer activity, likely having represented inflammatory changes. Linear increased activity in the right mediastinum is likely reflective of retained radiotracer within the right chest wall port catheter, which was used for injection. No new sites of FDG avidity are present to suggest disease progression or metastasis. | 1.Stable increased FDG avidity of the distal esophagus, compatible with known primary esophageal malignancy.2.No evidence of disease progression/metastases.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Seven day old full-term male with multiple congenital anomalies including imperforate anus and hydronephrosis, status post ileostomy/mucous fistula placement. Clinical concern for teratoma. A 2.6 x 2.2 cm pedunculated nonenhancing predominantly fat containing mass is seen extending from the expected location of the anus inferiorly between the gluteal folds. Note is made of an imperforate anus. The fluid containing rectal stump terminates approximately at the level of the pubic symphysis. A left lower quadrant diverting ileostomy is in place. | 1.Pedunculated non-enhancing predominantly fat mass arising from the expected location of the anus.2.Imperforate anus.3.Left lower quadrant diverting ileostomy. |
Generate impression based on findings. | Female; 34 years old. Reason: Metastatic breast cancer receiving chemotherapy. Evaluate for treatment response and extent of disease. History: Clinically responding in primary breast mass. CHEST:LUNGS AND PLEURA: Significant interval decrease in number and size of numerous bilateral pulmonary nodules and micronodules. For future reference, there is a 5-mm right lower lobe nodule on image 44, series 5 and a 6-mm left upper lobe nodule on image 40, series 5.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary artery atherosclerotic calcifications.CHEST WALL: Interval decreased size of prominent left axillary lymph nodes. A single enlarged right axillary lymph node measures 19 x 10 mm (image 32, series 3). Left breast retroareolar small focus of enhancement and inferior left breast ill-defined area of enhancement, corresponding to known left breast cancers and decreased since prior PET-CT (images 55 and 76, series 3). Small well-circumscribed soft tissue lesions in the left lateral breast are stable and likely due to fibroadenomas (images 42 and 43, series 3).Sclerotic metastasis in the T8 vertebral body.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: See above.OTHER: No significant abnormality noted. | 1. Significant interval decreased in number and size of numerous pulmonary metastases.2. Interval decreased size of prominent left axillary lymph nodes. Single enlarged right axillary lymph node as described above.3. Single bony metastasis in the T8 vertebral body.4. Left breast findings as above, which should be correlated with dedicated breast imaging. |
Generate impression based on findings. | 60 female with newly diagnosed Hodgkin's Lymphoma. Reason: Initial staging of Hodgkin's Lymphoma.RADIOPHARMACEUTICAL: 15.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates small bilateral pleural effusion/thickening. There are several small lymph nodes in the bilateral inguinal regions. An IVC filter is noted below the right kidney. Multiple soft tissue densities are seen in the subcutaneous tissue hips. Post craniotomy changes are noted in the right skull.Today's PET examination demonstrates increased activity in the multiple small lymph nodes in the right supraclavicular region, mediastinal prevascular space, right lung hilum, right pericardium, and left inguinal region and in the left external iliac lymphatic chain, suspicious for lymphoma. There is a focus of increased activity in the right lower neck at prevertebral space. Multiple foci of increased activity are seen in the peripancreatic the regions. These finding are also suspicious for nodal involvement by the lymphoma.Diffuse and heterogeneous FDG uptake is seen in the skeleton including whole spine, pelvis, ribs, sternum, scapulae, proximal humeri and proximal femora, which is consistent with bony involvement by the tumor. Diffuse FDG uptake is seen in the spleen, which can be due to tumor involvement. | 1.Extensive osseous and the splenic lymphoma.2.Nodal involvement of the tumor in the neck, chest, abdomen and pelvis. |
Generate impression based on findings. | 64-year-old female with pancreatic mass. Evaluate. CHEST:LUNGS AND PLEURA: Stable scattered micronodules, some of which are calcified and likely secondary to prior granulomatous disease. No new suspicious nodule. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart is normal in size without pericardial effusion. Severe coronary artery atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in the inferior right hepatic lobe posteriorly is unchanged dating back to 2011. No other parenchymal abnormality noted. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple cystic lesions within the pancreatic head with the largest measuring 5.5 x 4.2 cm (series 8, image 53) previously measuring 5.2 x 4.2 cm. No proximal pancreatic ductal dilatation or atrophy. There is mass effect at the portal confluence without occlusion.ADRENAL GLANDS: Nonspecific thickening of the left adrenal gland is unchanged.KIDNEYS, URETERS: Incompletely evaluated right renal lesion measuring approximately 1.7 x 1.8 cm and measuring approximately 18 Hounsfield units (series 8, image 69). Other subcentimeter hypoattenuating lesions in the kidneys bilaterally are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: At least two wide mouth anterior abdominal wall fat and bowel-containing hernias without evidence of bowel obstruction. Diverticulosis without evidence of diverticulitis or colitis.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized spine.PELVIS:UTERUS, ADNEXA: Prior hysterectomy.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: At least two wide mouth anterior abdominal wall fat and bowel-containing hernias without evidence of bowel obstruction. Diverticulosis without evidence of diverticulitis or colitis.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized spine. Few scattered sclerotic lesions, e.g., in left iliac wing, are unchanged. | 1.Multiple cystic lesions in the pancreatic head with mild interval increase in the largest as above. Differential considerations includes intraductal papillary mucinous neoplasms.2.Incompletely characterized right renal hypoattenuating lesion. |
Generate impression based on findings. | 40-year-old female with history of kidney stones. 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, BLADDER: Bilateral hydronephrosis/ureteronephrosis (increased on the right side and marked, stable mild degree on the left) and bilateral staghorn nephrolithiasis, stone burden greater on the right. Given that the ureters are are prominent beyond the level of the stones, appearance in this area may be due to reflux. Right renal parenchymal cortical thinning, similar to prior. There has been resolution of previously seen collecting system gas. Left lower renal pole hypoattenuating area with adjacent coarse calcifications may be related to a dilated portion of the collecting system although cannot exclude neoplasm without contrast. This portion appears similar to the previous exam. Additionally, subtle medullary parenchymal calcifications on the left suggests papillary necrosis. No normal urinary bladder is seen, correlate with surgical history. Underlying xanthogranulomatous pyelonephritis difficult to exclude on this unenhanced exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Right greater than left hydronephroureter (greater than on prior exam on the right with obstructing stone formation seen near UPJ level, without significant change on the left) and bilateral staghorn nephrolithiasis and nephrocalcinosis, right greater than left. Underlying xanthogranulomatous pyelonephritis difficult to exclude on this unenhanced exam.2.Stable left lower renal pole hypoattenuating area as described which may be a dilated portion of the collecting system although cannot exclude neoplasm, further evaluation with ultrasound imaging or dedicated contrast study suggested. |
Generate impression based on findings. | 45-year-old female with history of colorectal cancer. Evaluate for extent of disease. CHEST:LUNGS AND PLEURA: Nonspecific micronodule in the left lower lobe measures 6 x 4 mm (series 3, image 87), previously measuring 4 x 4 mm. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: Right chest port with catheter tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypoattenuation in the right hepatic lobe, likely a cyst. An additional hypoattenuating lesion adjacent to the right hepatic vein is too small to characterize (series 3, image 84) and unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is nonspecific matted appearance of the small bowel in the right hemiabdomen at the level of the anterior abdominal wall inflammatory changes (series 3, image 130) as described below. No evidence of small bowel obstruction.BONES, SOFT TISSUES: Soft tissue infiltration in the anterior abdominal wall on the right (series 3, image 129), which may be postsurgical in etiology.PELVIS:UTERUS, ADNEXA: Uterus is surgically absent. Small soft tissue attenuation in the region of the vaginal cuff is presumably postoperative in etiology. Attention on subsequent imaging is recommended.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes involving distal colon and pelvic debulking with small presacral edema with possible small loculated fluid measuring approximately 8 mm (series 3, image 186). This is likely postoperative in etiology. No gaseous focus or rim enhancement to suggest abscess.BONES, SOFT TISSUES: Soft tissue infiltration in the anterior abdominal wall on the right (series 3, image 129), which may be postsurgical in etiology. Osseous structures are stable including the right sacral sclerotic focus. | 1.Postoperative changes as above without specific findings to suggest residual tumor.2.Soft tissue attenuation in the anterior abdominal wall on the right may be postoperative in etiology. Correlation with physical examination recommended. |
Generate impression based on findings. | Male; 73 years old. Reason: SCCHN restaging scans please compare to previous scans with measurments. History: as above CHEST:LUNGS AND PLEURA: Emphysema. Calcified nodules unchanged. No suspicious pulmonary nodules or masses. Scant amount of tracheal debris near the carina.MEDIASTINUM AND HILA: Reference right paratracheal lymph node slightly decreased from 9 to 8 mm on image 36/142. Reference subcarinal lymph node stable at 10 mm on image 54/135. A pretracheal lymph node on image 25, series 3 has mildly increased in size and measures 8 mm, previously 4 mm.Other mediastinal and hilar nodes are not significantly changed. Moderate coronary calcification.CHEST WALL: Degenerative changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications and mild ectasia of the abdominal aorta, stable.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted. | Mediastinal lymphadenopathy is overall not significantly changed, aside from a single pretracheal lymph node that has increased in size as detailed above. Continued follow-up is recommended. |
Generate impression based on findings. | Metastatic breast carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right thoracic inlet metastatic adenopathy. A representative node best seen on image two series 3 measures 2.2 x 1.4 cm.CHEST WALL: Bulky right axillary metastatic adenopathy. A representative right axillary lymph node best seen on image 24 series 3 measures 2.7 x 2.2 cm.Two worrisome right breast masses. A representative mass best seen on image 33 of series 3 measures 3.9 x 3.1 cm. Associated with diffuse right breast skin thickening.Worrisome asymmetrical right internal mammary lymph node prominence. A representative right internal mammary lymph node best seen on image 33 of series 3 measures 1.3 x 0.7 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing ventral hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Right breast masses associated with right breast skin thickening consistent with known right breast carcinoma. Associated with bulky metastatic right axillary adenopathy as well as right thoracic inlet metastatic adenopathy and probable right internal mammary lymph node involvement. |
Generate impression based on findings. | Male 73 years old Reason: 73yo with long-standing HTN, parkinsons, CKD now with ESRD on HD. h/o abd aneurysm s/p repair in 2007 and told "it was leaking". Now with mid-abd pain worse after eating. Eval for leaking aneursym and mesenteric ischemia History: abd pain ABDOMEN:LUNG BASES: Dependent atelectasis the lung bases.LIVER, BILIARY TRACT: Pneumobilia, of uncertain etiology and significance.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: There is an infrarenal abdominal aortic aneurysm measuring 3.4-cm in largest dimension. The wall of the distal thoracic aorta and bilateral common iliac arteries is diffuses thickened likely secondary to atherosclerotic disease.There is ectasia of bilateral common femoral arteries. The right common femoral artery measures 1.8 cm. Left common femoral arteries measures 1.9 cm.Nonspecific borderline enlarged retroperitoneal lymph nodes. Index node measures 1.2 x 0.9 cm on image number 52, series number 10.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 | Infrarenal abdominal aortic aneurysm with diffuse atherosclerotic changes and bilateral ectasia of the bilateral common femoral arteries. Diffuse wall thickening of the distal abdominal aorta and bilateral common iliac arteries may be secondary to a combination of atherosclerosis and postsurgical repair changes.Borderline enlarged, nonspecific, retroperitoneal lymph nodes.Pneumobilia of uncertain etiology and significance. |
Generate impression based on findings. | 55 year-old female with breast cancer. Right breast soft tissue activity may correlate with known right breast tumor/skin thickening. No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. Minimal patchy subcortical white matter hypoattenuation is consistent with chronic small vessel ischemic changes. There are no areas of pathological enhancement. There is no extraaxial fluid collection. There is mild mucosal thickening throughout the visualized paranasal sinuses, with partial opacification of the right sphenoid sinus. There is minimal left and severe right mastoid air cell opacification. Fluid is also identified in the right middle ear.NECK | 1. Interval development of diffuse facial and neck soft tissue edema without focal collection or abscess. Lack of visualization of contrast opacification of the internal jugular veins bilaterally with progressive decreased opacification of the vessels over the course of multiple exams. The left internal jugular vein was patent on the November 2013 exam. Current findings are felt to relate to venous congestion from now bilateral internal jugular vein occlusion, and clinical correlation is recommended. The superior vena cava is contrast opacified.2. Stable appearance of bilateral common carotid artery stents which are directly exposed to the airway without significant change.3. No acute intracranial abnormality. Paranasal sinus and mastoid air cell opacification as detailed above. Please correlate clinically.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 51 years old Reason: follow up for testes cancer History: testicular cancer s/p chemo and surgery CHEST:LUNGS AND PLEURA: Index left upper lobe nodule measures 2-mm in diameter image number 29, series number 5, slightly smaller compared to previous study. The second left lower lobe index nodule measures 5 by 4 mm on image number 56 on series number 5, slightly smaller compared to previous study. Right lower lobe index nodule measures 11 by 8 mm on image number 59, series number 5, not significantly changed from previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the liver are unchanged. Index lesion in the right lobe measures 7-mm in diameter image number 90, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Previous described low attenuation mass in the left para-aortic space is no longer visualized. Postsurgical changes involving the retroperitoneum.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: Sclerotic lesions in the right iliac bone are stable.OTHER: No significant abnormality noted | Interval resection of the left para-aortic mass. Postsurgical changes in the retroperitoneum.Stable to slightly decreased lung nodules. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable minimal chronic small vessel ischemic changes. There is no extraaxial fluid collection. The right sphenoid sinus is partially opacified. The visualized portions of the paranasal sinuses and mastoids/middle ears are otherwise grossly clear. | No acute intracranial abnormality. Stable mild chronic small vessel ischemic changes. |
Generate impression based on findings. | Female 61 years old; Reason: preop MV repair History: fatigue, palpitations Suboptimal evaluation of solid organs secondary to arterial timing of IV contrast bolus.ABDOMEN:LUNGS BASES: Please refer to concomitant CT chest imaging from same day for additional findings, small pericardial fluid.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: Large left sided extrarenal pelvis. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Possible tiny hiatal hernia.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformities of T12 and L1 vertebral bodies is seen with loss of height of greater than 50% at T12 level and approximately 25% at L1 level. Tiny probable bone island in left femoral head.VASCULAR: Non-aneurysmal abdominal aorta. Abdominal aorta measures 2 by 1.7 cm at level of celiac artery origin. At level of the renal arteries, aorta measures 2 x 1.8 cm. Infrarenal aorta measures 1.2 x 1.2 cm. Right common iliac artery measures 1 cm on transaxial imaging, and left common iliac artery measures 0.9 cm. Right external iliac artery measure 0.6 cm, and left external iliac artery measure 0.6 cm. Right common femoral artery measures 0.7 cm, and left common femoral artery measure 0.7 cm. Patent celiac, superior mesenteric and inferior mesenteric arteries and renal arteries. | 1. Vascular measurements as above.2. Thoracolumbar compression deformities. 3. Please refer to concomitant CT chest imaging from same day for additional findings. |
Generate impression based on findings. | Female 48 years old Reason: metastatic proximal tibial lesion, eval for primary source History: see above CHEST:LUNGS AND PLEURA: There are nodular air space opacities in the right upper lobe posteriorly near the fissure associated with airway wall thickening. These are more likely to be infectious, however, neoplasm cannot be excluded.There is also an area of consultation the left lower lobe. Etiology is unknown. Although infection is favored, neoplasm cannot be excluded.Subcentimeter scattered lung nodules. An index nodule measures 3-mm in the right middle lobe on image number 43, series number 8.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodense lesion in the right lobe of the liver measuring 2.2 x 2 cm image number 81, series number 6. MRI may be helpful for further evaluation of this lesion. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: 2.3 x 1.6 cm cystic lesion between the pancreatic tail and the spleen, all unknown etiology but most likely benign.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: Lytic lesions in the lower thoracic and lumber vertebral body consistent with metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prominent cervix. Correlation with pelvic exam is recommended to exclude a cervical carcinoma.Possible left Bartholin's cyst. 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. | Pelvic exam is recommended to exclude a cervical carcinoma.Right middle lobe and left lower lobe lesions. Although infection is favored over neoplasm, lung cancer cannot be excluded. Further evaluation with bronchoscopy may be helpful.Lytic bone lesions in the lower thoracic and lumber vertebral bodies consistent with metastatic disease.Hypodense lesion in the liver. Metastatic disease cannot be excluded. MRI of the liver may be helpful for further characterization. |
Generate impression based on findings. | 78 year old female with history of metastatic colon cancer. CHEST:LUNGS AND PLEURA: Right lung base posteriorly located pleural-based nodule (5/76) is unchanged in size, at 9 x 7 mm.MEDIASTINUM AND HILA: Heterogeneous/nodular thyroid, unchanged. Severe coronary artery calcifications. No significant pericardial effusion. Right chest Port-A-Cath tip is at the superior cavoatrial junction. Right hilar reference lymph node (3/44) measures 1.4 x 2 cm, unchanged.CHEST WALL: Right chest Port-A-Cath with tip at the superior cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Stable postoperative findings of left lobectomy and cholecystectomy. Previously described small fluid collection at the inferior tip of the right hepatic lobe is slightly smaller in size, measuring 1.5 x 1.1 cm, down from 1.9 x 1.7 cm.Hypoattenuating segment 8 liver lesion (3/78) measures 2.1 x 1 .4 cm, previously 1.6 x 1.3 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Heterogeneous left adrenal nodule (3/88) is unchanged in size, measuring 2 x 1.8 cm.KIDNEYS, URETERS: Nonobstructing left intrarenal nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Unchanged infrarenal abdominal aortic aneurysm, measuring approximately 3 cm.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cyst, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes are similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Segment 8 hepatic hypoattenuating lesion has slightly increased in size over the interval. Other reference lesions are unchanged.2.No new foci suspicious for metastases. |
Generate impression based on findings. | Female 75 years old Reason: RLQ pain- r/o appendicitis History: RLQ pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Benign liver cysts.SPLEEN: No significant abnormality notedPANCREAS: Subcentimeter cyst in the body of the pancreas, best seen image number 41, series number 3.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 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 | No CT findings to explain patient's complaint of right lower quadrant pain. |
Generate impression based on findings. | 85 year-old female with new diagnosis of colon cancer.RADIOPHARMACEUTICAL: 14.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 83 mg/dL. Today's CT portion of the neck demonstrates two thyroid nodules in the right lobe and isthmus. No other pertinent neck findings are identified. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates FDG avid mesenteric lymph nodes in the right lower quadrant, including conglomerate necrotic lymph nodes noted on CT, retroperitoneal lymph nodes, left common iliac chain lymph nodes, and a large portacaval node, all demonstrating intense radiotracer activity. SUV max of the portacaval node is 13.9. Small, mild left gluteal and left outer thigh soft tissue foci of radiotracer activity may represent injection granulomas. | 1.Portacaval, retroperitoneal, and mesenteric lymphadenopathy demonstrating FDG avidity is compatible with metastatic nodal disease.2.FDG avid thyroid nodules may represent adenomas, though primary thyroid malignancy is not excluded.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Worsening right hip pain. History of prior fracture with repair (screws/plate). Evaluate for OA versus hardware malfunction. A dynamic hip screw device affixes the proximal femur in near-anatomic alignment. There is thin lucency about the dynamic hip screw which is not necessarily of any clinical significance. I see no definite hardware complications. Moderate osteoarthritis affects the hip. Multiple round metallic densities in the soft tissues of the thigh likely represent shot pellets. | Postoperative changes of fracture fixation and osteoarthritis of the hip as described above. |
Generate impression based on findings. | Asymptomatic. Status post left hip replacement. Rule-out right hip pathology. Two views of the left hip show components of a total hip arthroplasty device situated in near-anatomic alignment. Since the prior study there has been progression and maturation of heterotopic ossification between the trochanters and the acetabulum. I see no hardware complications.The AP view of the pelvis reveals the aforementioned left total hip arthroplasty. Mild osteoarthritis affects the right hip. Cystic changes along the pubic symphysis are when compared with the prior study and are presumably degenerative in etiology. Note is made of a transitional lumbosacral vertebra and degenerative disk disease affecting the lower lumbar spine. Thin ossification within the medial aspect of the proximal right thigh likely represents heterotopic ossification from old trauma. | Postoperative changes of left total hip arthroplasty and degenerative arthritic changes as described above. |
Generate impression based on findings. | CT HEAD: There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is a small fenestration of the basilar artery which is incidentally noted. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in otherwise course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. | No evidence of intracranial hemorrhage or aneurysm. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Ongoing lower extremity edema, severe pain. Acute process -- gouty changes, osteo-, fracture? There is diffuse soft tissue swelling about the ankle. Mild deformity of the distal fibula may reflect an old healed fracture. A small ossicle distal to the medial malleolus may likewise reflect old trauma. I see no acute fracture. The bones appear slightly demineralized. I see no specific radiographic features of osteomyelitis. Mild osteoarthritis affects the ankle joint. I see no specific regression features of gout. | Soft tissue swelling, old posttraumatic changes, and mild osteoarthritis without evidence of acute fracture, osteomyelitis, or gout.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 47-year-old male with hypotension. Evaluate for infection. ABDOMEN: Lack of contrast enhancement limits evaluation of solid organs.LUNG BASES: Interval resolution of bilateral pleural effusions. Mild left basilar atelectasis.LIVER, BILIARY TRACT: Unchanged segment 8 hypoattenuating focus which has previously been characterized as a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypoattenuating lesion consistent with a cyst.RETROPERITONEUM, LYMPH NODES: IVC filter is noted.BOWEL, MESENTERY: Postoperative changes of partial colectomy and diverting loop ileostomy. Soft tissue mesenteric metastatic deposit in the left lower quadrant is not significantly changed in size. Additional mesenteric nodularity consistent with metastatic disease is not significantly changed.BONES, SOFT TISSUES: Again noted is large anterior abdominal wound. Additionally, there is a tract extending from the skin to the level of the anterior abdominal wall musculature in the left lower quadrant (series 3, images 83 through 87) with associated fat infiltration concerning for infection. Additional soft tissue nodules in the anterior abdominal wall likely related to previous injection sites.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air within the bladder likely iatrogenic secondary to Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above. Large fecal bolus in the rectum measuring approximately 7.8 cm, unchanged.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted | 1.No significant interval change in metastatic disease. 2.Postoperative findings of partial colectomy and diverting loop ileostomy.3.Anterior abdominal wall wound and left lower quadrant anterior abdominal wall tract with air suspicious for infection. Correlate with physical examination. |
Generate impression based on findings. | 60 year-old male with newly diagnosed gastric malignancy. Patient with hyperechoic liver lesions suspicious for metastatic disease. Evaluate. CHEST:LUNGS AND PLEURA: Multiple groundglass and solid nodules in the right lung suspicious for metastatic disease. Reference right upper lobe nodule measures approximately 7 mm (series 4, image 52). Small right pleural effusion with overlying mild atelectasis.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes with left paratracheal lymph node measuring approximately 1.5 cm (series 3, image 34). Heart size is normal without pericardial effusion. Moderate coronary artery calcifications noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions throughout both lobes of the liver with reference segment 8 lesion measuring approximately 6.5 x 5.5 cm (series 3, image 87) consistent with metastatic disease. There is a hypoattenuating lesion in segment 2/3 with a fistulous connection with the lesser curvature of the stomach (coronal series, image 101) consistent with tumor invasion; superimposed infection cannot be excluded.The main left portal vein is patent without significant attenuation. The medial and lateral segments of the left portal vein are attenuated distally. Mild perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypoattenuating foci compatible with cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged gastrohepatic lymph nodes with reference lymph node measuring 1.1 cm (series 3, image 91).Aorto bifemoral end-to-side graft with occlusion of the right limb of the graft. Aneurysmal enlargement of the left bypass graft anastomosis. Partially visualized right femoral-popliteal bypass graft with lack of opacification consistent with occlusion.BOWEL, MESENTERY: Moderate to severe antral gastric wall thickening compatible with known gastric malignancy. Aforementioned tumor invasion from the lesser curvature of gastric body to the left hepatic lobe (axial series images 97 to 101). BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Nonspecific right perirectal soft tissue nodule measures 1.6 x 1.3 cm (series 3, image 193). Mildly enlarged bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Gastric antral wall thickening compatible with stated history of gastric malignancy with tumor invasion of the left hepatic lobe as above.2.Findings consistent with diffuse hepatic metastatic disease. Superimposed infection of segment 2/3 cannot be excluded.3.Thoracic metastatic disease.4.Retroperitoneal lymphadenopathy. Nonspecific right perirectal soft tissue nodule and bilateral mildly enlarged inguinal lymph nodes.5.Aorto bifemoral end-to-side graft with occlusion of the right limb of the graft.Findings discussed with Dr. Sahota over the phone at approximately 10:20 am |
Generate impression based on findings. | 23-year-old female with pain and swelling, evaluate for jaw abscess The left mandibular and maxillary third molars are impacted and there are caries of the left mandibular first molar and left maxillary first molar. There is lucency surrounding the impacted left mandibular third molar, which likely represents a dentigerous cyst, with thinning of the adjacent cortex. Mild periapical lucencies surround the left mandibular first molar. There is soft tissue stranding surrounding the left mandible, particularly along the anterior aspect, without a discrete fluid collection. The adjacent gingiva appears thickened. Several prominent level 1 lymph nodes are present on the left. There is an enlarged right level 2a node on the right.The parotid, submandibular and visualized thyroid glands are normal. Vascular structures are intact. Right maxillary mucus retention cyst/polyp, otherwise the visualized paranasal sinuses and mastoid air cells are clear. The visualized intracranial structures are unremarkable. No acute fractures are evident. | Inflammatory changes in the soft tissues surrounding the left mandible without discrete abscess. There is mild adjacent periodontal disease involving the left mandibular molars including a dentigerous cyst, periapical lucencies and caries which may be the source of the infection. |
Generate impression based on findings. | Limited study due to motion.There is a thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. However, there is diffusely abnormal bone marrow signal involving much of the thoracic spine and includes the vertebral bodies and pedicles at many levels which has progressed when compared to the CT from 12/18/2013. There is evidence of extra-osseous spread at multiple levels, the worst of which starts about T3 and continues until at least T6. The right pedicles of T4-T6 are enlarged and there is extension of tumor within the right lateral epidural space which narrows the spinal canal in the transverse dimension, effaces the CSF and encroaches the right side of the spinal cord. The spinal canal narrowing is most severe at T6 where there is involvement of the lateral epidural space by tumor bilaterally. The cord is compressed but there is no cord signal abnormality. C5-T3 and T7-T12 demonstrates no significant spinal canal stenosis or cord encroachment.The metastatic disease also involves the proximal ribs at multiple levels which are only partially visualized. Scattered tumor nodules are also seen at the cost-vertebral junction of multiple levels. A left pleural effusion is seen and there are one or two fluid filled structures in the partially visualized pelvis. | 1.Extensive metastases of the visualized osseous structures, including many of the vertebral levels and pedicles, which are most severe in the thoracic spine.2.Transverse spinal canal narrowing and CSF effacement at the T4-T6 levels secondary to pedicle involvement and epidural spread of disease.3.Mild cord compression most notably at T6, but no abnormal cord signal.4.Left pleural effusion. |
Generate impression based on findings. | 87-year-old female with severe pain, no trauma. An AP view the pelvis shows mild-moderate osteoarthritis affecting the left hip and moderate-severe osteoarthritis affecting the right hip without fracture. There are chronic enthesopathic changes along the pelvis. Severe degenerative arthritic changes affect the lower lumbar spine. Surgical suture material is present overlying the lower abdomen and pelvis.Two views the left hip show mild-moderate osteoarthritis affecting the left hip and enthesopathic changes along the trochanters but no fracture. | Osteoarthritis and other findings as described above without fracture. |
Generate impression based on findings. | ABDOMEN:LUNG BASES: Minimal basal atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered calcified granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild nodular thickening of the left adrenal gland, nonspecific and incompletely evaluated on this noncontrast exam.KIDNEYS, URETERS: Hypoattenuating left renal foci, but may represent cysts although this cannot be determined on single phase CT. No hydronephrosis or hydroureter. No parenchymal or collecting system stones.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: The small bowel instruction or free air. The appendix is visualized and within normal limits. Diverticulosis affects the colon.BONES, SOFT TISSUES: Degenerative changes affect the spine. Anterior abdominal wall surgical clips from prior operation at the midline. No fracture is evident.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No fracture is evident. Degenerative changes affect the hips and lower spine.OTHER: No significant abnormality noted. | 1.No displaced fracture is evident.2.No nephrolithiasis, hydronephrosis or hydroureter.3.Mild nodular thickening of the left adrenal gland, nonspecific. |
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