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Generate impression based on findings. | Status post right total knee arthroplasty Components of a total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | Left shoulder pain status post fall from height I see no fracture or malalignment. Mild osteoarthritis affects the acromioclavicular joint. | Mild osteoarthritis without fracture evident. |
Generate impression based on findings. | Pain after injury. Rule out fracture. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. I see no acute fracture or dislocation. | Mild osteoarthritis without acute fracture evident. |
Generate impression based on findings. | Pain I see no fracture or malalignment. I see no joint effusion. I see no specific findings to account for the patient's pain. | No fracture or other findings to account for the patient's pain are evident. |
Generate impression based on findings. | mental status change. No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy mild low attenuations on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. Minimum mucosal thickening on the left maxillary sinus. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal to mild non specific small vessel disease. |
Generate impression based on findings. | Thumb injury. Pain and swelling. Rule out fracture versus dislocation. There is soft tissue swelling along the thumb, particularly along the first metacarpal. I see no fracture or dislocation. | Soft tissue swelling without fracture or dislocation. |
Generate impression based on findings. | Rib pain. Bony prominence over the right chest wall lateral to the sternum. History of "nb" fracture in the past. Rule-out rib cage abnormality. I see no fracture or rib cage deformity. I see no findings to account for the patient's rib pain or bony prominence. A surgical clip in the right upper quadrant of the abdomen likely reflects prior cholecystectomy. | Normal-appearing ribs without findings to account for the patient's rib pain or bony prominence. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy bilateral periventricular white matter low attenuations indicate mild non specific small vessel disease.Minimal brain atrophy is age appropriate.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Age appropriate minimal brain atrophy with mild non specific small vessel disease. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.There is focal subgaleal soft tissue on the right posterior parietal area without evidence of underlying skull fracture (series 80249, image 68/81, series 80248, image 32/49). This lesion likely represent subgaleal hematoma, but clinical correlation is indicated.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Localized scalp soft tissue lesion likely represent subgaleal hematoma as described above. |
Generate impression based on findings. | question of hemorrhagic conversion Evolving right frontal ischemic infarction was again demonstrated without significant interval change since prior exam.There is no definitive evidence of hemorrhagic conversion on this scan.Left convexity extra axial lesion is again re-demonstrated, no change since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No definitive evidence of hemorrhagic conversion on this scan. If clinically indicated, brain MRI is recommended since it is more sensitive for detecting petechial hemorrhage.2. No change of right frontal evolving ischemic infarction since prior exam.3. No change of left convexity extra axial lesion. |
Generate impression based on findings. | 4 day old male, evaluate pneumothorax.VIEW: Chest AP (one view) 1/14/2015, 07:19 Endotracheal tube tip at the level of thoracic inlet. The umbilical lines are unchanged. Three right-sided chest tubes are in place, with interval advancement of the middle chest tube, with the side port now within the thoracic cavity.Significantly improved right pneumothorax, with a moderate residual pneumothorax present. Air outlines the cardiac silhouette consistent with pneumopericardium. Persistent patchy left lower lobe atelectasis. | Persistent moderate right pneumothorax, significantly improved. Persistent pneumopericardium. |
Generate impression based on findings. | Female 9 years old Reason: possible fracture History: leg painVIEWS: Pelvis AP and frog leg , right femur and tibia-fibula AP and lateral 1/14/15 (6 views) Pelvis: Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. No evidence of AVN or SCFE.Right femur and tibia-fibula: There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 8 years old Reason: r/o fx History: ttp and swelling over top of 1st metatarsalVIEWS: Left foot AP, lateral and oblique 1/14/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 69 years, Male. Reason: Evaluate for free air, obstruction - 69 yo w dementia p/w AMS, has inconsistent guarding in LLQ and prominent bowel loops on upright CXR History: AMS, inconsistent/intermittent guarding in LLQ on exam, prominent small bowel loops on upright CXR Incompletely imaged lung bases demonstrate mild patchy airspace disease. There is no evidence of free air. Mildly prominent small bowel loops and there is mild dilatation of the ascending colon up to 7.7 cm. The rectum is also distended to 9.0 cm and is filled with stool. | Mildly prominent small and large bowel with moderate to large stool at level of rectum, correlate clinically for fecal impaction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 4 years old Reason: Evaluate for constipation History: abdominal painVIEW: Abdomen AP (one view) 1/14/15 at 127 hours Generalized, nonspecific bowel distention we mild fecal accumulation. No obstruction or free air. | Generalized, nonspecific bowel distention. |
Generate impression based on findings. | 4 day old male, evaluate pneumothorax.VIEW: Chest and abdomen AP (two view) 1/14/2015, 04:57 Endotracheal tube tip at the level of thoracic inlet. The umbilical lines are unchanged. Three right-sided chest tubes are in place, position unchanged.Increased right pneumothorax with associated right lung collapse. Air again outlines the cardiac silhouette consistent with pneumopericardium. Persistent patchy left lower lobe atelectasis.No bowel gas is present. No pneumatosis intestinalis or portal venous gas is seen. | Increased right pneumothorax with associated right lung collapse. Persistent pneumopericardium. |
Generate impression based on findings. | 66-year-old female with wound infection, ankle pain. Evaluate for osteomyelitis, fracture. Three views of the left ankle show swelling along the lateral soft tissues with irregularity of the skin surface consistent with ulceration. There is chronic appearing periosteal reaction along the distal fibula which may represent chronic osteomyelitis but no frank osteolysis to confirm acute osteomyelitis. Mild osteoarthritis affects the midfoot. | Soft tissue swelling and ulceration with chronic appearing periosteal reaction in the distal fibula. This may reflect chronic osteomyelitis but there is no frank osteolysis to confirm acute osteomyelitis. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 30 year-old male with right foot pain, right knee pain and limp. Three views of the right foot show no fracture or other findings to account for the patient's pain. A tiny ossicle adjacent to the fifth metatarsal head may simply represent a small sesamoid.Four views of the right knee show no fracture or other findings to account for the patient's pain. Mild enthesopathic changes at the patellar tendon insertion may not be of clinical significance. | No fracture or other findings to account for the patient's pain. |
Generate impression based on findings. | 4 day old male, evaluate pneumothorax.VIEW: Chest AP (one view) 1/13/2015, 17:07 Endotracheal tube tip at thoracic inlet. Umbilical catheters unchanged in position. Three right-sided chest tubes are in place and there has been slight interval retraction of the middle chest tube, with the side port now at the level of the thoracic wall.Significantly increased right pneumothorax with associated right lung collapse. Persistent patchy left lower lobe atelectasis. Air appears to outline the cardiac silhouette suggestive of pneumopericardium. | Increased right sided pneumothorax. Findings suggestive of pneumopericardium. |
Generate impression based on findings. | 14-year-old male with osteomyelitis in the right side of the sacrum which has leaked to the sacroiliac joint and then pelvisEXAMINATION: MR pelvis with and without intravenous contrast. The previously noted rim enhancing fluid collections in the right iliac is muscle is no longer present. There is persistent marrow edema in the right iliac bone and sacral ala adjacent to the right sacroiliac joint. Previously noted fluid within the right sacroiliac joint has since resolved. Interval resolution of edema within the soft tissues.There are scattered bilateral inguinal lymph nodes not pathologically enlarged by size criteria. No pelvic fluid is present. | 1.Interval resolution of right iliacus abscesses, sacroiliac joint fluid, and surrounding soft tissue edema. 2.Persistent bone marrow edema adjacent to the right sacroiliac joint. |
Generate impression based on findings. | There is hypoattenuation in an MCA distribution involving the left frontal, parietal and occipital lobes. There is encephalomalacia of the left parieto-occipital lobe with adjacent ex vacuo dilatation of the left occipital horn. An additional focus of hypoattenuation involves the pericallosal right parietal lobe. No acute hemorrhage is identified. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.Large area of hypoattenuation in a left MCA distribution with areas of encephalomalacia in the left parieto-occipital lobes is likely chronic, however a superimposed subacute or acute component cannot be excluded. 2.Focal hypoattenuation in the right parietal lobe likely represents age indeterminate ischemia.3.Follow-up with MRI is recommended. |
Generate impression based on findings. | 14-year-old female with chest pain and right-sided crackles, evaluate for pneumonia.VIEWS: Chest AP/lateral (two views) 1/13/2015 Streaky retrocardiac opacity consistent with subsegmental atelectasis. There are arch, cardiac apex and stomach are left-sided. The cardiomediastinal silhouette is normal. | Left lower lobe subsegmental atelectasis without specific evidence of pneumonia. |
Generate impression based on findings. | 57-year-old female with lower back pain and history of left knee injury, leg discrepancy Knee: Tiny patella osteophytes indicate minimal osteoarthritis. The knee otherwise appears normal for the patient's age.Left hip: Tiny osteophytes indicate minimal osteoarthritis affecting the hip.Right hip: The right hip appears normal for the patient's age.Pelvis: The pelvis appears normal for the patient's age | Minimal osteoarthritis affecting the left knee and hip, essentially within normal limits for the patient's age. |
Generate impression based on findings. | Male 1 day old History: imperforate anusVIEW: Abdomen AP (one view) 1/14/15 at 732 hours. Proximal side-port of NG tube are above GE junction. Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, slightly distended and nonspecific abdominal gas pattern unchanged. |
Generate impression based on findings. | 13-year-old male status post snake bite to left second digit, with numbness and pain.VIEWS: Left hand PA oblique and lateral (3 views) 1/13/2015 No acute fracture or malalignment evident. No significant soft tissue swelling is seen. | Normal examination. |
Generate impression based on findings. | 14-year-old male with inability to flex the DIP joint, evaluate for avulsion.VIEWS: Right hand PA oblique and lateral (3 views) 1/13/2015 The fourth distal interphalangeal joint is held in extension. A 2-mm ossific density is seen along the volar aspect of the fourth middle phalanx, which likely represents an avulsion fracture fragment, with donor site likely the base of the fourth distal phalanx, although this is not clearly seen. | Findings consistent with a volar plate avulsion fracture of the distal fourth phalanx. |
Generate impression based on findings. | Male 1 day old Reason: Infant with imperforate anus VIEW: Abdomen AP (one view) 1/14/15 at 613 hours Proximal side-port of NG tube is above GE junction. Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, slightly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | 44-year-old male with left ankle pain, swelling, bruising to lateral malleolus There is soft tissue swelling about the lateral ankle. An oblique fracture through the distal fibula extends to the tibiotalar joint with approximately 1 cortical width lateral displacement of the distal fracture fragment. | Distal fibular fracture as described above. Findings discussed with Dr. Mackenzie (pager 1093) at the time of dictation. |
Generate impression based on findings. | Female, 68 years old.Missing curved needle. There is basilar atelectasis. Patient is status post sternotomy.Skin staples overlying the bilateral proximal femurs and abdomen. Right pelvic drain and bilateral iliac stents unchanged. NG tube tip is noted projecting over the gastric body. No definite RFO is noted. Gas in the small and large bowel noted, consistent with postoperative ileus. | Postoperative changes. No definite radioopaque foreign object. |
Generate impression based on findings. | 59-year-old male with right hand and wrist pain and swelling Wrist: The bones are slightly demineralized. No fracture is evident. Chondrocalcinosis affects the articular cartilage of the wrist. Vascular calcifications are noted within the soft tissues. Small degenerative cysts are noted within the lunate.Hand: The exam is slightly limited due to inability to properly position the patient. There is swelling along the dorsum of the hand extending to the middle finger. Chondrocalcinosis is noted at the second metacarpophalangeal joint with cyst formation within the metacarpal head. There is also calcification of the flexor tendon apparatus of the middle finger. Moderate osteoarthritis affects scattered interphalangeal joints. Deformity of the middle phalanx of the middle finger may be related to old trauma. | Soft tissue swelling, chondrocalcinosis and other findings as described above without acute fracture evident. |
Generate impression based on findings. | 14-year-old female with bilious emesis, position of NG tubeVIEW: Abdomen AP (one view) 01/13/15 1846 hrs NG tube side port is at the GE junction and tip is in the gastric body. Left lower quadrant ostomy is present. Distended loops of small bowel are present with paucity of bowel gas in the colon. No free intraperitoneal air. | NG tube with tip in the gastric body with proximal side port above the GE junction..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Feeding intolerance. Rule-out obstruction.VIEWS: Abdomen AP supine and left lateral decubitus 1/13/15 (2 view/s) Spinal fixation device, Baclofen pump, gastrostomy and VDRO hardware are again noted. Generalized, nonspecific bowel distention with mild to moderate fecal accumulation. No obstruction or free air. | Mild to moderate fecal accumulation and bowel distention with no evidence of obstruction. |
Generate impression based on findings. | 67 years Female with possible CVA. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. Scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, consistent with previously seen chronic small vessel ischemic changes. Opacification of the left posterior ethmoid sinus; otherwise, the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage.2. Minimal subcortical/periventricular white matter hypoattenuation, consistent with previously described chronic small vessel ischemic disease. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | Male 69 years old Reason: metastatic rectal cancer s/p hepatic resection of disease 12/1. Evaluate for current status of disease History: rectal cancer CHEST:LUNGS AND PLEURA: There are multiple bilateral pulmonary micronodules are again demonstrated. The reference nodule at the left lung base (image 75; series 4) again measures 6 mm and is unchanged. MEDIASTINUM AND HILA: There are slightly prominent mediastinal lymph nodes measuring up to 8 mm, which appear stable. Severe atherosclerotic calcifications of the coronary arteries are again noted.CHEST WALL: Enlarging right axillary lymph nodes are noted. For reference purposes, the largest node currently measures 1.5 x 1.0 cm (image 40; series 3); this same lymph node measured less than 1 cm in the prior examination. There is a left chest wall Port-A-Cath with the tip terminating in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Since the prior examination, there has been interval cholecystectomy and right lobe resection. Residual hypodense nodules in segment 4 appear stable. There is no evidence of intrahepatic biliary ductal dilatation. Portal vein remains patent. Fluid along the cut edge of the liver measures 10.3 x 4.0 cm (image 79; series 3). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are bilateral renal sinuses cysts as well as renal parenchymal cyst. Nonobstructing left renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is asymmetric mural thickening with associated induration of the mesorectal fat, compatible with the reported history of rectal cancer. There are multiple perirectal lymph nodes again noted. The reference lymph node (image 94; series 3) has increased in size and currently measures 1.4 x 1.1 cm (previous 1.1 x 0.7 cm, image 191; series 11; 9/30/2014 study). BONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis. Minimal fluid along the right lateral abdominal wall presumably secondary to recent surgery.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple perirectal lymph nodes again noted with enlargement of the reference lymph node as noted above.BOWEL, MESENTERY: There is asymmetric mural thickening with associated induration of the mesorectal fat, compatible with the reported history of rectal cancer.BONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality noted | 1.Status post right lobe resection and cholecystectomy. Fluid noted along the cut edge of the liver as described above.2.Asymmetric mural thickening of the rectum associated mesorectal fat stranding compatible with known rectal carcinoma and possible treatment related change.3.Enlarging perirectal and right axillary lymph nodes. |
Generate impression based on findings. | Seven-month-old male status post cardiac surgeryVIEW: Chest AP (one view) 01/14/15 Right internal jugular central venous catheter tip is at the SVC. ET tube tip is below the thoracic inlet and above the carina. Enteric tube tip is in the gastric antropyloric region. Epicardial pacing leads are unchanged. Two mediastinal chest tubes and a drainage catheter is present.Cardiothymic silhouette is unchanged. No pleural effusion or pneumothorax. Unchanged right lower lung opacity may represent atelectasis. Unchanged perihilar opacities. | Unchanged right lower lung opacity may represent atelectasis. Mild pulmonary edema. |
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. Periventricular and subcortical hypoattenuation s nonspecific but unchanged from the prior exam and likely related to mild small vessel ischemic disease of indeterminate age. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.No acute intracranial abnormality.2.Mild age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | Male, 70 years old.RFO for prolonged OR time, missing 3 rounded suture needles, per OR tech, accurate count "not possible" due to surgical complexity. Bilateral nephroureteral stents, presumed Foley catheter, and enteric tube with tip in duodenal region and sideport at level of pylorus noted. Multiple surgical clips project over the abdomen and bilateral lower extremities. No definite unexpected radioopaque foreign body seen. Findings relayed to the attending physician Dr. Milner by the oncall radiology resident at 1700 on 1/13/15. Degenerative disease affecting spine and hips. | Postoperative changes. No definite RFO seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 18 year old female, evaluate NG placement, intubated/paralyzed.VIEW: Abdomen AP (one view) 1/13/2015 No enteric feeding tube is evident. Partially imaged left lower lobe atelectasis/consolidation. The bowel gas pattern is nonobstructive and no pneumatosis intestinalis or pneumoperitoneum is seen. | No enteric feeding tube evident. Partially imaged left lower lobe atelectasis/consolidation. |
Generate impression based on findings. | 46 year old male with a productive cough and pleuritic chest pain. Previous history of sickle cell disease and pulmonary embolism. Evaluate for pneumonia and pulmonary embolism. PULMONARY ARTERIES: Limited infusion quality. No evidence of central pulmonary embolism. The main pulmonary artery is again mildly dilated and measures up to 3.6 cm suggestive of pulmonary hypertension. No evidence of right heart failure.LUNGS AND PLEURA: Minimal apical emphysema is visualized which is similar to prior. No consolidation or pleural effusion. Left upper lobe micronodule and right lower lobe scar are unchanged.MEDIASTINUM AND HILA: Mild cardiomegaly. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without cholecystitis. Hypodense right renal lesions are unchanged and likely represent renal cysts. | Limited examination secondary to suboptimal contrast opacification. Within these limitations, no pulmonary embolus to the level of the lobar arteries. Minor contrast extravasation documented in patient chart.PULMONARY EMBOLISM: PE: NegativeChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | HEAD:The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. CERVICAL SPINE:The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with a normal cervical lordosis. The vertebral body and disk space heights are well-maintained.There is no acute fracture.At C1-C2, there is a normal relationship of the dens with the arch of C1.The axial images do not demonstrate any significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis. | 1.No acute intracranial abnormality.2.No cervical spine fracture or malalignment. |
Generate impression based on findings. | Sinonasal basaloid carcinoma. Planning for chemo/RT. There are postoperative findings in related to interval resection of a sinonasal mass. There is subcentimeter nodular hyperattenuation in the olfactory recess with associated dehiscence of portions of the ethmoid roof, with possible intracranial extension of tumor. There is complete opacification of the left maxillary sinus and sphenoid sinuses. There is apparent dehiscence of the anterior aspect of the sellar floor and dehiscence of a portion of the left nasolacrimal duct. There is otherwise diffuse thickening and sclerosis of the sinus walls. There is a small retention cyst within the right maxillary sinus. There is staphylomatous deformity of the bilateral globes, which contain lens implants. | Postoperative findings in related to interval resection of a sinonasal mass with subcentimeter nodular lesion that may represent residual tumor in the olfactory recess with associated dehiscence of portions of the ethmoid roof and possible intracranial extension of tumor. Please refer to the concurrent face MRI for additional details. |
Generate impression based on findings. | 15 year old female with swelling and redness of the back after fall.VIEWS: Thoracic spine AP lateral and swimmers view (3 views) 1/13/2015 No acute fracture or malalignment evident. The vertebral body heights and intervertebral disc spaces are preserved. | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History breast carcinoma in her mother in her 80s. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 92 year-old female with altered mental status. Rule out intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Mild diffuse volume loss and prominence of the sulci, likely age-related, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminate small vessel ischemic changes.There is dilatation and slightly heterogeneous mildly hyperdense appearance of the tubular right superior ophthalmic vein, which abuts the superior rectus and superior oblique muscles, the distal right optic nerve, and the superior-medial aspect of the globe, measuring 11 x 12 mm on coronal images. No phleboliths are identified. Focal prominence of the middle portion of the left superior ophthalmic vein.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage. Age-indeterminate small vessel ischemic changes. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Significant dilatation of the right superior ophthalmic vein, most likely representing an orbital varix. Please correlate with proptosis or orbital symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsies. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A 0.4 cm asymmetry is present within the upper right breast, best visualized on the MLO view. A second 0.4 cm asymmetry is present within the central right breast on MLO views only. Asymmetric tissue is present within the left lower inner and left lateral breast, unchanged from prior examinations. No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. | Subcentimeter right breast asymmetries. Further evaluation with spot compression views and ultrasound if necessary is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Ms. Hawkins is a 78 year old female with a known history right breast cancer currently on neoadjuvant chemotherapy. She is scheduled for a lumpectomy on 1/23/2015. Three standard views of the right breast (along with an additional MLO view) 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. There has been interval decrease in the biopsy-proven malignancy in the right upper outer breast. Biopsy marker clip remains within the central aspect of this lesion. Benign vascular calcifications are noted. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | Decrease in size of known right breast cancer. Per patient, she is scheduled for a lumpectomy on 01/23/2015. She should follow up with Dr. Chhablani as warranted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 65-year-old male with 3 hernias in the past, status post surgical repair. Abdominal wall mass. Hernia versus hematoma versus other process. Blood in stool. ABDOMEN:LUNG BASES: Mild dependent atelectatic changes at the lung basesLIVER, BILIARY TRACT: Status post cholecystectomy. Minimally prominent biliary ducts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change in nonobstructing subcentimeter bilateral renal stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant normality identified.BONES, SOFT TISSUES: There is an 8.3 x 5.0 x 8.3 cm complex fluid collection in the left rectus sheath (image 47; series 4). This is indeterminate by CT but possible etiologies include complex hematoma or abscess or mass. It is not a recurrent ventral hernia.OTHER: No recurrence of ventral hernia. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Extensive diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis, most severe at the L5 -- S1 level.OTHER: Surgical clips in the scrotum bilaterally, probably from vasectomy. | New 8.3 x 5 cm complex fluid collection in the left rectus sheath. A complex hematoma would be the most likely consideration but other other etiologies including an abdominal mass are in the differential diagnosis. Consider needle aspiration for further evaluation. Findings were discussed with Sam Fuller at the time of dictation (pager 1524). |
Generate impression based on findings. | Abdominal distentionVIEW: Abdomen AP 1/14/15 NG tube tip in the stomach. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Diffuse lung haziness in the right lower lobe and left lower lobe. | Mildly dilated loops of bowel without pneumatosis or pneumoperitoneum. |
Generate impression based on findings. | T3N2c/N3 right-sided hypopharyngeal mass treated with chemotherapy. There is residual asymmetric effacement of the left piriform sinus associated with diffuse swelling in the hypopharyngeal region. However, the assessment is limited by the lack of intravenous contrast. There is no definite evidence significant cervical lymphadenopathy based on size criteria, although the assessment is also limited by the lack of intravenous contrast. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The osseous structures are unremarkable. The airways are patent. The imaged orbits and intracranial structures are grossly unremarkable. There is mild left maxillary sinus mucosal thickening. There are multiple nodules within the partially-imaged lungs. There is also pulmonary emphysema and a left apical calcified granuloma. | 1. Residual asymmetric effacement of the left piriform sinus associated with swelling in the hypopharyngeal region, which likely represents the treated tumor, although the assessment is limited by the lack of intravenous contrast. Therefore, endoscopy may be useful for further evaluation.2. No evidence of significant lymphadenopathy in the neck, although the assessment is limited by the lack of intravenous contrast. Nevertheless, correlation with endoscopy may be useful.3. Multiple nodules within the partially-imaged lungs are compatible with metastases. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | 55-day-old female, status post chest tube placement. Evaluate pleural effusion.VIEW: Chest AP (one view) 1/14/2015, 05:01 Endotracheal tube tip is above the carina and below the thoracic inlet. Enteric feeding tube tip in the body of the stomach. Left upper extremity PICC tip is in left brachiocephalic vein. Left chest tube position unchanged.Persistent soft tissue edema and subcutaneous gas collection. Increased bibasilar opacities likely reflecting pleural effusions. Cardiac silhouette size is mildly enlarged. No pneumothorax seen. | Increased bibasilar opacities suggestive of pleural effusions. Persistent subcutaneous air collection along the chest tube tract. |
Generate impression based on findings. | PainVIEWS: Right foot AP, oblique and lateral No acute fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Left knee painVIEWS: Left knee AP, lateral and oblique 1/15/15 (3 view/s) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Cough and wheeze.VIEWS: Chest AP and lateral 1/13/15 (2 view/s) Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening, large lung volumes, and flattened diaphragms. Bibasilar streaky opacities, likely subsegmental atelectasis. No effusions or pneumothorax. | Bronchiolitis pattern. |
Generate impression based on findings. | Bilious emesisVIEWS: Abdomen AP supine and upright 1/13/15 (2 view/s) Thoracolumbar dextroscoliosis and lumbar levoscoliosis as well as gastrostomy tube are noted. Generalized, nonspecific bowel distention with no evidence of obstruction or free air. | Generalized, nonspecific bowel distention. |
Generate impression based on findings. | 55-day-old female, evaluate chest tube placement. History of RDS.VIEW: Chest AP (one view) 1/13/2015, 18:58 Endotracheal tube tip is just below the thoracic inlet . Enteric feeding tube tip in the body of the stomach. Left upper extremity PICC tip is in left brachiocephalic vein. Left chest tube position unchanged.Persistent soft tissue edema and new subcutaneous gas collection at the origin of the left chest tube tract. Opacity in the left lung base improved from the prior examination. Persistent small bilateral pleural effusions. The cardiac silhouette size is mildly enlarged. | Improved left lower lobe opacity, and persistent subcutaneous air collection along the chest tube tract. |
Generate impression based on findings. | 7-month-old female with intubationVIEW: Chest AP (one view) 01/14/15 ET tube tip is below thoracic inlet and above the carina. An enteric tube and left central line are unchanged in position. An IVC stent and surgical sutures in the right upper quadrant is again noted.Cardiothymic silhouette is unchanged. Interval resolution of patchy bibasilar atelectasis. No pleural effusion or pneumothorax. | ET tube tip is below thoracic inlet and above the carina. |
Generate impression based on findings. | 10-year-old female with hypoxemia, status-post intubation.VIEW: Chest AP (one view) 1/14/2015, 03:32 Endotracheal tube tip below the thoracic inlet and above the carina. Enteric feeding tube extends out of the field-of-view. Right central line with tip at the cavoatrial junction. Patchy left lower lobe atelectasis unchanged. The cardiothymic silhouette is normal. | Persistent left lower lobe patchy atelectasis, unchanged. |
Generate impression based on findings. | IntubatedVIEW: Chest AP 1/14/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis in the right middle lobe and lingula. Bilateral small pleural effusions with no pneumothorax. | Bilateral patchy atelectasis minimally improved in the interval. |
Generate impression based on findings. | 32-year-old male with diffuse abdominal pain worse in the suprapubic area. Evaluate for spigelian hernia. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Segment 7 hypoattenuating focus most likely a cyst. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: 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: No small bowel obstruction or findings to suggest colitis. No evidence of a spegelian hernia. 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 small bowel obstruction or findings to suggest colitis. No evidence of a spegelian hernia. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of spegelian hernia as clinically questioned. 2.No acute findings to account for patient's pain. |
Generate impression based on findings. | 10 year old female with abdominal distention and emesis.VIEW: Abdomen AP (one view) 1/13/2015, 19:41 Enteric feeding tube tip in the first part of duodenum. The bowel gas pattern is nonobstructive. A moderate stool burden present in the rectosigmoid colon. No pneumatosis intestinalis or portal venous gas seen. Partially imaged left lower lobe atelectasis again seen, slightly improved from the 1/5/2015 examination. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 14-year-old male status post closed reduction of proximal tibial fracture.VIEWS: Left knee AP, notch and lateral (3 views) 1/14/2015, 01:59 There has been interval reduction and casting of the proximal tibial fracture, which is not well seen on this examination, as overlying cast material obscures fine bone detail. Alignment is near-anatomic. | Casting and reduction of the proximal tibial fracture. |
Generate impression based on findings. | Altered mental status, rule out stroke or intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminate small vessel ischemic changes. Small, hypoattenuating foci are noted within the bilateral basal ganglia and left caudate, compatible with chronic lacunar infarcts. Regions of encephalomalacia in the right superior frontal lobe and right cerebellar hemisphere likely represent chronic infarcts.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. Focal soft tissue density thickening in the left posterior parietal scalp appears contiguous with subgaleal soft tissues, with overlying reticulation of the subcutaneous fat, of uncertain etiology but possibly relating to scarring versus recent trauma. | 1. No evidence of intracranial hemorrhage. 2. Probable age-indeterminate small vessel ischemic disease. Multiple regions of encephalomalacia are compatible with chronic infarcts. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.3. Focal thickening of the left posterior parietal scalp of uncertain etiology, may represent scarring versus recent trauma. Please correlate with physical exam. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis 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. Scattered benign calcifications identified in the right 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: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 82 year old female status post right lumpectomy for invasive ductal carcinoma and with associated DCIS, in July 2014, presents today for routine follow up. Patient is currently on hormonal therapy. History of left lumpectomy in 1995 for malignancy with subsequent radiation and chemotherapy. No current breast complaints. No family history of breast cancer. Three standard views, and 3 magnification views of the right 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 linear marker has been placed in the scar overlying the upper central right breast expected underlying postsurgical architectural distortion. Stable benign calcifications are present throughout the right breast. Other stable areas of asymmetry are noted. Benign appearing lymph nodes are projected over the right axilla. | Postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 44-year-old female with rectovaginal fistula. Evaluate. ABDOMEN:LUNG BASES: Minimal bilateral basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydroureteronephrosis resulting from mass effect upon the mid to distal right ureter from pelvic mass as detailed below. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a large lobulated heterogeneously enhancing mass with epicenter at the uterus measuring approximately 18 x 12 cm (series 3, image 94) and 14 cm in the craniocaudal dimension (coronal series, image 65). While this may represent progressive fibroid uterus, further evaluation with pelvic sonography may be considered to further evaluate if clinically indicated. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Perianal and peri-labial inflammatory changes are again seen. In the location of the previously noted right gluteal cleft abscess, there are extensive inflammatory changes which may be chronic in etiology. Additionally, there are multiple regions of small fluid collections within and adjacent to the labia. None of the fluid collections are large enough for catheter drainage. Additionally, there are foci of gas within the labia on the left (series 3, image 142) with possible extension to the rectum/anus.OTHER: No significant abnormality noted | 1.Inflammatory changes and small pockets of fluid collections within the labia, none of which are large enough for catheter drainage. Additionally, gaseous focus extending within the left labia to the level of the anus raises suspicion for fistulous disease. Further evaluation with MRI may be considered.2.Large mass with epicenter at the uterus likely progressive fibroid uterus. However if there is clinical concern for underlying malignancy, further evaluation with pelvic sonography is recommended.3.Mild right hydroureteronephrosis from mass effect on the right mid to distal ureter from the pelvic mass. |
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. Scattered benign calcifications, including arterial calcifications, are seen in both breasts. 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. | 82-year-old female with pain. Left wrist: There is widening of the scapholunate interval on the grip view, suggesting ligamentous laxity or disruption. There is slight positive ulnar variance. Mild diffuse soft tissue swelling is present. There is mild to moderate basilar joint osteoarthritis. Sclerotic foci within the distal radius may represent foci of chronic bone infarctionsRight wrist: Widening of the scapholunate interval accentuated on the grip view measures up to 4 to 5 mm, suggesting ligamentous laxity or disruption. Slight positive ulnar variance is noted. Mild osteoarthritis affects the basilar joint. Diffuse soft tissue swelling is present. Sclerotic foci within the distal radius may represent foci of chronic bone infarction. | Arthritic changes and widening of the scapholunate interval suggesting ligamentous laxity/disruption as described above. |
Generate impression based on findings. | Ms. Cleaves is a 61 year old female presenting for a short term follow for calcifications in the central left breast. Three standard views of both breasts and with two left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Coarse, popcorn-like calcifications are again identified in the central left breast, compatible with a hyalinizing fibroadenoma. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Benign calcifications in the central left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History breast carcinoma in her mother at age 75. History of benign left breast aspiration. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, 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: NSA - Screening Mammogram. |
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. | There is a large left juxtasellar dural based enhancing mass extending into the widened left orbital apex, left aspect of the sella, left sphenoid sinus along the left middle cranial fossa and into left Meckel's cave. Encasement of left optic nerve and mild irregularity and narrowing of the left internal carotid artery and left middle meningeal artery appear similar to the prior exam. The proximal left optic nerve is not visualized throughout its entirety. There is stable extension of smooth dural enhancement along the anterior wall of the left internal auditory canal.The extent and size of the lesion is overall unchanged measuring 4.9 x 4.2 x 4.1 cm (15/89, 1501/220), previously 4.7 x 4.3 x 4.0 cm. A small lobulated enhancing component along the superior posterior aspect of the lesion is unchanged from the prior exam but increased in confluence of enhancement from 1/16/2013, where more heterogeneous enhancement was noted. There is unchanged local mass effect on the medial left temporal lobe, left pons, left optic chiasm, and left cranial nerves 3 through 6. The mass continues to abut the left vertebral artery and basilar artery. Adjacent vasogenic edema is unchanged.Ventricles are unchanged in size with persistent mass effect by the mass upon the floor of the third ventricle. Scattered periventricular and subcortical T2 hyperintensities are unchanged, likely minimal chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. | Left juxtasellar meningioma is unchanged in size and extent, with slight qualitative change in enhancement pattern of a small posterior lobule of the mass as compared to more remote exam of 1/16/2013. |
Generate impression based on findings. | Palpable lymph node as well as possible lesion on the PET from 2012. History of a left thyroid colloid nodule and hypophosphatemic rickets. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is a left thyroid nodule that measures up to 10 mm. The major salivary glands are unremarkable. There is an aberrant right subclavian artery. The major cervical vessels are patent. There appears to be diffuse osteopenia. The airways are patent. The imaged orbits are unremarkable. There is a partially-empty sella. There is mild mucosal thickening within the maxillary sinuses. There is a partially-imaged cavity lesion or bronchiectasis in the left lower lobe. | 1. No evidence of significant cervical lymphadenopathy based on size criteria. 2. A left thyroid nodule that measures up to 10 mm likely corresponds to the previously biopsied colloid nodule.3. Partially-imaged cavity lesion or bronchiectasis in the left lower lobe. Please refer to the separate chest CT report for additional details.4. Nonspecific partially-empty sella. 5. Apparent diffuse osteopenia may be related to hypophosphatemic rickets. |
Generate impression based on findings. | TachypneaVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast excisional biopsy. Two standard digital views of both breasts were performed with tomosynthesis 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. Scattered benign calcifications are present. 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: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal great aunt and paternal great aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications are seen in both breasts. 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: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | PainVIEWS: Right knee AP, oblique and lateral No acute fracture or dislocation. No knee joint effusion. There is a fibrous cortical defect at the posterior aspect of the distal femur. | No acute fracture or dislocation. |
Generate impression based on findings. | 48-year-old female with extremely tender abdomen and history of gastric lap band. Evaluate for hernia, pancreatitis, perforated visceral organ. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty liver with no focal lesions. No CT findings to suggest cholecystitis. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: 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: Small fat containing anterior abdominal wall hernia without evidence of small bowel obstruction. Gastric lap band in appropriate position with reservoir in the left upper abdominal wall soft tissues.BONES, SOFT TISSUES: No significant abnormality.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No acute findings to account for patient's pain. 2.Gastric lap band in appropriate position. 3.Diffuse fatty liver. |
Generate impression based on findings. | 71-year-old male with pain, trauma one week ago. Three views of the right ankle show diffuse soft tissue swelling but we see no underlying fracture or malalignment. | Soft tissue swelling without fracture or malalignment. |
Generate impression based on findings. | 73 year old female who has biopsy proven left breast invasive ductal carcinoma and DCIS on neoadjuvant letrozole. A history poorly differentiated squamous cell carcinoma of the right lung. No new breast related complaints. Family history of breast carcinoma in her mother. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of a Hydromark clip within the posterior central outer left breast with vague adjacent asymmetry. This finding is not significantly changed from prior examination. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | Stable asymmetry which contains a Hydromark clip at the 3 o'clock position of the left breast, corresponding to the patient's known left breast malignancy. Left unilateral diagnostic mammogram is suggested in 6 months. Results and recommendation were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother. Two standard digital views and tomosynthesis 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. There are multiple circumscribed masses of varying sizes seen in both breasts, several of which have been previously identified as simple cysts on prior ultrasounds. However, there are two new masses seen in the central right breast, posterior depth. No suspicious microcalcifications or areas of architectural distortion are present. | Two new masses in the central right breast, posterior depth. Additional imaging, including spot compression views and possible ultrasound, is recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Concern for cirrhosis. Elevated INR and synthetic dysfunction. Study was limited secondary to bowel gasLIVER: The liver measures 13.4cm in length. Echotexture is mildly complex. There are two near anechoic nodules with posterior acoustic enhancement which probably represent cysts. The larger measures 2.6 cm and is located in the right lobe. No intrahepatic biliary ductal dilatation. The portal is patent with flow towards the liver and color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 10 cm in length and left kidney measures 11.4 cm in length.OTHER: Spleen measures 13.6 cm in length. Bilateral pleural effusions | Bilateral pleural effusions. Right hepatic cysts. Mild splenomegaly. |
Generate impression based on findings. | Female; 57 years old. Reason: COPD Lung Transplant Evaluation History: SOB LUNGS AND PLEURA: Moderate predominantly upper lobe centrilobular emphysema. Minimal bibasilar subsegmental atelectasis. Scattered pulmonary micronodules are stable. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Prominent mediastinal and bilateral hilar lymph nodes, which are nonspecific. The largest in the precarinal space measures up to 15 mm in short axis (image 38, series 3). Normal heart size without pericardial effusion. No visible atherosclerotic calcifications of the coronary arteries.CHEST WALL: Prominent axillary lymph nodes, which are nonspecific. Small sclerotic focus in the T6 vertebral body is stable, most likely benign in the absence of known primary cancer.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Moderate predominantly upper lobe centrilobular emphysema. |
Generate impression based on findings. | NG placementVIEW: Abdomen AP NG tube tip in the stomach. Right femoral line in place. Mildly dilated loops of bowel in the right lower quadrant without obstruction. No pneumatosis or pneumoperitoneum. | NG tube tip in the stomach. |
Generate impression based on findings. | Hepatitis C. Assess liver contour rule-out HCC. LIVER: The liver measures 14.4 cm in length. Its minimally echogenic. No focal lesions. The portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length and the left kidney measures 9.6 cm in length. No hydronephrosis.OTHER: The spleen measures 10 cm in length. | Slightly echogenic liver which may reflect underlying hepatitis C. No focal liver lesions. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of ovarian or uterine cancer in sister. Personal history of benign breast biopsy. 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. Three focal asymmetries are identified in the central to inferior right breast (best seen on the MLO view). No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. | Multiple focal asymmetries in the central to inferior right breast. An attempt to obtain patient's prior mammograms should be made first. If not possible, then additional imaging including spot compression views and possible ultrasound, is recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | 15-year-old male with right big toe pain, status post injury. Rule out fracture.VIEWS: Right foot AP oblique and lateral (3 views) 1/13/2015 There is a probable nondisplaced obliquely oriented fracture along the lateral aspect of the distal first phalanx. The bones appear demineralized. | Probable nondisplaced obliquely oriented fracture along the lateral aspect of the distal first phalanx |
Generate impression based on findings. | 80 year-old male with chronic right hip pain. Two views of the right hip demonstrate severe osteoarthritis. There is sclerosis and flattening of the superior femoral head suggesting underlying avascular necrosis.An AP view the pelvis shows the aforementioned osteoarthritis of the right hip. There is relatively mild osteoarthritis affecting the left hip. Mild degenerative changes affect the lower lumbar spine. The bones appear slightly demineralized. | Severe osteoarthritis of the right hip and other findings as described above. |
Generate impression based on findings. | Ms. Khan is a 64 year old female with a personal history of right breast lumpectomy in 2010 for IDC followed by chemoradiation therapy. Three standard views of both breasts along with a laterally exaggerated right CC view and two right spot compression views 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 linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also identified in the right axilla. Focal asymmetry in the right superior breast, anterior to the lumpectomy site, disperses into normal breast parenchyma on spot compression views. Right retroareolar calcified fat necrosis is stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over both axillae. | Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: 77 yo with cardiac disease, progressive dysphagia over past 1-2 weeks. Requesting esophagram for evaluation History: abdominal pain, dysphagia; gastric bypass ~20 years ago Scout radiography of the chest unremarkable.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormality. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild dysmotility with proximal escape. Mild dilatation of the small bowel distal to the gastrojejunal anastomosis was noted, of unclear clinical significance and may be postoperative in etiology. The gastrojejunal anastomosis is patent and contrast is seen beyond the expected level of the jejunojejunal anastomosis. Barium pill traversed the gastroesophageal junction with sips of water.TOTAL FLUOROSCOPY TIME: 4:23 minutes | 1.Mild esophageal dysmotility with proximal escape as above. |
Generate impression based on findings. | Reason: please evaluate for j tube placement with contrast in j tube and small bowel follow through History: abdominal pain, j tube in place, please use water soluble contrast. Scout radiograph showed a nonobstructive bowel gas pattern. IVC filter noted. There was prompt normal opacification of the jejunum following the instilling of water soluble contrast via the patient's J-tube overlying the mid abdomen. There was no abnormal contrast extravasation to suggest a leak. Nonobstructive bowel gas pattern.TOTAL FLUOROSCOPY TIME: 2:18 minutes | Satisfactory jejunostomy tube positioning, no leak. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in her sister and paternal grandmother. Two standard digital views of both breasts were performed with tomosynthesis 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. There is stable focal asymmetry left retroareolar region. | 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. | 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. An asymmetry in the right upper breast is unchanged when compared to examination dated December 23, 2009. | 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; 64 years old. Reason: 64 y/o f with h/o RLL lobectomy 6/2014 for adenocancer, please follow-up for cancer recurrence. History: see above LUNGS AND PLEURA: Postsurgical findings consistent with right lower lobectomy. Interval decreased right pleural effusion and pleural thickening. Small residual effusion is seen at the right posterior costophrenic angle.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mild coronary artery calcifications. Stable small right paratracheal and cardiophrenic lymph nodes. No pathologically enlarged mediastinal or hilar lymph nodes.CHEST WALL: Interval resolution of right anterior chest walls the pectoral hematoma. No pathologically enlarged axillary lymph nodes. T6 vertebral body hemangioma is unchanged. Mild multilevel degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Interval decreased right pleural effusion and pleural thickening.2. No evidence of residual/recurrent or metastatic disease. |
Generate impression based on findings. | CLINICAL DATA: Age: 57 years. Sex : Male. Indication: Reason: Concern for intra- abdominal abscess History: Concern for intra- abdominal abscess. LUNG BASES: Minimal bibasilar atelectasis, similar to prior. No significant pleural effusion.LIVER, BILIARY TRACT: Postoperative findings of orthotopic liver transplant are again noted. Hepatic vasculature is grossly patent. Interval increase in the intrahepatic loculated fluid collection, currently measuring approximately 7.7 x 4.3 cm in the largest pocket, but spanning along the posterior margin of most of the liver. A left upper quadrant percutaneous drain is coiled superficially, and is not positioned to drain this fluid collection.SPLEEN: Nonspecific hypoattenuation in the spleen a similar prior collimated related to an infarct.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: G. J. tube in expected location.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant amount noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small loculated left anterior pelvis fluid collection (3/134) measures 17 x 11 mm, decreased from 24 x 18 mm. | 1.Increased intrahepatic loculated fluid collection, and at the percutaneous left upper quadrant drain is not positioned for optimal drainage. Findings discussed with GI service.2.Postoperative findings of orthotopic liver transplant. |
Generate impression based on findings. | 14-year-old male with left upper tibial pain, fracture versus dislocation.VIEWS: Left tibia/fibula AP and lateral (two views) left ankle AP and lateral (two views) and left knee AP and lateral (two views) 1/14/2015 KNEE: There is a complex minimally displaced fracture through the tibial metaphysis, likely involving the physis. Partially imaged joint effusion seen.TIBIA/FIBULA: The aforementioned tibial metaphyseal fracture is again seen. No additional fracture or malalignment evident.ANKLE: No acute fracture or malalignment. | Tibial metaphyseal fracture as above. |
Generate impression based on findings. | 61-year-old female with history of multiple myeloma, pre-stem cell transplant evaluation. SKULL: Several subcentimeter poorly defined lucencies in the calvarium may represent myelomatous deposits.CERVICAL SPINE: No discrete myelomatous lesions. Degenerative disk disease affects C5-6 and C6-7.THORACIC SPINE: No discrete myelomatous lesions. Vertebral body heights are preserved. LUMBAR SPINE: No discrete myelomatous lesions. Coarsened vertically oriented trabeculae in the L2 vertebral body likely represents a hemangioma. Moderate facet joint osteoarthritis affects the lower lumbar spine.RIBS: No discrete myelomatous lesions. Right chest port with tip overlying the right atrium.PELVIS: No discrete myelomatous lesions.UPPER EXTREMITY: Poorly defined 1 cm lucencies in the right and left humeral heads may simply represent pseudo-lesions rather than true myelomatous deposits.LOWER EXTREMITY: No discrete myelomatous lesions. | Subcentimeter lucent lesions in the skull may represent myelomatous deposits. We see no other definite myelomatous lesions. Degenerative arthritic changes and other findings as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Scattered benign calcifications are seen in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Physical examination is of increased importance for patients with dense breasts. As long as the patient's physical examination remains unremarkable, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Male; 46 years old. Reason: smoker with HIV and recent positive Quantiferon and mild cough. CXR normal. Please eval for nodule or evidence of active TB. History: see above LUNGS AND PLEURA: A flat 4-mm nodule along the horizontal fissure is compatible with an intrapulmonary lymph node (coronal image 72, series 80212). No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible atherosclerotic calcifications of the coronary arteries.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Examination within normal limits. No evidence of infection. |
Generate impression based on findings. | 15-year-old male status post gunshot wound in August, evaluate for any intra-abdominal abnormalities.VIEW: Abdomen AP (one view) 1/13/2015 Multiple metallic fragments project over the left upper quadrant, consistent with bullet fragments. The bowel gas pattern is nonobstructive. No portal venous gas or pneumatosis intestinalis is evident. | Bullet fragments projecting over the left upper quadrant. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 9 year old male with HLH, hyperammonenia, and altered mental status. There is intraventricular hemorrhage within the dependent occipital horns as well as within the interpeduncular cistern, anterior suprasellar cistern, and left sylvian fissure. There is thin hyperdensity likely representing subdural blood products along the tentorium bilaterally. There is mild temporal horn dilatation bilaterally.There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is fluid within the bilateral mastoid air cells as well as mucosal thickening secretions within the paranasal sinuses. | 1.Mild scattered subarachnoid and bilateral occipital horn intraventricular hemorrhage and tentorial subdural hematoma with suspected mild developing hydrocephalus. These findings may be secondary to cyclosporin toxicity or the patient's coagulopathy. Follow-up imaging is recommended. 2.No CT stigmata of HLH, although MRI is more sensitive.3.Paranasal sinus and mastoid air cell fluid bilaterally is suspicious in an immunocompromised patient. Please correlate clinically.Findings discussed with Dr. Sokol by Dr. Mike Rozenfeld at 10:00am on 1/14/15. |
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