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Generate impression based on findings. | Screen for HCC. Hepatitis C virus. LIVER: The liver measures 14.4 cm in length. Its mildly echogenic compatible with underlying hepatitis C infection. 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: No hydronephrosis of either kidney. The right kidney measures 10.9 cm in length and the left kidney measures 10.3 cm in length. OTHER: The spleen measures 7.7 cm in length. | Mildly echogenic liver. No focal liver lesions. |
Generate impression based on findings. | Chronic lymphoid leukemia. There is no evidence of significant cervical lymphadenopathy. The Waldeyer ring structures are not enlarged. The airways are patent. The major salivary glands and thyroid are unremarkable. There is mild plaque in the carotid bifurcations. There is mild multilevel degenerative spondylosis. There is partial fusion of the left first and second ribs. The partially imaged intracranial structures are grossly unremarkable. There is persistent retention cyst formation and mucosal thickening within the bilateral maxillary sinuses. | No evidence of significant cervical lymphadenopathy to suggest recurrent leukemia. |
Generate impression based on findings. | Anemia, unspecified. Palpable liver on examination. Evaluate for liver or spleen enlargement. LIVER: The liver measures 15.6 cm in length. There are multiple near anechoic nodules which probably represent cysts although at least one is septated with a possible mural nodule making it indeterminate on ultrasound. This one measures 1.7 x 2 x 1.8 cm and is located in the right lobe. The portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Gallbladder sludge noted. No wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 9.4 cm and the left kidney measures 11.9 cm.OTHER: The spleen measures 10.2 cm. | Indeterminate cystic lesion in the right lobe of the liver measuring 2 cm in diameter. This could represent a benign septated cyst although the possibility of a complex cystic lesion with a mural nodule exists; therefore, further evaluation with cross-sectional imaging (dedicated liver CT or MRI) is suggested for more definitive for evaluation as clinically indicated. No evidence of hepatomegaly or splenomegaly as clinically queried. |
Generate impression based on findings. | T4aN2b squamous cell cancer of the anterior floor of mouth, completed chemoradiation in November 2011, mandibular debridement postoperatively, and stereotactic radiation for 4 metastatic sites in the lungs completed in March of 2013. There are stable post-treatment findings in the neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and remaining salivary glands are unremarkable. The are calcifications with moderate narrowing of the right proximal internal carotid artery. There is multilevel degenerative cervical spondylosis, which is most pronounced at C5-6. There is fusion of the posterior left first and second ribs. The airways are patent. The imaged intracranial structures are unremarkable. There are emphysematous changes in the lungs. | 1.Stable post-treatment findings in the neck without evidence of measurable locoregional tumor recurrence.2.No significant cervical lymphadenopathy by size criteria.3.Moderate narrowing of the right proximal internal carotid artery. |
Generate impression based on findings. | Renal stones. RIGHT KIDNEY: The right kidney measures 11.3 cm in length and remains mildly echogenic. No hydronephrosis. Multiple small calculi that are not obstructive.LEFT KIDNEY: The left kidney measures 11.7 cm in length and remains mildly echogenic. Minimal pelvocaliectasis with cortical thinning as noted previously. Multiple non-obstructing calculi at the lower pole also noted.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted. | Bilateral nonobstructive renal calculi. Unchanged mildly echogenic kidneys. |
Generate impression based on findings. | 64-year-old female status post lumbar fusion There are posterior stabilization rods with screws entering the L4 and L5 vertebral bodies. A disk spacer device is noted at L4/L5. The bone graft appears slightly more dense, although there is no frank interbody fusion. There is grade 1 anterolisthesis of L4 on L5, appearing similar to the prior exam. Degenerative disk disease affects the remaining lumbar spine, similar to the prior exam. A slight leftward curvature of the lumbar spine is noted. | Postoperative changes of lower lumbar fusion as described above. |
Generate impression based on findings. | 56-year-old female with bilateral knee osteoarthritis and pain Right knee: Moderate to severe osteoarthritis particularly affects the lateral tibiofemoral joint compartment, appearing similar to the prior exam. The bones are demineralized suggesting osteopenia.Left knee: Moderate to severe osteoarthritis particularly affects the lateral tibiofemoral joint compartment, appearing similar to the prior exam. The bones are demineralized suggesting osteopenia. | Osteoarthritis, as described above. |
Generate impression based on findings. | 70 year-old female with pain Right knee: Moderate osteoarthritis affects the knee with narrowing of the medial tibiofemoral joint compartment seen particularly on the skiers view. An ossicle along the proximal aspect of the medial femoral condyle is likely due to old injury to the MCL.Left knee: Moderate to severe osteoarthritis affects the knee with near bone-on-bone apposition of the medial joint compartment seen particularly on the skiers view. | Osteoarthritis as described above. |
Generate impression based on findings. | Testicular carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: 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 | Stable examination. No acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign left breast biopsy in 1992. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the left medial breast is stable. Scattered benign calcifications, including arterial calcifications, are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable left focal asymmetry. 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. | 39 year-old female 6 weeks status post TKA Hardware components of a right total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Anterior soft tissue swelling limits evaluation of the patella tendon. Postoperative changes of ACL reconstruction are noted in the left knee as seen on the frontal view. | TKA as described above. |
Generate impression based on findings. | Reason: 71-year-old male with history of SDH and intraparenchymal hemorrhage in 11/2014. Now restarted on ASA and anticoagulation. Please assess for bleeding. No evidence of new/acute intracranial hemorrhage, mass effect or midline shift.Stable appearance of encephalomalacia along the right middle frontal gyrus and right precentral gyrus, compatible with chronic infarction.The site of previous intraparenchymal hematoma in the left inferior frontal lobe appears stable, measuring approximately 24 x 27 mm. There is redemonstration of adjacent periventricular white matter hypodensity. The overlying subdural collection measures approximately 4 mm and appears minimally less dense.Unchanged appearance of punctate hypodensity in the posterior limb of the left internal capsule.Atherosclerotic calcifications are again noted in the distal internal carotid arteries.Stable appearance of mild opacity in the anterior right maxillary sinus. There is underpneumatization of the bilateral mastoid air cells. A small amount of fluid is present in the right aditus ad antrum. The calvarium is intact. There is persistent proptosis. | 1. No evidence of new intracranial hemorrhage or mass effect. Stable appearance of resolving left frontal lobe intraparenchymal hematoma and adjacent small subdural collection.2. Stable right frontal encephalomalacia, likely representing chronic infarct. |
Generate impression based on findings. | 65-year-old male with left lower extremity pain, history of multiple myeloma, rule out fracture Lumbar spine: The bones are demineralized, which may reflect osteopenia/osteoporosis or underlying multiple myeloma. Compression fractures of the L1, L2, and L4 vertebral bodies appear similar to the prior osseous survey dated 6/27/14. Severe degenerative disk disease affects L5/S1 with findings suggestive of L5 spondylolysis. Compression fractures of the T10, T11, and T12 vertebral bodies with cement within the T11 and T12 vertebral bodies are also again noted. Surgical clips in the right upper quadrant are likely from prior cholecystectomy.Pelvis, hip and femur: We see no acute fracture. The hip joint is within normal limits. There are poorly defined, mottled lucencies within the pelvis and proximal femurs compatible with myelomatous involvement, with a larger, more discrete lesion in the left ilium that appears similar to the prior study. | Findings compatible with multiple myeloma and vertebral body compression fractures as described above. We see no acute fracture. |
Generate impression based on findings. | Ms. Meek is a 48 year old female with a personal history of right breast mastectomy in September 2014 for IDC followed by chemotherapy. Three standard views of the left breast with an additional left 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 is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. A vascular port overlies the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 63-year-old female status post intramedullary rod placement for left humerus pathologic fracture Again seen is an intramedullary rod and screw device affixing a pathologic fracture through a lytic lesion of the proximal humeral diaphysis in near-anatomic alignment. Increased bone formation along the medial aspect of the lesion suggests an attempt at healing. No hardware complications are evident. | Orthopedic fixation of pathologic fracture of the proximal humerus as described above. |
Generate impression based on findings. | CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified. Bibasilar subsegmental atelectasis/scarring, without pleural effusions.MEDIASTINUM AND HILA: Heart size within normal limits comment no pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications.CHEST WALL: Mild degenerative changes affect the spine.ABDOMEN:LIVER, BILIARY TRACT: No biliary dilatation, and no appreciable hepatic masses.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Minimal left adrenal nodularity, nonspecific.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No small bowel obstruction or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No suspicious masses or findings of metastatic disease. |
Generate impression based on findings. | Reason: s/p gastric bypass 11/2014, evaluate for stenosis History: nausea/vomiting Scout radiography unremarkable, nonobstructive bowel gas pattern, IUD present.Postsurgical changes related to gastric bypass seen. Contrast was seen beyond the gastrojejunal anastomosis and expected location of the jejunojejunal anastomosis, transit time was normal. There was at least two episodes of unprovoked reflux, to the level of mid esophagus, while the patient was in the upright position. Reported ulcer near the gastrojejunal anastomosis was not well delineated. TOTAL FLUOROSCOPY TIME: 3:14 minutes | 1.Normal gastric bypass anatomy without evidence of significant stenosis or obstruction. 2.Unprovoked esophageal reflux.3. |
Generate impression based on findings. | 70-year-old female with pain, suspected osteoarthritis The lower cervicothoracic spine is not well seen on the lateral view due to overlying anatomy. Moderate degenerative disk disease affects C5/6. There are anterior vertebral body osteophytes at C3, C4, and C5. Moderate multilevel facet joint osteoarthritis is noted. There is left C4/5 and C5/6 neuroforaminal narrowing, as well as right C5/6 neuroforaminal narrowing. Note is made of impacted molars. Surgical clips project over the neck. | Degenerative disk disease/osteoarthritis and other findings as described above. |
Generate impression based on findings. | 41 year-old female with pain, evaluate navicular fracture. Three views of the right foot show a 5-mm crescentic ossicle along the dorsal navicular representing a minimally displaced avulsion fracture. Ossicles overlying the anterior recess of the tibiotalar joint likely represent loose bodies. | Navicular avulsion fracture and loose bodies in the tibiotalar joint. |
Generate impression based on findings. | Reason: S/p laparoscopic IPAA handsewn in September 2014. Please evaluate to see if pouch is healed. Take down tomorrow. History: UC There is prompt opacification of the J-pouch.Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed appropriate passage of intraluminal contents. No abnormal contrast extravasation seen to suggest a leak. There was small residual on postevacuation. | Evaluation of J-pouch demonstrated no leak. |
Generate impression based on findings. | 11 year old male status post kidney transplant, graft monitoring. RENAL TRANSPLANT: Appropriate renal cortical echogenicity. No perinephric fluid collection. LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedCOLLECTING SYSTEM/URETER: There is grade 1 hydronephrosis.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. The resistive indices of the renal artery range from 0.6 to 0.7 with a peak systolic velocity of 1.6 m/sec at the level of the anastomosis. The renal artery wave forms demonstrate continuous diastolic flow and sharp upstroke. The arcuate arteries at the upper, mid and lower pole have resistive indices ranging from 0.5 to 0.6 with wave forms demonstrating sharp upstrokes and continuous diastolic flow. The renal veins are patent.OTHER: No significant abnormality noted | Patent renal vasculature. |
Generate impression based on findings. | 10-month-old female not move arms symmetrical left arm limited range of motionVIEWS: Left shoulder, right shoulder, internal and external rotation (4 views); Left clavicle, right clavicle AP/axial (4 views) 1/14/2015 Right shoulder: No fracture or malalignment is evident.Left shoulder: No fracture or malalignment is evident.Right clavicle: No fracture or malalignment is evident.Left clavicle: No fracture or malalignment is evident. | Normal examination. |
Generate impression based on findings. | 62-year-old male with history of relapsed CLL on treatment regimen. Evaluate disease status. CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule measures 1.0 x 1.1 cm (series 4, image 70), unchanged. No new suspicious nodules or masses. Scattered micronodules are again noted. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significant change in the mild mediastinal adenopathy. Reference pretracheal node measures 0.8 x 0.7 cm (series 3, image 41), previously measuring 0.9 x 0.6 cm. Reference pre-esophageal node measures 0.7 x 0.6 cm (series 3, image 39), previously measuring 0.8 x 0.6 cm.CHEST WALL: Reference right axillary lymph node measures 0.7 x 0.7 cm (series 3, image 36), previously measuring 0.8 x 0.6 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in retroperitoneal lymphadenopathy. Reference lymph node measures 0.9 x 0.6 cm (series 3, image 127), previously measuring 1.2 x 1.9 cm. Mild atherosclerotic calcifications affect the abdominal aorta.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: Reference calcified left obturator lymph node measures 1.1 x 1.0 cm (series 3, image 181), previously measuring 1.3 x 1.1 cm. BOWEL, MESENTERY: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Surgical clips in the left inguinal region.OTHER: No significant abnormality noted | 1.No significant interval change in reference lymph nodes. 2.No evidence of new disease. |
Generate impression based on findings. | Female 35 years old Reason: 35F with CD s/p total proctocolectomy with end ileostomy c/b recurrent intraabdominal abscesses s/p IR drainage with evidence of partial SBO on recent imaging. Not progressing with diet, continues to have lower abdominal pain. History: s/p total proctocolecotmy with end ileostomy c/b abscess s/p IR drain. Ongoing abdominal pain and inability to advance diet. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated compressive atelectasis. The right pleural effusion is slightly larger compared to prior.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. New moderate volume perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in the bilateral renal parenchyma are too small to characterize, but likely benign in etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As noted previously, there are multiple areas of small bowel distention in the upper abdomen which is not changed substantially BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal ascites has resolved.PELVIS:UTERUS, ADNEXA: Fluid collection along the left adnexa likely reflects ascites; however, this collection could be adnexal in etiology. It is unchanged compared to priorBLADDER: There is a Foley catheter in place.LYMPH NODES: Several slightly prominent pelvic lymph nodes are stable.BOWEL, MESENTERY: Multiple areas of small bowel dilation as described above and previously. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Previously described presacral fluid collection has nearly completely resolved after percutaneous trans-gluteal abscess drainage. The pigtail catheter remains in place. Persistent fluid in the region of the left adnexa unchanged | 1.Multiple dilated loops of small bowel predominating in the upper abdomen presumably representing a mechanical small bowel obstruction which has been described in detail previously and appears stable.2.Resolution of abdominal ascites3. Enlarging right pleural effusion. Stable left pleural effusion |
Generate impression based on findings. | Ms. Cooney is a 67 year old female with a personal history of left breast mastectomy in 2008 for IDC followed by implant-based reconstruction and chemotherapy. She also had a right breast reduction and benign right breast biopsy. Three standard 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. Biopsy clip is identified in the right medial breast, at site of prior benign biopsy. Scattered benign calcifications and expected postsurgical changes from prior breast reduction are present. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral 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. | 54-year-old male with knee pain. Preoperative examination. Mechanical axis radiograph of the right lower extremity demonstrates moderate-severe osteoarthritis affecting the right knee with approximately 5 degrees of varus angulation relative to the neutral mechanical axis. Severe osteoarthritis affects the right hip. There is soft tissue swelling about the leg and ankle. | Osteoarthritis and varus deformity of the knee. |
Generate impression based on findings. | Five year old female with history of neuroblastoma. Off therapy. CHEST:LUNGS AND PLEURA: Lingular pinpoint densities are nonspecific and of uncertain significance.MEDIASTINUM AND HILA: The heart size is normal. There is no evidence of mediastinal or hilar lymphadenopathy on the basis of size criteria.CHEST WALL: There is no evidence of axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. Numerous surgical clips are seen distributed throughout the retroperitoneum compatible with prior lymph node dissection. Previously described soft tissue thickening anterior to the L1 vertebral body appears similar to the prior examination (image 59, series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic foci are again identified in the bilateral proximal femurs and sclerotic and lytic lesions are again identified in the pelvis. These lesions appear similar to the prior examination.OTHER: 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: Sclerotic foci are again identified in the bilateral proximal femurs and sclerotic and lytic lesions are again identified in the pelvis. These lesions appear similar to the prior examination.OTHER: No significant abnormality noted | 1.Soft tissue prominence anterior to the L1 vertebral body, without significant interval change dating back to 1/29/2014.2.Pinpoint densities in the lingula are nonspecific and of uncertain significance. |
Generate impression based on findings. | 65 year-old female with metastatic breast cancer and chronic subdural hematoma, evaluate for progression. There is no evidence of acute intracranial hemorrhage. Redemonstration of right cerebral convexity subdural fluid collection, again measuring up to 6 mm in thickness in at least one area, but overall significantly improved. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is no significant midline shift. There is redemonstration of postoperative findings related to previous left parieto-occipital craniotomy, as well as regions of hypodensity in the right cerebellum, consistent with known metastases. Encephalomalacia within the left cerebellar hemisphere likely represents a chronic infarct.Mucosal thickening of the bilateral ethmoid and inferior maxillary sinuses. The mastoid air cells are clear. The skull and extracranial soft tissues are unchanged. | 1. No evidence of new/acute intracranial hemorrhage.2. Redemonstration of right subdural fluid collection, which appears to be resolving.3. Stable appearance of postoperative findings related to left parieto-occipital craniotomy. |
Generate impression based on findings. | There are postsurgical changes of right frontal and temporal craniotomy from prior meningioma resection appearing similar to the prior exam. No evidence of tumor recurrence. Small foci of susceptibility in the region of the resection cavity appear similar to the prior exam and likely represent microhemorrhage secondary to the resection. Bony hyperostosis along the floor of the right anterior cranial fossa and right sphenoid wing appears similar to the prior exam. Increased T2 signal surrounding the surgical cavity is similar to the prior exam, likely reflecting gliosis and encephalomalacia.Punctate T2 hyperintensities in the left peri-ventricular and subcortical white matter are unchanged and nonspecific. Ventricles are unchanged with ex vacuo dilatation of the right frontal horn. No extra axial fluid collection. No diffusion restriction. No new abnormal enhancement. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Postsurgical changes of meningioma resection without evidence of recurrence. |
Generate impression based on findings. | 10 year old female status post PICC placement.VIEW: Chest AP (one view) 1/14/2015, 10:50 Endotracheal tube tip below the thoracic inlet and above the carina. Left upper extremity PICC with tip at the level of the tricuspid valve. 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. | Left upper extremity PICC with tip at the tricuspid valve, retraction recommended. Persistent left lower lobe patchy atelectasis, unchanged. |
Generate impression based on findings. | Female; 65 years old. Reason: h/o HNC and Chemo, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Reference right lower lobe mass superiorly extending from the pleural surface to the right hilum measures 5.5 x 4.6 x 7.5 cm (image 53, series 4 and coronal image 42, series 80216), slightly decreased since prior study when it measured 6.5 x 4.8 x 7.7 cm. Reference right lower lobe mass posteromedially measures 2.8 x 2.6 cm (image 65, series 4), slightly decreased since prior study when it measured 3.1 x 3.3 cm. Both masses demonstrate central bronchiectatic airways. Patchy nonspecific opacities surrounding both masses have slightly decreased.Reference left lower lobe mass medially measures 3.5 x 3.5 cm in length (image 68, series 3), previously 3.7 x 3.5 cm and not significantly changed. Reference left apical spiculated nodule measures 2 x 1 cm, previously 2.1 x 1 cm and not significantly changed (image 8, series 4).Additional bilateral apical and upper lobe nodules have slightly increased. For future reference, a left upper lobe nodule measures 13 mm, previously 9 mm (image 27, series 4). A right upper lobe subpleural nodule measures 13 mm, previously 11 mm (image 28, series 4). A small left posterior costophrenic angle subpleural nodule has slightly increased as well (image 74, series 4).Upper lobe predominant centrilobular emphysema. Trace right pleural effusion.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 14 mm (image 35, series 3), slightly decreased since prior study when it measured 20 mm. Stable calcified prevascular lymph nodes, likely from prior granulomatous disease. Normal heart size with small pericardial effusion, similar to prior study. Right chest Port-A-Cath tip in SVC.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered tiny hepatic hypoattenuating lesions are too small to characterize.SPLEEN: Scattered calcifications, likely from prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral hypoattenuating lesions, most like representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild aortic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tube in place.BONES, SOFT TISSUES: Degenerative arthritic changes of the lumbar spine.OTHER: No significant abnormality noted. | 1. Mixed response to multiple bilateral pulmonary masses and nodules, as detailed above.2. Slightly decreased mediastinal lymphadenopathy. |
Generate impression based on findings. | 38-year-old female with history of multiple endocrine tumors. Evaluate for changes. CHEST:LUNGS AND PLEURA: Scattered stable nonspecific pulmonary micronodules. No masses, no consolidation and no pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. No appreciable coronary artery calcifications. No mediastinal lymphadenopathy. Left hilar lymph node, unchanged in size. Thyroid metallic clips are again seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference liver dome lesion (7/82) is unchanged in size, measuring 3.7 x 5.4 cm.Reference segment 7 liver lesion (7/87) is unchanged in size, measuring 4 x 2.7 cm.Hypoattenuating segment 6 lesion (7/106) is unchanged in size when using the same measurement technique, 9 mm.No new enhancing hepatic lesions, and there are persistent coarse parenchymal calcifications.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic atrophy, and postoperative findings of partial pancreatectomy, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate right renal pelvis hyperattenuating focus, may represent a nonobstructing stone. Accessory right renal artery.RETROPERITONEUM, LYMPH NODES: A soft tissue density nodule at the pancreatic tail (7/108) is unchanged in size, measuring 1.2 x 1 cm and may be a peripancreatic lymph node.BOWEL, MESENTERY: Postoperative findings of prior omentectomy, unchanged. Several foci of nodular omentum, consistent with neoplastic involvement, unchanged.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. | Unchanged reference lesion measurements. No new findings of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple benign morphology masses are present bilaterally, unchanged. No new 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: NSB - Screening Mammogram. |
Generate impression based on findings. | 19-year-old male with nocturnal emesis, evaluate for constipationVIEW: Abdomen AP (one view) 01/14/15 Nonobstructive bowel gas pattern. Normal stool burden. No evidence of obstruction or ileus. | Normal stool burden. |
Generate impression based on findings. | Worsening cough, check for progressing pneumonia or hemorrhage LUNGS AND PLEURA: Essentially unchanged biapical scarring with relative decreasing appearance and more linear structure to the right upper lobe nodular opacity (image 33 series 4), again supporting a resolving infectious process. Patchy areas of bilateral basilar minimal consolidation makes a tree in bud opacities again suggests aspiration and less pronounced in shifting when compared to prior studies. Of note however are two new pleural effusions, mild to moderate in size and greater on the left. Associated compression atelectasis. Persistent diffuse and bilateral bronchial wall thickening.MEDIASTINUM AND HILA: No discrete lymphadenopathy.The cardiac and paracardial remain within limits other than moderate coronary calcifications, specifically near the takeoff of the left coronary.CHEST WALL: Right chest port unchangedUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Extensive new moderate to marked ascites incompletely visualized. The remainder of the visualized upper abdomen was limited yet grossly clear of new findings | Marked interval increasing effusions and abdominal ascites with underlying compression changes the lung bases. Additional findings suggesting aspiration without a discrete focal pulmonary process or specific findings to suggest a discrete infection. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in a maternal aunt. 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. Small bilateral circumscribed masses are again present, unchanged. Numerous benign morphology calcifications are present bilaterally. No new 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: NSB - Screening Mammogram. |
Generate impression based on findings. | 23 year-old female with Hodgkin's lymphoma status post chemotherapy in June 2014. Evaluate disease status. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Continued interval decrease in supraclavicular and hilar lymphadenopathy. Reference supraclavicular lymph node measures 1.2 x 0.6 cm (series 3, image 16), previously measuring 1.2 x 1.2 cm. Reference right hilar lymph node measures 1.3 x 1.3 cm (series 3, image 33), previously measuring 1.7 x 1.3 cm.CHEST WALL: Interval removal of right chest port. Unchanged sclerosis of T7 vertebral body.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: 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: Small free pelvic fluid likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Continued mild improvement in reference lymphadenopathy. 2.No new sites of disease. |
Generate impression based on findings. | 52-year-old female with known right breast cysts presents for routine follow-up examination. 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, unchanged in pattern and distribution. There is redemonstration of a circumscribed round mass within the upper outer right breast, increased in size from prior examination, today measuring approximately 2.5 cm. Numerous loosely clustered benign appearing calcifications are noted throughout both breasts, and have minimally progressed in a benign fashion. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.Right Breast Ultrasound: On physical examination, no palpable mass is identified. A targeted right ultrasound was performed for the mammographic area of concern. At the 12 o'clock position of the right breast, 3 cm from the nipple, there is a well-circumscribed anechoic cyst the posterior acoustic enhancement measuring 2.5 x 1.4 x 2.8 cm, corresponding to the mammographic finding. Additionally, the the right breast 10:00, 3 cm from the nipple, there is a well-circumscribed, anechoic cyst with posterior acoustic enhancement measuring 0.5 x 0.3 x 0.5 cm. | Right simple breast cysts. 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. | Ms. Mechem is a 60 year old female with a history of bilateral mastectomy with reconstruction in Dec 2014. Her husband palpated a mass in the far right lateral reconstructed breast. The patient thinks it may have gotten smaller since then. Upon physical exam at the patient's area of concern, there is a soft, mobile, non-tender mass appreciated.A targeted right ultrasound was performed for the patient’s area of concern. In the far lateral portion of the right chest wall (approximately 12 cm from the reconstructed nipple), there is an anechoic lesion measuring 2.2 x 1.4 x 2.5 cm. There is associated posterior acoustic enhancement and subtle punctate echogenic foci about the periphery, suggestive of faint calcifications. This mass may be located adjacent to or within the underlying muscle. There is no suspicious solid or cystic mass identified. | Right lateral chest wall cyst. No sonographic evidence for malignancy. This cyst is amenable to aspiration if clinically warranted. All results and recommendations were relayed to Dr. Park via phone on 1/14/2015 at 11:00 am.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Male, 21 years old, status post intracranial lead placement. Redemonstrated are multiple intracranial electrode arrays including two which traverse the right frontal lobe, 3 which traverse the right temporal lobe from a lateral approach, one which traverses the medial right temporal lobe from a posterior approach, and one which traverses the medial left temporal lobe from a posterior approach. The relative positions of these electrodes have not significantly changed.Otherwise, the brain parenchyma is free of significant abnormalities. No evidence of intracranial hemorrhage or any large extra axial fluid collection is seen. The ventricular system is stable and normal in size. | Redemonstration of multiple intracranial electrodes without significant interval change. |
Generate impression based on findings. | Lung cancer CHEST:LUNGS AND PLEURA: A discrete right hilar mass projects inferiorly measuring 5.1 x 4.0 cm (image 59 series 3) with displacement and compression of the adjacent turning right lower lobe pulmonary vein. No definite evidence of discrete invasion is observed although narrowing and displacement is noted. Associated lower lobe patchy groundglass opacities are also observed with mild interstitial changes concerning for lymphangitic spread of known tumor and minimal irregularity in posterior wall pleural thickening. No discrete effusion or focal satellite nodules. Left lung clear.Minimal irregularity along the inferior wall of the right mainstem bronchus (best observed on image 51 series 8028), likely retained debris, however serial imaging will be important to confirm and exclude bronchial extension.MEDIASTINUM AND HILA: No discrete lymphadenopathy, however borderline preaortic lymph node is observed (image 30 series 3) measuring 1.0 cm.Moderate coronary calcifications without additional cardiac or pericardial abnormalityCHEST WALL: Moderate lower thoracic degenerative changes and bridging osteophytesABDOMEN: 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: Minimal lower lumbar degenerative changesOTHER: No significant abnormality noted. | Discrete right hilar mass compatible with known nonspecified lung cancer with questionable lymphangitic spread of tumor extending into the right lower lobe and with potential early extension to the pleural surface. See reference measurements provided |
Generate impression based on findings. | 79-year-old female with right shoulder pain. Three views of the right shoulder demonstrate moderate osteoarthritis affecting the glenohumeral and acromioclavicular joints. The bones appear demineralized. | Moderate osteoarthritis. |
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. | 39 year-old female with persistent heel pain, pattern not consistent with plantar fasciitis. Three views of the left foot demonstrate a mild pes planus deformity with small midfoot osteophytes indicating minimal osteoarthritis. We see no fracture or plantar calcaneal spurs. | Flatfoot deformity and minimal osteoarthritis of the midfoot. |
Generate impression based on findings. | Reason: continued evaluation of a RUL nodule History: f/u LUNGS AND PLEURA: Stable right upper lobe nodule associated scar like opacity (image 83 series 5) measuring 5 mm.Reference right upper lobe nodule (image 112 series 5) measures 6 mm x 8 mm previously measuring the same.No new suspicious pulmonary nodules or masses.Moderate to severe upper lobe predominant centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Nonspecific stable splenic hypodensity. | 1.Stable right upper lobe nodule. Follow-up examination in one year is recommended.2.Moderate to severe central lobular emphysema. |
Generate impression based on findings. | Metastatic lung cancer status post 6 doses of Gemzar. CHEST:LUNGS AND PLEURA: Right hemithorax volume loss with numerous pleural and subpleural nodules, subjectively improved. Reference measurements on the right as follows:1. Abutting the superior mediastinum, aortic arch level (4/29): When measured in a similar fashion, the previously confluent lesions now appear separate measuring 19 and 9-mm respectively, previously a total of 55-mm.2. Right upper lobe lesion (4/35, 10:30 position) 11-mm compared to 23-mm previously.3. Right lower lobe, posterior to the suprahepatic IVC (4/69), 12-mm compared to 26-mm previously.Bronchial wall thickening, groundglass opacity and septal thickening in the right lung has improved. Trace residual pleural fluid on the right.Emphysema in the left lung with scattered 2-3 mm micronodules appearing unchanged.MEDIASTINUM AND HILA: Improved size of bilateral non-index mediastinal and right hilar lymph nodes. Pleural lesions remains adherent and inseparable from pericardium at the level of the right atrium (3/59). Otherwise stable pericardial thickening. Rightward mediastinal shift. Mild coronary artery calcifications. No significant pericardial fluid. Small hiatal hernia.CHEST WALL: Improved size of non-index right axillary and subpectoral lymph nodes.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions in the liver are likely cysts but too small to accurately characterize, unchanged. Right hepatic lobe hypoattenuating partially exophytic lesion incompletely assessed but unchanged, also possibly a cyst. Gallbladder is dilated. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule measures negative 5HU, consistent with a benign adenoma. Right adrenal gland mass is unchanged, likely.KIDNEYS, URETERS: Cortical lesions incompletely characterized but appear unchanged over multiple prior examinations.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L2 chronic pathologic fracture with vertebroplasty material and spinal stenosis at that level; extruded vertebroplasty material may cause cord compression, AP dimension of the spinal canal measuring 6-mm (3/105).OTHER: No significant abnormality noted. | Interval improvement in the reference measurements and overall tumor burden in the right hemithorax. Improved non-index bilateral mediastinal and right axillary, subpectoral and hilar lymphadenopathy. |
Generate impression based on findings. | Male 28 years old; Reason: 6 month colon cancer survellance History: surveillance CHEST:LUNGS AND PLEURA: No significant abnormality noted MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right subcentimeter hypodensity too small to characterize, but probably a 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 | 1. No evidence of recurrence. |
Generate impression based on findings. | Reason: 64 yo F smoker hx of R lower lobectomy for mgmt of T1aN0M0 Stage IA adenocarcinoma 2010 - last surveillance CT 2011 (pt failed other surveillance). pls eval for malig History: cough, smoker LUNGS AND PLEURA: Status post right lower lobectomy with volume loss in the right lung. No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal evidence of pericardial effusion.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hypodensity within the right lobe of the liver. Status post cholecystectomy. | No interval change without evidence of metastatic disease. |
Generate impression based on findings. | Female; 55 years old. Reason: f/u old pulmonary nodules, r/o progression of disease, malignancy History: chronic cough, 60-70 pack year history of smoking LUNGS AND PLEURA: No significant interval change in scattered subpleural micronodules in the right upper and middle lobes, which may be post inflammatory in etiology. No new suspicious pulmonary nodules or masses. Resolution of mild streaky opacity in the right upper lobe. Mild upper lobe predominant emphysema.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. Status post gastric bypass and left nephrectomy. | Stable scattered subpleural micronodules, which may be post inflammatory. No new suspicious pulmonary nodules or masses. |
Generate impression based on findings. | Ms. Booth is a 40 year old female with a personal history of known left breast IDC treated with neoadjuvant chemotherapy. She presents today for imaging to assess for response to therapy. Three standard views of the left breast 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. Hydromark clip is identified in the left upper outer breast, at site of biopsy proven malignancy. A wing clip is identified in the left outer breast, at site of satellite lesion. Additional Hydromark clip is identified in the metastatic axillary node. The index cancer is smaller when compared to original mammogram with faint residual calcifications associated with it. The metastatic lymph node is also smaller when compared to the original mammogram. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | Decrease in size of index cancer and axillary lymph node. Per patient, she is scheduled for a mastectomy in Feb 2015. Follow up with Dr. Chhablani as surgically warranted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Evaluate Dobbhoff tube position.VIEW: Abdomen AP Enteric feeding tube tip in the body of the stomach. The urinary catheter has been removed. Nonspecific disorganized bowel gas pattern. No evidence of pneumatosis, portal venous gas, or intraperitoneal free air. Numerous clips project over the superior right thigh. There is marked body wall edema. | Enteric feeding tube tip in the body of the stomach.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 83-year-old female with unequal and minimally reactive pupils. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Dilatation of the ventricles and prominence of the sulci compatible with moderate age-related atrophy. No extra-axial collections. There is moderate hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminate small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mild amount of fluid in the left mastoid air cells, and under-pneumatization of the right mastoid air cells. Calvarium is intact. The lenses have been surgically removed. | 1. No evidence of intracranial hemorrhage. 2. Moderate periventricular/subcortical white matter hypodensities likely represent age-indeterminant 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; 78 years old. Reason: Pleural mesothelioma please compare to prior exam per recist criteria. History: Pleural mesothelioma LUNGS AND PLEURA: Left hemithorax pleural thickening and nodularity compatible with known diagnosis of mesothelioma. Left pleurex catheter similar in position. Reference lesions on the left as follows:Level of the aortic arch (image 29, series 4): 2 o'clock position 14 mm, previously 13 mm. 8 clock position 11 mm, previously 11 mm. 9 o'clock position 26 mm, previously 23 mm.Level of the main pulmonary artery (image 49): 12 o'clock position 17 mm, previously 14 mm. 8 o'clock position 25 mm, previously 24 mm. Fissural measurement of 28 mm, previously 24 mm.Level of the cardiac apex (image 81): 1 o'clock position 22 mm, previously 27 mm. 2 o'clock position 27 mm, previously 35 mm. 4 o'clock position 15 mm, previously 15 mm.Anterior chest wall/pleural nodule (image 55) measures 22 mm, previously 27 mm. Small right pleural fluid collection, mildly decreased. Loculated left pleural fluid collections, not significantly changed.Numerous pulmonary metastases bilaterally are similar in number but slightly increased in size in the right lung. For example, a right lower lobe nodule on image 130, series 5 measures 6 mm, previously 3 mm. A 5-mm right upper lobe nodule on image 129 and previously measured 3 mm.MEDIASTINUM AND HILA: Stable extension of pleural tumor into the mediastinum both anteriorly and posteriorly. Stable infiltration of the periaortic fat at the level of the aortic arch and descending thoracic aorta. Moderate pericardial effusion is similar to prior study. Pericardial thickening and nodules are also similar to prior study. Mediastinal and left hilar lymph nodes are not significantly changed.CHEST WALL: Internal mammary chain lymphadenopathy on the left is similar to prior study. Extensive chest wall involvement on the left is also similar to prior study. Subcentimeter left subpectoral nodes are similar to prior study. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left hemidiaphragm thickening by tumor is similar to prior study. Chest wall tumor extends into the left flank inferiorly. Please see report from dedicated CT abdomen and pelvis performed concomitantly. | Slightly increased size of numerous right intrapulmonary metastases, but otherwise, no significant interval change in the left pleural, mediastinal, and left chest wall disease. No new sites of disease identified. |
Generate impression based on findings. | Reason: thymoma, s/p chemo and RT. Pls c/w previous study and evalaute dx status History: thymoma CHEST:LUNGS AND PLEURA: Right perihilar opacity unchanged.Right lower lobe opacity (image 40 series 5) is difficult to accurately measure measure. Best estimate is 12 mm x 10 mm decreasing measuring 11 mm x 10 mm. Right basilar nodule (image 81 series 5) measuring 5 mm x 7 mm previously measuring 6 mm x 7 mm.Additional right basilar nodule (image 77 series 5) measures 6 mm measuring 5 mm on the prior exam.No new suspicious nodules or masses.Postsurgical and post radiation left lung volume loss with paramediastinal surgical clips.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. No evidence of a recurrent mediastinal mass.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Left-sided thoracotomy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Stable multiple hypoattenuating nodules.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: .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: Intraspinal neural stimulator | Stable pulmonary nodules. |
Generate impression based on findings. | 86-year-old male with history of type B dissection with chest pain. Evaluate.Per conversation with the ordering physician, patient in acute renal failure and evaluation with noncontrast examination is preferred. Evaluation for aortic dissection is significantly limited given noncontrast examination for the above stated reason.CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No significant interval change in the medial displacement of the intimal calcifications and the hyperdense crescent indicating intramural hematoma of the thoracic aorta which appears to start distal to the left subclavian artery and terminates in the mid thoracic aorta several centimeters above the diaphragmatic hiatus. No significant interval change in the caliber of the thoracic aorta; however, evaluation for dissection is significantly limited on this noncontrast examination.Small right thyroid lobe nodule again noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged bilateral adrenal gland thickening without a focal mass.KIDNEYS, URETERS: Unchanged bilateral hypoattenuating renal lesions most likely cysts.RETROPERITONEUM, LYMPH NODES: Evaluation for aortic dissection is significantly limited on this noncontrast examination. Aneurysmal dilatation of the right iliac artery is unchanged. Mild atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No evidence of small bowel obstruction.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Presumably status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No evidence of small bowel obstruction.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality noted | Evaluation for aortic dissection is significantly limited given noncontrast examination.1.No significant interval change in the intramural aortic hematoma starting distal to the left subclavian artery and terminating in the mid thoracic aorta.2.Bilateral hypoattenuating renal lesions are unchanged and most likely cysts. |
Generate impression based on findings. | History of hepatic hemangiomas. LIVER: There are at least 3 subcentimeter well-circumscribed slightly hypoattenuating lesions identified within the right hepatic lobe, which are probably hemangiomas. Trace free fluid is evident about the liver. The liver measures 7.5 cm in length and demonstrates appropriate parenchymal echogenicity. There is no evidence of intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: There is no evidence of cholelithiasis or gallbladder wall thickening.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 6 cm in lengthRIGHT KIDNEY: The right kidney measures 5.4 cm in length, demonstrating normal cortical echogenicity, and without evidence of hydronephrosis. LEFT KIDNEY: The left kidney measures 5.5 cm in length and demonstrates normal cortical echogenicity. Hyperechoic shadowing focus in the inferior pole consistent with a non-obstructing renal stone. There is no evidence of hydronephrosis. OTHER: No significant abnormality noted. | 1.Subcentimeter hypoechoic lesions in the right hepatic lobe probably representing hemangiomas.2.Nonobstructing left renal stone. |
Generate impression based on findings. | 41 year old female who was recalled from screening mammogram for questionable architectural distortion in the right breast. Family history of breast carcinoma in her maternal aunt. An ML view and one spot compression view of the right breast 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. The area questioned architectural distortion in the posterior right breast is not visualized on today's examination, compatible with overlapping Cooper's ligaments and fibroglandular tissues. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | 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: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Ankle pain status post trauma. Evaluate for fracture. There is a nondisplaced fracture through the base of the fifth metatarsal which I suspect is acute. A triangle-shaped ossicle posterior to the talus may represent an old fracture fragment or perhaps an os trigonum, but I suspect that it is chronic in etiology rather than representing an acute fracture. There is diffuse soft tissue swelling about the ankle. In addition to osteoarthritic changes, there are chronic-appearing erosions involving the bones of the hindfoot and midfoot which I suspect are due to gout. A wire fragment is noted within the lateral soft tissues of the ankle, either representing a foreign body or perhaps prior surgery. | 1.Fracture of the base of the fifth metatarsal which I suspect is acute.2.Ossicle posterior to the talus which I suspect is chronic in etiology; however, if there is clinical concern for an acute fracture at this location, CT may be considered for further evaluation.3.Arthritic changes as described above likely representing a combination of osteoarthritis and gout.4.Other findings as above. |
Generate impression based on findings. | PICC repositioningVIEW: Chest AP (one view) 01/14/15 Left upper extremity PICC with tip in the right atrium. Right internal jugular central venous catheter tip is at the superior cavoatrial junction. ET tube tip is below thoracic inlet and above the carina. Enteric tube appears within the duodenum with tip below the field of view. Cardiothymic silhouette is normal. No pneumothorax or pleural effusion. Persistent left lower lobe patchy atelectasis. | Left PICC tip in the right atrium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Head and neck and lung cancer. CHEST:LUNGS AND PLEURA: A spiculated nodule is observed in the right upper lobe in the posterior segment (image 28 series 4) measuring 15 x 9 mm. There is associated biapical scarring with scattered mild central lobular emphysematous changes, again greater in the upper lungs. Additional superimposed mild scattered ground glass nodularity largely observed in the right upper lobe and minimally in the right lung lower lobe. Left lung remains clear of focal abnormalities.Minimal dependent density observed along the inferior left mainstem bronchus, presumably retained debris. Serial imaging will improve sensitivity. Diffuse 4 quadrant mild bronchiectasis.MEDIASTINUM AND HILA: Large hypodense and incompletely visualized nodule in the right thyroid lobe. Please correlate physical exam and history. Consider dedicated imaging.No lymphadenopathy.Extensive coronary calcifications without additional cardiac or pericardial abnormality.Small hiatal herniaCHEST WALL: Minimal degenerative disk disease, however no scattered lytic or blastic lesions identifiedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Minimal calcifications scattered throughout the gallbladder wall of uncertain significance. Liver otherwise unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. A right upper lobe focal spiculated nodule concerning for a primary malignancy with additional scattered changes suggesting aspiration. See detail provided above |
Generate impression based on findings. | Shortness of breath. Stage IV lung cancer based on outside hospital reports. Has pleurex on the right not draining ; evaluate placement of the tube as well as extent of malignancy. LUNGS AND PLEURA: Near circumferential nodular pleural thickening in the right hemithorax consistent with known tumor. For reference, tumor thickness at the level of the aortic arch 3 clock position is 2.6-cm. Tumor at the subcarinal level 4 clock position is 7.1-cm and at the level of the left atrium 12 o'clock position (excluding adjacent internal mammary lymphadenopathy) is 2.9-cm (3/63).Right pleurex catheter enters the eighth/ninth rib interspace, directed medially in the subpleural space, then extends in a cranial fashion abutting the mediastinum to terminate anteriorly in the right cardiophrenic angle. There is no drainable pleural fluid along the catheter course.A small volume of pleural fluid is loculated within the cranial aspect of the right major fissure (3/47). A large area of loculated fluid is located along the lateral aspect the right lower thorax extending posterior to the collapsed lung. There are a few small air foci in the right pleural space likely related to tube placement.Mild emphysema. Ground glass opacity in the anterior aspect of the left lower lobe consistent with pulmonary hemorrhage secondary to PE.MEDIASTINUM AND HILA: Filling defects compatible with acute pulmonary emboli within the distal left main pulmonary artery extending into branches of the left lower lobe. Clinical service verbally notified at the time of dictation (12:07 p.m. on 1/14/2015, Dr. Kopelman.)Leftward mediastinal shift. The SVC and right atrium are compressed by extrinsic tumor. Tumor extends under the base of the heart (series 3 image 90, coronal image 50). Small volume of pericardial fluid. Ipsilateral mediastinal, hilar and interlobar lymphadenopathy. For reference, subcarinal lymph node measures 2.4-cm (3/52).CHEST WALL: Tumor extends up to right sided thoracic neural foramina at several levels, though there is no conclusive invasion into the spinal canal. This appears most pronounced in the lower thoracic spine (for example, series 3 image 75).Tumor extends through the bony thorax adjacent to the right side of the sternum, and through intercostal spaces laterally and posteriorly at several sites. Cortical erosions and/or lytic lesions involving the right ribs 11, 9 and 8, 7.Moderate right internal mammary chain lymphadenopathy. Right axillary and sub-pectoral lymph nodes are not enlarged however are abnormal in multiplicity and isoattenuating to tumor, highly suspicious for additional sites of nodal metastases.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Tumor extends deep into the recesses of the pleural space. Several subcentimeter lymph nodes are noted in the gastrohepatic ligament and paraceliac regions. | 1. Extensive pleural tumor of the right hemithorax causing leftward mediastinal shift and mass effect upon the right atrium, SVC, and suprahepatic IVC. Tumor extends through the chest wall at several sites and encroaches upon right neural foramina of the lower thorax. 2. Acute pulmonary emboli extending from the distal left main bronchus to the left lower lobe involving lobar and segmental branches and causing acute pulmonary hemorrhage in the affected areas. Clinical service contacted at time of preliminary interpretation.3. Right pleurex catheter is not within a drainable fluid collection. Large loculated fluid collection is located in the lower aspect of the right thorax laterally and posteriorly. |
Generate impression based on findings. | Alcohol abuse, status post fall Head: There is no intracranial hemorrhage, edema, midline shift, or abnormal extraaxial fluid collections. There is global parenchymal volume loss. There is mild patchy subcortical and periventricular white matter hypoattenuation, most compatible with chronic small vessel ischemic change. The gray-white matter differentiation is preserved. There is a soft tissue thickening involving the occipital scalp extending to the left parietal scalp and was also present on prior CT from 9/5/2014 and may be related to prior trauma. Underlying calvarium is intact. There is an unchanged hyperattenuating mass in the left frontal sinus which likely represents an osteoma with adjacent obstructed secretions.Cervical Spine: No acute fracture or subluxation is seen within the cervical spine. There is mild retrolisthesis of C4 on C5. There are degenerative changes throughout the cervical spine. There is loss of normal cervical lordosis. No high-grade spinal canal stenosis is appreciated. Mild widening of the C5-C6 facet joints, likely on a degenerative basis. There is uncovertebral hypertrophy with mild right neural foramina stenosis at C4-C5, moderate to severe on the right at C5-C6 and bilaterally moderate to severe at C6-C7. Paraspinous soft tissues demonstrate no edema, hematoma or other abnormality. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. No acute cervical fracture or subluxation. Moderate degenerative change in the cervical spine as described above.3. Unchanged left frontal sinus mass, which likely represents an osteoma. |
Generate impression based on findings. | Ms. Wilson is a 75 year old female with an focal asymmetry identified on mammogram and ultrasound. She presents today for biopsy of this area. Left ultrasound identified two target lesions for biopsy, one of which was seen on most recent ultrasound and recommended for biopsy. The two target lesions were closely adjacent to each other. Both hypoechoic lesions measured 0.4 cm respectively, at the 12 o’clock position without increased vascularity, 2 cm from the nipple. The lesions were somewhat subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram 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 a inferolateral to superomedial approach, three 14-gauge core needle (InRad) specimens were obtained of the lesions. Of note, the more lateral lesion collapsed as soon as the biopsy needle approached the target. The more medial lesion collapsed at the end of the second biopsy core. Targeting was judged very good. Three specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be anterior to the expected location, in the retroareolar region. Multiple additional benign circumscribed masses were seen posterior to the clip, including the original mammographically detected mass. As a result, a second ultrasound exam was performed. Two additional anechoic lesions were identified in the 11:00 position, 5-6 cm away from the nipple. These two lesions measured 0.4 cm and 0.8 cm respectively. They look identical to the recently biopsied targets. Given the similarity in appearance, they are likely of the same etiology as the lesions biopsied today.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. 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. | (1) Successful ultrasound-guided core biopsy of two hypoechoic left breast lesions, both of which collapsed entirely by the end of the procedure, suggesting cysts. Clip was placed. (2) The two biopsied lesions were anterior to the original mammographically detected mass. A second look ultrasound identified two additional hypoechoic lesions more posteriorly that likely correlate with the mammographic findings. These looked very similar to the biopsied targets and were likely present on mammograms dating back to 2011, favoring a benign etiology. If the pathology results are benign, then a short term follow-up may be all that is necessary to confirm stability of these new findings. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her maternal uncle. 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. | 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. Personal history of ovarian carcinoma diagnosed at age 49. 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. | Head and neck cancer CHEST:LUNGS AND PLEURA: Interval decreasing number of the multiple scattered right sided nodules, specifically the right upper lobe nodules currently not appreciated. However, the largest reference lesion in the right lower lobe (image 84 series 4) has increased in size, currently measuring 2.4 x 2.1 cm, previously 1.5 x 1.3 cm. Central cavitation is again observed with surrounding spiculation and extension to the major fissure anteriorly and pleural surface with irregular thickening laterally.The additional right lower lobe nodule previously identified has been removed with adjacent surgical suture (image 73 series 4). Postsurgical changes observed in the adjacent pleural surfaces and associated volume loss.Scattered moderate central lobular changes without additional new superimposed focal masses or nodules. No effusions.MEDIASTINUM AND HILA: No lymphadenopathyScattered severe coronary calcifications without additional cardiac or pericardial abnormalityCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis with multiple scattered subcentimeter hypodensities again likely numerous benign hepatic cystsSPLEEN: Status post splenectomyADRENAL GLANDS: No gross adrenal abnormality however detail obscured, specifically on the left given artifact from surgical clips throughout the left upper quadrantKIDNEYS, URETERS: Stable scattered renal cysts and focal cortical change previous the described as a possible infarctPANCREAS: Again the region of the pancreas is obscured due to surgical clipsRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes of the aortaBOWEL, 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. | Continued interval increasing size and surrounding changes to the cavitary right lower lobe nodular mass. Interval resolution of previously noted additional pulmonary nodules and interval surgery, see detail provided above |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Back pain, right lower extremity radiculopathy. Preoperative planning. There is a slight levoscoliosis of the lumbar spine as seen on the AP view. Severe degenerative disk disease affects L5/S1 as well as L1/2, with moderate degenerative disk disease affecting the remaining lumbar levels. There is also multilevel facet joint osteoarthritis. There is a grade 1 anterolisthesis of L4 relative to L5. Vertebral body heights are preserved. The bones appear demineralized suggesting osteopenia. | Degenerative disk disease/osteoarthritis as above. |
Generate impression based on findings. | Left hip osteoarthritis Severe osteoarthritis affects the left hip with near bone-on-bone apposition superiorly. | Severe osteoarthritis. |
Generate impression based on findings. | Status post fall with low back pain. There is a mild compression fracture of L2 that I suspect is acute or perhaps subacute. The remaining lumbar vertebral body heights are within normal limits. Slight anterior wedging of the lower thoracic vertebra is probably of no clinical significance. Severe degenerative disk disease affects L5/S1. Relatively mild degenerative disk disease affects L3/4 and L4/5. Mild facet joint osteoarthritis affects the lower lumbar spine. The bones are slightly demineralized. | Findings suggestive of an acute/subacute compression fracture of the L2 vertebral body. Degenerative arthritic changes as described above. |
Generate impression based on findings. | Acute respiratory infectionVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Acute pain and swelling in left foot and ankle. Evaluate for fracture versus gout flare. Three views of the left ankle are provided. There is mild diffuse soft tissue swelling. I see no fracture. The bones appear demineralized, suggesting osteopenia/osteoporosis. There is mild osteoarthritis of the ankle joint, but I see no specific radiographic features of gout. Arterial calcifications are noted within the soft tissues.Three views of the left foot are provided. The bones appear demineralized, suggesting osteopenia. There is a moderate hallux valgus deformity and moderate osteoarthritis of the first metatarsophalangeal joint. I see no fracture or specific radiographic features of gout. Note is made of small plantar and posterior calcaneal spurs which are not necessarily of any current clinical significance. | Soft tissue swelling and osteoarthritic changes as described above. I see no fracture or specific radiographic features of gout. |
Generate impression based on findings. | Female 58 years old; Reason: 57 yr old patient with ovarian cancer s/p 8 cycles of MEK-162 compare to 11-5-14 scan eval disease process. History: none CHEST:LUNGS AND PLEURA: Scattered left lung micronodules. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Left chest wall port terminates at the cavoatrial junction.CHEST WALL: Thyroid contains multiple hypodense nodules.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is diffuse fatty infiltration of the liver. There is a hyperdense band in the right hepatic lobe likely represent an area of scar. There are postsurgical changes along the surface. A calcified lesion adjacent to the left hepatic lobe measures 1.5 x 1.4 cm (image 112/series 3) previously, 1.6 x 1.4 cm.SPLEEN: Hypodense splenic lesion is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts. Angiomyolipoma in the lower pole of the right kidney is unchanged.There are collecting system calcifications in the lower pole of the right kidney without hydronephrosis.Nonobstructive left proximal ureter calculus.RETROPERITONEUM, LYMPH NODES: Postsurgical changes in the retroperitoneum. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postsurgical series in the bowel with a right abdominal ostomy. Status post omentectomy. Scattered calcifications in the upper abdomen and peritoneum . Of note, there is increased nodularity in the soft tissue nodular cluster adjacent to the right iliac fossa.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. There is calcified soft tissue in the pelvis at the apex of the vaginal cuff.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right pelvic calcified lymph node measures 1.5 x 1.6 cm (image 171/series 3) previously, 1.5 cm.BOWEL, MESENTERY: Soft tissue nodules in the pelvis have increased in size. it measures 1.7 x 1.5 cm (image 153/series 3). BONES, SOFT TISSUES: Soft tissue nodularity in the right thigh is new.OTHER: No significant abnormality noted. | 1.Stable measurements of the reference lesions which are partially calcified. Increase in the size of the right retroperitoneal nodularity with measurements provided above. |
Generate impression based on findings. | Reason: follow up lung cancer History: exertional SOB CHEST:LUNGS AND PLEURA: Right lower lobe postsurgical changes again noted.Postsurgical and post radiation volume loss on the left.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Stable left thyroid hypoattenuating nodule.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable multiple hepatic hypoattenuating lesions compatible with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable exam without evidence of recurrent tumor or metastatic disease. |
Generate impression based on findings. | 38 years Male. Reason: eval for hydrocephalus; history of hydrocephalus and shunt placement History: AMS. Redemonstration of bilateral parietal-approach ventriculostomy catheters, and remnant of a left frontal approach ventriculostomy catheter. The left parietal-approach catheter continues to drain into the cervical subarachnoid space.The ventricular system is stable in size. The frontal horns continue to measure 45 mm in transverse dimension, and the third ventricle measures 10 mm in transverse dimension. The fourth ventricle remains nondilated.Stable appearance of colpocephaly and a thin corpus callosum. A subependymal calcification is again noted at the trigone of left lateral ventricle.No evidence of acute intracranial hemorrhage or edema. The paranasal sinuses are clear. There is trace fluid within the mastoid air cells. The orbits appear intact. Stable small fluid collection in the right frontal scalp at the site of the prior EVD. | 1. Compared to 1/12/2015, stable appearance of the lateral ventricles and third ventricle.2. Status post multiple ventriculostomies including left Torkildsen shunt.3. No evidence of acute intracranial hemorrhage, mass-effect, or edema.4. Stable 5 mm fluid collection in the right frontal scalp at the site of the prior EVD which may represent a small seroma or pseudomeningocele. |
Generate impression based on findings. | Extensor retinaculum nerve compression. Any acute findings? The soft tissues appear mildly edematous, but I see no fracture or malalignment. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Male 78 years old; Reason: Pleural mesothelioma please compare to prior exam per recist criteria. History: Pleural mesothelioma ABDOMEN:LUNG BASES: Extensive left thoracic tumor. This is detailed in the chest section.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. No biliary ductal dilatation. Hepatic vasculature are patent.SPLEEN: Tumor adjacent to the left hemidiaphragm encroaches upon the splenic surface.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hyperdense left renal cyst is unchanged. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left posterior chest wall mass measures 6.4 x 2.4 cm (image 70/series 7) previously, 5.9 x 2.2 cm.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increase in the left chest wall mass. |
Generate impression based on findings. | 5 year old female with metastatic neuroblastoma now nine months off therapy. There is slight interval increase in size of level 1 lymph nodes. For example, a left level 1A lymph node measures 6 mm in short axis, previously 4 mm and a right level 1B lymph node measures 6 mm, previously 4 mm. There is interval increase in size of the adenoid and palatine tonsils with resultant mild oropharyngeal airway narrowing. The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. The major cervical vessels are patent. The imaged intracranial structures are unremarkable. The lung apices are clear. The osseous structures are unremarkable. There is new fluid within the bilateral mastoid air cells as well as near complete opacification of the maxillary sinuses and mucosal thickening and secretions within the sphenoid sinuses. | 1.Level 1 lymph nodes and tonsils have slightly increased in size, which may be reactive in nature, but nonspecific. 2.Evidence of acute sinusitis and mastoiditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Postoperative changes are seen from interval decompression of the foramen magnum, with suboccipital craniectomy and resection of posterior arch of C1. The neo-foramen magnum is now widely patent, with ample CSF along the dorsal aspect of the tonsils. The tip of the now rounded cerebellar tonsils extend to the level of the superior margin of the dens. The right cerebellar tonsil remains lower in position as compared to the left.The CSF flow imaging is limited by patient motion. There is redemonstration of prominent flow ventral to the brainstem and along the ventral aspect of the neo-foramen magnum and cervical spinal canal. There is interval increased biphasic flow along the dorsal aspect of the upper cervical cord, and along the caudal aspect of the cerebellar tonsils. The CSF space along the dorsal aspect of the tonsils does not demonstrate definite biphasic flow. There is slight increased prominence of biphasic flow suggested through the fourth ventricle.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures are within normal limits. There is mild mucosal thickening in the left maxillary sinus, which is slightly diminutive in size compared to the right.CERVICAL/THORACIC SPINE | 1. Interval suboccipital decompression with widely patent neo-foramen magnum. Improved biphasic CSF flow through this level, as well is suggested through the fourth ventricle.2. Significant interval reduction in extent and caliber of the cervical thoracic syringohydromyelia as detailed above. No residual central spinal canal stenosis as cord expansion has resolved.3. Abnormal T2 appearance of the renal cortex bilaterally likely related to iron deposition from patient's known sickle cell disease. |
Generate impression based on findings. | Lateral pain and swelling. Rule out fracture. There is perhaps mild soft tissue swelling. I see no fracture. Small osteophytes are noted affecting the ankle and midfoot articulations. | Mild soft tissue swelling and small osteophytes; I see no fracture. |
Generate impression based on findings. | Male, 73 years old, altered mental status on anticoagulation. Extensive patchy areas of hypoattenuation and encephalomalacia in the left cerebral hemisphere are again seen without significant interval change. Similar patchy hypoattenuation within the right cerebral hemisphere has progressed, at least in the frontal lobe. Encephalomalacia involving the right parietal and temporal lobes is probably unchanged.Chronic ischemia within the left insula is unchanged. Extensive patchy hypoattenuation and encephalomalacia is again seen in the cerebellum appearing similar to prior.No evidence of intracranial hemorrhage or any definite parenchymal edema is seen. No significant mass effect is detected. There is evidence of ex vacuo dilatation of the lateral ventricles similar to prior. | Sequelae of extensive prior ischemic injury are demonstrated with some progression in the right cerebral hemisphere. While many of these areas do appear chronic, the possibility of subtle superimposed acute ischemia cannot be excluded. This can be better assessed with MRI if clinically warranted.No evidence of intracranial hemorrhage or any other definite acute intracranial abnormality. |
Generate impression based on findings. | Female 32 years old; Reason: persistent pelvic fluid collection History: pelvic fluid collection ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No focal hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Duplicated right renal collecting system. No nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course.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: A drainage catheter is noted in the lower abdominal soft tissues. No surrounding fluid collection. There is mild surrounding inflammation which is decreased.OTHER: Fluid collections within the pelvis has nearly resolved. | 1.Decreasing abdominal and pelvic fluid collections |
Generate impression based on findings. | Hip total arthroplasty, primary, uncemented Precursor components of a right total hip arthroplasty device are situated in gross anatomic alignment. Gas density in the soft tissues represents a surgical wound. The superior aspects of the iliac wings are not included on the field of view of this study. | Intraoperative findings of right total hip arthroplasty placement as described above. |
Generate impression based on findings. | 80 years, Female. Reason: GI bleeding, evaluate for bowel perforation Nonobstructive bowel gas pattern. No evidence of free air. Incompletely imaged patchy bibasilar airspace opacities. Vascular calcifications noted. | Nonobstructive bowel gas pattern. No evidence of free air. |
Generate impression based on findings. | Neutropenic fever and AML history LUNGS AND PLEURA: Persistent unchanged scattered right-sided nodules with mild surrounding ground glass changes. Appearance again given patient's history is concerning for atypical infection including fungal etiologies. No evidence of significant change or new superimposed findings. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limitsCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Unchanged pulmonary status without new focal abnormalities. Scattered multiple right-sided pulmonary nodules again concerning for atypical infection including fungal etiologies given patient history |
Generate impression based on findings. | Toe pain. Left sciatica, previous surgery (L5/S1 fusion). Three views of the left great toe are provided. Moderate osteoarthritis affects the first metatarsophalangeal joint with prominent osteophyte formation dorsally.Five views of the lumbar spine are provided. There is orthopedic fixation of L5/S1 anteriorly, with a spacer device between L5 and S1 vertebral bodies. Faint density within the L5/S1 intervertebral disk space likely represents bone graft material and perhaps early bony bridging. The remaining intervertebral disk spaces appear normal, as do vertebral body heights. Alignment is within normal limits. | Osteoarthritis of the great toe and postoperative changes of lower lumbar spine fusion as described above. |
Generate impression based on findings. | 54-year-old male with right knee osteoarthritis, preop for right UKA. CT images of the right knee demonstrate moderate-severe osteoarthritis of the knee with near bone-on-bone apposition of the medial femoral compartment. There are also tricompartmental osteophytes. A 6-mm ossicle within the anterior aspect of the lateral compartment likely represents a loose body. There is a small joint effusion with extension posteromedially into a Baker's cyst which measures approximately 7 cm in craniocaudal dimension. There are scattered arterial calcifications.Additional imaging of the right hip reveals moderate-severe osteoarthritis with near bone-on-bone apposition superiorly and cyst formation in the acetabular dome.Additional imaging of the right ankle shows mild osteoarthritis affecting the tibiotalar and midfoot articulations. There is mild edema particularly along the lateral aspect of the ankle extending into the foot. A collection of low density arising from the sinus tarsus extending along the anterior aspect of the lateral malleolus may represent a ganglion. | Osteoarthritis and other findings as described above. |
Generate impression based on findings. | Recurrent lung adenocarcinoma, surveillance CHEST:LUNGS AND PLEURA: Postsurgical change in the right upper and left lung laterally and lingular regions, demonstrating unchanged suture material and volume loss. No suspicious new nodules or masses. No effusionsMEDIASTINUM AND HILA: Small left thyroid hypodense nodule, presumably a cystThe high right paratracheal lymph node is nonpathologic, is unchanged in size and demonstrates a discrete fatty center. This lesion should now not be measured.The cardiac and pericardium are within limitsCHEST WALL: Focal C7 sclerotic lesion unchanged. Mild degenerative changes without new lytic or blastic lesions observedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific findings or changes, specifically no metastatic disease |
Generate impression based on findings. | Esophageal adenocarcinoma status post chemotherapy, restage. CHEST:LUNGS AND PLEURA: Interval development of multifocal fibrosis in the right apex and a scarlike opacity in in the anterior right lung.Right lower lobe segmental/subsegmental atelectasis related to acute pulmonary embolus. No pleural fluid. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Nonocclusive acute pulmonary embolus right lower lobe extending from the proximal right descending pulmonary artery into two subsegmental branches.. Right tracheoesophageal lymph node measures 7 mm, previously 10-mm (3/15).Non-index posterior periaortic lymph node (377) 6 mm, previously 8-mm. Small (sub-5 mm) lymph nodes adjacent to the distal thoracic esophagus on the right appear unchanged. Esophageal thickening extending to the level of the aortic arch to the GE junction appears improved, 10-mm in thickness versus 16mm previously (3/73).No pericardial fluid. Upper normal heart size. Moderate coronary artery calcification. No signs of right heart strain.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Probable flash filling hemangioma anterior to the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: 11-mm left adrenal gland nodule unchanged, indeterminate in appearance.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: Superior endplate compression fracture L3 vertebral body.OTHER: No significant abnormality noted. | 1. Small acute right lower lobe pulmonary embolus with associated atelectasis. Dr. Saha verbally notified at time of preliminary interpretation.2. Improved thickening of the distal esophageal segment and size of index/non-index mediastinal lymph nodes.3. Indeterminate left adrenal gland nodule is unchanged, favoring a benign lesion although it is incompletely characterized. |
Generate impression based on findings. | Pain. Evaluate fracture. Again seen is an oblique fracture through the proximal diaphysis of the fifth metatarsal with fracture fragments in near-anatomic alignment. The full extent of the fracture is better visualized on the current study than on the prior study, likely due to the resorptive phase of healing. A small amount of callus is seen along the inferolateral aspect of the fracture margin. | Fifth metatarsal fracture as above. |
Generate impression based on findings. | 67 years, Female. Reason: n/v, abdominal pain Moderate scoliosis of the spine and degenerative joint disease. Mild blunting of costophrenic angles. Pelvis is excluded from the field of view. No evidence of bowel obstruction. | Pelvis is excluded from the field of view. No evidence of bowel obstruction. |
Generate impression based on findings. | 59-year-old male with cirrhosis. Screen for HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic morphology of the liver is re-demonstrated. Reference hypodense lesion in segment 4b with high density material within the lesion status post radiofrequency ablation measures 2.9 x 2.4 cm (series 11, image 43), previously measuring 2.1 x 2.3 cm. Stable minimal arterial enhancement along the medial margin of this lesion with no definite washout (series 9, image 42) which likely is a siderotic nodule.Second treated lesion in the inferior tip of right hepatic lobe measures 2.7 x 2.3 cm (series 11, image 49), previously measuring 2.8 x 2.1 cm. No evidence of any adjacent residual or recurrent disease.Multiple previously noted arterially enhancing lesions demonstrate washout on the current examination and are worrisome for HCC. Reference segment 8 lesion measures 1.2 x 0.8 cm (series 9, image 24) and reference segment 4a lesion measures 1.5 x 1.8 cm (series 9, image 29). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered lymph nodes noted at the aortocaval region, porta hepatis, and gastrohepatic region not significantly changed.BOWEL, MESENTERY: Diffuse haziness at the root of the mesentery is unchanged. Small perihepatic and pelvic ascites is new. 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: Diffuse haziness at the root of the mesentery is unchanged. Small perihepatic and pelvic ascites is new. BONES, SOFT TISSUES: Stable degenerative changes about the visualized spine.OTHER: No significant abnormality noted | 1.Cirrhotic morphology of the liver with treated liver lesions as above. 2.Multiple previously noted arterially enhancing lesions now demonstrate washout, worrisome for HCC. Reference measurements as above.3.Retroperitoneal lymphadenopathy is unchanged.4.Small new ascites, nonspecific. |
Generate impression based on findings. | 51-year-old female with hammertoe of second toe bilaterally Right foot: There is moderate hallux valgus deformity with flattening of the medial aspect of the first metatarsal head, which may represent prior surgery.Left foot: Mild hallux valgus deformity. The foot otherwise appears unremarkable. | Bilateral hallux valgus deformities as described above. |
Generate impression based on findings. | 61-year-old male with NSCLC presumably stage IV based on outside hospital reports; needs staging PET/CT.RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 98 mg/dL. Today's CT portion grossly demonstrates extensive right pleural nodularity compatible with tumor. Moderate right pleural effusion. Right chest tube with tip at the right cardiophrenic angle. Mediastinal lymphadenopathy, including right paratracheal, precarinal, and subcarinal lymphadenopathy. Three-vessel coronary artery stents. Left lower lobe ground glass opacity and consolidation.Today's PET examination demonstrates intense FDG activity involving extensive pleural nodularity and mediastinal lymphadenopathy compatible with hypermetabolic tumor. For reference, subcarinal lymph node measures an SUV of 23.3. Additional small foci of FDG activity in the upper abdomen correlates with probable gastrohepatic lymphadenopathy. Additional focus of FDG activity measuring and issues E. of 2.1 in the left lesser trochanter also likely represents tumor involvement.Mild FDG activity involving the left lower lobe ground glass opacity/consolidation, likely inflammatory infectious in etiology. | 1.Extensive markedly hypermetabolic tumor involving the right pleura and mediastinum. Additional small foci of probable FDG avid tumor also involving gastrohepatic lymph nodes and the left femoral lesser trochanter.2.Mild FDG activity involving both lower lobe ground glass opacity/consolidation likely infectious or inflammatory in etiology. |
Generate impression based on findings. | PICC placementVIEW: Chest AP 1/14/15 Cardiothymic silhouette normal. Placement of a left upper extremity PICC with tip in the right atrium. Bilateral moderate size pleural effusions not significantly changed. Patchy atelectasis bilaterally in the right lower lobe and left lower lobe. | Placement of a left upper extremity PICC with tip in the right atrium. |
Generate impression based on findings. | There is mild supraglottic edema which is likely treatment related but no enhancing laryngeal or hypopharyngeal masses suggest recurrence. A small retropharyngeal effusion is unchanged. There is no evidence of significant cervical lymphadenopathy. Subcentimeter right thyroid nodule. Submandibular glands are atrophic bilaterally. The parotid glands are normal. The osseous structures are unremarkable. The airways are patent. There is moderate mucosal thickening in the right maxillary sinus with mild adjacent periosteal thickening suggesting chronic sinusitis, with opacification increased from the prior exam. The visualized intracranial parenchyma is unremarkable. Status post gastric pull up procedure. Areas of scarring are noted in the lung apices. For findings in the chest, please refer to dedicated chest CT. Mild atherosclerotic calcifications at the carotid bifurcations without significant stenosis. | 1.No evidence of supraglottic tumor recurrence or lymphadenopathy in the neck.2.Chronic right maxillary sinusitis is slightly worse than the prior exam.3.For findings in the chest, please see dedicated chest CT performed on the same day. |
Generate impression based on findings. | Esophageal cancer, follow-up CHEST:LUNGS AND PLEURA: Interval resolution of the previously observed small right pneumothorax and underlying effusion. Additionally the biapical scarring appears unchanged with scattered focal areas of tree in bud deformity largely on the right and right upper lobe. These changes are superimposed upon moderate centrilobular emphysema and previously described postsurgical changes and rib deformities.Additionally the multiple bilateral peripheral focal changes again possibly representing old infarcts appear unchanged and likely scarringMEDIASTINUM AND HILA: No lymphadenopathy and gastric pull up appears largely collapsed.Old calcified lymph nodes compatible with healed granulomatous disease exposureICD stents limits sensitivity of cardiac evaluation, however no discrete change or new disease is observedCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal appearance is scattered small cysts in questionable small old left infarct. In addition a 1.4-cm hypodensity with poor margination is observed in the mid left kidney and appears somewhat larger compared to the prior study. Without clear characteristics of a benign cyst given its size, follow dedicated imaging and/or close observation serial imaging is suggested. Dr. Villaflor contactedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Enteric tube removedBONES, SOFT TISSUES: Mild stable appearing lumbar spine degenerative changesOTHER: No significant abnormality noted. | 1. Status post gastric pull up with enteric tube removed2. Nonspecific new ill-defined hypodensity in the left kidney, not clearly a cyst, and questionably warranting serial and/or dedicated imaging.3. No specific findings to support a intrapulmonary new metastatic disease yet aspiration changes noted. |
Generate impression based on findings. | 52-year-old female with severe pain at medial, anterior and lateral joint and involving the tarsal bones, evaluate for stress fracture The bones appear demineralized suggesting osteopenia/osteoporosis. No fracture is evident. There is mild pes planovalgus deformity. Diffuse soft tissue swelling is noted. | Mild pes planovalgus deformity. |
Generate impression based on findings. | Chronic constipationVIEW: Abdomen AP Large amount of fecal burden. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Large amount of fecal burden. |
Generate impression based on findings. | Frontal sinus: Mild left frontal sinus mucosal thickening and frothy secretions within the right frontal sinus. Findings are new since prior.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is mild mucosal thickening within the bilateral maxillary sinuses, and a new fluid level on the left. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: Layering fluid collection within the sphenoid sinus, mildly increased when compared to prior. Sphenoethmoidal recesses are clear. No fat stranding within the premaxillary or retromaxillary soft tissues. No osseous destruction. No findings to suggest an aggressive sinonasal process.There is mild S-shaped nasal septal deviation, unchanged. 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. Partially sclerotic mastoid temporal bone and mild thickening of the tympanic membranes again noted; findings can be seen with prior/chronic otomastoiditis. There is mild opacification of the mastoid air cells. Unchanged punctate and calcifications within the bilateral parotid glands, may relate to sialolithiasis. | Mild paranasal sinus disease, as detailed above, including interval increase in amount of layering fluid within the sphenoid and left maxillary sinus as well as within the frontal sinuses. These findings may represent acute sinusitis. No findings to suggest an aggressive sinonasal process. |
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