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Generate impression based on findings. | Female 50 years old; Reason: Evaluate for progressive disease/myeloma lesions. History: Multiple myeloma post stem cell transplant. Increasing low back pain radiating to bilateral ribs. Evaluate for progressive disease.RADIOPHARMACEUTICAL: 13.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates numerous lytic lesions involving the skull, spine, pelvis, bilateral proximal femurs and proximal humeri. There is no FDG activity associated with these lesions. The biggest lytic lesions are noted in the L2 vertebral body as well as the T9 vertebral body which is associated with a compression fracture. There are dense solitary foci along the lateral aspect of the left ribs 5, 7, and 10, as well as right rib 10 along the costochondral junction. There are bilateral breast implants.Today's PET examination demonstrates focal uptake in the pituitary gland. The lytic lesion in the L2 vertebral body has an SUV value of 1.5, with the adjacent remaining vertebral body having an SUV value of 2.5. There is associated FDG activity involving the dense foci of the ribs noted on CT above. For example, SUV of the left 5th rib is 1.8. There is normal physiologic activity throughout the GI tract. There is FDG activity along the paraspinal muscles predominately at the mid spine likely related to muscle spasm. There is focal activity in the right axillary region likely due to residual radiotracer in the vein. | 1.Numerous lytics lesion involving the skull, spine, pelvis, bilateral proximal femurs and proximal humeri as described above compatible with patient's history of multiple myeloma. There is an associated compression fracture involving the T9 vertebral body which was seen previous spine radiograph. There is no FDG activity associated with these lesions. 2.Uptake involving several ribs bilaterally as described above, associated with increased density on CT. Given the location and appearance on CT, these findings are likely related to previous trauma and represent healing fractures.3.FDG activity in the pituitary gland, which may represent a pituitary adenoma. Suggest clinical correlation or additional anatomical imaging such as MRI. |
Generate impression based on findings. | Female; 71 years old. Reason: Changes in I.L.D. LUNGS AND PLEURA: Significant interval decrease in nonspecific basilar predominant subpleural reticulations. Minimal residual scar-like opacities persist. Again, no architectural distortion, honeycombing, or groundglass opacities. Minimal scarring/fibrosis in the lingula is similar to prior study and likely related to radiation treatment. No air trapping on expiration images. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Dense mitral valve annular calcifications. No visible atherosclerotic calcifications of the coronary arteries.CHEST WALL: Degenerative arthritic changes of the thoracic spine. Bilateral mastectomies. Surgical clips in the left axilla.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Significant decrease in nonspecific basilar reticulations, which may have been post inflammatory in etiology. |
Generate impression based on findings. | 57 year female with pain, preoperative evaluation Three views of the left knee show severe osteoarthritis affecting the knee with approximately 1.5cm lateral translation of the tibia with respect to the long axis of the femur. Hardware components of a right total knee arthroplasty are situated in near anatomic alignment as seen on the frontal view.Mechanical axis exam of the left lower extremity again shows severe osteoarthritis affecting the knee. There is approximately 25 degrees varus alignment of the knee with respect to the neutral mechanical axis. Evaluation of the left hip is limited due to body habitus, however, there appears to be narrowing of the joint. | Severe osteoarthritis and varus deformity of the knee as described above. |
Generate impression based on findings. | Female 49 years old; Reason: 49y/o female with right breast cancer RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | Male 68 years old; Reason: 67 yo M hx of increasing lymphadenopathy with no clear malignancy. Eval for mets/cancer History: LAD CHEST:LUNGS AND PLEURA: Left upper lobe lesion measures 2.6 x 2.2 cm (image 33/series 4) previously, 2.4 x 1.9 cm.Scarring is noted in the right anterior lung. Multiple pleural based nodules in the left lung base.MEDIASTINUM AND HILA: Extensive mediastinal lymphadenopathy. Left thoracic inlet lymph node measures 3.1 x 2.0 cm (image 11/series 3) previously, 2.8 x 1.7 cm.Mediastinal anterior nodal mass measures 3.7 x 1.5 cm (image 35/series 3) previously, 3.9 x 1.7 cm.CHEST WALL: Bilateral axillary lymphadenopathy.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense hepatic foci are too small to characterize. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Cystic pancreatic tail mass measures 4.4 x 2.4 cm (image 111/series 3) previously, 5.0 x 3.2 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is normal in morphology. No hydronephrosis. Postsurgical changes of the lower pole of the left kidney.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. A left para-aortic lymph node 4.0 x 3.4 cm (image 133/series 3) previously, 4.1 x 3.4 cm.BOWEL, MESENTERY: Extensive mesenteric lymphadenopathy. Representative mesenteric lymph node measures 5.2 x 5.2 cm (image 156/series 3) previously, 5.0 x 4.8 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is absent or atrophic.BLADDER: No significant abnormality notedLYMPH NODES: Extensive pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesion in the left femur that destroys the anterior cortex is best seen on image 227 series 3 and has increased in size.OTHER: No significant abnormality noted | 1.Extensive lymphadenopathy in the chest, abdomen and pelvis. Distribution is most compatible with a lymphoma which correlates with the flow cytometry results.2.Left femoral destructive cortical based lesion has increased in size. Follow-up with orthopedics is suggested. |
Generate impression based on findings. | 70 year-old female with increased back pain. Three views of the lumbar spine are provided. There are 5 lumbar type vertebral bodies. There is moderate dextroscoliosis of the thoracolumbar spine. Orthopedic fixation devices are again seen between the spinous processes of L3-4 and L4-5. There is moderate-severe multilevel degenerative disk disease. Evaluation of vertebral body heights is limited due to scoliosis but there is no evidence of compression fracture. There is slight rightward translation of L3 on L4 as seen on the prior CT from 2012. The bones appear demineralized suggesting osteopenia. There are atherosclerotic calcifications of the distal abdominal aorta. A right total hip arthroplasty is partially visualized. Severe degenerative changes affect the partially visualized left hip. | Scoliosis, degenerative disease, and postoperative changes as described above without acute compression fracture. |
Generate impression based on findings. | 54-year-old male with elevated white blood cell count and drain in place. Evaluate for abscess status post drain. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Multiple surgical clips around an unopacified urinary bladder again noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left lower quadrant colostomy with mildly dilated loops of bowel likely secondary to stasis. BONES, SOFT TISSUES: Postsurgical findings related to amputation of the pelvis and sacrum again noted. Large sacral decubitus ulcer, unchanged. Diffuse stable anasarca.Interval placement of a pigtail catheter with near complete resolution of fluid collection extending along the lateral aspect of the left iliac bone and extending into the soft tissues of the prominence superior left thigh. Residual component within the left iliacus muscle (series 3, image 20) measures 2.6 x 0.4 cm.Again noted is cortical disruption of the left iliac bone with possible sinus tract (series 3, image 19) most likely acute on chronic osteomyelitis.Bullet fragment along the left transverse process of L5 vertebral body.OTHER: No significant abnormality noted | 1.Near complete resolution of abscess in soft tissues of the left hemipelvis with residual component in the left iliacus muscle as above.2.Stable cortical breakthrough and fracturing of left iliac bone with possible sinus tract to the previously identified abscess suggestive of acute on chronic osteomyelitis.3.Stable large sacral decubitus ulcer.4.Extensive stable post surgical changes related to amputation of pelvis and sacrum. |
Generate impression based on findings. | 54-year-old female with pain in palmar aspect of fourth digit No acute fracture is evident. Mild deformity of the volar aspect of the base of the middle phalanx of the fourth finger may represent old trauma. | No acute fracture or other specific findings to account for the patient's pain. |
Generate impression based on findings. | 16 year-old male, follow-up for gunshot wound A plate and screw device affixes a proximal tibia fracture in near-anatomic alignment. No hardware complications are evident. Skin staples are noted along the medial soft tissues. The distal tibia and fibula appear intact. | Orthopedic fixation of proximal tibia fracture as described above. |
Generate impression based on findings. | 82-year-old female with abrupt onset of loss of motion of the right thumb, pain, minimal swelling. Three views of the right wrist show a volar plate and screw device affixing the distal radius in near anatomic alignment. There is also cement density in the distal radius without evidence of complication. Mild osteoarthritis affects the wrist. The bones appear demineralized. | Postoperative findings of distal radius fixation and osteoarthritis as described above without specific finding to account for the patient's loss of motion of the right thumb and pain. |
Generate impression based on findings. | History-year-old female with right thigh radicular pain The bones appear demineralized suggesting osteopenia. Mild lumbar scoliosis is noted. There is severe degenerative disk disease at L2/3 and L4/5, as well as moderate degenerative disk disease at L3/4. Multilevel facet joint osteoarthritis affects the lumbar spine. There is minimal anterolisthesis of L2 on L3 and minimal retrolisthesis of L4 on L5. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | 57-year-old female, evaluate for first MTP joint deformity There is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. The interphalangeal joints appear normal. Old healed fracture deformities of the second metatarsal and second proximal phalanx are noted. | First metatarsophalangeal joint dislocation and old healed fractures as described above. |
Generate impression based on findings. | Female 28 years old; Reason: H/O Gallstone Pancreatitis and fluid collection. Pt scheduled for surgery lap chole on 1/22/15, Need to evaluate extent of fluid collection near pancreas and gallbladder History: Wound drainage ABDOMEN:LUNGS BASES: Bibasilar atelectasis has resolved.LIVER, BILIARY TRACT: Hepatomegaly is unchanged. Small focal fatty infiltration seen at level of ligamentum teres is also stable. Percutaneous cholecystostomy tube has been removed. Patent portal veins. Patent splenic vein and SMV. Patent hepatic veins.SPLEEN: No significant abnormality noted. Small splenule, as noted previously.PANCREAS: Previously described pancreatic fluid collection has resolved. Body and tail atrophy noted. Normally enhancing pancreatic head and uncinate process seen. No new fluid collection delineated. No definite pseudoaneurysm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube has been removed. Unchanged chronic sequela of prior inflammation in left paracolic gutter area.OTHER: No significant abnormality noted. | Resolution of previously described pancreatic fluid collection. Cholecystostomy and enteric tubes have been removed. |
Generate impression based on findings. | Renal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable segment two and 4B enhancing foci; favor benign etiology.SPLEEN: No significant abnormality notedPANCREAS: Distal pancreatic ductal dilatation again noted and unchanged. Degree of associated pancreatic atrophy unchanged. Subcentimeter cystic focus arising from the tail of pancreas also unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change in enhancing mass arising from the lower pole of the right kidney best seen on image 67 of series 7 measuring 2.3 x 2.5 cm. stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No change in large prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right lower pole renal mass unchanged and again consistent with renal cell carcinoma. No evidence for metastasis.Stable focal pancreatic ductal dilatation and associated pancreatic tail cyst and pancreatic atrophy; stricture versus IPMN are favored. |
Generate impression based on findings. | 41-year-old male status post ACDF. Surveillance imaging. Five views of the cervical spine were obtained in flexion, extension, and neutral positioning. The cervical spine is not well seen on the lateral views below C6 due to overlying anatomy. An anterior plate and screw device is present with screws entering the C4 and C6 vertebral bodies with bony fusion of the C4-C6 vertebral bodies. An additional plate and screw device enters C3-4 with a spacer device between the C3 and C4 vertebral bodies. We see no frank interbody bony fusion at this level. There is no instability between flexion, extension, and neutral positioning. Moderate degenerative disk disease affects C6-7. | Postoperative changes of ACDF without radiographic evidence of instability. |
Generate impression based on findings. | 78 years, Female. Reason: NGT placement Pelvis is excluded from the field of view. Mild increase in the gaseous distention of the bowel. There is incompletely imaged stool in the rectum, correlate clinically for fecal impaction.IVC filter present. Enteric tube tip is coiled in the gastric fundus. Partially imaged central venous catheter tip is in the cavoatrial junction. Degenerative disease of the spine is noted. | Mild increase in the gaseous distention of the bowel. There is incompletely imaged stool in the rectum, correlate clinically for fecal impaction. |
Generate impression based on findings. | 87 year-old female with pain and tenderness The bones are slightly demineralized. Moderate osteoarthritis predominantly affects the patellofemoral joint. A moderate joint effusion is noted. Moderate osteoarthritis affects the right knee as seen on the frontal view. No fracture is evident. | Osteoarthritis without fracture evident. |
Generate impression based on findings. | 59-year-old female with pain status post fracture of the distal phalanx of the third toe Again seen is a fracture through the distal phalanx of the third toe. The fracture remains visible without radiographic evidence of healing. Severe osteoarthritis affects the first metatarsophalangeal joint. | Fracture of the third toe as described above without specific radiographic evidence of healing. |
Generate impression based on findings. | Neuroendocrine carcinoma of the thymus. Check for metastatic disease CHEST:LUNGS AND PLEURA: Left upper lobe paramediastinal wedge resection with postsurgical changes in suturing. No suspicious intrapulmonary nodules or masses. No effusions, however two small pleural focal soft tissue masses are observed in the left hemithorax (image 17 and image 53, series 4). The appearance is nonspecific and smoothly marginated however in light of the patient's history and surgery on this side, postsurgical changes as well as metastatic disease cannot be excluded.MEDIASTINUM AND HILA: Minimal fluid density is observed in nature mediastinum and bed of the thymus. Postsurgical scarring and change similar to prior studies.No lymphadenopathy.The cardiac and pericardium other than mild coronary calcifications appear similar.Moderate hiatal hernia.CHEST WALL: Mild scattered degenerative changes without additional new suspicious lytic or blastic lesionsABDOMEN: 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 scattered degenerative changesOTHER: No significant abnormality noted. | Interval new small pleural nodular densities, nonspecific. In light of patient's history and surgery, metastatic disease cannot entirely be excluded versus interval scarring. Dr. Salgia contacted |
Generate impression based on findings. | Ms. Beard is a 44 year old female presenting with a self palpated mass in the right upper outer breast for the past few weeks along with a physician palpated mass in the left lateral breast. Three standard views of both breasts with two spot compression views in both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography.A triangular marker is placed in the palpable area of abnormality in the right upper outer breast and left lateral breast. No discrete mass or area of architectural distortion is identified underneath the marker. There are no suspicious microcalcifications in either breast. BILATERAL BREAST ULTRASOUND | (1) No mammographic or sonographic evidence of malignancy in the right breast, at site of patient's area of concern. This area can be followed by her primary care physician as clinically warranted. If physical exam findings remain concerning, surgical consultation may be warranted. (2) 0.8 cm solid mass with benign sonographic features in the left superior breast. We advocated for short term imaging follow-up, however, patient strongly desired histologic sampling for pathologic confirmation. She will be scheduled for an US-guided biopsy. She is not on any blood thinning medications. All results and recommendations were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 74 years, Female. Reason: evaluate tube Percutaneous jejunostomy tube is in place. Instilled contrast opacifies left sided jejunum, no definite abnormal contrast extravasation to suggest a leak. Nonobstructive bowel gas pattern. Evaluation suboptimal on this single supine film but no gross free air. Degenerative disease of spine and scoliosis. | Jejunostomy tube as above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 20 old male with dysplastic small round cell tumor, evaluate disease status postsurgery. CHEST:LUNGS AND PLEURA: Left basilar scarring unchanged. Previously seen multifocal semi-solid nodules have resolved suggesting an inflammatory etiology.MEDIASTINUM AND HILA: The heart size is normal as is the caliber the great vessels. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: Left chest wall Port-A-Cath with the tip terminating in the superior vena cava.ABDOMEN:LIVER, BILIARY TRACT: Resolution of the previously seen hypoattenuating lesion in the left hepatic lobe and interval decrease in size of the index right hepatic lobe lesion, now measuring 0.9 x 1.5 cm (image 107, series 5), previously 1.5 x 1.6 cm. Hypoattenuating lesion in the periphery hepatic segment 8 appears significantly smaller compared to the prior exam. There is mild periportal edema. The gallbladder is collapsed.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: Scattered retroperitoneal lymph nodes are not pathologically enlarged by size criteria, but appears slightly more prominent compared to the prior examination.BOWEL, MESENTERY: Hypoattenuating fluid within the lesser sac and along the greater curvature of the stomach likely reflecting loculated ascites. New small volume ascites limits evaluation of the previously seen omental nodularity; however, given this limitation, the previously seen large pelvic nodular mass is not identified. Gastrojejunostomy tube in place with the tip terminating in the proximal jejunum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small volume ascites.PELVIS: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: Small volume ascites. | 1.Markedly improved/resolved peritoneal and omental masses/nodularity; however, evaluation limited by ascites.2.New loculated fluid within the lesser sac.3.Resolution and decrease in size of the hepatic metastases.4.Resolution of the previously seen pulmonary nodules, likely reflecting an inflammatory etiology. |
Generate impression based on findings. | 47-year-old female with also, evaluate for progression of osteomyelitis of the distal first phalanx Again seen is tapering of the tuft of the distal phalanx of the great toe compatible with resorption due to osteomyelitis. The tapering appears slightly more prominent, which is suggestive of further resorption of the bone. The bony margins however appear sharp, arguing against active osteomyelitis. | Deformity of the distal phalanx of the great toe, compatible with prior infection. If there is clinical concern for active osteomyelitis, MRI may be considered for further evaluation. |
Generate impression based on findings. | Appendiceal carcinoma with solitary pulmonary nodule. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules can be followed.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left subclavian vein chest port.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter segment 5 hypodense nodule (image 92) is nonspecific and can be followed. No enhancing lesions are evident.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Subcentimeter mesenteric lymph nodes can be followed.BOWEL, MESENTERY: Left lower quadrant ostomy. Parastomal hernia is not obstructive.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Scattered clips in the upper abdomen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: 3.5 x 2.6 cm right inguinal lymph node (image 193; series 401).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: 2.1 x 1.6 cm soft tissue nodule in the anterior right hemipelvis (image 172; series 401) is suspicious for recurrent disease. | Finding suspicious for local recurrence in the right hemipelvis with associated enlarged right inguinal lymph node. |
Generate impression based on findings. | Brain: Compared to the previous exam, there has been no significant change in the ill-defined T2/FLAIR hyperintensity within the right hippocampus. The associated small enhancing nodule measures 8 x 11 mm (series 1301, image 32) compared to 11 x 11 mm previously and may be minimally smaller, allowing for differences in technique. There is stable surrounding probable vasogenic edema including anterior extension surrounding the right temporal horn. Again seen is smooth diffuse enhancement of the cisternal segment of the right trigeminal nerve without significant change, likely relating to post-treatment changes from the patient's stereotactic radiosurgery for trigeminal neuralgia.T2/FLAIR intensity along the right lateral aspect of the pons including along the root entry zone of the trigeminal nerve, as well as along the nerve root entry zone of the seventh and eighth cranial nerves is similar to prior.Again seen are numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. Multiple lesions with associated T1 hypointensity are also noted. No new lesions or enhancing lesions to suggest active demyelination. On perfusion evaluation sequences, there is no elevated rCBV in the area of the persistent nodular enhancement in the right mesial temporal lobe although this is limited by adjacent hyperperfusing vasculature. | 1.Minimally decreased size of the enhancing nodule in the right hippocampus with stable surrounding ill-defined abnormal signal. No elevation of the rCBV on perfusion imaging although this is somewhat limited by adjacent vasculature. Findings again are favored to represent post-treatment changes.2.Stable enhancement of the cisternal segment of the right trigeminal nerve likely from stereotactic radiation therapy for trigeminal neuralgia. 3.Stable chronic demyelinating lesions. No new lesions or findings to suggest active demyelination. Similar appearance of T2/FLAIR hyperintensity in the right lateral pons. |
Generate impression based on findings. | 9-year-old male, rule out calcaneal lesion, stress fracture or infection. There is increased density of the calcaneal apophysis, which is nonspecific and can be seen in healthy children or those with Sever's disease. There is a linear defect in the inferomedial calcaneal apophysis of questionable clinical significance. A small lucent focus in the posterior tuberosity of the calcaneus is nonspecific and most likely corresponds to a focus of signal abnormality seen on the prior MRI. The remainder of the calcaneus is unremarkable apart from a fine tubular lucency which may represent the biopsy tract. We see no fracture line or soft tissue abnormality. | Nonspecific sclerosis of the calcaneal apophysis with small lucency in the posterior calcaneal tuberosity as described above. While it is conceivable this could represent sequela of prior infection or CRMO, the possibility of Sever's disease is also considered. |
Generate impression based on findings. | Male; 61 years old. Reason: Esophageal cancer History: initial staging CHEST:LUNGS AND PLEURA: Minimal bibasilar dependent subsegmental atelectasis. No suspicious pulmonary nodules or masses. No pleural effusions. Small amount of tracheal debris.MEDIASTINUM AND HILA: Moderate circumferential thickening of the distal esophagus with soft tissue mass projecting into the lumen, consistent with the patient's known distal esophageal adenocarcinoma (images 60-65, series 4). Moderate hiatal hernia. Single enlarged right paratracheal lymph node measuring up to 12 mm in short axis, suspicious for metastasis (image 27, series 4).Normal heart without pericardial effusion. Mild atherosclerotic calcification of the coronary arteries. CHEST WALL: Degenerative arthritic changes of the thoracic spine.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: Bilateral renal cysts. Nonobstructing small left renal midpole calculus.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative arthritic changes of the lumbar spine.OTHER: No significant abnormality noted. | Distal esophageal adenocarcinoma with single enlarged mediastinal lymph node that is suspicious for metastasis. |
Generate impression based on findings. | 67-year-old female with nausea and vomiting post IV TPA administration. Interval increase in hypodensity involving the right frontal lobe pre-central gyrus is seen extending to the operculum and consistent with evolving acute infarct. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained in the remainder of the brain. . Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. Scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, consistent with previously seen chronic small vessel ischemic changes. Persistent opacification of the left posterior ethmoid sinus; otherwise, the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. Rightward gaze deviation. | Evolving acute right frontal infarct involving the precentral gyrus. No evidence of hemorrhagic transformation or significant mass effect.Findings discussed with Dr. Buerki at 1440 hrs 1/14/2015. |
Generate impression based on findings. | Reason: S/p lap myotomy and partial fundoplication 7 years ago. History: dysphagia Scout radiograph of the chest unremarkable.Presbyesophagus with severe esophageal dysmotility including proximal escape was noted. There was circumferential cervical esophageal narrowing, lumen measured 0.6 cm in the smallest dimension with prestenotic dilatation noted (series 5). As study progressed, there was delay in transit past the level of the patient's fundoplication wrap, which may reflect an element of partial obstruction. Type II fundoplication migration was also seen. There was mild holdup of the barium pill at the gastroesophageal junction but pill eventually traversed this level. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. TOTAL FLUOROSCOPY TIME: 7:46 minutes | 1.Presbyesophagus with severe esophageal dysmotility including proximal escape.2.Cervical esophageal narrowing with prestenotic dilatation noted, no significant delay in transit of contrast beyond this level. Further evaluation with endoscopy to exclude an underlying stricture recommended.3.Some delay in transit time past the fundoplication wrap, which may reflect an element of partial obstruction. Type II fundoplication migration also seen.4.Mild holdup of barium pill at gastroesophageal junction before eventual passage, nonspecific but may have implications with solid food ingestion. |
Generate impression based on findings. | There is prominence of the lateral and third ventricles as well as sulcal prominence. The fourth ventricle appears within normal limits. The corpus callosum appears thin especially anteriorly (less than 2 mm) but is intact. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. Myelination in the left anterior limb of the internal capsule is not well visualized, however the remaining myelination is within normal limits. Specifically, the optic radiations are well myelinated. This may be artifactual in etiology. No extra-axial fluid collection is identified. No tonsillar herniation. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits are overall normal. The globes are intact. There is no abnormal enhancing lesions or abnormal signal. No retrobulbar hematoma. The optic nerves are well visualized and appear normal as well as symmetric. Optic chiasm is unremarkable. | 1.Prominence of the lateral and third ventricles may in part be due to benign external enlargement of the subarachnoid spaces of infancy given the patient's age, which should resolve by two years of age, however more diffuse sulcal prominence may suggest a superimposed component of global volume loss.2.The corpus callosum is thinned which may be developmental.3.Myelination of the anterior limb of the left internal capsule is not well visualized, however evaluation is somewhat limited due to lack of T1 inversion recovery images. This may be artifactual, however attention to this structure on follow-up is recommended.4.No specific MR abnormalities of the orbits or optic pathway. |
Generate impression based on findings. | 27-year-old female, evaluate for fracture of the wrist after volleyball injury No fracture is evident. A small cortical irregularity along the lateral distal radius likely represents a normal variant physeal spur. | No fracture evident. |
Generate impression based on findings. | Female 78 years old; Reason: Hx of Large Cell Lymphoma History: F/u; Compare with previous CHEST:LUNGS AND PLEURA: There is a small left pleural effusion. There is scarring and atelectasis at the left lung base.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Coronary calcifications are present in the triple vessel distribution.Reference mediastinal lymph node measures 7 mm (image 30/series 4) previously, 6 mmCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Moderate calcific arteriosclerotic disease affects the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcification in the uterus likely represent a calcified fibroid.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. | 1.Stable exam with no new sites of 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Multiple partially circumscribed masses are again noted throughout the right breast, and are not significantly changed. The largest is identified at the approximate 3 o'clock position, previously shown to be a cyst by sonography. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | The bilateral external auditory canals, middle ear cavities and mastoid air cells are completely clear. There is an asymmetrically enlarged air cell within the right mastoid, which is likely developmental in the absences of surgical history. There is no evidence for congenital atresia of the external auditory canals or middle ear cavities. The scuta and ossicles are intact bilaterally. No erosive changes are identified. There are no soft tissue masses identified within either middle ear cavity. The roofs of the attic are intact on both sides. The oval and round window niches are patent bilaterally. The course of the seventh nerves are well defined bilaterally without positional anomalies identified on either side.The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. The cochlea and vestibules are patent bilaterally. There are no dehiscences or fenestrations of the semicircular canals on either side. The cochlear and vestibular aqueducts and internal auditory canals are symmetric bilaterally. The carotid and jugular plates are intact on both sides. Incidental note is made of a small right sided serpentine normal variant bony vascular channel just medial to where the right superior semicircular canal resides and exits the petrous bone anteriorly and medially. | Negative high-resolution CT scan of the temporal bones |
Generate impression based on findings. | Nausea vomiting abdominal pain ABDOMEN:LUNG BASES: EmphysemaLIVER, BILIARY TRACT: 1 x 1.6 cm low attenuation focus within segment 3 left lobe liver best seen on image 52 of series 3; favor benign etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aneurysmal dilatation of distal abdominal aorta best seen on image 71 of series 3. Maximal AP diameter 2.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Abdominal aortic aneurysm with maximum AP diameter of 2.9 cm. Otherwise unremarkable examination for age without evidence for acute, inflammatory, or neoplastic process. |
Generate impression based on findings. | Postoperative changes right frontal craniotomy for resection of colloid cyst. There is a defect in the anterior body of the corpus callosum with exvacuo dilatation of the left frontal horn compatible with postsurgical change. There is underlying dural enhancement which is likely postsurgical. Pneumocephalus has resolved, however there is an underlying extra axial fluid collection measuring 5 mm in thickness which is unchanged from the prior CT of 10/4/2014. No abnormal enhancement or abnormal T2 signal within the brain parenchyma. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. Enhancement and mucosal thickening in the anterior ethmoid sinuses is increased from the prior exam. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1.Postsurgical changes of colloid cyst resection without evidence of recurrence.2.Small residual right extra axial fluid collection which was present on prior. |
Generate impression based on findings. | 53-year-old female status post surgery Resection of the fifth ray through the fifth metatarsal diaphysis is again noted. Osteolysis of the tuft of the distal phalanx of the great toe is consistent with osteomyelitis. A defect along the plantar aspect of the calcaneal tuberosity is compatible with osteomyelitis and perhaps postoperative changes. There is gas density adjacent to the heel pad, tracking proximally along the posterior calcaneus into the leg approximately 11 to 12 cm proximal to the calcaneus. Furthermore, there is new angular deformity along the superior aspect of the posterior calcaneal tuberosity that we suspect reflects a complete fracture of the calcaneus in the coronal plane with slight retraction of the posterior fragment by the Achilles' tendon. | 1. Osteomyelitis of the calcaneus with what appears to be a fracture through the posterior tuberosity and with soft tissue gas extending to the lower leg. If further evaluation is clinically warranted, dedicated leg radiographs may be considered.2. Osteomyelitis of the distal phalanx of the great toe.Dr. Shi was notified of these findings at the time of dictation. |
Generate impression based on findings. | 65-year-old female with syncope. History of breast cancer. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery measures to 3.6 cm which suggests pulmonary arterial hypertension without evidence of right ventricular strain.LUNGS AND PLEURA: Small right pleural effusion. Solitary right middle lobe nodule measuring 7 mm, metastasis cannot be excluded. MEDIASTINUM AND HILA: Normal heart size. Heavily calcified aorta with severe coronary artery and mitral valve calcifications. Small anterior pericardial effusion. No mediastinal or hilar lymphadenopathy. CHEST WALL: Extensive anasarca with skin thickening overlying both breasts. No axillary lymphadenopathy. Surgical clips in the right axilla. Moderate to marked degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Post surgical changes from previous gastric bypass. Small perihepatic ascites is present. | 1.No evidence of pulmonary embolism.2.Solitary lung nodule in the right lobe measuring 7 mm. Given the patient's history of breast cancer, metastasis cannot be excluded. 3.Small right pleural effusion.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative. |
Generate impression based on findings. | 79-year-old female with pain, total shoulder arthroplasty, question of dislocation. Three views of the left shoulder show hardware components of a left reverse total shoulder arthroplasty. There appears to be superior angulation of the glenoid component that was not present on the recovery room radiographs with lucency surrounding the central screw consistent with loosening. We see no frank dislocation of the humeral component and the glenoid component at this time.Three views of the left wrist are provided. The bones appear demineralized. There is mild osteoarthritis affecting the first carpometacarpal joint. There appears to be chondrocalcinosis of the wrist as well as soft tissue swelling dorsally. A 5-mm ossicle is present in the dorsal soft tissues. | 1. Reverse total shoulder arthroplasty with findings consistent with loosening and angulation of the glenoid component. 2. Osteoarthritis and soft tissue swelling of the left wrist as described above. |
Generate impression based on findings. | 73-year-old male with right parotid mass. Extensive streak artifact from dental hardware limits sensitivity.An ovoid, enhancing, well-circumscribed lesion is noted in the superior right parotid gland, measuring 20 x 13 x 23 mm. There is fatty atrophy of the bilateral parotid glands. The remainder of the major salivary glands and thyroid are unremarkable. Scattered subcentimeter lymph nodes are seen. There is no significant cervical lymphadenopathy. There is mild mucosal thickening of the bilateral maxillary sinuses with likely small retention cyst on the right. The mastoid air cells appear clear.Areas of hypodensity within the jugular veins likely represent flow-related artifact and are grossly patent.Moderate degenerative changes in the cervical spine without destructive osseous lesions. The airways are patent. The imaged intracranial structures are unremarkable. | Enhancing, ovoid lesion in the superficial right parotid gland measuring 20 x 13 x 23 mm. Differential is broad but finding may represent a benign salivary gland tumor such as pleomorphic adenoma. Consider MRI or tissue sampling as clinically indicated. |
Generate impression based on findings. | Altered mental status. There is no evidence of intracranial hemorrhage or mass. There is an unchanged punctate focus of hypoattenuation in the right caudate and patchy cerebral white matter hypoattenution. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are vertebrobasilar and carotid siphon calcifications. The mastoid air cells are clear. There is mild mucosal thickening within the left sphenoid sinus. The skull appears to be intact. There is are unchanged subcentimeter hyperattenuating structures in the frontal scalp. There are bilateral lens implants. | 1. No evidence of acute intracranial hemorrhage.2. Chronic lacunar infarct in the right caudate head and probable small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | 64-year-old female with knee pain status post ORIF. Three views of the left knee again show a plate and screw device affixing a comminuted fracture of the distal femur in near anatomic alignment. There has been progressive sclerosis and callus formation adjacent to the fracture indicating some interval healing. There is no evidence of hardware complication. Severe osteoarthritis affects the left knee. Multiple screws affix the right proximal tibia and severe osteoarthritis affects the right knee as seen on the frontal view. | Orthopedic fixation of healing left distal femoral fracture and other findings as described above. |
Generate impression based on findings. | Male 68 years old; Reason: 67 yo M increasing LAD and pancreatic tail mass. No clear malignancy. Eval for bony mets History: LAD Increased activity involving the proximal left femur which correlates with the lytic lesion seen on recent CT. Scattered uptake involving the bilateral AC joints, knees, ankles and elbows likely degenerative in nature. | Increased activity involving the proximal left femur associated with the lytic lesion seen on CT. This is suspicious for osseous metastatic disease. |
Generate impression based on findings. | 17 year-old female with nausea vomiting and weight loss. History of pyloric gastritis and near gastric antrum. Rule-out Crohn's disease or malignancy. ABDOMEN:LUNGS BASES: Nodular density in the right lower lobe is somewhat ill-defined, and presumably represents inflammatory change.LIVER, BILIARY TRACT: The gallbladder is collapsed. 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: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post total colectomy and right lower quadrant ileostomy formation. The stomach is patulous with a markedly increased craniocaudal dimension. There is wall thickening of the antrum of the stomach and the stomach is distended with oral contrast. Contrast progressed into the small bowel to the level of the ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Hypoattenuating adnexal lesions likely reflect physiologic cysts. Fluid within the endometrial canal and free fluid within the pelvis is likely physiologic in etiology.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Patulous distended stomach with thickening of the antrum, which may be infectious or inflammatory in etiology, and could be better evaluated with endoscopy.2.Postoperative changes related to total colectomy and end ileostomy formation as above. |
Generate impression based on findings. | Exam is limited by noncontrast technique, and by motion.ABDOMEN:LUNG BASES: Small bilateral pleural effusions, left greater than right, and associated atelectasis. Severe coronary artery calcifications. Large hiatal hernia.LIVER, BILIARY TRACT: No biliary dilation, no widening of the fissure.SPLEEN: No significant abnormality noted.PANCREAS: Coarse calcifications, suggestive of chronic pancreatitis, similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating renal foci, incompletely evaluated on this noncontrast exam, appear similar to prior.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches. Low attenuation of the blood pool in the aorta may represent anemia.BOWEL, MESENTERY: No small bowel traction or free air.BONES, SOFT TISSUES: Body wall edema, similar to prior.OTHER: Large amount of abdominal/pelvic ascites, similar to prior.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis affects the colon.BONES, SOFT TISSUES: Extensive body wall edema.OTHER: No significant abnormality noted. | 1.Persistent large amount of ascites.2.Small, left greater than right pleural effusions.3.Unchanged findings of chronic pancreatitis. |
Generate impression based on findings. | 32 year old female with pain. Three views of the right ankle show no fracture or other findings to account for the patient's pain. | No fracture or other findings to account for the patient's pain. |
Generate impression based on findings. | Postoperative as from prior right parietal craniotomy as well as post radiation changes are again seen. There is further slight decreased extent of confluent subcortical T2/FLAIR hyperintensity within the subcortical white matter of the paramedian parietal lobes bilaterally, slightly greater on the right and extending into the right occipital pole. The overall confluence of associated nodular and irregular enhancement in this area has decreased as well. The previously identified right paramedian parietal dural based heterogeneously enhancing tissue measuring 11 x 8 mm on 1101/113 on the current exam is not significant change, and again extends into the superior sagittal sinus on the right side. Adjacent portions of the superior sagittal sinus are again not contrast opacified, presumably thrombosed.In addition, there is no interval development of an extra-axial oval-shaped area of enhancement along the right posterior lateral parietal region with associated FLAIR hyperintensity. This measures 5 x 10 mm on 1101/123, and has a plaque-like appearance. Also, near the right posterior parietal convexity, there has been increased extra-axial convexity of dural based enhancement, best seen on 1102/85, measuring 7 x 10 mm on 1101/147. There is mild associated FLAIR hyperintensity.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal intraaxial signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the remainder of the major intracranial vascular structures. There is an incidental partially empty sella. The remainder of the midline structures and craniocervical junction are within normal limits. | 1. Interval further expected evolution of posttreatment changes in bilateral paramedian parietal lobes and extending into the right occipital lobe. Further decreased signal abnormality and confluence of enhancement in these locations, likely representing resolving radiation necrosis.2. Interval development of small dural based extra-axial mass along the lateral margin of the craniotomy flap, as well as increased prominence of a small but now conspicuous extra-axial mass near the right posterior parietal convexity. These are suspicious for recurrent meningiomas.3. Stable irregular enhancing soft tissue along the right side of the superior sagittal sinus, which remains partially thrombosed. |
Generate impression based on findings. | 49-year-old male status post revision of right total knee arthroplasty. Four views of the right knee demonstrate hardware components of a long stem right total knee arthroplasty in near-anatomic alignment. There is periosteal reaction along the anterior aspect of the distal femur which is maturing. There is perhaps slight lateral translation of the patella, not necessarily of any clinical significance. There is swelling along the anterior soft tissues. Hardware components of a left total knee arthroplasty are in near anatomic alignment as seen on the frontal view. | Total knee arthroplasty without evidence of complication. |
Generate impression based on findings. | Male 45 years old; Reason: pt with metastatic cancer, likely rcc. path pending. needs bone scan for full staging History: metastatic carcinoma based on fna lymph node results Focal activity seen at the craniocervical junction, more prominent on the left. | Focal activity at the craniocervical junction, more on the left may represent tumor or degenerative change. Please correlate with MRI study if clinically indicated. |
Generate impression based on findings. | There is minimal mucosal thickening involving the right frontal sinus. Left frontal sinus and bilateral anterior and posterior ethmoid air cells are clear. There is mild to moderate mucosal thickening involving the sphenoid sinuses. There is also mild mucosal thickening involving the bilateral maxillary sinuses. There are frothy secretions within the right maxillary sinus. The ostiomeatal units are clear. No findings to suggest an aggressive sinonasal process.There is S-shaped nasal septal deviation, convex right anteriorly and convex left posteriorly. There is left-sided septal spur. The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Mild paranasal sinus disease as above. There are frothy secretions within the right maxillary sinus, which while nonspecific, can be seen with acute sinusitis. |
Generate impression based on findings. | 34-year-old male with pain. Four views of the right foot show a mild pes planovalgus deformity. There are tiny osteophytes along the anterior aspect of the tibial plafond but no fracture. | Mild pes planovalgus deformity. |
Generate impression based on findings. | Femoral fracture, tachycardia. PULMONARY ARTERIES: Adequate infusion quality. No pulmonary embolus.LUNGS AND PLEURA: Mild lobular groundglass opacity in the lung periphery, predominantly the superior segment of the right lower lobe.MEDIASTINUM AND HILA: The airways are clear; no endobronchial debris to suggest aspiration.Normal heart size. No signs of right heart strain. No visible coronary artery calcifications on this non-gated study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute (thrombotic) pulmonary embolus. Nonspecific small lobular groundglass foci in the dependent aspect of the right lower lobe of unclear etiology or clinical significance. Though not typically a radiographic diagnosis, the possibility of lipid microemboli may be considered in the appropriate clinical context.PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 44-year-old female with broken left lower molar, jaw pain Several teeth are absent. The remaining left mandibular molar appears intact although there may be a small cavity in the crown. A broken right maxillary first incisor is noted. | Several absent teeth and possible cavity in the remaining left mandibular molar. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in a maternal cousin. 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. There is stable asymmetry within the upper outer left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 38 years old; Reason: 38 yo M with locally advanced esophageal/GEJ cancer. s/p chemo-RT. Please eval for response. History: dysphagia CHEST:LUNGS AND PLEURA: Mosaic perfusion in the left lower lobe. Diffuse scattered pulmonary nodules. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right chest wall port terminates at the cavoatrial junction. Decrease in the thickening of the distal esophagus.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small right renal cyst. The right kidney is mildly atrophic. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Left upper abdominal nodal mass near the greater curvature of the stomach measures 2.2 x 2.0 cm (image 96/series 3). 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.Decrease in the size of the distal esophageal mass.2.Necrotic left upper abdominal lymphadenopathy. |
Generate impression based on findings. | 72-year-old female with history of bladder cancer. Evaluate for metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Two segment 4a subcentimeter hypoattenuating lesions are too small to characterize but statistically likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter left renal lesion measures approximately 46 Hounsfield units on noncontrast without enhancement, most likely a proteinaceous cyst. Kidneys enhance and excrete contrast symmetrically. The ureters are opacified throughout their length without filling defect. The bladder is underdistended; within this limitation, no specific CT findings to suggest bladder mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to suggest disease recurrence or metastatic disease. |
Generate impression based on findings. | 50 year-old female with anterior neck pain and tenderness, assess for lymphadenopathy or mass There is no evidence of mass lesions or significant cervical lymphadenopathy. Small bilateral jugular chain nodes are not enlarged by CT criteria. Mild mucosal thickening of the right maxillary sinus, otherwise the paranasal sinuses and mastoid air cells are clear. The major cervical vessels are patent. Moderate degenerative changes and straightening of the cervical spine with anterior fusion at C5-C6. There is prominent ventral osteophyte at the C4-C5 level with mild impression on the hypopharyngeal wall on the right. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. No neck masses or cervical lymphadenopathy.2. Status post anterior cervical fusion at C5-6 with solid osseous fusion. There is prominent anterior cervical osteophyte at the C4-5 level with mild impression on the posterior hypopharyngeal wall. Finding is of questionable significance in relation to the dysphagia. |
Generate impression based on findings. | Altered mental status after anticoagulations for stroke, evaluate for hemorrhage Again seen is evolving subacute infarct in the right frontal lobe. No new mass-effect. Unchanged petechial hyperdensities within the infarct. No evidence of frank hematoma formation. Again seen are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. Unchanged small area of low density in the left thalamus also compatible with chronic ischemia. Unchanged subcentimeter extra-axial lesion along the medial convexity of the left frontal lobe, presumably meningioma. No midline shift or uncal herniation. Gray-white differentiation is maintained in the remainder of the brain. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. Evolving subacute right frontal infarct. Unchanged tiny hyperdensities within the infarct which may represent petechial hemorrhages. No frank hemorrhagic transformation. No new mass effect.2. Small left frontal extra-axial lesion compatible with a meningioma again seen. |
Generate impression based on findings. | 55-year-old male with lung cancer non-small cell. Newly diagnosed non-small cell lung cancer in need of PET for staging.RADIOPHARMACEUTICAL: 13.780 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates an enlarged right lower paratracheal lymph node. Additional smaller right paratracheal lymph nodes. Right upper lobe consolidation with air bronchograms, significantly decreased compared to prior. Additional adjacent nodular opacity. Hypoattenuating focus in the left kidney likely represents a renal cyst. Atherosclerotic calcification of the abdominal aorta and its branches. Today's PET examination demonstrates increased FDG activity involving one right hilar lymph node and several right paratracheal lymph nodes. For reference, right lower paratracheal lymph node that is enlarged on the CT portion measures a maximum SUV of 5.2.Mild increased FDG activity involving the right upper lobe patchy consolidation with air bronchograms, measuring a maximum SUV of 4.0, likely representing pneumonia.Nodular focus adjacent to right upper lobe consolidation demonstrates increased FDG activity, measuring a maximum SUV of 3.8.Focus of FDG activity within the right triceps muscle is nonspecific. Small focus of FDG activity involving a left rib is also nonspecific, measuring a maximum SUV of 2.2. | 1.Nodular focus of FDG activity in the right upper lobe suspicious for primary malignancy or metastasis.2.Multiple hypermetabolic right hilar and right paratracheal lymph nodes also suspicious for tumor involvement.3.Significant decrease in right upper lobe consolidation compatible with history of resection of mucous plugging. Residual small amount of mildly hypermetabolic patchy consolidation with air bronchograms likely represents pneumonia.4.Nonspecific small foci of FDG activity within the right triceps and a left rib.5.No definite contralateral chest involvement or distant metastases. |
Generate impression based on findings. | Assess pleural effusion. LUNGS AND PLEURA: Volume of pleural fluid not significantly changed in the interval, with a large right and moderate left collection. Compressive atelectasis of the lung parenchyma appears proportionate to volume of pleural fluid and unchanged.Mild mosaic attenuation of the aerated lung parenchyma, with scattered new foci of groundglass opacity in the anterior lung fields and lingula, left greater than right. Areas of lobular hypoattenuation are more suggestive of air trapping than hypoperfusion.No evidence of pleural enhancement, loculation or layering densities within the fluid to suggest hemothorax or empyema, though this would only be visible at a late stage.MEDIASTINUM AND HILA: Beam hardening artifact limits assessment for detail.In the region of the left atrial appendage, there continues to be subtle relative hyperattenuation compared to the remainder of the left atrium (series 4, image 44). While this could represent a dilated and high riding atrial appendage, the possibility of blood products in this area may be considered in the appropriate clinical context as this finding appears new from the 9/27/2014 examination.Tracheostomy tube terminates above the carina. Enteric tube can be followed to the distal stomach. Small amount of debris in the trachea and right mainstem bronchus consistent with aspirated secretions. Intermittent right lower lobe endoluminal obstruction presumably due to debris in airways.Multichamber cardiomegaly unchanged. Left ventricular assist device causes extensive streak artifact, limiting evaluation. Right jugular dual-lumen catheter distal tip at the SVC/RA junction. Left subclavian pacemaker/AICD with leads in the right atrial appendage and right ventricular apex. Prosthetic mitral ring. Native coronary arteries are heavily calcified. Ectatic ascending aorta, not reliably measurable, approximately 4-cm in AP dimension (4/40).Small (12-13 mm) nonspecific fluid collection posterior to the right brachiocephalic vein near a1 millimeter calcification or pledget, new from the study of 1/10/2015 though the calcification/pledget was present on the prior study.Small circumferential pericardial fluid collection unchanged. Heterogeneous enlarged thyroid gland containing coarse calcifications, poorly seen.CHEST WALL: Sternotomy fracture fragments are well approximated and the closure devices are in expected position. Subcutaneous fluid and edema similar to previous exam.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Large volume of intra-abdominal fluid incompletely assessed due to limited scanning range. Heterogeneous attenuation pattern of the liver unchanged. Gallbladder is partially collapsed and cannot be accurately assessed. | 1. New small lobular foci of groundglass opacity in the anterior lung fields bilaterally could represent early ARDS or pulmonary contusion. Volume of pleural fluid and creative atelectasis is similar to the previous study; apparent differences on plain film likely are related to patient positioning.2. The region of the left atrial appendage appears to be of higher density than blood pool and has changed in configuration from the 9/27/2014 examination. While this might represent dilatation of an anatomically high riding left atrial appendage, the possibility of blood products in this area may be considered in the appropriate clinical context. This finding is unchanged from the 1/10/2015 exam.3. Small fluid collection adjacent to the right brachiocephalic vein, new from previous, possibly an organizing hematoma, correlate for recent surgical intervention or line placement in this area. |
Generate impression based on findings. | Female 34 years old; Reason: abdominal pain History: pain Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 81.6 % of peak activity (normal >70 %)1 hour: 83.8 % of peak activity (normal 30-90 %) 2 hours: 39.3 % of peak activity (normal <60 %) 4 hours: 1.8 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | 20-year-old female status post MIBG #2, relapsed neuroblastoma CHEST:LUNGS AND PLEURA: Interval decrease in size of multiple bilateral pulmonary nodules. The reference left lower lobe nodule now measures 7 x 4 mm, previously 6 x 6 mm (series 4, image 73). No pleural effusions. No new nodules.MEDIASTINUM AND HILA: Extensive mediastinal and cervical lymphadenopathy has decreased in size compared to the prior exam. Slight interval decrease in the conglomerate superior mediastinal and cervical lymphadenopathy with reference lesion now measuring 7 mm, previously 11 mm (series 3, image 14). Reference periaortic soft tissue is unchanged measuring 7 mm (series 3, image 51). No significant hilar lymphadenopathy. Heart size is normal. No pericardial effusion.CHEST WALL: No axillary or cardiophrenic lymphadenopathy. Diffuse osseous lytic and sclerotic lesions.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 17.8 cm. No focal liver lesions. Gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The left adrenal adrenal gland is not present. Surgical clips are noted in this region.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy appears unchanged. Reference periaortic lymph node at the level of the renal vein measures 6 mm, unchanged (series 3, image 98).BOWEL, MESENTERY: The bowel is within normal limits without evidence of obstruction.BONES, SOFT TISSUES: Diffuse osseous lytic and sclerotic lesions.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Nonspecific thickening of the bladder wall may be due to under distention.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse osseous lytic and sclerotic lesions.OTHER: No significant abnormality noted. | Slight interval decrease in reference pulmonary nodules and mediastinal lymphadenopathy. Unchanged retroperitoneal lymphadenopathy and diffuse osseous changes. |
Generate impression based on findings. | 74-year-old male with malignant neoplasm of lower third of esophagus. Evaluate for response after induction; follow CALGB 80803 procedure. RADIOPHARMACEUTICAL: 12.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly again demonstrates masslike thickening of the distal esophagus and enlarged bilateral hilar lymph nodes. Previously seen scattered bilateral ground glass pulmonary parenchymal opacities have resolved. Mild coronary artery calcifications. Extensive degenerative osteophytes again noted. Healed left inferior pubic ramus fracture deformity again noted.Today's PET examination demonstrates interval decrease in size and activity of distal esophageal mass, measuring a maximum SUV of 3.2, previously 4.7.Bilateral hilar lymph nodes have also decreased in activity. For example, previous reference right hilar lymph node measures a maximum SUV of 3.2, previously 4.1.Previously seen hypermetabolic ground glass pulmonary parenchymal opacities have resolved and likely were inflammatory or infectious in etiology.Mildly hypermetabolic left adrenal gland nodule measures a maximum SUV of 3.4, unchanged, and is most likely benign.Posterior hypopharyngeal wall linear hypermetabolic focus has significantly decreased in activity and size, also most likely benign.No new or metabolic foci. | 1.Interval decrease in size and activity of known distal esophageal mass.2.Interval decrease in FDG activity of bilateral hilar lymph nodes and posterior hypopharyngeal wall focus, likely benign.3.Stable left hypermetabolic adrenal nodule, most likely benign.4.Interval resolution of scattered hypermetabolic bilateral ground glass opacities, likely infectious or inflammatory in etiology.5.No new foci of FDG activity. |
Generate impression based on findings. | 57 year old female with right lower quadrant pain and weight loss. Patient with history of diverticulosis and abdominal surgery. Evaluate for small bowel obstruction or diverticulitis.Per additional history obtained from Dr. Lu, patient with two weeks of intermittent right lower abdominal pain and two to 3 pounds of weight loss. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild gallbladder wall thickening with pericholecystic fluid concerning for cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Incompletely characterized heterogenous left adrenal gland nodule measuring 68 HU and 1.4 x 0.8 cm in size. KIDNEYS, URETERS: No hydroureteronephrosis. Kidneys enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No findings to suggest diverticulitis or colitis. Appendix is normal. No small bowel obstruction.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No findings to suggest diverticulitis or colitis. Appendix is normal. No small bowel obstruction.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized spine.OTHER: No significant abnormality noted | 1.Findings consistent with cholecystitis. Findings relayed to Dr. Lu, covering pager 2809, over the phone at approximately 3:20 p.m.2.No evidence of diverticulitis or small bowel obstruction as clinically questioned.3.Incompletely evaluated left adrenal nodule. |
Generate impression based on findings. | 55-year-old female with history of primary lung neoplasm. Evaluate for metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality noted. Please see dedicated concurrent CT chest report for details thoracic findings.LIVER, BILIARY TRACT: Hypoattenuating segment IVb lesion measures 2.4 x 1.4 cm; there is suggestion of minimal peripheral discontiguous nodular enhancement. A few scattered subcentimeter hypoattenuating lesions are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter left lower pole hypoattenuating lesion is too small to characterize.RETROPERITONEUM, LYMPH NODES: Few scattered mildly prominent retroperitoneal lymph nodes without evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes affect L4/5 and L5/S1.OTHER: Prominent left gonadal vein noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate to severe degenerative changes affect L4/5 and L5/S1.OTHER: No significant abnormality noted | 1.No specific findings to suggest metastatic disease.2.Hypoattenuating segment IVb hepatic lesion is favored to be a hemangioma; however, liver MRI is recommended for definite characterization.3.Please refer to concurrent CT chest report for thoracic findings. |
Generate impression based on findings. | There are posttreatment findings in the bilateral temporal lobes with a left-sided craniotomy. Large heterogeneous area of flair hyperintensity in the mid left temporal lobe extending into the temporal pole and involving the cortex and subcortical white matter is similar to the prior exam. There are foci of T1 shortening as well as susceptibility. There is a new cystic focus within this lesion (4/12). Patchy enhancement within the posterior aspect has minimally increased, however diffusion restriction within this region of enhancement has significantly increased. Increased T2 signal without associated enhancement or diffusion restriction in the right temporal pole is unchanged.An anterior right frontal lobe focus measuring 1.5 x 1.0 (5/23), previously 0.9 x 0.5 cm shows increased diffusion restriction, enhancement and edema (8/23) as well as increased relative cerebral blood flow on perfusion imaging.Periventricular white matter changes as well as increased T2 hyperintensity within the bilateral thalami is overall similar to the prior exam, although there is small focus of slightly increased T2 signal within the left cingulate gyrus (5/23) without associated enhancement or diffusion abnormality which is increased from the prior exam but unchanged from the exam of 5/25/2013. A focus of diffusion restriction involving the splenium of the corpus callosum without associated enhancement or increased cerebral blood flow is unchanged. The ventricles and sulci are within normal limits are unchanged. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1.Multifocal glioblastoma with enhancing ovoid focus in the right anterior frontal lobe demonstrating interval increase in size and increased diffusion restriction and relative cerebral blood flow. Finding is highly suspicious for tumor progression.2.Large focus of T2 abnormality in the left temporal pole demonstrates stable to slight interval increase in enhancement and diffusion restriction which may suggest progression. Continued attention on follow up is recommended.3.Large focus of T2 abnormality in the right temporal pole without enhancement or diffusion restriction is unchanged.4.Small focus of increased T2 signal in the left cingulate gyrus is increased in prominence from the most recent exam but unchanged from remote exams. This is compatible with additional focus of tumor but without clear progression. |
Generate impression based on findings. | Ms. Jordan is a 61 year old female presenting with bilateral non-focal retroareolar pain for the past year. Three standard views of both breasts (total of 15 images) were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. Patient should follow up with her primary care physician for her breast pain as clinically warranted. 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. | 56 year old male with appendiceal cancer baseline clinical trial.RADIOPHARMACEUTICAL: 13.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion of the neck demonstrates no lymphadenopathy based on CT size criteria.Today's PET examination demonstrates numerous hypermetabolic foci predominantly within the right abdomen and pelvis. Some foci correlate with focal thickening involving the stomach and bowel walls, predominantly on the right. Specifically, there is also focal thickening adjacent to the right ileocolic anastomosis. Additional foci correlate with peritoneal implants. Hypermetabolic portocaval, right external iliac, and right inguinal lymph nodes, the latter two which correlate with enlarged nodes seen on today's diagnostic CT. For reference, right external iliac lymph node measures a maximum SUV of 8.4.No hypermetabolic foci involving the chest or neck. | 1.Numerous hypermetabolic foci that correlate with focal areas of wall thickening involving the stomach and intestines, peritoneal implants, and lymph nodes in the abdomen and pelvis, predominantly on the right side. These findings are suspicious for peritoneal carcinomatosis. 2.No definite hypermetabolic foci within the chest or neck. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 50-year-old female with pain in both knees status post fall one week ago Right knee: A vertically oriented lucency within the medial aspect of the patella is compatible with a nondisplaced fracture. No joint effusion is noted. Mild osteoarthritis affects the knee.Left knee: Mild tricompartmental osteoarthritis affects the knee but no fracture is evident. No joint effusion is noted. | Osteoarthritis and right patella fracture as described above. Dr. Birnie is aware of these findings. |
Generate impression based on findings. | Female 62 years old; Reason: R proximal femur metastatic carcinoma, evaluate for tumor burden/staging Multiple foci of uptake involving the right frontoparietal bones as well as multiple bilateral ribs, including the anterior aspect of the right 2nd, 3rd, 4th and 6th ribs, the posterior aspect of the right 8th and 9th ribs, the posterior aspect of the left 8th rib as well as the anterior aspect of the left 5th, 6th and 7th ribs. There is focal uptake involving the T3 vertebral body as well as T6 at the right costovertebral junction.The is evidence of right hip and bilateral knee prosthesis with uptake in the right proximal femur and bilateral proximal tibia likely reflecting postsurgical change. | Please note only anterior and posterior whole body images were obtained. No spot images were obtained as study had to be terminated due to patient's discomfort. 1. Multiple foci of activity involving the right frontoparietal bones as well as multiple bilateral ribs and thoracic vertebrae as described above suspicious for osseous metastatic disease.2. Likely postsurgical changes in the right proximal femur and bilateral proximal tibia. |
Generate impression based on findings. | 65-year-old female with neck pain, shoulder pain. Three views of the left shoulder are provided. The bones appear slightly demineralized. There are no specific findings to account for the patient's pain.Three views of the right shoulder are provided. The bones appear slightly demineralized. There is an approximately 1.5 cm density overlying the glenoid on the AP and Grashey views which is not seen on the transscapular view. This could represent a loose body or perhaps calcium hydroxyapatite deposition. Otherwise there are no specific findings to account for the patient's pain.Five views of the cervical spine are provided. There is severe degenerative disease at C6-7 and C7-T1. Mild degenerative disk disease affects C5-6. There is minimal retrolisthesis of C6 and loss of the normal cervical lordosis. There is neuroforaminal narrowing at C6-7 bilaterally and to a lesser degree at C5-6. | 1. Calcific density overlying the right glenoid of uncertain etiology could represent a loose body or calcium hydroxyapatite deposition in the adjacent soft tissue. If further imaging is clinically indicated, MRI may be considered.2. Cervical spine degenerative disease and neuroforaminal narrowing as described above. |
Generate impression based on findings. | Ms. Rafferty is a 25 year old female with a personal history of lymphoma treated with chest radiation (>20 Gy). She is presenting for surveillance in light of prior chest radiation. 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. There is no suspicious mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Per discussion with the patient, she is on a research protocol that allows for annual mammogram/MRI, which is reasonable given her prior history of chest radiation. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 33-year-old female with knee pain. Four views of the right knee are provided. Arterial calcifications are present in the posterior soft tissues. A tiny bony excrescence projects from the medial tibial metaphysis and may represent a tiny exostosis, but there are no specific findings to account for the patient's pain.Four views of the left knee are provided. Surgical clips and arterial calcifications are present in the soft tissues, but there are no specific findings to account for the patient's pain. | No specific findings to account for the patient's pain. Other findings as described above. |
Generate impression based on findings. | 53-year-old female with right hip pain, history of lung cancer. CT of the right hip was performed with and without intravenous contrast. There is moderate osteoarthritis of the right hip corresponding to radiographs from October 2014 with subchondral cysts in the acetabulum. Small densities along the anterior/superior femoral head may represent capsular calcifications or small loose bodies within the joint. We see no findings to suggest metastatic disease to bone. Osteoarthritis also affects the visualized inferior aspect of the sacroiliac joint. Small densities in the pelvis likely represent prior sterilization procedure. We see no abnormal enhancement. | Osteoarthritis without evidence of metastatic disease. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level. There is mild amount of narrowing of the mid to distal lumbar spinal canal due to short pedicles and slight prominence of epidural fat.At L5-S1, there is a trace disk bulge.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. Mild ligamentum flavum thickening is present along the lower lumbar levels.Limited visualization of retroperitoneum demonstrates partially visualized lobulated structures in the right paramedian pelvis which appear to be incidentally isointense to bone marrow signal. There is adjacent partially visualized fluid signal which may represent trace free fluid in the pelvis. | 1. Trace disk bulge at L5-S1 without significant stenosis at any level. Mild developmentally narrow mid to distal lumbar spinal canal.2. Partially visualized lobulated structures which appear isointense to bone marrow within the right hemipelvis. These could be related to partially visualized bowel contents or perhaps the ovaries and uterus. There is adjacent probable physiologic free fluid. Ultrasound pelvis could be obtained for further evaluation as clinically indicated. |
Generate impression based on findings. | Female; 55 years old. Per EPIC, patient has stage IV NSCLC/adenocarcinoma. LUNGS AND PLEURA: Spiculated right upper lobe mass measures 3.3 x 3 cm x 4.2-cm (transverse by AP by craniocaudal) (image 29, series 5 and sagittal image 40, series 80294), mildly increased since prior outside study when it measured approximately 2.7 x 2.4 cm (transverse by AP). The central portion of the mass is predominantly hypoattenuating, likely due to necrosis and similar to prior study. The mass is focally adherent to the adjacent posterior parietal surface, which appears mildly tented. No additional suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary artery atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Please see report for dedicated CT abdomen/pelvis performed concomitantly. | 1. Slightly increased size of spiculated, necrotic right upper lobe mass. 2. No evidence of tumor elsewhere.3. Please see report for dedicated CT abdomen/pelvis performed concomitantly. |
Generate impression based on findings. | 59-year-old male with pain. Four views of the left foot demonstrate postoperative changes of amputation through the base of the proximal phalanx of the great toe. Soft tissue swelling distal to the amputation has increased since the prior study. The osteotomy margins appear sharp without evidence of osteomyelitis. The bones appear demineralized suggesting osteopenia/osteoporosis. Poorly defined bandlike sclerosis of the neck of the second metatarsal with adjacent callus formation suggests a stress fracture. A small ossicle adjacent to the middle phalanx of the second toe may represent old trauma. Spurring along the dorsal aspect of the head of the talus is unchanged. Diffuse soft tissue swelling is present particularly along the dorsum of the ankle. Soft tissue arterial calcifications are present.Four views of the right foot demonstrate postoperative changes of amputation of the second ray through the head of the second metatarsal. The bones appear demineralized suggesting osteopenia/osteoporosis. There is a hallux valgus deformity with moderate osteoarthritis affecting the first metatarsophalangeal joint. There is fusion of the tibiotalar and subtalar joints via an intramedullary rod and screw device. The inferior margin of the rod penetrates the inferior margin of the calcaneus. There is a fractured screw within the calcaneus extending into/along the inferomedial margin of the cuboid that is presumably associated with this rod. Diffuse soft tissue swelling of the ankle extends along the dorsum of the foot. The majority of the Achilles' tendon is not visible amidst the soft tissue swelling. | 1.Postoperative changes of left great toe amputation as described above with soft tissue swelling distal to the remaining proximal phalanx of the great toe and finding suggesting a stress fracture of the second metatarsal neck.2.Postoperative changes in the right foot with a fractured calcaneocuboid screw and other findings as described above. |
Generate impression based on findings. | Infertility Opacification of the uterine cavity was unremarkable. Filling defect in lower endocervical canal is catheter balloon. Both fallopian tubes were freely opacified with free spillage into the pelvis, indicating tubal patency.TOTAL FLUOROSCOPY TIME: Approximately 1 minute | Patent fallopian tubes. |
Generate impression based on findings. | 60 year old female who has a complaint of diffuse bilateral intermittent breast pain x 1 year. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. Patient should return to her primary care physician for further management of bilateral breast pain. 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. | 47-year-old female with pain, question of glass foreign body. Three views of the right thumb show mild soft tissue swelling and osteoarthritis affecting the interphalangeal and metacarpophalangeal joints. No radiopaque foreign bodies are identified. | Soft tissue swelling and degenerative changes without foreign body evident. If further evaluation is clinically indicated, targeted ultrasound may be considered. |
Generate impression based on findings. | Reason: follow up lung cancer History: None. CHEST:LUNGS AND PLEURA: Stable circumferential nodular pleural thickening in the left hemithorax not significantly changed from the prior exam. Areas of subpleural rounded atelectasis in left lung are redemonstrated.Multiple poorly defined groundglass and silent nodules in the right lung remain similar in appearance to the prior exam.Reference nodule in the right lower lobe parentheses image 59 series 7) that measures 9 mm x 8 mm previously measuring 8 mm x 7 mm.Mild upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Right hilar enlarged lymph node (image 42 series 5) is unchanged measuring 13 mm in short axis.Pleural and pericardial nodularity along the left heart border and is stable.Cardiac size is normal evidence of a pericardial effusion.CHEST WALL: No axillary lymphadenopathy.Mild degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Stable nonspecific hypodensity.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 new sites of disease identified. |
Generate impression based on findings. | 75 year old male with new supraglottic ca with mediastinal adenopathy and RML nodule. RADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 138 mg/dL. Today's CT portion grossly demonstrates a base of tongue mass which also involves the aryepiglottic folds. Mild coronary artery and aortic valvular calcifications. Right middle lobe nodule, nonspecific. No mediastinal hilar lymphadenopathy based on CT size criteria. Enlarged prostate.Today's PET examination demonstrates increased FDG activity involving the base of tongue mass, measuring a maximum SUV of 11.2. No additional hypermetabolic foci identified. | 1.Hypermetabolic base of tongue soft tissue mass compatible with history of supraglottic cancer.2.No additional hypermetabolic foci to suggest metastases.3.Nonspecific right middle lobe pulmonary nodule. |
Generate impression based on findings. | 9 year old male with HLH, hyperammonemia, and intracranial hemorrhage. There is persistent intraventricular hemorrhage within the occipital horns, as well as subarachnoid hemorrhage within the interpeduncular cistern, anterior suprasellar cistern, and left sylvian fissure. There is unchanged mild temporal horn dilatation bilaterally. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is fluid within the bilateral mastoid air cells, as well as mucosal thickening and secretions within the paranasal sinuses. | 1.Unchanged mild scattered subarachnoid and intraventricular hemorrhage with suspected mild incipient hydrocephalus. The constellation of findings may be secondary to cyclosporin toxicity and/or underlying coagulopathy. 2.No definite evidence of cerebral edema, although MRI is more sensitive.3.Paranasal sinus and mastoid opacification may represent sinusitis and mastoiditis. |
Generate impression based on findings. | 57-year-old female with history of pain, fracture. Two views of the left ankle again show an oblique fracture through the distal fibula with one cortical width lateral displacement of the distal fracture fragment appearing similar to the prior study. Small densities distal to the medial malleolus may represent small avulsion fracture fragments; however this is equivocal. Small metallic densities in the midfoot may represent prior gunshot injury. | Distal fibular fracture appearing similar to the prior study. |
Generate impression based on findings. | 7-month-old female, rule out infection or perforation.VIEW: Abdomen and chest AP (two view) 1/14/2015 Gastrostomy tube in place. Amplatzer occlusion devices project over the heart.Bibasilar opacities suggestive of atelectasis. The cardiothymic silhouette is normal. There is a disorganized bowel gas pattern with slightly increased distention, but without evidence of obstruction. There is no evidence of pneumatosis intestinalis or free intraperitoneal air. No portal venous gas is seen. Multiple spinal segmentation and fusion anomalies are seen in the thoracic spine. 10 right and 11 left ribs are evident. PDA clip in place, position unchanged. | Bibasilar opacities suggestive of atelectasis. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of lupus and multiple myeloma diagnosed at age 40, in remission. Family history of breast carcinoma in her sister. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Male 88 years old; Reason: Pancreatic Mass; evaluate for progression History: See Above CHEST:LUNGS AND PLEURA: Subcentimeter right middle lobe pulmonary nodule is unchanged. Small calcified granuloma in the left lung base.There is a small right pleural effusion. This has decreased in size. The left pleural effusion has decreased in size.MEDIASTINUM AND HILA: Heart size is normal. There is a small pericardial effusion which is unchanged. Moderate coronary calcifications.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: The liver is normal pathology. There are bilateral intra-and extrahepatic hepatic biliary stents. The degree of ductal dilatation has decreased. Infiltrative mass near the Klatskin point measures 2.7 x 2.2 cm (image 83/series 6). The anterior branch of the right portal vein is not clearly identified and is likely thrombosed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland is nodular.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nodularity of the omentum in the right upper abdomen suggest peritoneal disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right ischium sclerotic lesion is unchanged.Compression deformities of the T2 and L2 vertebral bodies are unchanged.OTHER: Small amount of pelvic ascites. | 1.Decrease in the biliary ductal dilatation. Infiltrative mass in the liver at the Klatskin point measuring 2.7 cm most suggestive of a cholangiocarcinoma. |
Generate impression based on findings. | Left renal AVM follow. ABDOMEN:LUNG BASES: No significant abnormality noted. Minimal scarring at the left lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subcentimeter hypodense nodules in the spleen appear unchanged and are probably benign.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: In the medial aspect of the left kidney, there is a 2.3-cm enhancing nodular lesion with an early draining vein which is compatible with an arteriovenous malformation. This is unchanged in size and appearance compared to the prior outside study of 2012. There is no hydronephrosis or other lesions. On delayed images, there is symmetric excretion from both kidneys. The ureters appear normal in course and caliber.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality noted. Bladder is well distended and grossly normal in contour.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip replacement obscures images through the lower portion of the pelvis.OTHER: No significant abnormality noted | Stable left medial renal arteriovenous malformation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in a maternal aunt and her maternal grandmother. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is 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. | Ms. Mbengue submitted outside mammogram dated 09/20/2012, from Mercy Hospital. Submitted outside study was compared to the current mammogram dated 12/23/2014. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female; 74 years old. Reason: patient with previous h/o nsclc History: previous nsclc CHEST:LUNGS AND PLEURA: Postoperative changes of right pneumonectomy are similar to prior study aside from new in-situ thrombus within the right pulmonary artery stump. Scattered calcified granulomas in the left lung. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Postoperative rightward mediastinal shift. No pericardial fluid. Severe coronary artery calcifications. Calcified mediastinal lymph nodes statistically most likely reflect granulomas. Severe coronary artery calcifications.CHEST WALL: Stable enhancing subpleural and intercostal lymph nodes measuring up to 7-mm (images 67 and 68, series 3).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hyperattenuating lesion in the gallbladder lumen, which again may be due to polyp (image 111, series 3). Stable hepatic cysts and numerous subcentimeter hypoattenuating lesions, too small to characterize, but most likely benign. Stable hypoattenuating lesion in the anterior liver along the falciform ligament, most likely due to focal fatty infiltration (image 113, series 3).SPLEEN: Granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the aorta and its branches. Stable mild enlargement of central hypoattenuation of the left gonadal vein, likely due to chronic occlusion (image 123, series 2).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New in-situ thrombus within the right pulmonary artery stump. Otherwise, postsurgical changes from pneumonectomy are similar to prior study.2. Possible gallbladder polyp, again for which correlation with ultrasound is recommended.3. No definite recurrent/residual or metastatic disease. |
Generate impression based on findings. | Ms. Lyons submitted outside mammogram dated 10/22/2013, from St. Bernard Hospital. Submitted outside study was compared to the current mammogram dated 01/05/2015. The breast parenchyma is almost entirely fatty. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Ms. Lyons submitted outside mammogram dated 10/22/2013, from St. Bernard Hospital. Submitted outside study was compared to the current mammogram dated 01/05/2015. The breast parenchyma is almost entirely fatty. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Ms. Mbengue submitted outside mammogram dated 09/20/2012, from Mercy Hospital. Submitted outside study was compared to the current mammogram dated 12/23/2014. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 77 years old; Reason: evaluate vasculature to support kidney transplant History: abdominal bruit ABDOMEN:LUNG BASES: Heart size is enlarged. Calcifications within the left ventricle likely representing ischemic changes in the papillary muscles.LIVER, BILIARY TRACT: Liver is unremarkable for unenhanced technique. There is a focal calcification at the gallbladder fundus.SPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts likely from acquired cystic renal disease of dialysisRETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease affects the aorta and branch vessels with 360 degree thick calcification.Severe calcific arteriosclerotic disease affects the common iliac, internal and external iliac arteries. No aneurysm is identified.There are retroperitoneal lymph nodes for example, a right paracaval node measures 1.3 x 1.0 cm (image 59/series 3). Some of the upper abdominal lymph nodes are calcified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerosis of the osseous structures likely from renal osteodystrophy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.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: Soft tissue in the right pelvis represents a renal allograft. | 1.Calcific arteriosclerotic disease of the aorta and pelvic vasculature.2.Nonspecific but enlarged lymph nodes in the retroperitoneum. Follow up suggested. In a patient with renal transplant, PTLD should be a clinical consideration. |
Generate impression based on findings. | 57 years, Male. Reason: Evaluate for intraabdominal process History: Abdominal pain Mild scoliosis and spinal degenerative disease noted. IVC filter present. There are right femoral approach catheters. IABP marker overlies the lumbosacral junction. Residual contrast noted in the bladder, correlate with recent exam. Mild gaseous distention of the stomach. Large stool burden. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Lung cancer. LUNGS AND PLEURA: Numerous bilateral suspicious pulmonary nodules. Previously referenced lesions as follows:Right lower lobe cystic and groundglass lesion increased in size, 3 x 1.7 cm (4/41), compared to 2.5 x 1 .Seen previously. The cranial aspect of this lesion has developed a punctate soft tissue density component at its apex (4/39).Reference right middle lobe lesion unchanged at 16 x 12 mm (4/49).Solid 6-mm nodule in the right lower lobe unchanged (4/36).New area of focal vascular dilatation compatible with an endovascular lesion left lower lobe (4/55). Previously seen endovascular lesion left lower lobe in an adjacent segment of the left lower lobe has also enlarged significantly since the previous examination, from 7 to 12-mm in length (4/60). Additional small similar foci with in the same lobe unchanged.Mixed density part solid nodule right lower lobe costophrenic angle region measures 16 x 10 mm (4/68), previously 15 x 9 mm.New solid nodule lateral aspect of right costophrenic angle (4/67). An adjacent nodule in the same area (4/65) has enlarged and become cavitary.No pneumothorax. Emphysema as well as upper lobe peripheral and peribronchial irregular cysts indeterminate but mildly suspicious for Pulmonary Langerhans Lell Histiocytosis.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Normal heart size. No pericardial fluid enlarged lymph nodes.CHEST WALL: Chronic T7 and T8 compression fractures..UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.. | 1. Enlarging endovascular lesions left lower lobe most compatible with tumor emboli from the patient's known bladder cancer.2. New solid nodule right lower lobe, also consistent with a metastasis.3. Multiple additional suspicious sub-solid nodules, some with cystic components, in the lungs bilaterally with growth of a right lower lobe lesion, most compatible with a primary pulmonary neoplasm. The remainder of the suspicious nodules are not significantly changed but remain highly suspicious for synchronous sites of pulmonary neoplasm. |
Generate impression based on findings. | 50 year-old female with history of headache. Evaluate for intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes.Interval improvement of mucosal thickening in the maxillary sinuses, with mild residual. The mastoid air cells are clear. Mild right preauricular oval soft tissue which likely represents a lymph node, which is not enlarged by size criteria. Calvarium is intact. | 1. No evidence of intracranial hemorrhage or mass effect. Mild chronic small vessel ischemic changes. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Mild residual mucosal thickening in the maxillary sinuses. |
Generate impression based on findings. | 70 year old female who was recalled from screening mammogram for left breast calcifications and right breast asymmetry. History breast carcinoma in a maternal cousin in her late 20s. Bilateral Diagnostic Mammogram: An ML view of each breast, multiple spot compression views of the right breast, and multiple spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The asymmetry within the upper outer right breast partially disperses on spot compression imaging. A 4-mm focal asymmetry within the right upper outer breast persists on spot compression imaging.On magnification views, the question calcifications within the left breast are present along a vascular distribution, and are deemed benign.Benign appearing lymph nodes are projected over both axillae. Right Breast Ultrasound: On physical examination, no palpable abnormality is identified. The targeted right ultrasound is performed for the mammographic area of concern. At the 10 o'clock position of the right breast, 8 cm from the nipple, there is a circumscribed 0.4-cm normal morphology intramammary lymph node, corresponding to the 0.4-cm asymmetry on mammogram. A rest of dense breast tissue is present at the 10 o'clock radian of the right breast, 6 cm from the nipple, corresponding to the larger area of asymmetry within the upper outer right breast | 1. Left breast calcifications, vascular in origin.2. Normal morphology right intramammary lymph node, and a rest of dense breast tissue within the upper outer right breast, corresponding to the asymmetry seen on prior mammogram. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 72-year-old man with hepatocellular carcinoma. Evaluate size and location of the lesion. ABDOMEN:LUNG BASES: Cardiomegaly. Basilar scarring. Subcentimeter micronodule at the right lung base (image 7) is unchanged.LIVER, BILIARY TRACT: Cirrhotic appearing liver. Status post cholecystectomy. There is an enhancing lesion with washout measuring 2.8 x 2.7 cm in the right lobe of the liver compatible with hepatocellular carcinoma (image 44; series 12). This is better demonstrated on today's examination compared to the prior and roughly stable in size although a precise measurement on the prior examination is not possible given the phase of scanning.SPLEEN: No significant abnormality notedPANCREAS: Tiny focus of arterial enhancement (image 57; series 9) in the head of the pancreas is of unclear etiology or significance. This can be followed.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing left renal calculus.RETROPERITONEUM, LYMPH NODES: Portacaval lymph nodes measuring up to 2.2 cm in diameter (image 47; series 12) unchanged and present as far back as 2006. Subcentimeter retroperitoneal lymph nodes also 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: Large bilateral bladder diverticula.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: 2.0 x 1.6 cm cystic nodule noted in the right iliopsoas muscle (image 144; series 11), probably benign.OTHER: No significant abnormality noted | Right lobe HCC as noted above. |
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