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Generate impression based on findings. | Ms. Jefferson submitted outside mammograms dated 10/08/2013 and 09/19/2012, from Terre Haute Regional Hospital in Indiana. Submitted outside studies were compared to the current mammogram dated 11/25/2014. The breast parenchyma is heterogeneously dense. There are multiple bilateral circumscribed masses seen of varying sizes. When compared to prior exams, these are overall smaller in size, compatible with involuting cysts. No suspicious microcalcifications or areas of architectural distortion are present. | Bilateral circumscribed masses of decreasing size, compatible with involuting cysts. No mammographic evidence of malignancy. Palpable concern should be managed clinically. As long as the patient's clinical examination is unremarkable, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 57-year-old male with NHL, status post mobilization.RADIOPHARMACEUTICAL: 12.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 82 mg/dL. Today's CT portion grossly demonstrates a right chest port, which is coiled within the right internal jugular vein with its tip in the SVC. No lymphadenopathy throughout the neck, chest, abdomen, and pelvis by CT size criteria. Atherosclerotic calcification and aneurysmal dilatation of the left common iliac artery at the level of the bifurcation. Today's PET examination demonstrates no FDG avid tumor. | 1.No FDG avid tumor identified.2.Atherosclerotic calcification and aneurysmal dilatation of the left common iliac artery at the level of the bifurcation. 3.Right chest port coiled within the right internal jugular vein with tip in the SVC. |
Generate impression based on findings. | Ms. Jefferson submitted outside mammograms dated 10/08/2013 and 09/19/2012, from Terre Haute Regional Hospital in Indiana. Submitted outside studies were compared to the current mammogram dated 11/25/2014. The breast parenchyma is heterogeneously dense. There are multiple bilateral circumscribed masses seen of varying sizes. When compared to prior exams, these are overall smaller in size, compatible with involuting cysts. No suspicious microcalcifications or areas of architectural distortion are present. | Bilateral circumscribed masses of decreasing size, compatible with involuting cysts. No mammographic evidence of malignancy. Palpable concern should be managed clinically. As long as the patient's clinical examination is unremarkable, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | AORTOGRAM: Normal caliber aorta with no evidence of stenosis or aneurysm. Normal appearing single bilateral renal arteries. PELVIC ANGIOGRAM: Common, internal and external iliac arteries are widely patent. LEFT LOWER EXTREMITY: The common femoral artery is widely patent. The profunda femoris is patent and robust. The superficial femoral artery is diffusely diseased, with a greater than 60% stenosis in its midportion. There is a metallic self-expanding stent in the distal superficial femoral artery and proximal popliteal artery. This demonstrates a moderate degree of in stent stenosis. The most severe lesion is at the proximal portion of the stent and is greater than 50%. There is a bypass graft originating from the distal superficial femoral artery. The proximal anastomosis is widely patent. The body of the bypass graft is widely patent. There is no evidence of twisting, kinking, or retained valve segments. The bypass graft terminates on the distal dorsalis pedis artery which fills the dorsalis pedis artery retrograde and the plantar arch. The posterior tibial artery is not well appreciated. The popliteal artery terminates below the knee into a dense network of collaterals. The named tibial arteries of the lower leg are not seen to fill. After intervention as described above the two lesions of the mid superficial femoral artery and distal superficial femoral artery are improved with no evidence of dissection or distal embolization.RIGHT LOWER EXTREMITY: The visualized portions of the right common femoral and profunda femoris arteries are widely patent. CONTRAST: 80 mL VisipaqueFLUOROSCOPY TIME: 8.9 minutesAIR KERMA: 119.96 mGyESTIMATED BLOOD LOSS: Less than 5cc. | Successful angioplasty of the left superficial femoral artery with findings as noted above.PLAN: The patient will follow-up with repeat surveillance duplex ultrasound in one month. |
Generate impression based on findings. | 10 month old male with 5 days fever and wet coughVIEWS: Chest AP/lateral (two views) 11/14/15 Moderate peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern. Focal opacity in the right lower lobe may represent atelectasis. Cardiothymic silhouette is normal. No pneumothorax or pleural effusion. | Reactive airway disease/bronchiolitis pattern. Right lower lung atelectasis. |
Generate impression based on findings. | Ms. Mason submitted outside mammogram dated 12/05/2013, from Ingalls Memorial Hospital, from Harvey, IL. Submitted outside study was compared to the current mammogram dated 01/02/2015. The breast parenchyma is composed of scattered fibroglandular density. Benign calcifications, including arterial calcifications, are present. 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: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Ms. Mason submitted outside mammogram dated 12/05/2013, from Ingalls Memorial Hospital, from Harvey, IL. Submitted outside study was compared to the current mammogram dated 01/02/2015. The breast parenchyma is composed of scattered fibroglandular density. Benign calcifications, including arterial calcifications, are present. 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: NSB - Screening Mammogram. |
Generate impression based on findings. | 71 year-old female with history of hepatocellular carcinoma. Therasphere mapping. Lack of contrast enhancement limits evaluation, specifically for HCC.CHEST:LUNGS AND PLEURA: Reference nonspecific subpleural nodule in the left lower lobe measures 7 cm (series 5, image 65), stable. Scattered micronodules are not significantly changed. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable cirrhotic morphology with post ablation changes at left hepatic dome, not significantly changed. Evaluation for recurrent or residual disease is limited given lack of IV contrast. Again noted are hypoattenuating lesions scattered throughout the liver. Hepatic segment 6 lesion measures 2.8 X 2.3 cm (series 4, image 79), unchanged.Hepatic segment 8 lesion is not conspicuous on this noncontrast examination. Attention to this region on subsequent contrast enhanced examinations is recommended.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Embolization coils are evident in the gastroduodenal and pancreaticoduodenal arteries.BOWEL, MESENTERY: Mild unchanged ascites.BONES, SOFT TISSUES: Mild degenerative changes affect the visualized spine.OTHER: Multiple esophagogastric varices again seen.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable mild pelvic ascites.BONES, SOFT TISSUES: Mild degenerative changes affect the visualized spine.OTHER: No significant abnormality noted. | Evaluation for HCC is significantly limited given lack of IV contrast enhancement.1.Unchanged segment 8 hypoattenuating lesion previously characterized as HCC. 2.Previously referenced segment 6 HCC is not conspicuous on the current examination and attention on subsequent examinations is recommended.3.Unchanged cirrhotic morphology of the liver and stigmata of cirrhosis including ascites and splenorenal shunt. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Focal asymmetry in the right retroareolar region is unchanged. | 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. | 7 month old male with cough and fevers x 2 daysVIEWS: Chest AP/lateral (two views) 11/14/15 Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax. Mild to moderate peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern. | Reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. A tortuous blood vessel is noted in the right lower breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 48 years old; Reason: eval for progression History: metastatic RCC CHEST:LUNGS AND PLEURA: Reference left lower lobe pulmonary nodule measures 2.9 x 2.2 cm (image 81/series 5) previously, 1.9 x 1.8 cm.The remainder of the pulmonary nodules have also increased in size. No pleural effusions have developed.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right hilar lymph node measures 2.2 x 1.7 cm (image 54/series 3) previously, 2.6 x 1.8 cm.Second right hilar lymph node on the lateral aspect measures 3.3 x 2.4 cm (image 51/series 3) previously, 2.8 x 2.3 cm.This compresses the right lower lobe airway.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. No definite hepatic lesion. The hepatic and portal veins are patent.SPLEEN: LaminectomyPANCREAS: Status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Enhancing soft tissue in the left renal bed has increased in size measuring 5.6 x 4.7 cm (image 110/series 3) previously, 3.5 x 2.7 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fluid adjacent to the greater curvature of stomach measures 5.1 x 4.6 cm (image 95/series 3) previously, 5.8 x 3.2 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Surgical changes in the intraabdominal wall with ventral laxity.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: No significant abnormality noted | 1.Increase in the size of the reference right hilar lymph nodes, pulmonary nodule and left renal bed mass. |
Generate impression based on findings. | Female 34 years old; Reason: ? acute cholecystitis History: RUQ pain, rising bili and WBC Angiographic images are unremarkable. Prompt clearance of radiotracer from the blood pool and uniform accumulation of the tracer by the liver is present. There is normal excretion of tracer into the intrahepatic ducts, common bile duct and gallbladder. No GI activity was visualized, although there is no evidence of GI obstruction. | Normal hepatobiliary imaging. No evidence of acute cholecystitis. GI activity was not visualized although there is no evidence of biliary obstruction. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy. Family history of breast carcinoma in her mother at age 55. 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. A biopsy clip is present within the upper outer left breast. 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. | 56-year-old female with history recent fall with eye laceration. Evaluate for subdural hematoma. 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 match areas of previously described MR signal abnormalities relating to methotrexate toxicity, and may represent subsequent gliosis.The paranasal sinuses and mastoid air cells are clear. Calvarium is intact. No significant soft tissue hematoma surrounding the orbits. | No evidence of acute intracranial abnormality. Patchy abnormal low density in the white matter, likely representing sequelae of prior methotrexate toxicity. |
Generate impression based on findings. | Male 8 years old Reason: s/p fx clavicle History: s/p fx clavicleVIEWS: Right clavicle AP and axial (two views) 1/14/2015 The previously seen clavicular fracture line is no longer identified compatible with healing. | Healed right clavicular fracture. |
Generate impression based on findings. | Ileus Suboptimal exam secondary to patient motion artifact. No significant change, including enteric tube with tip in region of gastric antrum and colonic gaseous distention. Stable rectal tube.Please refer to concomitant chest radiography from same day for additional findings. | No significant change as above. |
Generate impression based on findings. | 25 year-old female with pain, 500-pound bed rolled over the patient's foot. Three views of the left foot show no fracture or malalignment. | No fracture evident. |
Generate impression based on findings. | 18 year old male for constipationVIEW: Abdomen AP (one view) 11/14/2015 Right femoral head is superior and laterally dislocated, unchanged from prior examination. Leftward curvature of the thoracolumbar spine. Disorganized bowel gas pattern. No evidence of obstruction. Gastrostomy tube is unchanged. | Disorganized bowel gas pattern. No evidence of obstruction. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip in gastric body. Incompletely imaged mildly dilated small bowel, measuring up to 4 cm. Residual contrast suggested in bowel located in pelvis. Remainder of exam without significant change from prior abdominal radiography. Pleural effusions and left retrocardiac consolidation/atelectasis seen. | Enteric tube as above. |
Generate impression based on findings. | 35-year-old male with toe deformity, crossed toes. Four views of the right foot show a slight hallux valgus deformity. The second toe is extended at the metatarsophalangeal joint with medial deviation such that it lies on top of the first toe. There is no fracture or dislocation.Four views of the left foot show a slight hallux valgus deformity. The second toe is extended at the metatarsophalangeal joint with medial deviation such that it lies on top of the first toe. There is no fracture or dislocation. | Mild hallux valgus deformities with medial deviation of the second toes bilaterally as described above. |
Generate impression based on findings. | Fall. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening in the right maxillary and bilateral sphenoid sinuses. There is opacification of the left mastoid air cells. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | Assess stool burden, heavy narcotic analgesic use, abdominal pain, reported history of diarrhea/constipation Large stool burden, particularly in the ascending colon and portions of transverse colon, including incompletely imaged splenic flexure. Nonobstructive bowel gas pattern. Multiple surgical clips seen in right abdomen. | Stool burden as described. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Enteric tube placement Enteric tube seen with side-port in gastric body. Incompletely imaged airdistended bowel, air seen at least to the level of the distal descending colon, findings may reflect ileus in the appropriate clinical setting and correlation with the patient's history recommended. Please refer to concomitant chest radiography from same day for additional findings. Prominent liver shadow, may be due in part to underlying Reidel lobe. | Enteric tube as above. |
Generate impression based on findings. | 10 year old male with hip subluxationVIEW: Pelvis AP (one view) 01/13/15 There is lateral uncovering of bilateral femoral heads, about 40% on the right side and 20% on the left side. The right acetabulum is slightly dysplastic owing to increased uncovering of the right femoral head. Bilateral coxa valga. No fractures identified. | Bilateral coxa valga and dysplastic right acetabulum with lateral uncovering of bilateral femoral heads, right greater than left. |
Generate impression based on findings. | 44-year-old male with history of ankle fracture, stress view to evaluate for medial clear space widening. A single AP weight-bearing mortise view of the left ankle again shows an obliquely oriented fracture of the distal fibula with slight lateral displacement appearing similar to prior study. The rest of the ankle is within normal limits and we see no widening of the medial gutter. | Distal fibular fracture appearing similar to the prior study. |
Generate impression based on findings. | Left lower quadrant abdominal pain ABDOMEN:LUNG BASES: Right basilar micronoduleLIVER, BILIARY TRACT: Gallbladder absent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Supraumbilical fat containing ventral hernia without bowel involvement.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: 2.3 x 2 cm focal fluid focus inseparable from the sigmoid colon best seen on image 98 of series 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Focal fluid focus inseparable from the sigmoid colon. Not associated with significant surrounding acute inflammatory changes. This focal fluid collection is atypical for acute diverticulitis but may represent sequela of chronic inflammation.Fat containing supraumbilical ventral hernia |
Generate impression based on findings. | Lung cancer right upper lobe. CHEST:LUNGS AND PLEURA: Necrotic mass obstructing the right upper lobe apical segment bronchus measures 5.8 x 4.3 cm in in greatest transaxial dimensions, inseparable the mediastinal pleural surface and cranial aspect of the hilum and producing spiculations extending to nearly the lung apex.No additional suspicious pulmonary nodules. Mild pulmonary fibrosis consisting of subpleural reticulation, mild honeycombing and bronchiectasis with mild basal groundglass opacity. Superimposed centrilobular emphysema. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Right hilar lymph node only minimally enlarged, 11-mm (3/41). Mass abuts the SVC, but there is no conclusive evidence of direct invasion. The azygos arch is occluded by the mass. The mass is inseparable from the lateral border of the trachea (3/24) for a length of approximately 2-cm. Small right paratracheal chain lymph nodes are not enlarged. However, in the posterior mediastinum, lower paraesophageal lymph nodes are enlarged and have irregular borders, suspicious for nodal metastases (3/69, 3/79).Mild cardiomegaly. Moderate coronary artery calcifications. No pericardial fluid.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches. Infrarenal mild fusiform dilatation of the distal abdominal aorta with AP dimension of 2.9-cm (3/135). The iliac arteries are heavily calcified, and there is probable stenosis of the right external and internal branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology. There appears to be circumferential thickening of the duodenal bulb with irregularity of its wall and and shouldering (3/104-107, coronal image 72), correlate for symptoms as this finding is incompletely assessed due to underdistention and of unclear etiology.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 5.8-cm right upper lobe mass obstructing the apical segmental bronchus extends from the right hilum to nearly the apex and the lateral margin of the distal thoracic trachea. The mass is difficult to separate from ipsilateral hilar lymph nodes with reference lesions provided in the body of the report. Irregularly marginated and enlarged distal paraesophageal lymph nodes are suspicious for additional sites of nodal metastases. Nonspecific apparent circumferential thickening of the duodenum appears irregular on some images and correlation for abdominal symptomatology is recommended. This can be further assessed by abdominal CT with oral contrast if required. |
Generate impression based on findings. | 56-year-old female with history of orthopedic fixation, follow-up examination. Four views of the right foot again show orthopedic fixation of the first tarsometatarsal joint and first intercuneiform joint in near-anatomic alignment appearing similar to the prior study, although there may be early bony bridging along the first tarsometatarsal joint. Two screws also affix a healed osteotomy of the first metatarsal in near anatomic alignment. Postoperative changes of arthroplasty of the second toe proximal interphalangeal joint are noted with removal of previously seen K wires in the second and third toes. Again seen is a fracture fragment along the medial aspect of the proximal phalanx of the second toe appearing similar to the prior study. | Postoperative changes of orthopedic fixation of the first metatarsal and cuneiforms with removal of K wires. |
Generate impression based on findings. | Abdominal distention, evaluate enteric tube and assess for SBO Enteric tube seen with tip just beyond gastroesophageal junction and further advancing by approximately 8 cm recommended. Right upper quadrant surgical clips, may be related to prior cholecystectomy. Incompletely imaged dilated small bowel, measuring up to 6.3 cm. Partially seen at lower lung fields not well assessed due to low lung volumes. | Advancing of enteric tube recommended.Findings suspicious for small bowel obstruction. |
Generate impression based on findings. | 62-year-old female with history of non-small cell lung cancer status post chemoradiation therapy. Evaluate for metastatic disease. LUNG BASES: Please refer to dedicated concurrent CT chest report for details regarding the thoracic findings. Small right pleural effusion partially visualized atelectasis.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild height loss of multiple thoracic vertebral bodies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes affect the visualized lumbar spine.OTHER: No significant abnormality noted. | 1.No evidence of metastatic disease in the abdomen or pelvis. 2.Please refer to concurrent CT chest report for details regarding thoracic disease. Small right pleural effusion.3.Moderate to severe degenerative changes affect the lumbar spine. |
Generate impression based on findings. | Male 64 years old; Reason: staging CLL History: early satiety, liver and spleen enlarged CHEST:LUNGS AND PLEURA: No dominant lung lesion. There is diffuse pleural thickening. There small bilateral effusions.MEDIASTINUM AND HILA: Heart size is normal. Extensive mediastinal lymphadenopathy. Reference precarinal lymph node measures 1.9 x 1.6 cm (image 30/series 3). CHEST WALL: Enlarged bilateral axillary lymph nodes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense foci in the liver the larger foci are cysts. The smaller foci are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and upper abdominal lymphadenopathy.Left para-aortic lymph node measures 2.5 x 2.2 cm (image 119/series 3). BOWEL, MESENTERY: Small mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Pear-shaped bladder due to compression pelvic lymphadenopathy.LYMPH NODES: Extensive pelvic lymphadenopathy. Left pelvic node measures 4.6 x 2.5 cm (image 181/series 3). Extensive inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Extensive lymphadenopathy in the chest, abdomen and pelvis. |
Generate impression based on findings. | Abdominal distention Relative paucity of bowel gas, no definitive evidence of bowel obstruction. | Paucity of bowel gas. No definitive evidence of bowel obstruction. |
Generate impression based on findings. | The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no acute fracture or pre-vertebral soft tissue swelling. There is no significant spinal canal stenosis. Minimal scattered spondylotic changes, mainly at C2/C3.For more complete findings regarding the paranasal sinuses, please see CT head on the same date. | No evidence of acute fracture or subluxation. |
Generate impression based on findings. | 27-year-old male hurt wrist playing frisbee 12/26. Evaluate for fracture. Three views of the right wrist show no fracture, malalignment, or other specific findings to account for the patient's pain. | No fracture evident. |
Generate impression based on findings. | Evaluate stool burden, history diarrhea Moderate to large stool burden seen throughout colon. Nonobstructive bowel gas pattern. Right upper and mid abdominal postsurgical sequela. Lower lumber spine postoperative hardware seen. | Stool burden as above, no bowel obstruction. |
Generate impression based on findings. | Newborn male with respiratory distress and increasing O2 requirement.VIEW: Chest and abdomen AP (two views) 1/14/2015, 14:50 UAC tip at the T9/T10 level. UVC tip in the right atrium, close to the SVC ostium. Mild diffuse hazy lung opacities. No pleural effusions or pneumothorax is seen. The aortic arch, cardiac apex and stomach are left sided. The cardiothymic silhouette is normal.The bowel gas pattern is mildly disorganized without evidence of obstruction. No pneumoperitoneum or pneumatosis intestinalis is evident. | Mild diffuse hazy lung opacities without focal opacity. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip in gastric body, with retained guidewire. Incompletely imaged moderate stool burden. Multiple bilateral healing rib fractures. Lower lumber spine laminectomy changes suggested. | Enteric tube as above. |
Generate impression based on findings. | 11 year old female whose boyfriend hit her wrist on the wall now with swelling and decreased movement, evaluate for fracture.VIEWS: Left wrist AP, oblique, lateral (3 views) 01/14/15 No acute fracture or malalignment is evident. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | Evaluate for capsule placed on January 7, 2015 Radiopaque capsule seen in right hemipelvis, may be located in distal ileum. Nonobstructive bowel gas pattern. Moderate stool seen throughout colon. Right upper quadrant surgical clips. | Capsule seen in right hemipelvis.Please refer to concomitant chest radiography from same day for additional findings. |
Generate impression based on findings. | 59-year-old female with pain. Four views of the left foot show a moderate hallux valgus deformity and mild osteoarthritis affecting the first MTP joint. The bones appear slightly demineralized.Four views of the right foot show a moderate hallux valgus deformity with a small ossicle along the medial aspect of the first metatarsal head. The bones appear slightly demineralized. | Bilateral hallux valgus deformities. |
Generate impression based on findings. | 64-year-old male with renal lesion seen on ultrasound examination. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Two hypoattenuating foci in segment 4a consistent with cysts. An additional punctate segment 2 hypoattenuating lesion is too small to characterize. Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole lesion measures 1.3 x 0.9 cm (series 8, image 64) with no convincing evidence of enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild to moderate degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality noted | 1.Right lower pole hypoattenuating lesion without convincing evidence of enhancement. Given small size, evaluation is unreliable and although we favor benign complex cyst, continued surveillance under ultrasound to document temporal stability is recommended.2.Diffuse fatty liver. |
Generate impression based on findings. | Evaluate stool burden and assess for possible obstruction, history of abdominal pain Small to moderate stool burden. Colonic intraluminal increased radiodensity presumably related to residual contrast, correlate with patient's clinical history. Scattered sitzmarkers seen, 3 are seen in the mid to distal transverse colon. Nonobstructive bowel gas pattern. Right upper quadrant surgical clips, may be related to prior cholecystectomy. Again seen is a left mid abdominal surgical clip. | Stool burden as described, nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: chronic constipation w/ rectal fullness History: constipation There is prompt opacification of the rectum. Mild rectal prolapse was seen at rest, which was significantly exacerbated with Valsalva maneuver and with evacuation, when degree of prolapse became moderate to severe. Formal straining and evacuation showed appropriate passage of rectal contents. Small postevacuation residual. | Findings compatible with rectal prolapse as above. |
Generate impression based on findings. | 59-year-old male status post fall with hip pain Right hip: We see no fracture. Mild osteoarthritis affects the hip.Left hip: Mild osteoarthritis affects the hip. No fracture is evident.Pelvis: No fracture is noted. Lytic lesion in the right iliac wing appears similar to the prior exam, corresponding to a metastatic lesion seen on recent PET/CT. An L4 compression fracture is presumably pathologic and appears similar to the prior exam. | No acute fracture. Findings compatible with metastatic melanoma as described above, appearing similar to the prior exam. |
Generate impression based on findings. | 75-year-old female with history of breast cancer Femur: A poorly defined sclerotic lesion involving the left femoral neck corresponds to the lesion seen on recent CT, likely representing metastatic disease. We see no fracture. The distal femur is intact.Hip: The aforementioned poorly defined lesion involving the left femoral neck is again noted. Mild osteoarthritis affects the hip. No fracture is evident.Pelvis: The aforementioned poorly defined sclerotic lesion in the left femoral neck is again noted. Mild osteoarthritis affects both hips. Degenerative disk disease affects the lower lumbar spine. Surgical clips are noted in the pelvis. No fracture is evident. | Poor defined sclerotic lesion involving the left femoral neck, presumably representing metastatic disease. No fracture is evident. |
Generate impression based on findings. | Upper abdominal pain, history of squamous cell carcinoma of the mouth Large stool burden seen throughout colon. No evidence of bowel obstruction. Incompletely imaged bilateral posterior spinal stabilization rods and screws. Mild dextroscoliosis. Subcentimeter radiodensity seen in right supraacetabular area may be a bone island but nonspecific. | Stool burden as described, no evidence of bowel obstruction. |
Generate impression based on findings. | 33 years, Female. Reason: 33F s/p RYGB in 2010 with chronic constipation History: retained barium Pelvis is excluded from the field of view. There is persistent large amount of residual contrast material in the colon, presumably from recent upper GI examination. Nonobstructive bowel gas pattern. Scattered postsurgical sequelae. | Persistent large amount of residual contrast in the colon. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 20 year-old male with pain and swelling, evaluate for fracture Mild soft tissue swelling is present along the dorsum of the toe. No fracture is evident. | No fracture or malalignment. |
Generate impression based on findings. | Lung cancer, follow-up LUNGS AND PLEURA: Left upper lobe wedge resection without new abnormality or findings to suggest recurrence. The right thoracic scattered scar like nodules and changes greater in the apex are also unchanged in appearance. No suspicious new findings or effusions. Scattered moderate emphysematous changes with a mild mosaic attenuation compatible with chronic small airway disease.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limits of and mild coronary artery and valve calcifications.Heterogeneous thyroid, poorly visualized due to phase of contrast, grossly unchangedCHEST WALL: Bilateral mastectomy and small residual seroma overlying the right chest wall, unchanged. Old healed rib fracture is postsurgical changes involving the upper left rib cage. Stable sclerotic focus in the sternumUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic hypodensities, consistent with a simple cyst. | No suspicious findings to suggest recurrent or metastatic disease |
Generate impression based on findings. | Postoperative changes are seen from previous bilateral antrostomies and partial ethmoidectomies. Middle turbinectomies are also noted bilaterally. There also appears to be bilateral sphenoidotomies, which are patent.Frontal sinus: The frontal sinuses are clear. There is trace mucosal thickening in the frontoethmoidal recesses.Anterior ethmoids: The remaining anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. The antrostomies are patent.Posterior ethmoids: The remaining posterior ethmoid air cells are clear.Sphenoid sinus: The right sphenoid sinus is clear. There is mild mucosal thickening along the anterior left sphenoid sinus.There is no significant nasal septal deviation. The remaining nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Extensive postoperative changes. Scattered trace mucosal thickening. Patent bilateral antrostomies. |
Generate impression based on findings. | 83 year old woman s/p bioprosthetic aortic valve replacement now with recurrent severe aortic valve stenosis. She is referred for evaluation of cardiovascular anatomy prior to possible TAVR procedure.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has moderate tortuosity. There is minimal calcification of the aortic root. There is severe calcification of the aortic arch. There is mild calcification of the descending aorta. In the descending aorta, at the level of diaphragm, there is a focal area of moderately protruding aortic atheroma. No aortic coarctation is noted. There is severe calcification of the proximal left subclavian artery which prohibits assessment of the lumen.Aortic Annulus: Dimension: 24mm x 24mm Circumferance: 7.6cm Area: 4.4cm2Sinus of Valsalva: Width: 33mm x 33mm x 34mm Height: 18mmSinotubular Junction: 33mm x 34mmAscending Aorta: 40x42mmMid Aortic Arch: 29x28mmDescending Aorta: 22x20mmAnnulus to LM Height: 16mmAnnulus to RCA Height: 17mmAortic Leaflet Length: 13mmAortic Valve: There is a bioprosthetic aortic valve noted. The internal diameter is 19mm. Mitral Valve: Mild mitral annular calcification is noted.Left Ventricle: There left ventricle is normal in size with moderate left ventricular hypertrophy (IVSd=15mm) and severely reduced systolic function (LVEF 24%). The left ventricular end-diastolic volume is normal (LV volume 107ml). There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. There is a subtle resting circumferential perfusion defect noted.Right Ventricle: Visually the right ventricular end-diastolic volume is within normal limits.Left Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is moderately dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is minimal calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is mild calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Coronary Bypass Grafts:None present. | 1. 19mm bioprosthetic valve noted in aortic position. 2. Aortic root anatomy as described above. 3. Moderate left ventricular hypertrophy with severely reduced systolic function (LVEF 24%). 4. Moderate biatrial dilation. 5. Mild coronary calcification noted.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdomen/ pelvis CTA will be reported slowly. |
Generate impression based on findings. | History of fall one week ago. Swelling and tender to palpation lateral malleolus. Concern for poor circulation of the toes. Three views of the left ankle are provided. There is an oblique fracture of the distal fibula extending to the level of the tibiotalar joint. Alignment is near-anatomic. There is diffuse soft tissue swelling. The bones appear demineralized. Arterial calcifications are noted within the soft tissues.Three views of the left foot are provided. Again seen is the distal fibular fracture. The bones appear demineralized suggesting osteopenia/osteoporosis. The base of the fifth metatarsal appears intact, as do the phalanges. There are arterial calcifications in the soft tissues. | Distal fibular fracture. |
Generate impression based on findings. | Male 62 years old; Reason: none History: new dx anaplastic thyroid, eval for distant diseaseRADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 115 mg/dL. Today's CT portion grossly demonstrates scattered bilateral pulmonary micronodules, some of which have increased in size since prior study. For reference a nodule in the left upper lobe currently measures 11 mm (series 4, image 102), previously measured 4 mm. There is soft tissue density in the left neck extending from level 2 to level 5 to the left superior mediastinum likely related to recent thyroidectomy and neck dissection. There surgical clips extending from the left neck to the superior mediastinum along the left side.Today's PET examination demonstrates diffuse activity in the left neck extending to the superior aspect of the left mediastinum. There is a focus of increased activity in the resection bed at the superior mediastinum slightly to the left of midline anterior to the brachiocephalic artery with an SUV value of 9.9. There is increased activity of several pulmonary micronodules, one located in the right middle lobe, one in the left upper lobe, and two in the left lower lobe. For reference the nodule in the left upper lobe has an SUV value of 3.8. There is asymmetrical activity of the bilateral vocal cords, right greater than left. | 1.Diffuse activity in the left neck extending to the superior aspect of left mediastinum likely reflects postsurgical change, although cannot exclude residual tumor.2.Focus of increased activity in the superior mediastinum slightly to the left and anterior to the brachiocephalic artery within the resection bed suspicious for tumor. 3.Findings suspicious for pulmonary metastatic disease as described above.4.Asymmetric activity of the bilateral vocal cords, right greater than left, likely related to left vocal cord paralysis. |
Generate impression based on findings. | Right wrist pain status post fall. Rule out fracture. I see no fracture or malalignment. Mild osteoarthritis affects the first carpometacarpal joint and the trapezioscaphoid articulation. There is perhaps mild soft tissue swelling. | Mild soft tissue swelling and osteoarthritic changes without fracture evident. |
Generate impression based on findings. | Hip pain. Prior hip replacement. Two views of the left hip reveal components of a total hip arthroplasty device situated in near anatomic alignment without radiographic evidence of complication. A small amount of heterotopic ossification is seen within the soft tissues adjacent to the lesser trochanter, of doubtful clinical significance.Two views of the right hip show components of a total hip arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication.The AP view of the pelvis reveals the aforementioned total hip arthroplasty devices. Minimal degenerative arthritic changes affect the pubic symphysis. Severe degenerative disk disease affects the visualized lower lumbar spine. The remainder of the pelvis is unremarkable. | Bilateral total hip arthroplasty devices appearing similar to those seen on the prior study. Degenerative disk disease of the visualized lower lumbar spine. |
Generate impression based on findings. | Metastatic lung cancer, status post one line of therapy. There is 4x6 mm extra-axial enhancing lesion along the left frontal convexity, best seen on coronal image 63/100. Otherwise no intracranial mass or evidence of mass-effect. No abnormal parenchymal enhancement is seen. No intracranial hemorrhage. Mild hypoplasia of the inferior cerebellar vermis is incidentally noted. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Mild mucosal thickening in the paranasal sinuses. Mastoid air cells are clear. Calvarium is intact. Mild thickening of the left frontal scalp which may be related to prior trauma. | No definite CT evidence of intracranial metastatic disease. 4 mm x 6 mm extra-axial lesion along the left frontal convexity is favored to represent an incidental meningioma and less likely dural-based metastasis. Consider comparison with prior studies if available or close follow-up evaluation. Please note MRI would be more sensitive for detection of small intraparenchymal lesions and can be obtained if clinically indicated. |
Generate impression based on findings. | Female 38 years old Reason: rule out pancreatitis vs vasculitis w/ hx of SLE History: Abdominal pain, epigastric. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted. No evidence of pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Duplicated collecting system on the left. There appear to be two ureters which join distally.RETROPERITONEUM, LYMPH NODES: Stable left periaortic node, series# 6 image 55, measures 1.3 x 1.1 cm. Previously 1.4 x 1 cm. No new nodes.BOWEL, MESENTERY: Suture line seen in the right upper quadrant with suggestion of duoden-jejunostomy, possibly performed for treatment of SMA syndrome given history per resident on call. If clinically indicated, this can be better evaluated with upper GI / small bowel series. No loculated intraperitoneal fluid. No bowel wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality noted. Two ureters on the left of the pelvis and series 6 image 125.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to explain abdominal epigastric pain. Postsurgical changes as described possibly related to SMA syndrome surgery. Correlate clinically as to the need for further evaluation with upper GI and small bowel series.Stable left periaortic lymph node.Duplicated collecting system and the left kidney. |
Generate impression based on findings. | 14-year-old female, assess for obstruction. Abdominal pain with prior blood per rectum, status post colectomy.VIEW: Abdomen AP (one view) 1/14/2015, 17:17 Nasogastric tube with tip in the fundus of the stomach, side port at the GE junction. Increased dilatation of multiple small bowel loops measuring up to 3.0 cm in maximal diameter, concerning for at least partial small bowel obstruction. Suture material is seen in the right lower quadrant, a right lower quadrant ostomy is in place. | Increased small bowel dilatation, concerning for at least partial small bowel obstruction. |
Generate impression based on findings. | 31 years, Male. Reason: DHT placement History: assess if in stomach or beyond Pelvis is excluded from field of view. Enteric tube tip is projected over gastric fundus. Nonobstructive bowel gas pattern. | Enteric tube tip is projected over gastric fundus. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 18 year old female status post Dobbhoff placement.VIEW: Abdomen AP (one view) 1/14/2015, 17:06 Interval placement of an enteric feeding tube tip terminating in the prepyloric antrum. The liver is enlarged. The bowel gas pattern is nonobstructive. The pelvis is excluded from the field of view. Partially imaged bibasilar opacities. | Enteric feeding tube tip terminating in the prepyloric antrum. |
Generate impression based on findings. | 29-day-old male ex-premie, evaluate pneumothorax.VIEW: Chest AP (one view) 1/15/2015, 05:01 The nasogastric tube has been removed. Left upper extremity PICC with tip in the superior vena cava. Endotracheal tube tip below the thoracic inlet and above the carina. Two right-sided chest tubes in place, position unchanged.Persistent large right anterior pneumothorax, improved in the apex. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. | Large right anterior pneumothorax, improved in the apex. |
Generate impression based on findings. | 2-year-old male for assessment of ET tube, lines, lung fieldsVIEW: Chest AP (one view) 01/15/15 ET tube tip is below thoracic inlet and above the carina. Right internal jugular central venous catheter tip is in the SVC. Left upper extremity PICC terminates at the right atrium. Nasogastric tube is unchanged.Cardiothymic silhouette is borderline enlarged. Enlarged pulmonary vasculature is new. Persistent left lower lobe atelectasis. No pleural effusion or pneumothorax. | Enlarged pulmonary vasculature and persistent left lower lobe atelectasis. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. Left temporoparietal encephalomalacia with ex vacuo dilatation of the occipital horn of the left lateral ventricle appears similar to prior exam. The ventricles are otherwise not significantly changed compared to the prior exam. Dense basal ganglia calcifications are again noted. Ventricular and subcortical white matter hypoattenuation which is nonspecific but likely related to the sequela of chronic small vessel ischemic disease. Additional region of hypoattenuation within the posterior pons is likely related to artifact but clinical correlation is recommended. Mild volume loss. There are no intra-or extra-axial fluid collections. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No evidence of acute intracranial hemorrhage or other acute intracranial abnormality. 2.Left temporoparietal encephalomalacia and moderate small vessel ischemic disease appears similar to prior the exam.3.Focal region of hypoattenuation within the posterior pons is likely related to artifact but clinical correlation is recommended. |
Generate impression based on findings. | fall No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. Minimal patchy low attenuations on bilateral periventricular white matter indicate non specific small vessel disease.There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal non specific small vessel disease. |
Generate impression based on findings. | 29-day-old male with pneumothorax, status post chest tube placement.VIEW: Chest AP (one view) 1/15/2015, 1:43 The nasogastric tube terminates out of the field-of-view with side-port above the GE junction. Left upper extremity PICC with tip in the superior vena cava. Endotracheal tube tip below the thoracic inlet and above the carina. Interval placement of a right-sided chest tube, with two right chest tubes now in place.Persistent large right anterior pneumothorax, increased in the apex. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. | Interval placement of a second right chest tube with the large right anterior pneumothorax increased in the apex. |
Generate impression based on findings. | 7-month-old male intubatedVIEW: Chest AP (one view) 01/15/15 ET tube tip is below thoracic inlet and above the carina. Nasogastric tube tip is at the gastric body. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Atelectasis of the right and left lower lobe. Patchy opacities in bilateral upper lobes may also represent atelectasis. | Right and left lower lobe atelectasis. |
Generate impression based on findings. | 29 day old male with pneumothorax.VIEW: Chest AP (one view) 1/15/2015, 00:51 The nasogastric tube terminates out of the field-of-view with side-port above the GE junction. Left upper extremity PICC with tip in the superior vena cava. Endotracheal tube tip below the thoracic inlet and above the carina. Interval removal of two of the right-sided chest tubes, with one chest tube remaining.Persistent large right anterior pneumothorax, increased. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. | Interval removal of two of the three chest tubes, with interval increase in size of the right anterior pneumothorax. |
Generate impression based on findings. | numbness No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy low attenuations on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel disease, no change since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Non specific small vessel disease, no change since prior exam. |
Generate impression based on findings. | 29 day old male with pneumothorax.VIEWS: Chest AP/lateral (two views) 1/14/2015, 19:44 The nasogastric tube terminates out of the field-of-view with the side-port above the GE junction. Left upper extremity PICC with tip in the superior vena cava. Endotracheal tube tip below the thoracic inlet and above the carina. Interval placement of a new right chest tube, with the side-port at the level of the skin. Two additional right-sided chest tubes positions unchanged.Persistent large right anterior pneumothorax, unchanged. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. | Interval placement of a third right chest tube with the side-port at the level of the skin, with a persistent unchanged large right anterior pneumothorax. |
Generate impression based on findings. | 12 year-old female intubatedVIEW: Chest AP (one view) 01/15/15 ET tube tip is below thoracic inlet and above the carina. Enteric tube courses below the field-of-view. Right upper extremity PICC terminates at the superior cavoatrial junction.Cardiothymic silhouette is enlarged. Bibasilar streaky opacities may represent atelectasis. No pleural effusion or pneumothorax. | Persistent bibasilar streaky opacities. |
Generate impression based on findings. | headache No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan. |
Generate impression based on findings. | Again noted is diffuse bone marrow signal abnormality within the vertebral bodies and pedicles with associated enhancement on postcontrast images compatible with diffuse osseous metastases. There is normal lumbar lordosis. The spine alignment is anatomic. There are no fractures or subluxations. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: A tiny right paracentral disk herniation is noted causing very mild spinal canal stenosis. No neuroforaminal narrowing.L1/2: No significant spinal canal stenosis or neuroforaminal narrowing.L2/3: No significant spinal canal stenosis or neuroforaminal narrowing.L3/4: Mild facet and ligamentum flavum hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.L4/5: Mild to moderate facet and ligamentum flavum hypertrophy. No significant spinal canal stenosis. Mild right and moderate left neuroforaminal narrowing. L5/S1: There is marked extra osseous soft tissue extension of tumor into the epidural space from the S1 vertebral body and pedicles causing moderate spinal canal stenosis. Moderate to severe facet and ligamentum flavum hypertrophy and severe neuroforaminal narrowing. SI Joints: The distal sacrum and bilateral ilia are completely replaced with tumor. | 1.Diffuse osseous metastases of the lumbosacral spine involving many of the vertebral bodies and pedicles with extra osseous soft tissue spread of tumor into the epidural space at the S1 level causing moderate spinal canal stenosis. Correlate clinically for the possibility of bowel and/or bladder function abnormalities. 2.Degenerative changes as described above. |
Generate impression based on findings. | headache, episodes of blurry vision. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan. |
Generate impression based on findings. | 29 day old male with pneumothorax.VIEW: Chest AP (one view) 1/14/2015, 16:56 The nasogastric tube terminates out of the field-of-view with the side-port above the GE junction. Left upper extremity PICC with tip in the superior vena cava. Endotracheal tube tip below the thoracic inlet and above the carina. Interval removal of one of the three right chest tubes, with the remaining chest tubes positions unchanged.Persistent large right anterior pneumothorax, unchanged. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. | Interval removal of one of the three right chest tubes with the large right anterior pneumothorax unchanged. |
Generate impression based on findings. | Female, 52 years old.XR PORT ABDOMEN 1V - RFO Enteric tube is coiled with tip projected over the gastric body. Rectal tube and left upper quadrant and pelvic catheters are noted. No definite RFO is identified.There is mildly prominent central bowel loops, likely related to generalized ileus from recent surgery. | Postsurgical changes and catheters as above. No RFO is identified. Suggestion of a mild ileus. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Diffuse brain atrophy is age appropriate.Patchy low attenuations on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Age appropriate diffuse mild brain atrophy and non specific small vessel disease. |
Generate impression based on findings. | fall No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal to mild diffuse brain atrophy is age appropriate.Patchy low attenuations on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Non visualization of bilateral ocular lenses indicate possible post cataract surgery. Clinical correlation is recommended. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Non specific small vessel ischemic disease.Age appropriate minimal to mild brain atrophy.Non visualization of bilateral ocular lenses, likely represent post surgical status. |
Generate impression based on findings. | A patient submitted outside study for review for a recent pea-sized palpable abnormality along the lateral margin of the scar along the inferior aspect of the left breast reported by the patient. Submitted for review are left breast mammograms and left breast ultrasound performed at South Bend Clinic. For comparison, mammograms are available from UCM 5/14/2014 and priors dating back to 11/20/2009. LEFT MAMMOGRAM Three standard views of the left breast were obtained with a lateral exaggerated left CC view. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Postoperative changes from lumpectomy in the left breast, 6 o'clock position with surgical clips and architectural distortion in the surgical bed. A BB was placed at the site of the palpable abnormality. No discrete abnormality is seen in the breast in this region.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. LEFT BREAST ULTRASOUND | Findings compatible with scar tissue. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 29-year-old female with history of left orbital pain status post MVC. There is no evidence of acute fracture. The orbits are unremarkable. There is an upper lip piercing. | No acute fracture. |
Generate impression based on findings. | 7-year-old male with spina bifida, evaluate hipsVIEWS: Pelvis AP (one views) 01/15/15 Large amount of stool within the rectum. Partially visualized VP shunt tubing is noted. Posterior fusion defect of lower lumbar vertebra and sacrum is present.Coxa valga deformities bilaterally are unchanged. No evidence of acute subluxation or dislocation. | Unchanged bilateral coxa valga deformities. |
Generate impression based on findings. | 66 year old female with history of sepsis and tachycardia.Additional history per EPIC: "history of stage IA Grade I endometrial cancer, s/p robotic hysterectomy on 11/10 and take-back to OR on 12/2 for vaginal cuff repair; transferred from OSH with imaging concerning for cholecystitis and possible neoplastic process, now s/p exploratory laparotomy revealing metastatic disease with colonic invasion causing perforation. " CHEST:Motion breathing limits evaluation of the lungs.LUNGS AND PLEURA: Small bilateral pleural effusions with associated atelectasis/consolidation. Patchy bilateral small foci of consolidation may be related to aspiration/infection.MEDIASTINUM AND HILA: Cardiomegaly, with only minimal pericardial fluid. No appreciable coronary artery calcifications. Small mediastinal and hilar lymph nodes, nonspecific. Right IJ venous catheter tip in the SVC. Nasogastric tube tip within the stomach.CHEST WALL: Mild diffuse sclerosis of the visualized spine and ribs. Small foci of gas adjacent to the right internal jugular venous catheter, likely related to recent procedure.ABDOMEN:Limited evaluation of the abdomen without IV contrast.LIVER, BILIARY TRACT: Two right percutaneous drains are seen, with one curling over the liver dome and one entering a subhepatic collection. The subhepatic collection is heterogeneously low-attenuation, involves the gallbladder fossa. Without IV contrast, it is impossible to tell whether this process involves the liver parenchyma. Another infrahepatic collection, superior to the pancreatic head, is most likely an extension of the aforedescribed infrahepatic collection, although this could conceivably represent pancreatic head inflammation.Right posterior hepatic lobe focal hypoattenuation, nonspecific.Additional lower density more homogeneous ascites is seen about the liver and spleen.SPLEEN: Small amount of fluid around the spleen, likely related to abdominal ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant hydronephrosis or hydroureter. Large left renal hypoattenuating focus, likely cyst although incompletely evaluated on this noncontrast exam. Right high-density renal cysts, and punctate nonobstructing stones are seen.RETROPERITONEUM, LYMPH NODES: Small lymph nodes within the peritoneum. Otherwise no significant abnormality.BOWEL, MESENTERY: No small bowel obstruction or free air. Right midabdominal ostomy site with enteric contrast material. Postoperative findings of right hemicolectomy.BONES, SOFT TISSUES: Heterogeneous soft tissue stranding at the right lateral superior abdomen in the subcutaneous tissues overlying the liver at the level of the 10th rib, measuring approximately 9 x 3 cm, nonspecific. Anterior midline open abdominal wound extending from the upper midabdomen inferiorly to the pelvis.OTHER: Nonspecific hypoattenuating area adjacent to the pancreatic head measuring approximately 4.4 x 3.9 cm, nonspecific and could represent a loculated fluid collection, versus an abnormal gallbladder, incompletely evaluated on this noncontrast exam.PELVIS:UTERUS, ADNEXA: The uterus is not visualized, likely surgically absent.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse subtle sclerosis, likely metabolic in nature although nonspecific.OTHER: No significant abnormality noted. | 1.Small bilateral pleural effusions and associated atelectasis/consolidation. Additional small, patchy consolidated foci may be related to infection/aspiration.2.Perihepatic fluid collections and two perihepatic drains. The inferior drain is coiled within a heterogeneous collection in the gallbladder fossa. Cannot exclude inflammatory involvement of the liver parenchyma.3.Nonspecific low density collection near the pancreatic head/hepatic hilum, nonspecific, and may be an extension of the adjacent subhepatic collection. |
Generate impression based on findings. | 80 years, Female. Reason: Dobbhoff placement History: As above Enteric tube side port is projected over the distal esophagus.Pelvis excluded from field of view. Postoperative changes and vascular calcifications are noted. Nonobstructive bowel gas pattern. Centralization of the bowel loops suggest ascites. | Enteric tube side port is projected over the distal esophagus. Advancing 3-5 cm is recommended. |
Generate impression based on findings. | Trauma, rule out acute intracranial process No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | No evidence of acute intracranial hemorrhage or mass effect. |
Generate impression based on findings. | 34-year-old female with history of MVC. Evaluate for fracture. There is no evidence of acute fracture or subluxation. Alignment is anatomic. There is mild degenerative disc disease affecting the upper thoracic spine. | No radiographic evidence of fracture. If pain persists, an MRI may be obtained. |
Generate impression based on findings. | 5-day-old male with pneumothorax and pneumopericardium.VIEW: Chest AP (one view) 1/14/2015, 18:05 Endotracheal tube tip just below the thoracic inlet. The umbilical lines are unchanged. Three right-sided chest tubes are in place, position unchanged.Slightly improved right pneumothorax, with a small residual pneumothorax present. Air outlining the cardiac silhouette is no longer seen, which may have been artifactual. Patchy left basilar atelectasis unchanged. | Slightly improved small right pneumothorax. No evidence of pneumopericardium. |
Generate impression based on findings. | Male; 61 years old. Reason: f/u ground glass opacity; pneumonia, pneumothorax History: Abnormal past chest CT; shortness of breath LUNGS AND PLEURA: Previously seen patchy groundglass opacities in the left upper lobe have resolved, likely post infectious or inflammatory in etiology. Moderate to severe upper lobe predominant paraseptal and centrilobular emphysema. Stable micronodule in the left upper lobe (image 20, series 5). No new or suspicious right nodules. No pleural effusions or pneumothorax. Mild central bronchial wall thickening is similar to prior study and suggestive of bronchitis.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Minimal coronary calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Tiny nonobstructing stone and small cyst left renal upper pole. Mild central intrahepatic biliary ductal dilation with common bile duct dilation measuring up to 12 mm, partially visualized but similar to prior study. Stable scattered calcifications in the region of the porta hepatis, which may be related to calcified lymph nodes from prior granulomatous process. | 1. Interval resolution of left upper lobe opacities, likely post infectious or inflammatory in etiology. No evidence of pneumonia on the current exam.2. Moderate to severe emphysema and bronchial wall thickening suggestive of bronchitis, similar to prior.3. Biliary ductal dilation, incompletely visualized but similar to prior. If there is clinical concern for obstruction, dedicated abdominal imaging is recommended. |
Generate impression based on findings. | Reason: mesenteric ischemia History: abd distension ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypodensity in the right hepatic lobe surrounding a small metallic clip is nonspecific and incompletely characterized, possibly representing perfusional abnormality or infarct, and does not have a typical appearance of metastatic disease. Small amount of pneumobilia likely postprocedural. Patent portal and hepatic veins.SPLEEN: No significant abnormality notedPANCREAS: Postoperative changes of Whipple procedure. Infiltrative soft tissue in the region the pancreatic head measuring up to 4.8 x 4.0 cm (series 10 image 71). This tissue encases the superior mesenteric artery and extends into the porta hepatis, partially encasing the celiac axis and hepatic artery. These findings are highly suspicious for pancreatic neoplasm, likely recurrent in the setting of prior surgery. The distal pancreas is atrophic. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, including high attenuation hemorrhagic or proteinaceous cyst in the right lower pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Gastrohepatic and mesenteric lymphadenopathy surrounds the pancreatic head mass. Reference enlarged periportal lymph node measures 2.9 x 2.4 cm (series 10 image 49). BOWEL, MESENTERY: No evidence of active gastrointestinal hemorrhage. Large wide based ventral hernia. Mild dilation of scattered bowel loops up to 3.2 cm without a definite transition point, most consistent with ileus. Mild apparent wall thickening in the distal small bowel surrounding mesenteric stranding is nonspecific, differential includes ischemic, inflammatory, and less likely infectious etiologies.BONES, SOFT TISSUES: Focal lucencies in the ilia bilaterally are nonspecific but do not have a typical appearance for metastatic disease.VASCULATURE: Pancreatic head mass encases the superior mesenteric artery and partially encases the celiac axis and hepatic artery. Tumor extends inferiorly and also abuts the right renal artery. The SMA, celiac, and hepatic arteries remain patent. There is narrowing of the origin of the celiac artery which is likely chronic. An aortobiiliac stent graft is patent.There is encasement of the superior mesenteric vein by tumor and a super mesenteric vein stent is occluded, likely chronically as there is reconstitution of the SMV distally by numerous large collateral venous branches. A splenic vein stent is patent. Tumor abuts the infrahepatic IVC as well. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathyBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: As aboveOTHER: No significant abnormality noted | 1. Postoperative changes of Whipple procedure with infiltrative pancreatic head mass as described above most likely representing recurrent pancreatic malignancy. 2. Encasement of arterial vasculature by tumor as described above but no acute arterial occlusion or hemorrhage. Thrombosed SMV stent reconstituted distally by a large collateral venous network. Patent splenic vein stent. 3. Nonspecific mild wall thickening of distal small bowel loops may represent ischemic, inflammatory, or less likely infectious etiologies.4. Right hepatic lobe hypoattenuating lesion surrounding a surgical clip most likely represents a perfusional abnormality or infarct. |
Generate impression based on findings. | Female 4 years old Reason: eval for stool burden History: history constipation, now with profuse diarrhea and concern for encopresisVIEW: Abdomen AP (one view) 1/14/15 at 1813 hrs. Surgical clips gastrostomy tube are again noted. Left lower lobe streaky opacity, likely atelectasis or pneumonia. Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Parkinson's disease, deep brain stimulator placement. Examination is obtained for operative planning and intraoperative navigation. Stereotactic frame is in place. Placement of bilateral DBS leads seen via bifrontal burr holes and terminating in the region of the bilateral subthalamic nuclei. Expected postsurgical changes include small amount of pneumocephalus and minimal extra-axial fluid collection. No significant midline shift or uncal herniation. Small ovoid lesions are again noted in the parotid glands. | Postoperative changes of bilateral DBS lead placement with tips at the level of the subthalamic nuclei. |
Generate impression based on findings. | Female 4 months old Reason: evaluat bowel gas pattern History: constipation, possible Hirschsprung'sVIEW: Abdomen AP (one view) 1/14/15 at 2248 hrs. Contras material is visualized in bowel loops. Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. Mild to moderate periventricular and subcortical white matter hypoattenuation, especially in the right parietal subcortical region is nonspecific but may be from sequela of small vessel ischemic disease and is without significant change from the previous exam. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. No intra-or extra-axial fluid collections. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No evidence of acute intracranial hemorrhage or other acute intracranial abnormality.2.Mild to moderate small vessel ischemic changes without significant change from the previous exam |
Generate impression based on findings. | 51-year-old male with chest pain, shortness of breath, and syncope. Previous history of pulmonary embolism. PULMONARY ARTERIES: No evidence of acute pulmonary embolus to the segmental level. There is a small filling defect adherent to the wall of a left lower lobe segmental artery consistent with a pulmonary arterial web or prior embolus. The pulmonary artery measures 26 mm without evidence of right ventricular strain.LUNGS AND PLEURA: Interval resolution of ill-defined subcentimeter right upper lobe nodular opacity seen on previous study. Mild paraseptal emphysema with apical bullae which is unchanged. Dependent atelectasis. No focal consolidation, pleural effusion or suspicious nodules.MEDIASTINUM AND HILA: Moderate coronary artery calcifications. Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the left kidney likely represents a cyst. | 1.No evidence of acute pulmonary embolism. 2.Small filling defect adherent to the wall of a left lower lobe segmental artery consistent with pulmonary arterial web or residual of a prior pulmonary embolus. 3.Resolution of previously seen ill-defined right upper lobe nodular opacity which was likely inflammatory in etiology.PULMONARY EMBOLISM: PE: Indeterminate.Chronicity: Chronic.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative. |
Generate impression based on findings. | 22-year-old female with history of pain. Right ankle: There is mild soft tissue swelling about the lateral aspect of the ankle. No acute fracture or malalignment.Right foot: No acute fracture or malalignment. Incidental mode is made of a bipartite os peroneum, a normal variant. There is abnormal ossification between the base of the fifth metatarsal and the cuboid which may represent a coalition. This may be congenital or perhaps secondary to remote trauma. | Lateral ankle soft tissue swelling without acute fracture. Other findings as above. |
Generate impression based on findings. | 66 year old female status post right breast lumpectomy in 1994 for DCIS and left breast lumpectomy in 2008 for IDC followed by radiation and chemotherapy treatment.BRCA 1 mutation. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear scar markers overlie both breasts. Surgical clips, skin retraction, and architectural distortion in the left breast at the site of the patient's prior lumpectomy are unchanged. Mild architectural distortion in the right breast at the lumpectomy site and right axillary clips are also unchanged.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | There is enlargement of the palatine tonsils bilaterally. There is an irregularly shaped low density left peritonsillar collection which measures approximately 1.8 x 2.3 cm in greatest axial dimensions. There are two foci of nondependent air which appear to be within the collection rather than in the adjacent left glossotonsillar sulcus which can be visualized. Additional low-density inflammatory change and edema extends posteriorly from the collection in the parapharyngeal space along the anterior aspect of the left cervical vessels, to approach the deep lobe of the left parotid gland. The right palatine tonsil also has a heterogeneous somewhat striated appearance with a small area of focal low density centrally measuring approximately 8 x 12 mm.A trace retropharyngeal effusion is also present, measuring up to 3 mm in greatest thickness. Inflammatory changes on the left extend caudally with partial effacement of the left vallecula and the left piriform sinus. The left aryepiglottic fold appears somewhat thickened. There is diffuse soft tissue thickening of the left lateral wall of the hypopharynx/larynx. Inflammatory changes also extend caudally along the anterolateral aspect of the neck with platysmal thickening and stranding within the deep fat planes including in the left submandibular space posteriorly and in the carotid space. Inflammatory changes are noted as far down as the clavicular heads.GLANDS: The left submandibular gland is slightly larger than the right, likely reactive to surrounding inflammatory changes. The postcontrast appearance of the salivary glands is unremarkable. There is a punctate nonspecific low density lesion in the inferior right thyroid.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There is extensive cervical lymphadenopathy bilaterally along the jugular chains which is most likely reactive. A reference right level 2a nodal conglomerate measures 2.2 cm in long axis on 5/56. The level 2a nodal conglomerate on the left measures up to 2.0 cm in length on 5/52.OTHER: Lobulated mucosal retention cysts are noted in the maxillary sinuses bilaterally, along with trace mucosal thickening. There is mild reversal of the normal cervical lordosis. | 1. Findings consistent with left worse than right tonsillitis, with left peritonsillar abscess and associated significant inflammatory changes extending predominantly caudally along the left neck, as far down as the clavicular heads. Trace retropharyngeal effusion.2. Smaller suspected forming right palatine tonsillar abscess.3. Reactive cervical lymphadenopathy with prominent nodal conglomerates.4. Asymmetric enlargement of the left submandibular gland, likely reactive due to surrounding inflammatory changes. |
Generate impression based on findings. | 65-year-old male with pain and swelling in hands, evaluate for inflammatory arthritis or subluxation Right hand: Mild to moderate osteoarthritis affects the basilar joint and first metacarpophalangeal joint. Deformity of the fifth metatarsal likely represents old trauma. Mild osteoarthritis affects scattered interphalangeal joints. No erosions are evident.Left hand: Mild to moderate osteoarthritis affects the basilar joint and scattered interphalangeal joints. No erosions are evident.Right foot: Mild osteoarthritis affects scattered interphalangeal joints in the mid foot. There is diffuse soft tissue swelling. No erosions are evident.Left foot: Mild to moderate osteoarthritis affects scattered interphalangeal joints and the midfoot. There is diffuse soft tissue swelling. No erosions are evident.Right knee: Mild to moderate osteoarthritis affects the knee. Vascular calcifications are noted in the soft tissues.Left knee: Deformity of the proximal fibula likely represents old healed fracture. Mild to moderate osteoarthritis affects the knee.Cervical spine: Multilevel anterior vertebral osteophytes and mild degenerative disease affecting the mid cervical spine. There is also multilevel facet joint osteoarthritis with mild right mid cervical spine neuroforaminal narrowing. | Osteoarthritic and post traumatic changes as described above without erosions or other specific evidence of inflammatory osteoarthritis. |
Generate impression based on findings. | 57-year-old female with history of pain. Evaluate for shoulder dislocation. This exam is limited secondary to patient's immobility.The bones are diffusely demineralized suggesting osteopenia/osteoporosis. There is no acute fracture or dislocation. The glenohumeral joint is grossly intact. Deformity of the posterolateral humeral head may represent a chronic Hill-Sachs deformity. Stable widened AC joint. Irregular humeral diaphysis may be the sequela of remote trauma. Right central venous catheter with tip in the right atrium. Incompletely visualized enteric tube. Right pleural effusion. | No evidence of shoulder dislocation. Other findings as above. |
Generate impression based on findings. | 93-year-old male with bilateral jaw pain, right worse than left, TMJ symptoms The TMJ joint is suboptimally evaluated due to technique. There appear to be moderate osteoarthritic changes affecting the joints. Diffuse small lucencies within the cervical spine and mandible perhaps reflect underlying renal osteodystrophy. Several missing teeth are noted. | 1. Suboptimal evaluation of the TMJ joints with moderate osteoarthritic changes noted. A Panorex view with open and closed mouth may be considered for further evaluation of the TMJ joints if clinically warranted.2. Diffuse small lucencies within the cervical spine and mandible may reflect underlying renal osteodystrophy. |
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