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Generate impression based on findings.
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11 year old female with severe constipation, evaluate stool burdenVIEW: Abdomen AP (one view) 01/15/15 A moderate amount of amorphous stool is noted within the rectum. No evidence of obstruction. No free intraperitoneal air.
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Moderate amount amorphous stool in the rectum.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Stable benign intramammary lymph node is present in the right upper outer breast. Scattered benign calcifications are seen bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of ovarian carcinoma in her sister. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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14-month-old male need of her shunt placement in atriumVIEW: Chest AP (one view) 01/15/15 Cardiothymic silhouette is enlarged. Right ventriculoatrial catheter tip is at the superior cavoatrial junction. No focal pulmonary opacities. No pleural effusion or pneumothorax.A G-tube is present.
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Right ventriculoatrial catheter tip is at the superior cavoatrial junction.
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Generate impression based on findings.
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15 year old female evaluate healing of pubic ramus fracture.VIEWS: Pelvis AP (one views) 1/15/2015 Minimally fractures of the superior pubic ramus are again identified, with associated callus formation and increasing indistinctness of the fracture lines compatible with healing.
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Healing fractures of the superior pubic ramus.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her sister at age 60. 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, some of which are vascular, are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt and maternal cousin. Personal history of benign left breast biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Scattered benign calcifications, including arterial calcifications, are present.
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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.
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Generate impression based on findings.
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66 your female with lumbar back pain and hip pain Posterior stabilization rods with screws entering the L4, L5, and S1 vertebral bodies. There is bone graft material at L4/L5. Severe degenerative disk disease particularly affects L5-S1 and L2-L3 as well as the lower thoracic spine. Facet joint osteoarthritis affects the lower lumbar spine. There is minimal retrolisthesis of L2 on L3. No evidence of instability on flexion and extension views.Cholecystectomy clips are noted in the right upper quadrant.
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Orthopedic fixation of the lumbar spine and degenerative changes as described above.
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Generate impression based on findings.
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Ms. Hayes is a 52 year old female with a personal history of left breast mastectomy in 2011 for DCIS along with a right breast mastopexy. Patient is currently on tamoxifen therapy. Three standard views of the right breast and one right spot compression view 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. Post-surgical changes consistent with a right breast mastopexy are again seen. There is no new mass, suspicious microcalcifications or areas of non-surgical architectural distortion identified in the right breast. Scattered benign calcifications are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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87-year-old female with pain There is approximately 15 degrees valgus deformity about the knee relative to the neutral mechanical axis. Severe osteoarthritis affects the knee.
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Osteoarthritis and valgus deformity.
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Generate impression based on findings.
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Male; 79 years old. Reason: h/o lung cancer, eval response to chemo, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant interval change in the appearance of right upper lobe mass with surrounding radiation reaction. It measures approximately 66 x 56 mm (4/23), not significantly changed since prior exam when it measured approximately 69 x 51 mm. Low density within the mass may represent areas of necrosis, similar to prior. Extension of the mass into the right chest wall and intercostal muscles with right second rib cortical destruction, similar to prior.No new pulmonary nodules or masses. Moderate centrilobular and paraseptal emphysema. Stable right middle lobe and bilateral lower lobe bronchial wall thickening and bronchiectasis. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Stable scattered small right upper paratracheal lymph nodes. Interposition graft is unchanged from the prior exam. Heart size is normal without pericardial effusion. Right coronary artery stent with mild calcifications are presentCHEST WALL: Median sternotomy wires and sternal fixation devices. Invasion of right second rib as above.ABDOMEN: Absence of enteric contrast material markedly 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 hypodensities are unchanged and likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small hiatal hernia. Diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: Mild degenerative changes of the lower lumbar spine. OTHER: No significant abnormality noted.
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No significant interval change in right apical mass.
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Generate impression based on findings.
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Reason: H/o lymphoma. Please restage (large renal mass and persistently FDG avid smaller nodes) History: neuropathy CHEST:LUNGS AND PLEURA: No new suspicious nodules or masses. Left posterior pleural-based scarring/calcification unchanged. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild atherosclerotic/coronary calcification.CHEST WALL: Right chest port with tip in the SVC.Nonspecific sclerosis/lucency in the T6 vertebral body unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Marked interval enlargement of infiltrative retroperitoneal mass encasing the renal vessels and likely invading the right kidney. In its entirety this infiltrative soft tissue now measures 12 x 6.8 centimeters (series 3 image 126), though it is difficult to ascertain the boundaries of the right renal pelvis and comparison to prior measurements is difficult. The right renal artery is encased by this lesion but still appears patent. Portions of the IVC and right renal vein appear replaced by tumor and are not well visualized. The origin of the left renal vein appears attenuated but the distal portions of the left renal vein remain patent.RETROPERITONEUM, LYMPH NODES: Marked interval enlargement of infiltrative retroperitoneal mass as described above. Additionally, there is a new circumscribed soft tissue component with higher attenuation than the surrounding tissue measuring 8.5 x 6.3 cm (series 3 image 129). There are also several new mildly enlarged retroperitoneal lymph nodes. BOWEL, MESENTERY: Mesenteric haziness throughout the upper abdomen is not significantly changed. BONES, SOFT TISSUES: Nonspecific sclerosis/lucency in the T6 vertebral body unchanged.OTHER: 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
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1. Marked interval enlargement in the retroperitoneal and infiltrative right renal mass as described above with a large new solid component and nonvisualization of the infrahepatic IVC and proximal renal arteries, which may represent tumor compression or possibly vascular invasion. 2. Mesenteric haziness in the anterior abdomen is not significantly changed.
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Generate impression based on findings.
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53-year-old male status post scapholunate surgery A screw affixes the scaphoid and lunate bones. There is no significant osseous bridging. The remaining osseous structures appear unremarkable.
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Orthopedic fixation as described above.
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Generate impression based on findings.
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Male; 49 years old. Reason: eval PE History: previous PE PULMONARY ARTERIES: Large bilateral pulmonary emboli in the left and right pulmonary arteries extending into all of the lobar and numerous segmental and subsegmental branches. This finding is similar to prior study from 12/4/14, but there has been slightly decreased overall clot burden, specifically in the main pulmonary artery and the right pulmonary artery.Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Scattered calcified granulomata. No suspicious pulmonary nodules or masses. No focal consolidations. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Large bilateral pulmonary emboli with overall slightly decreased clot burden as detailed above.PULMONARY EMBOLISM: PE: Positive.Chronicity: Chronic.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Negative.
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Generate impression based on findings.
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18 year old female evaluate for fifth metatarsal fracture.VIEWS: Right foot AP lateral and oblique (3 views) 1/15/2015 No acute fracture or malalignment evident. No significant soft tissue swelling seen.
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No acute fracture or malalignment evident.
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Generate impression based on findings.
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Female 49 years old; Reason: assess vasculature prior to kidney transplant History: Prekidney transplant evaluation Evaluation of organs of abdomen and pelvis and vasculature suboptimal without IV contrast.ABDOMEN:LUNGS BASES: Trace pericardial effusion.LIVER, BILIARY TRACT: Liver measures 18 cm in craniocaudal dimension.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable bilateral renal cysts, majority of which measure simple fluid. However, several lesions are higher in density, for example, right-sided 1.4 x 1 cm focus with associated Hounsfield units of 51. Bilateral renovascular calcifications as well as nonobstructing intrarenal nephrolithiasis, measuring up to 4 mm. Calcified bilateral renal arteries with noncalcified origins, origin of right main renal artery measures 0.8 cm, while origin of left main renal artery measure 0.7 cm. Renal veins and ureters not well assessed on this unenhanced study. Right kidney measures approximately 10 cm in longitudinal dimension and left kidney measures approximately 10 cm in longitudinal dimension. RETROPERITONEUM, LYMPH NODES: Extensively calcified aortobiiliac arteries. Tortuous abdominal aorta, measuring up to 1.7 cm in transverse dimension. Noncalcified celiac and SMA origins.BOWEL, MESENTERY: Mildly prominent fluid containing small bowel.PELVIS:UTERUS, ADNEXA: Right adnexal cyst measuring 3.4 x 3.1 cm, may be dominant follicle, image 279 series 2. Calcified fibroid uterus. BLADDER: Not well visualized, presumedly related to collapsed state.BONES, SOFT TISSUES: Diffuse osseous sclerosis, appearance compatible with renal osteodystrophy.
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1. Suboptimal exam without IV contrast.2. Kidneys containing innumerable cysts bilaterally, may reflect acquired cystic disease, extensive calcified arterial disease as above. 3. Renal osteodystrophy.
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Generate impression based on findings.
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Reason: Check J-Tube Placement- PLEASE INJECT CONSTATS IN TUBE TO CHECK PLACEMENT History: Pain at Site of Tube Difficulty With Feedings There was prompt opacification of normal appearing jejunum with contrast injection. J-tube was fast flowing. No contrast leakage was noted. TOTAL FLUOROSCOPY TIME: 1:05 minutes
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Prompt opacification of normal appearing jejunum. No contrast leakage.
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Generate impression based on findings.
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Reason: s/p 18 mo after RUL for T1aN0 Stage IA adenocarcinoma History: 6 mo f/u LUNGS AND PLEURA: Status post right upper lobectomy.No suspicious pulmonary nodules or masses.Mild upper lobe predominant centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal upon evidence of pericardial effusion.Moderate coronary calcification.CHEST WALL: Stable mildly prominent axillary lymph nodes.Subcutaneous low density lesions along the anterior chest wall may represent sebaceous cysts or epidermoid cysts.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Stable exam without evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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Right frontal, right lateral parietal, and bilateral posterior paramedian occipital burr holes are again seen. Several of the previously identified depth electrodes have been removed. There is a remaining right occipital approach mesial right temporal lobe electrode. Trace intrinsic T1 hyperintensity is identified along the left temporal occipital lobes in the extra axial space, consistent with subdural blood products. Trace subdural blood products are seen on the right adjacent to the superior sagittal sinus. These likely relate to previous placement of depth electrodes.Subsequent images demonstrate a laser fiber placed along a similar but slightly more lateral course with tip in the mesial right temporal lobe. The immediate but limited postcontrast images demonstrate enhancement along the partially visualized left occipital approach electrode tract, with less prominent linear prominent along the right occipital approach electrode tract. There is also trace enhancement identified along the visualized portions of the right lateral approach tracks in the right temporal lobe. There is thin peripheral enhancement of lobulated area along the distal aspect of the laser fiber in the right mesial temporal lobe, with overall dimensions of 1.2-cm transverse by 3.5-cm AP.Slightly more delayed post contrast images demonstrate additional areas of enhancement along right frontal approach electrode tracts coursing into the inferior right frontal lobe, with further delineation of the right lateral parietal and temporal lobe tracts. Mild enhancement is noted along the right occipital horn margins.There is again mild areas of thin dural enhancement which is likely reactive to instrumentation. The ventricular system is stable and normal in size.
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1. Expected post procedural changes following laser ablation of the mesial right temporal lobe, with removal of depth electrodes.2. Trace left much greater than right subdural blood products likely relating to prior depth electrode placement.
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Generate impression based on findings.
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29 years, Female. Reason: 29 y/o Hx of Noonan syndrome w/ severe constipation/obstipation/gastroparesis no BM x20days History: No BM x20days Scattered surgical clips are noted. Moderate stool burden with multiple scybala noted in the descending colon. Not much gas is seen overlying the rectum. No dilated loops of bowel to suggest obstruction. No definite evidence of free air.
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Moderate stool burden with multiple scybala. No dilated loops of bowel to suggest obstruction. No definite evidence of free air.
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Generate impression based on findings.
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8 year-old male, arm pain after fall.VIEWS: Left forearm AP and lateral (two views) left elbow AP oblique and lateral (3 views) 1/15/2015 No acute fracture or malalignment is evident. Proximal ulnar fracture no longer identified, compatible with healing. Small/moderate joint effusion.
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Small/moderate joint effusion without underlying fracture seen.
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Generate impression based on findings.
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Headache with subarachnoid hemorrhage Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There is airspace disease present with patchy alveolar type opacification of the visualized upper lung fields.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. There is a 6mmx6mm lobulated basilar tip aneurysm present with a 4mm neck measuring. This is surrounded by subarachnoid blood There is a 3.5x2.5 mm right MCA aneurysm present originating from the mid to distal m1 proximal to the bifurcation and adjacent to a lenticulostriate artery.There is 2mm left MCA aneurysm present at the bifurcation.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The temporal horns of the lateral ventricles are midly dilated. There is no sulcal effacement identified.There is subarachnoid blood present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.There is a basilar tip aneurysm present with findings suggestive of recent rupture.2.There is a right MCA aneurysm present3.There is left MCA aneurysm present4.Subarachnoid hemorrhage5.No evidence for cervicocerebral occlusive disease6.Mild enlargement of the lateral ventricles.7.There is airspace disease present. Please refer to chest x-rays for further comments.
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Generate impression based on findings.
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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 extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Asymmetry is present within the central left breast, seen on MLO view. No suspicious masses, microcalcifications or areas of architectural distortion are present in the right breast.
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Left breast asymmetry. Further evaluation with spot compression imaging, ultrasound of necessary, is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: ED - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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Reason: Hx of Floor of Mouth CA, S/P CRT eval for response. Compaire to prior scans, measurements please History: none CHEST:LUNGS AND PLEURA: Stable scattered calcified noncalcified micronodules compatible with prior granulomatous disease.Mild upper lobe predominant centrilobular and paraseptal emphysema.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible the prior granulomatous disease.No evidence of lymphadenopathy.Cardiac size normal evidence of a pericardial effusion.Mild coronary and moderate aortic calcification.CHEST WALL: Stable anterior wedging of several midthoracic vertebrae.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic hypodensities unchanged and compatible with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta and iliac arteries.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable exam without evidence of metastatic disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History BRCA1 genetic mutation carrier. Family history of ovarian carcinoma in her mother and breast carcinoma in 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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11-year-old male with cerebral palsy and spastic quadriceps, evaluate hipsVIEWS: Pelvis AP (one views) 01/15/15 Postoperative changes are identified in both proximal femurs. Femoral heads are well directed into the acetabula. No acute fracture or malalignment is evident. Bilateral coxa valga deformities are present.
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Femoral heads are well positioned in the acetabulum.
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Generate impression based on findings.
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Male 75 years old; Reason: bilateral renal masses, evaluate size ABDOMEN:LUNGS BASES: Visualized lung fields without significant change with scattered micronodularity noted. No pleural effusion.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: Bilateral heterogeneously enhancing renal masses seen, appearance consistent with small renal cell carcinomas. Right interpolar anterolaterally located enhancing mass measuring 1.6 x 1.5 cm (image 50 series 8) and accounting for differences in technique, no significant change. Posteriorly located enhancing left lower pole renal mass measuring 1.4 x 1.1 cm (image 67 series 8) and accounting for differences in technique, no significant change. In addition, stable left interpolar focus measuring 1.4 x 1.2 cm, image 55 series 8, previously measured 1.4 x 1.1 cm, relatively dense on noncontrast exam with associated Hounsfield units of approximately 69, no definite associated enhancement seen on postcontrast imaging, may be a cyst containing proteinaceous or hemorrhagic material. Additional bilateral hypoattenuating lesions seen that are too small to characterize. No radiopaque intrarenal calculi.RETROPERITONEUM, LYMPH NODES: Incidentally seen circumaortic left renal vein.BOWEL, MESENTERY: Moderate to large stool in colon.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate gland measuring 6.9 cm in transverse dimension, protrusion into bladder base seen. Postsurgical sequela related to prior TURP procedure seen. Penile prosthesis present with associated reservoir located in right pelvis.BLADDER: Underdistended bladder with mild circumferential wall thickening, may reflect sequela of chronic outlet obstruction due to an enlarged prostate gland but correlation with patient's clinical history and urinalysis suggested to exclude superimposed cystitis. BONES, SOFT TISSUES: Multilevel degenerative changes of spine, grade 1 L4 on L5 anterolisthesis, L5/S1 ankylosis.
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1. Stable exam as described, bilateral renal masses seen, appearance consistent with bilateral renal cell carcinomas.2. Prostatomegaly. Underdistended bladder with mild circumferential wall thickening, similar in appearance to earlier study, likely reflecting chronic outlet obstruction but correlation with patient's clinical history and urinalysis suggested to exclude superimposed cystitis.
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Generate impression based on findings.
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Decreased memory, dizziness, and falls. There is no evidence of intracranial hemorrhage or mass. There are unchanged scattered punctate and confluent areas of low attenuation in the periventricular and subcortical white matter. There is also mild encephalomalacia in the anterior right temporal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are scattered vascular calcifications. There is partial opacification of the right maxillary sinus. The paranasal sinuses are otherwise clear. There are postoperative changes related to a prior right posterior temporal craniotomy and bilateral mastoidectomies. The extracranial soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage, mass, or cerebral edema. 2. Unchanged scattered nonspecific areas of hypoattenuation in the cerebral white matter. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. 3. Bilateral mastoidectomy.
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Generate impression based on findings.
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Worsening sinusitis. There are bilateral air fluid level in the maxillary sinuses, as well as bubbly secretions within the left maxillary sinus and left sphenoid sinus. There is minimal diffuse bilateral ethmoid sinus mucosal thickening. The other paranasal sinuses are clear. The nasal cavity is clear. There is mild S-shaped nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. There is right tympanomastoid opacification. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There is a carious tooth # 15.
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1. Acute sinusitis.2. Right tympanomastoid opacification likely represent otomastoiditis.3. Carious tooth # 15.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign bilateral breast biopsies. Family history of breast carcinoma in her maternal grandmother in her 50s and maternal great aunt, as well as her paternal great-grandmother. Two standard digital views of both breasts, with additional bilateral MLO views, were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Linear markers have been placed on scars overlying both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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Female 71 years old Reason: eval for SBO, etc. History: abd pain, n/v. also recently treated for diverticulitis ABDOMEN:LUNG BASES: Large hiatal hernia.LIVER, BILIARY TRACT: Mild diffuse fatty infiltration of the liver.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: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. There is a well-circumscribed fat density round lesion on the left side of the rectal wall measuring 1.7 cm number 101, series number 4. This likely represents a rectal wall lipoma.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Diverticulosis without CT evidence of diverticulitis. Small rectal wall lipoma.Large lateral hernia.Diffuse fatty infiltration
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, with additional left CC and MLO views, were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. Left MLO tomosynthesis was not performed due to limited mobility and positioning of the left breast as a result of patient injury. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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T4aN0 supraglottic squamous cell carcinoma status post chemoradiotherapy. There are post-treatment findings with mild diffuse supraglottic swelling and heterogeneous enhancement and persistent effacement of the left pre-epiglottic fat, but no measurable discrete mass lesion or evidence of significant cervical lymphadenopathy. The thyroid gland and major salivary glands appear unchanged. Sclerotic foci in the posterior right fourth rib are unchanged. The imaged intracranial structures and orbits are grossly unremarkable. There is mild centrilobular emphysema in the apices.
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Post-treatment findings in the neck without evidence of measurable residual tumor or significant cervical lymphadenopathy.
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Generate impression based on findings.
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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. Scattered benign calcifications are present. Several scattered focal asymmetries do not appear significantly changed. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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Female 80 years old Reason: baseline exam prior to starting systemic therapy; please provide bi-dimensional measurements History: hx of metastatic bladder cancer; CHEST:LUNGS AND PLEURA: Index right lower lobe nodule now measures 2.6 x 1.8 cm image number 97, series number 3, slightly increased in size compared to previous study. Other nodules are also minimal increase in size. Emphysema, unchanged.MEDIASTINUM AND HILA: Slight interval increase in the size of the borderline enlarged mediastinal lymph nodes. Index node measures 9-mm in diameter image number 46, series number 8. Previously, this node was measuring 7 mm diameter image number 43, series number 3. Moderate size hiatal hernia, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided hydronephrosis, new from previous study. Right ureter is also dilated. Double-J stents now migrated inferiorly and extends from distal right ureter to the ileal pouch in the right lower quadrant. Subcentimeter lesions in the left kidney, likely representing small cysts are stable.RETROPERITONEUM, LYMPH NODES: Right lower quadrant ileal pouch. Left retroperitoneal lymph node is slightly increased in size and now measures 1.5 x 1.2 cm on image number 148, series number 8. Previously, was measuring 1.2-cm in diameter image number 73, series number 3.BOWEL, MESENTERY: Previously described hazy soft tissue in the right lower quadrant is unchanged and measures 1.9 x 1.8 cm on image number 186 on series number 8. Significance and etiology of the soft tissue is unknown.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Again noted heterogeneous soft tissue enhancement in expected periurethral/perineal region. The etiology is unknown. This is difficult to measure and appears less prominent compared to previous study. Neoplasm cannot be excluded.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval increase in the size of the lung nodules and left retroperitoneal adenopathy.Interval development of the right-sided moderate hydronephrosis.Ill-defined enhancing soft tissues in the urethral/periurethra region. The etiology is unknown. Neoplasm cannot be excluded.Interval increase in the size of the mediastinal lymph nodes.
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Generate impression based on findings.
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Ms. Toncray-Smerz is a 53 year old female presenting with medial left breast pain. She does report a longstanding history of intermittent left breast pain along with a recent history of trauma. She says this may all be due to hormonal changes and is no longer in pain at the moment. Three standard 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. Benign intramammary lymph node is identified in the left outer breast. Additional focal asymmetry in the left medial breast is stable when compared to multiple prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast.
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No mammographic evidence of malignancy. Her breast pain should be managed clinically. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is due in May 2015 as her last bilateral mammogram was in May 2014. After that, presuming no new findings are seen, an annual schedule would be reasonable. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Four year old female, assess for aspiration.EXAMINATION: Oropharyngeal motility study 1/15/2015 Julie Ecclestone, speech and language therapist, supervised the examination.99 seconds of fluoroscopy was used.PRESENTATION: Nectar thickened liquids were presented via spoon.RESULTS: Poor bolus control, premature spillage and oral stasis were evident. Delayed onset of swallowing, pharyngeal stasis, incomplete clearance and multiple week swallows were noted. Penetration without cough. Although aspiration not directly observed, the patient is felt to be at high risk due to stasis.
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Penetration without cough. Although aspiration not directly observed, patient felt to be at high risk due to stasis.Please see the speech and language therapist's report for feeding recommendations.
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Generate impression based on findings.
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Male 80 years old Reason: elevated LFT's in 80 year old with metastatic prostate cancer History: elevated LFT's LIVER: Mildly echogenic possible fatty infiltration. 14 cm in length. Single punctate cyst in the left lobe.Flow in the portal vein is hepatopedal, peak velocity .2 m/s.GALLBLADDER, BILIARY TRACT: Bladder. No intrahepatic or extra biliary dilatation. Common bile duct .4 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney 10.4 cm in length morphologically normal.Left kidney 10.5 cm in length morphologically normal. Calculus seen on CT of 8/24/14 is not visible.OTHER: No evidence of ascites.Spleen upper normal 12.9 cm in length.
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Sludge in gallbladder. Punctate hepatic cyst. Possible fatty liver.
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Generate impression based on findings.
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Male 24 years old Reason: injury, evaluate spine. History: decreased ROM and pain Bone mineralization is normal. There is mild straightening of the lumbar spine which may be positional.The disk spaces are normal. No compression fracture is evident.
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No acute bony abnormality. If pain persists, consider MRI
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Generate impression based on findings.
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Status post ORIF for right orbital wall fracture. There has been interval right lateral canthoplasty and screw and plate fixation of the lateral right orbital wall and rim comminuted fracture with improved alignment of the fracture fragments. There is a medial displaced bone fragment that measures up to 6 mm, adjacent to the lateral aspect of the right lateral rectus muscle, which is mildly swollen. Otherwise, there is no evidence of hardware complications. There is right extraconal collection that measures up to 4 mm in thickness. The right lacrimal gland also appears to be mildly swollen. The globes appear to be grossly intact. However, there is persistent diffuse right preseptal stranding and swelling and small amount of right pneumo-orbit. There are also residual punctate foci of hyperattenuation in the inferior right preseptal soft tissues. There is minimal diastasis of the right frontozygomatic suture. There is a displaced fracture of the superior aspect of the anterior wall of the right maxillary sinus with associated focal opacification of the right maxillary sinus that likely represent hemosinus. The imaged intracranial structures are grossly unremarkable.
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1. Interval open reduction and internal fixation of the lateral right orbital wall and rim comminuted fracture with improved alignment of the fracture fragments, although a bone fragment is medially displaced along the lateral aspect of the right lateral rectus muscle and extensive right periorbital contusions and hyperattenuating foci that may represent foreign body material or additional bone fragments persist. 2. Residual displaced fracture of the superior aspect of the anterior wall of the right maxillary sinus. 3. Minimal diastasis of the right frontozygomatic suture. 4. Right lateral rectus muscle contusion and mild regional extraconal hemorrhage.
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Generate impression based on findings.
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Male 20 years old Reason: ankle injury, evaluate for fracture History: pain and decreased ROM Bone mineralization is normal. Alignment is anatomic. No acute fracture is evident. Moderate soft tissue swelling is noted along the lateral aspect of the ankle.Possible trace tibiotalar joint effusion.
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Lateral soft tissue ankle swelling without underlying fracture.
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Generate impression based on findings.
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Male 51 years old Reason: history of locally advanced recurrent urothelial cancer; s/p pelvic exenteration/penectomy, assess for reccurrence History: none CHEST:LUNGS AND PLEURA: Emphysema and upper lobe Beulah, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the left lobe of the liver is unchanged. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Chronic atrophic changes involving the right kidney. There is high density within the proximal right ureter associated with wall thickening of the right ureter. Interval removal of the right percutaneous nephrostomy catheter.Small renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Benign-appearing posterior abdominal wall well defined lesion is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cholecystectomy.BLADDER: Status post cystectomy.LYMPH NODES: Interval increase in the size of the right inguinal lymph nodes. An index node measures 2.1 x 1.4 cm on image number ponder 20, series number 8. This node was measuring 1.3-cm in diameter on the previous study on image number 121, series number 7. There is additional bilateral adenopathy which have also increased in size compared to the previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previous described large pelvic mass has been resected within the interval.OTHER: No significant abnormality noted
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Interval resection of large soft tissue mass in the pelvis.Interval increase in the size and number of pelvic adenopathy.
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Generate impression based on findings.
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Female 64 years old Reason: evaluate for pain History: knee pain Right knee: Components of a total right knee arthroplasty are in anatomic alignment without radiographic evidence of hardware complication. There is a trace right knee joint effusion. No acute malalignment or fracture.Left knee: Severe osteoarthritis affects the left knee with near bone-on-bone apposition in the lateral compartment. On the AP view, there is mild genu valgus. No acute fracture or dislocation. Small joint effusion.
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Total right knee arthroplasty as detailed above.Moderate to severe left knee osteoarthritis.
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Generate impression based on findings.
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Female 63 years old Reason: thyroid nodule History: thyroid nodule RIGHT LOBE MEASUREMENTS: 2.9 x 1.7 x 1.5 cm. Previously 3.8 x 1.7 x 1 .6 cm.LEFT LOBE MEASUREMENTS: 3.4 x 1.6 x 1.3 cm. Previously 3.3 x 1.6 x 9 cm.ISTHMUS MEASUREMENTS: .2 cm in thickness unchanged.RIGHT LOBE: Heterogeneous nodules which I believe spongiform morphology. In the lower pole the nodule has punctate echogenic foci with ringdown suggesting colloid and measures 0.6 x 0.6 x 0.6 cm, unchanged. Minimal internal vascularity in possible calcifications.Mid gland nodule 0.6 x 0.6 x 0.4 cm. Previously 0.6 x 0.5 x 0.3 cm.LEFT LOBE: Lower pole nodule a solid homogeneous echogenic but hypovascular on color Doppler imaging with no calcifications evident. It measures 1.2 x 1.3 x 1 cm. Previously 1.2 x 1 x 1.2 cm.ISTHMUS: One right aspect of the isthmus nodule measures 0.4 x 0.4 x 0.5 cm. 3.4 x 0.4 x 0.14. Some rim calcification, unchangedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small nodes unchanged. Index nodes as follows:On the right side level 2.9 x 0.3 x 1.7 cm. Previously 0.9 x 0.3 x 1.4 cm.On the left level 2.8 x 0.2 x 2.1 cm. Previously 0.6 x 0.2 x 1.1 cm.OTHER: No significant abnormality noted.
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Stable bilateral nodules as described and small benign-appearing lymph nodes.
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Generate impression based on findings.
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62-year-old male with history of invasive squamous cell cancer of the skin. Also coal dust exposure with pleural plaques on CT. Rule out metastatic disease.RADIOPHARMACEUTICAL: 14.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 119 mg/dL. Today's CT portion grossly demonstrates several pleural based nodules and plaques, not significantly changed from previous diagnostic CT. A stable low-attenuation left adrenal nodule is compatible with benign adenoma. Bilateral punctate nonobstructing renal calculus are additionally noted. Hypoattenuating right renal lesion is compatible with a simple cyst.Today's PET examination demonstrates no suspicious FDG avid lesion. Mild hypermetabolic activity is associated with the benign appearing left adrenal nodule.
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No suspicious FDG avid lesion to suggest tumor recurrence or metastasis. Specifically, the pleural nodules/plaques demonstrate no FDG activity and may be benign.
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Generate impression based on findings.
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Male 71 years old; Reason: evaluate pelvis History: 71 yo pt w/ hx of T1 penile cancer (hx of Squamous of penis) s/p partial penectomy with penile reconstruction in 6/2013. Evaluate evidence of metastatic disease, abdomen/pelvis.RADIOPHARMACEUTICAL: 15.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 119 mg/dL. Today's CT portion of the neck, chest and abdomen demonstrates evidence of prior median sternotomy, several coronary artery calcification, dense atherosclerotic calcification, and degenerative changes of the thoracolumbar spine. Please see diagnostic CT report for details of the pelvis.Today's PET examination demonstrates no suspicious FDG avid lesions to suggest tumor activity. There is focal activity along the right anterior aspect of the L1/L2 disk space which correlates with degenerative changes seen on CT.
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No suspicious FDG avid lesion to suggest tumor activity currently.Diagnostic CT of the pelvis also performed at today's visit will be reported separately.
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Generate impression based on findings.
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Diffuse heterogeneity of the marrow is seen with enhancement throughout the calvarium compatible with metastatic osseous disease. Osseous metastasis includes skull base including the clivus and petrous apices.There is an extra-axial fluid collection along the right cerebral convexity measuring up to 9 mm in the maximal transverse dimension. There is minimal local mass effect without midline shift or uncal herniation. There is an enhancing lesions involving the left frontal/orbital calvarium along the left inferior frontal convexity measuring 2.4 x 2.0 x 0.9 cm in the AP, transverse, and craniocaudal dimensions. There is extensive associated susceptibility which may be related to mineralization or hemorrhage. Adjacent intracranial extra-axial enhancing component measures 1 cm in thickness. There is an adjacent parenchymal subcortical focus of T2/flair hyperintensity involving the left inferior frontal gyrus which likely represents edema. There is also dural-based enhancing tissue along the right anterior temporal convexity also compatible with metastasis and appears to be associated with osseous lesion involving the right greater sphenoid wing. There is questionable mild adjacent FLAIR hyperintensity in the right anterior temporal lobe versus artifact.Additional minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Punctate focus of susceptibility involving the left cerebellar hemisphere is compatible chronic microhemorrhage.There is diffuse opacification of the bilateral mastoid air cells. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.
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1. Diffuse calvarial metastatic disease including the skull base.2. Enhancing soft tissue along the left inferior frontal convexity and right anterior temporal convexity are compatible with mild intracranial extension and dural invasion associated with adjacent osseous metastases. There is mild edema involving the left inferior frontal gyrus and minimally in the right anterior temporal lobe. There is susceptibility effect with the left inferior frontal lobe which may be related to mineralization or hemorrhage. Consider CT for further evaluation. 3. Subdural hematoma (favored chronic) along the right convexity measuring up to 9 mm. Mild local mass effect without midline shift.4. No evidence of infarct or abnormal enhancement involving the brainstem, cerebellopontine angles or internal auditory canal. 5. Diffuse opacification of the bilateral mastoid air cells.
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Generate impression based on findings.
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Female 66 years old; Reason: hx of ventral hernia, evaluate for SBO ABDOMEN:LUNGS BASES: Incompletely imaged minimal calcified coronary artery disease. LIVER, BILIARY TRACT: Right upper quadrant surgical clips related to prior cholecystectomy. Prominent liver measuring up to 21 cm in craniocaudal dimension, unchanged, may be due in part to underlying Reidel lobe, a normal variant. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable since 2012 right adrenal mass measuring 3.5 x 2.5 cm, image 26 series 3, associated Hounsfield units of 6 seen, lesion compatible with a lipid rich adrenal adenoma.KIDNEYS, URETERS: 1.3 cm lower pole left renal cyst. RETROPERITONEUM, LYMPH NODES: Aortobiiliac calcified atherosclerotic disease. BOWEL, MESENTERY: No bowel obstruction. Normal appendix.PELVIS:UTERUS, ADNEXA: Mild interval increase in size of right adnexal mass with small peripheral calcification, structure measures 3.5 x 3.4 cm, image 86 series 3, previously measured 3.5 x 2.8 cm.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No evidence of ventral abdominal hernia. Mild ventral abdominal subcutaneous induration and scattered radiodensities in region of left rectus muscle anteriorly, correlation with patient's surgical history recommended. Multilevel degenerative changes of spine.
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1. No evidence of ventral abdominal hernia. No bowel obstruction.2. Mild interval increase in size of right adnexal cystic lesion, for which correlation with patient's clinical history and dedicated pelvic sonography if not already performed is recommended.3. Unchanged right adrenal adenoma.
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Generate impression based on findings.
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Female 73 years old Reason: Change in nodules History: Multinodular goiter, tracheal deviation, low TSH RIGHT LOBE MEASUREMENTS: 8.5 x 5.3 x 3.9 cm. Previously 8 x 5.1 x 3 cm.LEFT LOBE MEASUREMENTS: 7.7 x 3 x 3.8 cm. Previously 6.5 x 3.5 x 2.7 cm.ISTHMUS MEASUREMENTS: 2.5 cm in thickness, previously 2.1 cm in thickness.RIGHT LOBE: No right lobe is occupied by two large nodules which are unchanged in character. Lower pole nodule is solid, echogenic, with punctate foci suggestive of microcalcifications. It is mildly vascular color Doppler imaging.The upper pole nodule is solid with several small cystic areas and a few punctate possible calcifications. It has a hypoechoic rim and is moderately vascular on color Doppler imaging.LEFT LOBE: Large superior pole heterogeneous nodule 3.2 x 1.8 x 3.1 cm. Previously 2.4 x 1.6 x 2 .9 cm. Solid and cystic components. No calcifications. Moderately vascular on color Doppler imaging.ISTHMUS: 2.1 x 0.6 x 2 cm nodule. Previously 2.4 x 1.4 x 2.1 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No pathologic size nodes.OTHER: No significant abnormality noted.
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Minimal change in size of nodules. Character unchanged as detailed above. Findings most consistent with multinodular goiter.
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Generate impression based on findings.
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Reason: Size lung nodule. Progression ILD. History: Baseline mild DOE. Needs O2 with exercise. LUNGS AND PLEURA: There are decreased lung volumes with redemonstration of basilar predominant fibrosis consisting of septal thickening, traction bronchiectasis, and subpleural areas of consolidation and groundglass opacities. No honeycombing identified. No evidence of air trapping on the expiratory images.No new pulmonary opacities identified.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Remonstration cardiac enlargement with a small pericardial effusion.Stable mildly prominent prevascular paratracheal lymph nodes without definite evidence of lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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No interval change in basilar predominant interstitial fibrosis with subpleural areas of consolidation and groundglass opacities which may represent organizing pneumonia or fibrosing NSIP associated with known connective tissue disease. No specific evidence of acute infection.
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Generate impression based on findings.
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Female 57 years old Reason: 57 yo F hx of Hep C with RUQ pain, focal ttp. CT abdomen neg. s/p cholecystectomy. pls eval for liver abnormalities, retained stone History: RUQ pain. LIVER: Cirrhotic morphology. Coarse echotexture. 15 cm in length. No discrete mass. The flow in the portal vein is hepatopedal, with a peak velocity of .2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is surgically absent. No intrahepatic or extrahepatic biliary dilatation. Common hepatic duct measures .4 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic, 9.6 cm in length. No hydronephrosisOTHER: Left kidney measures 9.2 cm in length. Echogenic, no hydronephrosis.Spleen 9.7 cm length. No evidence of ascites.
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Cirrhotic morphology liver with no focal lesions. Echogenic kidneys suggest medical renal disease. No biliary dilatation.
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Generate impression based on findings.
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Female 59 years old Reason: SBO History: recurrent SBOs, similar feeling The exam is not sensitive for detecting lesions in the solid organs and vasculature due to lack of intravenous contrast. Given those limitation, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcifications aorta. Mild bulging of the distal abdominal aorta just above the bifurcation the maximum dimensions of only 2-cm.BOWEL, MESENTERY: No bowel wall thickening or dilatation. Previously seen focal small bowel dilatation is resolved. No loculated peritoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel wall thickening or dilatation. Colonic diverticulosis, no of diverticulitis. No free or loculated peritoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of small bowel obstruction. No specific findings to explain abdominal pain.
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Generate impression based on findings.
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Female 66 years old Reason: Preop History: PAIN Severe osteoarthritis affects the right knee with bone on bone apposition in the medial compartment and tricompartmental osteophytes. Trace joint effusion. No acute fracture or malalignment. Mechanical axis of the right lower extremity is approximately 6 degrees of varus.
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Severe right knee osteoarthritis and mechanical axis as detailed above.
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Generate impression based on findings.
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Male 71 years old Reason: 71 yo pt w/ hx of T1 penile cancer (hx of Squamous of penis) s/p partial penectomy with penile reconstruction in 6/2013. Evaluate evidence of metastatic disease, abdomen/pelvis History: CT/PET scan preferred exam. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Previously seen right external iliac/obturator node is no longer measurable. There are tiny punctate nodes bilaterally in the common and external iliac distributions. There are small bilateral inguinal nodes, unchangedBOWEL, MESENTERY: Marked scattered diverticulosis. No evidence of diverticulitis. No free or loculated intraperitoneal fluid. No signs of carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Heavy atherosclerotic calcification aorta, iliac and femoral arteries. No discrete aneurysm.
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No definite evidence of metastatic disease. Decrease in size of previously seen pelvic nodes.
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Generate impression based on findings.
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Female 21 years old Reason: fracture? History: pain Bone mineralization is normal. Alignment is anatomic. No acute fracture is evident.
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No evident fracture.
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Generate impression based on findings.
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Female, 67 years old, reported trigger: elevated BMI, counts correct. Packing material seen in pelvis, reportedly located in the vagina and intentionally left behind, curvilinear material extends into upper pelvis. Multiple pelvic surgical clips also seen. Pelvic drainage catheter. Scoliosis and laminectomy changes suggested in visualized spine. Bilateral hip degenerative disease. Enteric tube seen with sideport at/just above gastroesophageal junction. Linear focus seen in incompletely imaged lower thorax presumably external to patient. Curved radiolucency to right of lower spine may be a skin fold, nonspecific. No unexpected radiopaque foreign body seen otherwise. Findings discussed with resident physician Dr. Kearns at 12:40 p.m. on 1/15/15 and with attending physician Dr. Steinberg at 12:42 p.m.
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Postsurgical sequela as above.
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Generate impression based on findings.
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Male 48 years old; Reason: Pre-kidney transplant evaluation. Evaluate vasculature to support transplant. Rule out carcinomatosis reported on previous scan from 2013. ABDOMEN:LUNGS BASES: No significant abnormality noted.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: Kidneys are replaced with numerous small cysts and demonstrates some atrophy consistent with chronic medical renal disease.RETROPERITONEUM, LYMPH NODES: Moderately heavy atherosclerotic calcification of the aorta and branch vessels.BOWEL, MESENTERY: Small to moderate amount of generalized ascites with areas of nodularity in the omentum particularly in the right abdomen consistent with carcinomatosis (see S3 Im#55). No evidence of bowel wall thickening or dilatation.BONES, SOFT TISSUES: Sclerotic consistent with renal osteodystrophy.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate generalized ascites. No measurable solid carcinomatosis in the pelvis.BONES, SOFT TISSUES: Sclerotic consistent with renal osteodystrophy.OTHER: Heavy diffuse atherosclerotic calcification. Note that there is segment of the external iliac artery that are devoid of calcification.
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1.Ascites and carcinomatosis. 2.Chronic medical renal disease. Renal osteodystrophy. 3.Atherosclerotic disease.
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Generate impression based on findings.
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Female 57 years old Reason: Colon Cancer: Restaging History: NA CHEST:LUNGS AND PLEURA: Scattered calcified pulmonary micronodules unchanged. Opacity irregularly-shaped in the lingula or left lower lobe is increased in size. Series #4, image #51 measures 1.5 x 0.8 cm. previously difficult to separate from adjacent vessel on series 5 image 50 of the 10/23/2014 study estimated 0.5-cm.New micronodule left apex Series IV mid 17.5-cm. MEDIASTINUM AND HILA: Port-A-Cath tip in SVC above the right atrium.Small left hilar lymph node, series 2 image 46, 1.2 x 1 cm. Previously 1 x 1 cm. No new nodes.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Percutaneous biliary catheter.There are a few scattered small punctate hypoattenuating foci scattered in the right lobe and some in the left lobe suspicious for new metastatic disease.The previously seen wedge-shaped hypoattenuating foci along the anterior margin of the liver probably unchanged. Series III image 87 is the index lesion measuring 0.7-cm previously 1.2-cm.SPLEEN: No significant abnormality noted.PANCREAS: Two lesions seen in the pancreas body; the more medial solid hypoattenuating lesion measures 1.2 x 1 cm Series III image 99. Previously 1.1 x 1 .exam. Anterior and peripheral to it is a small fluid density lesion measuring 1.1 x 0.9 cm, previously 1.2 x 1 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference lymph nodes in the left periaortic area of ill-defined and smaller difficult to measure, series image 113, 1 0.4 x 1.1 cm. Previously 1.4 x 1 .exam.More caudally at the level of the inferior mesenteric artery takeoff cluster of nodes measures 1.9 x 1.2 cm on series 2 image 120. Previously 2.3 x 1.8 cm.BOWEL, MESENTERY: Cecal wall thickening with adjacent fat stranding length fluid abutting adjacent ileal loops and mesenteric vasculature. The extent of the fat stranding and fluid is increased compared to the prior exam. The reference pericolonic soft tissue lesion, possibly a node, is more heterogeneous and measures 2.1 x 1.5 cm Series III image 123. Previously 2.5 x 2.4 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Large uterine mass without calcification, unchanged nonspecific but statistically most likely a fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Progression of disease particularly based on new liver and probably new lung lesions. Other findings as above.
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Generate impression based on findings.
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Female 46 years old; Reason: evaluate for response/progression. History: uterine adenosarcoma. CHEST:LUNGS AND PLEURA: Visualized lung fields essentially stable in appearance with scattered micronodularity seen, e.g., 2 mm right upper lobe and lower lobe nodules without significant change. MEDIASTINUM AND HILA: Reference prevascular/paraaortic lymph node without significant change accounting for difference in technique, measuring 9 x 8 mm, image 27 series 3, previously measured 10 x 8 mm. Residual anteromediastinal soft tissue attenuation, may be residual thymic tissue. Right chest port with tip in distal SVC. Trace pericardial fluid. Left-sided lower pole thyroid nodularity not as well seen. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis, making assessment for underlying liver lesion suboptimal. Mild interval increase in size of hepatic segment 2/3 lesion measuring 10 x 8 mm, image 87 series 3, previously measured 7 x 6 mm. Additional subcentimeter hepatic hypoattenuating foci, for example, in right hepatic lobe, image 98 series 3, without significant change.SPLEEN: No significant abnormality noted.PANCREAS: In the uncinate process is a subcentimeter cystic focus, stable in size and appearance, measuring 9 x 6 mm, may be a sidebranch intraductal papillary mucinous neoplasm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter present.BOWEL, MESENTERY: Stable right-sided mesenteric mass measuring 2 x 1.6 cm, image 137 series 3. Another right lateral mesenteric nodular is seen that appears new, measuring 9 x 6 mm, image 137 series 3.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovoid soft tissue attenuation seen in the right adnexal area, measuring approximately 2.4 x 1.4 cm, image 163 series 3, new from earlier study. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela with small bowel containing umbilical hernia, measures 1.1 cm, no associated bowel obstruction. Stable increased radiodensity involving left L3 vertebral body, nonspecific but developing metastatic disease a consideration.
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Findings suspicious for new and worsening metastatic disease, with new right adnexal and mesenteric soft tissue nodularity as well as mild interval enlargement of a liver lesion as described.
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Generate impression based on findings.
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Female 54 years old Reason: lymphoma History: surveillance at 1 year CHEST:LUNGS AND PLEURA: No new lung nodules. Probable scars right middle and lower lobes and changedMEDIASTINUM AND HILA: Enlarged heterogeneous thyroid with nodular character in several discrete nodules largest in the inferior aspect the left lobe measuring 1.7-cm in largest dimension. Correlate clinically as to the need for fine-needle aspiration.Port-A-Cath tip SVC RA junction.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypoattenuating lesion in the spleen 3.1 x 1.5 cm cyst image 84, probably unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerosis. No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: Haziness and a small lymph nodes unchanged. Index lymph node series 2 image 108.1 x 1 cm. previously 2.7 x 1.3 cm. Other small mesenteric nodes are unchanged. No new nodes. No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Stable hypodense lesions right adnexa likely ovarian cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion L1 and sacrum unchangedOTHER: No significant abnormality noted.
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Minor difference in measurements as above. Probably stable disease.Other findings as above including enlarged nodular thyroid gland.
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Generate impression based on findings.
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Refractory Hodgkin's lymphoma status post chemotherapy, in need of reimaging. Adenopathy or other CHEST:LUNGS AND PLEURA: Small 4-mm right lower lobe lung nodule (series 4 count image 71) is unchanged. No new nodules, airspace disease or effusions are seen.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue density or shape configuration typical of thymus is unchanged. Small right hilar lymph node (series 3 and image 47) is stable measuring 7 mm. No other mediastinal adenopathy or significant abnormality seen. Right chest wall Port-A-Cath is again seen with tip of catheter in the distal superior vena cava.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy or other significant abnormality. Small scattered sub-5 mm periaortic lymph nodes are seen unchanged.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: Prior referenced right external iliac lymph node (series 3, image 178) continues to decrease in size and now measures 1.0 x 0 .7 cm, compared with 1.2 x 0.9 cm on 9/22/14 and 1.2 x 1.2 cm in 8 sites 6/14. No new lymphadenopathy is seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Small residual lymph nodes in the chest and pelvis as described above which do not meet size criteria for lymphadenopathy and have either slightly decreased in size or remained stable. No new foci of disease seen.
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Generate impression based on findings.
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Reason: 77 yo female with hx of pancreas cyst following a subtotal panreatectomy History: pancreas cyst ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered hepatic hypodensities most compatible with cysts are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Status post subtotal pancreatectomy. Again seen is a cystic focus in the uncinate process measuring 1.2 x 0.6 cm (series 9 image 48) which is unchanged compared with prior studies and is most consistent with an intraductal papillary mucinous neoplasm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No discrete focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is distended with oral contrast. The small bowel is normal in caliber without obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.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
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Status post subtotal pancreatectomy with unchanged cystic focus in the pancreatic head most likely representing an intraductal papillary mucinous neoplasm.
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Generate impression based on findings.
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51 years, Male. Reason: New onset emesis, evaluate for ileus; bladder cancer s/p radical cystectomy and neobladder and pelvic LN dissection 1/12/2015 Skin staples, surgical clips in the abdomen and pelvis, and pelvic catheters are noted. There is dilatation of the proximal small-bowel measuring up to 3.7-cm. Colon contains air and is of normal caliber. These findings are compatible with early developing partial bowel obstruction vs ileus.
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Early developing partial bowel obstruction vs ileus.
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Generate impression based on findings.
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53-year-old male with history of end-stage renal disease/PCKD, pretransplant evaluation ABDOMEN:LUNG BASES: Minimal basilar dependent atelectasis/scarring.LIVER, BILIARY TRACT: Multiple hypoattenuating liver foci, consistent with given history of polycystic kidney disease. Gallbladder is contracted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral enlarged dysmorphic kidneys, with innumerable cysts varying in size. The left kidney measures approximately 26 centimeters, and the right kidney measures approximately 27 cm in the coronal plane. No significant hydronephrosis or hydroureter. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectosigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of abdominal and pelvic ascites, with an anterior percutaneous coiled catheter in the inferior abdomen. Minimal atherosclerotic calcifications in the distal aorta, no appreciable calcifications in the bilateral common or external iliac arteries.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is collapsed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate pelvic ascites.
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Findings consistent with given history of polycystic kidney disease and cystic involvement of the liver. Minimal atherosclerotic disease of the distal aorta as above without calcifications visible in the iliac arterial tree.
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Generate impression based on findings.
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Male 33 years old Reason: H/O Hodgkin Lymphoma now s/p 2 cycles of ABVD in need of restaging. Please compare to prior. History: Hodgkin Lymphoma. CHEST:LUNGS AND PLEURA: Right middle lobe disease increased in size compared to the prior exams is image 27/57. A few punctate micronodules.MEDIASTINUM AND HILA: Lateral mediastinal nodes AP window and possibly anterior mediastinum unchanged.CHEST WALL: Small left-sided axillary nodes, markedly decreased in size compared to 10/29/14. Baseline purposes the largest node in the left axilla as measured on series 3 image 23/221, 2 x 1.3 cm.ABDOMEN:LIVER, BILIARY TRACT: Large multifocal masses in the liver markedly decreased in size compared to the prior exam. For baseline purposes lesion in the right lobe measured on series 2 image 83, 2.7 x 3.1 cm. On the 10/13 4/14 CT it measured approximately 6 x 5.7 cm, series 2 image 19/89.SPLEEN: Punctate lesions, unchanged normal size spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal nodes Markley decreased in size compared to the prior exam. For baseline purposes a node abutting a segmental left renal vein is measured on series #3 image #102, 2.2 x 1.2 cm. Previously 2.6 x 1.9 cm.BOWEL, MESENTERY: Multifocal adenopathy mesentery particularly the mesenteric root markedly decreased in size compared to the prior exam. No evidence of bowel thickening or dilatation. Loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small lymph nodes throughout the iliac chains bilaterally markedly decreased in size. Bilateral inguinal nodes markedly decreased in size. For baseline purposes, a right inguinal node is measured on series 2 image 192 as 1.7 x 1.3 cm. On the prior exam, series 2 image 75 it measured 2.6 x 2.2 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Marked decrease in all lesions.
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Generate impression based on findings.
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3-year-old female with foreign bodyVIEW: Abdomen AP (one view) 01/15/15 Previously noted metallic foreign body is seen unchanged in position within the distal thoracic esophagus. The bowel gas pattern is nonobstructive.
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Metallic foreign body is unchanged in position.
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Generate impression based on findings.
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86 year old female with history of pain and weakness. Evaluate for fracture or hardware loosening. The bones are demineralized suggesting osteopenia/osteoporosis.Right hip: Hardware components of a right total hip arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication. There is no acute fracture or dislocation. Surgical clips are located in the right lower pelvis.Pelvis: Again seen is a right total hip arthroplasty. Additionally, there is a left total hip arthroplasty in anatomic alignment without radiographic evidence of hardware complication. Surgical clips project over the right lower pelvis. There is severe degenerative disease affecting the visualized lower lumbar spine.
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Postsurgical changes and severe degenerative disease as above.
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Generate impression based on findings.
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64 years, Male. Reason: Assess NJ tube position History: NJ tube Limited visualization of abdomen. Pelvis is excluded from view. Two enteric tubes are seen again, one tip in the gastric body and another tip in the distal duodenum. Pleural effusions noted.
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Stable appearing enteric tubes.
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Generate impression based on findings.
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12-year-old female status post surgical hardware removal of screw.VIEWS: Right ankle AP/lateral (two views) 01/15/15 Interval removal of cast material, two orthopedic fixation screws, and two K wires. Radiodense foreign body is seen within the soft tissues inferior to the lateral malleolus.There has been fusion of the physis since the prior exam. Periosteal reaction is present in the fibula and tibia with no fracture line seen.
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Healing ankle fractures status post removal of orthopedic hardware.
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Generate impression based on findings.
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24 year-old female with history of hallux valgus Status post osteotomy of the first metatarsal head with two screws affixing the first metatarsal and medial cuneiform. Gas in the soft tissues reflects recent surgery.
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Postoperative changes as described above without evidence of hardware complication.
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Generate impression based on findings.
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Reason: H/o intestinal lymphoma; please restage History: constipation, nausea CHEST:LUNGS AND PLEURA: Stable left lower lobe micronodule. No suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes unchanged.CHEST WALL: Bilateral prepectoral breast implants.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: 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: Lumbar spine fixation hardware with transpedicular screws at L3-L5.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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74 years, Female. Reason: Dobbhoff History: Dobbhoff; VSD repair, patch, aneurysm resection 1/14/2015 Limited view of the abdomen and pelvis.Numerous large bore catheters are noted. Please refer to same day chest radiograph for positioning. Postsurgical changes with scattered clips noted.Dobbhoff tube tip is noted slightly curved projected over the gastric antrum. Nonobstructive bowel gas pattern.
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Dobbhoff tube tip projected over gastric antrum.
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Generate impression based on findings.
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74-year-old female status post IM nail placement An intramedullary rod affixing a pathologic fracture of the proximal femoral diaphysis is again noted in near-anatomic alignment. Fracture fragment alignment is unchanged without significant osseous bridging. Surgical clips are present in the soft tissues.
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Orthopedic fixation of pathologic proximal femur fracture as described above.
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Generate impression based on findings.
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40 year-old male with a history of elevated AFP, retroperitoneal lymphadenopathy. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 1.8 x 1.3 cm enhancing lesion seen in right lobe of liver (series 3 and image 38) -- in retrospect this was seen is an enhancing lesion similar in size on the 4/1/13 examination. This examination is really a late arterial phase which allows visualization of enhancing lesions whereas most of the prior examinations particularly the 2012 examinations were fully portal venous phase which would obscure arterial phase enhancing lesion such as this. In light of absence of chronic liver disease to suggest small HCC, and without hypervascular primary tumor elsewhere, this most likely represents benign etiology such as focal nodular hyperplasia, confirmed by stability over almost 2 years.No other lesions are seen in the liver. Gallbladder and biliary tract appear normal. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered small subcentimeter lymph nodes are again seen in the para-aortic and. Iliac regions. Referenced aorta caval lymph node (series 3, image 87 measures 1.1 x 0 .7 cm, previously 1.3 x 0.9 cm. Other remaining small nodes are unchanged. No new areas of lymph node enlargement are seen.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: Mildly prominent lymph nodes are again seen about the iliac chains bilaterally. The prior referenced right external iliac lymph node (series 3, image 111) measures 1.3 x 0 .9 cm, previously 1.3 x 1.1 cm. While most of these small lymph nodes are unchanged, knee one node along the more distal external iliac chain has increased in size (series 3 , image 121) measuring 1.8 x 1 .0 cm, previously not reported but measuring 1.6 x 0.8 cm (series 3, image 124 on 4/1/13).BOWEL, MESENTERY: No significant abnormality notedno other significant abnormalities identified.BONES, SOFT TISSUES: Sclerotic focus in the right sacrum (series 3 count image 111) unchanged.OTHER: No significant abnormality noted
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1. Predominately stable or slightly smaller retroperitoneal and pelvic lymph nodes -- 1 exception lymph node in the right external lymph node chain is slightly increased in size. 2. 1.8 x 1.3 cm homogeneous enhancing lesion in the liver unchanged since 2013 and most likely representing benign focal nodular hyperplasia, but single phase CT does not definitively characterize this lesion. Stability of two years without change greatly favors benign process.
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Generate impression based on findings.
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39 year old male with neurofibromatosis type I.VIEWS: Thoracolumbar spine AP and lateral (two views) 1/15/2015 There is 16 degrees of dextroscoliosis between L4 and T2. Mild degenerative changes affect the thoracic spine.
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16 degrees of dextroscoliosis of the thoracolumbar spine as detailed above.
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Generate impression based on findings.
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78-year-old male with chronic right hip pain Three orthopedic screws affix the femoral head and neck without evidence of hardware complication. Deformity and sclerosis of the femoral neck is consistent with healing fracture.
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Orthopedic fixation without evidence of hardware complication
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Generate impression based on findings.
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34 years, Male. Reason: eval for cause of lower abd pain, concern for constipation History: LQ abd pain Moderate stool burden is noted. Nonobstructive bowel gas pattern.
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Moderate stool burden.
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Generate impression based on findings.
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43 year old female with history of right upper quadrant abdominal pain. Evaluate for pancreatitis versus colitis. ABDOMEN:LUNG BASES: Minimal left pleural effusion and underlying atelectasis, increased from prior. Scattered bilateral pulmonary micronodules, many of which are calcified. Four chamber cardiomegaly, with partially visualized moderate sized pericardial effusion.LIVER, BILIARY TRACT: Cholelithiasis. Small amount of fluid around the gallbladder is likely related to abdominal ascites.SPLEEN: No significant abnormality notedPANCREAS: The pancreas is normal in appearance, however this does not exclude possibility of uncomplicated pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal cysts. No hydronephrosis or hydroureter. No collecting system nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The descending and sigmoid colon are nondistended, so evaluation is limited however there is no convincing bowel wall thickening or pneumatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is collapsed, with Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel wall thickening or pneumatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Pancreas within normal limits - this indicates no complications of pancreatitis, but can commonly be the appearance of pancreas with pancreatitis..2.No CT evidence of colitis.
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Generate impression based on findings.
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Restaging Mantle cell lymphoma status post 6 cycles of chemotherapy.RADIOPHARMACEUTICAL: 13.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 75 mg/dL. Today's CT portion grossly demonstrates emphysematous changes at both lung apices. Extensive atherosclerotic including coronary arterial calcifications are present. The left kidney is absent.Today's PET examination demonstrates complete interval resolution of extensive hypermetabolic lymph nodes previously seen in the neck, chest, abdomen and pelvis without abnormal FDG avid lymph node activity currently.There is also been complete interval resolution of previously seen diffuse abnormal splenic activity. There has also been a marked interval reduction in splenic size.No current suspicious FDG avid lesion. Increased linear activity in the muscles lateral to the right hip are consistent with benign inflammation.
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Complete interval resolution of previous extensive hypermetabolic lymph node and diffuse splenic activity without FDG avid tumor currently in the neck, chest, abdomen or pelvis.
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Generate impression based on findings.
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50 year old female status post lumpectomy left for triple negative breast carcinoma,presents today for routine follow up. Patient is BRCA 1 positive. Patient is scheduled for prophylactic bilateral mastectomies. Family history of breast carcinoma in two paternal aunts, two paternal cousins, and her paternal grandmother. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed in the scar overlying the upper central left breast with expected underlying postsurgical architectural changes. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.
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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.
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Generate impression based on findings.
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61-year-old male status post left hip arthroplasty. Left hip: Hardware components of a left total hip arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication.Pelvis: There is a left total hip arthroplasty. Severe osteoarthritis affects the right hip with bone-on-bone apposition superiorly and subchondral cyst formation.
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Left total hip arthroplasty without evidence of complication. Severe osteoarthritis of the right hip.
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Generate impression based on findings.
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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. Scattered benign calcifications are present in the left breast.
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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.
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Generate impression based on findings.
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73-year-old male with cirrhosis, questionable HCC. Focus of increased uptake at the anterior right seventh rib correlates with post traumatic appearance seen on current CT. Increased radiotracer activity at the right T8 vertebral body is compatible with degenerative changes also correlating with CT findings. No suspicious abnormal osseous foci are identified to indicate metastatic disease.
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No evidence of bone metastases.
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Generate impression based on findings.
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77-year-old female with history of myeloma now presenting with shoulder pain. No acute fracture or dislocation. There is no evidence of myelomatous lesions. Mild degenerative changes affect the AC joint, glenohumeral joint and visualized thoracic spine.
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Degenerative changes without evidence of fracture or myelomatous lesions.
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Generate impression based on findings.
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Reason: ILD pt with MCTD, had outside scan from Advocate hosp in spring 2014 with nodularity rule out progression - History: shortness of breath LUNGS AND PLEURA: Diffuse patchy upper and lower lung subpleural reticulonodular interstitial opacities are not significantly changed from the previous study, most severe in the anterior portions of the upper lobes. Minimal subpleural honeycombing and traction bronchiectasis along the dependent portions of the lung bases is not significantly changed from the previous study. No air trapping on expiration imaging.Scattered bilateral small solid and ground glass nodules are unchanged, with no new suspicious nodules identified.MEDIASTINUM AND HILA: Nodular enlargement of the left lobe of the right and coma unchanged.Scattered small mediastinal lymph nodes with no significant lymphadenopathy and no significant change.No pericardial effusion.CHEST WALL: Numerous prominent bilateral axillary lymph nodes with benign morphology. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Unchanged diffuse interstitial lung disease with a predominantly subpleural distribution and evidence of fibrosis, most compatible with UIP or fibrosing NSIP secondary to connective tissue disease.
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Generate impression based on findings.
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Ms. Attanasio is a 61 year old female with a personal history of right breast lumpectomy in September 2012 for IDC followed by radiation and hormonal therapy. Three standard views of both breasts with two right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Right breast skin thickening has improved when compared to prior exam. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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59-year-old female with chest wall pain for 3 months. Evaluate for COPD progression and chest wall mass. CHEST:LUNGS AND PLEURA: Left apical mass with lobulated margins and consistent with primary lung carcinoma. The apical mass measures 59 x 46 mm (series 5, image 24) and is contiguous with and likely invades the pleura. There is questionable cortical erosion of the posterior left second rib, though no definite evidence of chest wall invasion. There are two adjacent left upper lobe nodules compatible with tumor metastases. These nodules have adjacent ground glass opacity which may be due to hemorrhage. The larger nodule measures 23 x 24 mm (series 5, image 36) and the smaller nodule measures 10 x 8 mm (series 5, image 31).In addition, there are scattered nonspecific bilateral micronodules which likely represent intrapulmonary lymph nodes or granulomas. Scar like opacities in the bases, including a likely nodular scar in the left lower lobe. No pleural effusions.MEDIASTINUM AND HILA: Extensive mediastinal and hilar lymphadenopathy, including enlarged high left paratracheal, right paratracheal, subcarinal, and left hilar lymph nodes. These are suspicious for metastatic disease. For reference, the right paratracheal lymph node measures 26 mm in short axis and the subcarinal lymph node measures 31 mm in short axis. Calcified left hilar lymph node with associated granulomas. Mild aortic atherosclerotic disease without visible coronary artery calcifications.CHEST WALL: No evidence of soft tissue mass.CT CHEST AND UPPER ABD W, 1/15/2015 11:42 AMCLINICAL INFORMATION:Cough and chest painTECHNIQUE: Two view chestCOMPARISON: 2/21/8
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COPD and minimal scarring without acute disease
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Generate impression based on findings.
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45-year-old female with multicentric left breast cancer (3 masses).RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.51 mCi Tc-99m filtered sulfur colloid was injected subcutaneously. Following injection, intraoperative probe localization was performed. No images were acquired.
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Successful left breast injection for intraoperative identification of sentinel lymph node.
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Generate impression based on findings.
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53-year-old female with history of pain. Left knee: There are tiny osteophytes present compatible with mild osteoarthritis. No acute fracture or malalignment. No joint effusion.Right hip: No acute fracture or dislocation. Alignment is anatomic. Minimal degenerative disease affects the hip.
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Minimal degenerative disease as above.
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Generate impression based on findings.
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The exam is limited by a striated artifact of uncertain etiology. Mild prominence of the ventricles and sulci is consistent with parenchymal volume loss greater than expected for the patient's age. There is no intracranial hemorrhage, midline shift, or significant mass effect. Focal prominence of the extra-axial space in the superior posterior fossa with mild mass effect may represent an arachnoid cyst. The visualized portions of the paranasal sinuses and mastoids/middle ears are clear. The calvarium and scalp soft tissues are unremarkable.
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No acute intracranial abnormality. Probable arachnoid cyst in superior posterior fossa.
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Generate impression based on findings.
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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. There is a cluster of calcifications in the right upper inner breast, mid-depth. No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. A few benign calcifications are noted on the left.
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Incompletely characterized calcifications in the right breast. An attempt should be made to obtain patient's prior examinations for comparison purposes. If not possible, then additional imaging including spot magnification views should be obtained.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.
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Generate impression based on findings.
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LVAD on coumadin with MAPs in the 130s and prior hemorrhagic CVA. There are postoperative findings related to right frontal craniotomy. There is no evidence of intracranial hemorrhage or mass. There is extensive hypoattenution in the right frontal lobe, which is appears slight more hypoattenuating than on the prior exam. There is unchanged hypoattenuation in the left cerebellar hemisphere. The ventricles are essentially unchanged in size and configuration. There is no midline shift or herniation. Thre is partial opacification of the right maxillary sinus. The imaged mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of acute intracranial hemorrhage with evolution of the prior right frontal hemorrhage and postoperative alterations.2. Chronic left cerebellar hemisphere infarct.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are bilateral screening mammogram dated June 17, 2014, and images from left axillary lymph node biopsy dated December 4, 2014 performed at Northwestern Memorial Hospital. For comparison, left axillary ultrasound dated November 20, 2014 and multiple screening mammograms dating back to March 11, 2011 are available. Bilateral Screening Mammogram (6/17/2014): Two standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over both axillae.Bilateral Axillary Ultrasound (11/20/14): Multiple benign morphology lymph nodes are visualized within the right axilla. Within the left axilla there are two adjacent lymph nodes within the mid aspect which demonstrate borderline cortical thickening. No evidence of non hilar blood flow within these nodes, which maintain their normal fatty hila. Elsewhere in the left axilla are scattered benign morphology lymph nodes.Images from Left Axillary Lymph Node Biopsy (12/4/14): Images were provided from ultrasound guided biopsy of a left axillary lymph node. Targeting appears appropriate. A clip is noted on postprocedural sonographic images.PATHOLOGY: Outside pathology report is not available at this time. Per outside radiology report "pathology is benign and concordant. if there is clinical suspicion for malignancy, consider repeat biopsy. If repeat biopsy is not performed, recommend follow-up axillary ultrasound in 6 months to ensure stability."
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Low suspicion left axillary lymph nodes. Patient is status post biopsy of one of the left axillary nodes with reports of a benign result. We concur with outside interpretation that this result is concordant. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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47-year-old male with history of knee pain. Tiny osteophytes indicate mild osteoarthritis. No acute fracture or dislocation. Mild osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of ovarian cancer in mother. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the right upper outer breast is unchanged from prior exams. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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.
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Generate impression based on findings.
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Exam is limited by beam hardening related to patient's elevated shoulders. Straightening of the normal cervical lordosis is likely secondary to positioning or muscle spasm. The vertebral body heights are preserved and alignment is anatomic. There is no evidence of fracture. The prevertebral soft tissues are normal. There is degenerative disk disease predominantly affecting C4-5 and C5-6 with loss of disk height, osteophytes, and endplate cystic changes. Mild bilateral neuroforaminal narrowing affects C4-5. Mild neuroforaminal narrowing affects C5-6 on the left with moderate narrowing on the right. No significant central stenosis.
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No acute fracture or malalignment of the cervical spine.
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Generate impression based on findings.
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Reason: SBO History: abdominal pain. Additional clinical history of Crohn's status post total colectomy and J pouch/ileoanal anastomosis now status post diverting loop ileostomy with pain and recent CT with rectal contrast administered at Pallos hospital. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Right hepatic lobe hemangioma unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate renal cysts unchanged. Right ureteral stent with tip in the bladder.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of total colectomy, J-pouch/ileoanal anastomosis, and loop ileostomy. Loops of small bowel proximal to the loop ileostomy are normal in caliber without evidence of obstruction. A small amount of contrast is observed passing into the ostomy bag. Distal to the loop ileostomy are significantly dilated loops of bowel measuring up to 5.3 cm with multifocal areas of luminal narrowing, such as in the anterior abdominal wall on coronal series image 46 and on series 3 image 83. Enteric contrast and desiccated stool is present in these dilated loops and within the pouch, perhaps representing a combination of contrast from the current examination and rectal contrast administered previously. 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: As above.Additionally, there is a contrast-filled perianal fistulous tract with extraluminal contrast in a left perianal collection seen previously (series 3 images 121-123).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Postoperative changes of total colectomy, J-pouch/ileoanal anastomosis and diverting loop ileostomy with dilation of bowel loops containing a large amount of fecal material and multifocal areas of luminal narrowing distal to the loop ileostomy as described above. Contrast opacification of the pouch and distal bowel in part reflects recent rectal contrast administration at an outside hospital and limits evaluation. 2. Perianal fistula with a small amount of rectal contrast residing in the location of a left perianal collection which was drained previously. No drainable collections are identified at this time. Continued follow up is recommended as warranted clinically. 3. Other findings as described above.
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Generate impression based on findings.
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67-year-old female with history of C7 fracture and myeloma. The cervicothoracic junction is obscured by overlying anatomy. Moderate to severe degenerative disease affects the cervical spine with anterior osteophyte formation at C5, C6, and C7. There is also evidence of uncal vertebral hypertrophy and facet arthropathy. There is a grade 1 anterolisthesis of C3 on C4. There is a healing C7 spinous process fracture. The prevertebral soft tissues are within normal limits. There is a lucency through the vertebral bodies of C4 and C5 compatible with myeloma.
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Degenerative changes and myelomatous lesions as above.
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Generate impression based on findings.
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Reason: 75 yo F with scleroderma with abnl PFTs, concerning for ILD with Pulm HTN. Please evaluate for ILD findings History: no sob. LUNGS AND PLEURA: Mild diffuse bronchial thickening and very mild bronchiectasis in the left lower lobe.Three mild subpleural reticulonodular opacity in the right upper and middle lobes, likely secondary to radiation reaction related to radiation therapy for breast cancer in the past.Scattered small focal scars but no significant diffuse interstitial lung disease.MEDIASTINUM AND HILA: Dilated patulous esophagus with an air fluid level, consistent with a history of scleroderma.No significant lymphadenopathy.Severe coronary artery calcification. Mild nonspecific pericardial thickening with no significant effusion.Main pulmonary artery measuring 31 mm, mildly enlarged but not specific.CHEST WALL: Abnormalities in the right anterior chest wall consistent with previous lumpectomy with reconstruction and scarring.Surgical clips in the right axilla.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No evidence of diffuse interstitial lung disease.2. Patulous dilated esophagus consistent with scleroderma.3. Mild subpleural radiation reaction on the right and very mild left lower lobe bronchiectasis.
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Generate impression based on findings.
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CVA No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No 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. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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