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Generate impression based on findings.
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Male 66 years old; Reason: evaluate for lymphedema History: edema to bilateral legs. Bilateral lower leg surgeries.RADIOPHARMACEUTICAL: The bilateral feet, specifically the web spaces between the first-second and second-third digits of both feet were prepared in a sterile manner. 2 syringes were prepared each containing 0.5 mci of Tc-99m sulfur colloid, and a total of 1.0 mci was used (divided by 4 injections, 2 in each extremity) injected subcutaneously into the web spaces between the first-second and second-third digits of both feet. There is regional fairly symmetric mild-moderate obstruction to lymphatic flow below the knees with cutaneous collateralization / retention of radiotracer most prominently along the medial aspects of the proximal tibia levels.There is no evidence of lymphatic obstruction more proximally (above the knees) with normal drainage otherwise seen to the bilateral inguinal and iliac nodes.
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1.Regional fairly symmetric obstruction to lymphatic flow below the knees bilaterally, most prominently along the medial aspects of the proximal tibial levels.2.No evidence of lymphatic obstruction proximal to the knees.
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Generate impression based on findings.
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58 year-old female with history of right fifth toe pain. There is a minimally displaced comminuted fracture through the fifth proximal phalanx extending to the articular surface with mild dorsal angulation of the distal fracture fragment. Mild callus formation indicates healing. There is mild soft tissue swelling about the toe.
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Healing fifth toe fracture as above.
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Generate impression based on findings.
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Male; 73 years old. Reason: r/o metastases, questionable HCC, History: 8mm by 8mm nodule left posterior costophrenic angle series on recent scan, please evaluate, Cirrhosis, questionable HCC LUNGS AND PLEURA: No focal air space opacities. 12-mm nodule in the left posteromedial costophrenic angle (image 91, series 5), stable since prior CT on 4/23/13 and likely postinflammatory in etiology, although was not present 3/24/2009. Calcified granuloma in the lingula. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Small calcified mediastinal lymph nodes, likely from prior granulomatous process. Normal heart size without pericardial effusion. Moderate coronary artery calcifications. Mild aortic and mitral valve calcifications.CHEST WALL: No axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cirrhotic liver morphology. Hypervascular liver lesions are better visualized on prior contrast enhanced CT abdomen from 11/6/14. Status post cholecystectomy. Splenomegaly.
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No evidence of metastatic disease in the chest, left lower lobe nodule unchanged for nearly two years.
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Generate impression based on findings.
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45-year-old female with history of pain. Left knee: There are tricompartmental osteophytes, subchondral cyst formation, and joint space narrowing worse in the medial compartment compatible with moderate to severe osteoarthritis. There is no evidence of acute fracture or dislocation. There is a small joint effusion.Right knee: There are tricompartmental osteophytes, subchondral cyst formation, and joint space narrowing worse in the medial compartment with bone on bone apposition compatible with severe osteoarthritis. There is no evidence of acute fracture or dislocation. There is a small joint effusion.
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Osteoarthritis as above.
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Generate impression based on findings.
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Reason: Hx Larynx CA S/P CRT compare to previous scans, measurements please. History: none CHEST:LUNGS AND PLEURA: Stable 5-mm nodule in the right lower lobe compatible with a lymph node, unchanged and scattered micronodules elsewhere, also unchanged.No suspicious nodules.Consolidation and atelectasis in the right middle lobe, increased from previous, compatible with infection and aspiration.Diffuse tree in bud pattern indicative of bronchiolitis with bronchial thickening and ground glass opacity, also consistent with recurrent aspiration, considerably increased from previous.MEDIASTINUM AND HILA: Moderately enlarged high left paratracheal lymph node measuring 8 mm, not significantly changed.Other mildly enlarged nonspecific lymph nodes are also unchanged.Moderate coronary artery calcification.No pericardial effusion.CHEST WALL: Focal sclerosis in the right fourth rib posteriorly, unchangedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Fixation device in the lumbar spine with with laminectomy defect at L5.OTHER: No significant abnormality noted.
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1. Increased opacities in the right middle lobe and right lower lobe consistent with recurrent aspiration.2. No specific evidence of metastatic disease.
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Generate impression based on findings.
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62-year-old female with history of seronegative arthropathy and DIP swelling. Left hand: There is no evidence of bony erosions. Mild degenerative disease affects the second DIP. No acute fractures. The soft tissues are unremarkable.Right hand: There is no evidence of acute bony erosions. There are tiny lucencies with surrounding sclerosis in the lunate which are nonspecific. No acute fractures. The soft tissues are unremarkable.
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No evidence of acute osseous erosions. Other findings as above.
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Generate impression based on findings.
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Female, 59 years old.RFO No RFO is identified. Scattered surgical clips noted. No obstructive bowel gas pattern.
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No RFO is identified. Postsurgical changes. Finding discussed with Dr. Yamada at the time of dictation.
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Generate impression based on findings.
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61-year-old male with left elbow pain, rule out fracture Mild osteoarthritis affects the elbow. No fracture or joint effusion is evident.
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Mild osteoarthritis without evidence of fracture.
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Generate impression based on findings.
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Male; 60 years old. Reason: eval for lymphadenopathy History: night sweats LUNGS AND PLEURA: No focal pulmonary opacities. No suspicious pulmonary or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Severe atherosclerotic calcifications of the coronary arteries. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Single small gallstone is seen within the partially visualized gallbladder.
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Severe coronary artery atherosclerotic calcifications, otherwise unremarkable examination.
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Generate impression based on findings.
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79-year-old female with pain, preoperative evaluation There is approximately 6 degrees valgus deformity of the knee relative to the neutral mechanical axis. Moderate to severe osteo arthritis affects the knee.
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Osteoarthritis and valgus deformity.
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Generate impression based on findings.
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58 years, Female. Reason: r/o SBO, constipation History: RUQ and RLQ ab pain/tenderness, no BM x2 weeks Nonobstructive bowel gas pattern. No definite evidence of free air. Moderate stool burden.
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Nonobstructive bowel gas pattern. No definite evidence of free air. Moderate stool burden.
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Generate impression based on findings.
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73-year-old female with history of fall, right leg pain Small osteophytes are present along the anterior vertebral bodies as well as mild degenerative disk disease affecting L3/4 and L4/5. Vertebral body heights are maintained. There is a mild rightward curvature of the lumbar spine. Right upper quadrant surgical clips are noted.
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Mild degenerative changes without fracture.
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Generate impression based on findings.
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Male; 63 years old. Reason: Hx lung CA, status post chemo. Pls compare to previous and measurements pls. History: none CHEST:LUNGS AND PLEURA: Mildly decreased size of the mass in the anterior segment of the right upper lobe with chest wall and mediastinal invasion, which measures 38 x 26 mm, previously 45mm x 34mm (image 36, series 4). Stable irregularly marginated nodule in the right upper lobe measures 9 mm, previously 9mm (image 35).Stable left upper lobe part solid/cystic lesion measures 31 x 20 6 mm, previously 31 mm x 28 mm (image 22).Stable left lower lobe partly solid lesion (image 66). Stable focal nodular ground glass opacities suggestive of atypical adenomatous hyperplasia or invasive adenocarcinoma (image 39). MEDIASTINUM AND HILA: Mildly decreased right hilar nodule or conglomeration of nodules, which measures 14 mm, previously 19 mm (image 45, series 3). Stable prominent mediastinal and left hilar lymph nodes.Normal heart size without pericardial effusion. Severe coronary artery disease. Stable hypoattenuating lesion in the left lobe of the thyroid.CHEST WALL: Median sternotomy. No axillary lymphadenopathy. No suspicious osseous lesions.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter right hepatic lobe hypoattenuating lesion is too small to accurately characterize, but likely benign. No other focal liver lesions are seen. No intrahepatic or extrahepatic biliary ductal dilatation.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: Degenerative disease of the lumbar spine.OTHER: Atherosclerotic calcification of the abdominal aorta and its branches.
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1. Mildly decreased right upper lobe mass and right hilar nodule or conglomeration of nodules. 2. Stable left upper lobe partly cystic lesion and multiple additional small ground glass and solid nodules.3. No evidence of metastatic disease in the abdomen.
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Generate impression based on findings.
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65-year-old male with lumbar back pain with radiation to left greater than right lower extremity Multilevel degenerative disk disease most severely affecting L3/4, L4/5 and L5/1. There small anterior vertebral body osteophytes and mild to moderate facet joint osteoarthritis.
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Degenerative arthritic changes as described above.
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Generate impression based on findings.
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Ms. Kaba is a 53 year old female with a personal history of left excisional biopsy in Dec 2006for diabetic mastopathy and history of right breast biopsy for hyalinized fibrous tissue in Oct 2007. Family history of breast carcinoma in maternal aunt. Three standard views of both breasts along with four magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Loosely clustered calcifications in the right breast are stable when compared to prior exams.In the left upper outer and left inferior breast are two loose clusters of calcifications. Spot magnification views show these calcifications to be heterogenous and predominately course in appearance.
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Two clusters of high probability benign calcifications in the left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months to ensure stability of these calcifications. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).
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Generate impression based on findings.
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87 year-old male with history of fifth metacarpal fracture Deformity of the base of the fifth metacarpal is again visualized consistent with a nondisplaced fracture. The fracture line is indistinct, suggesting some interval healing. No additional fractures are noted.
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Nondisplaced fifth metacarpal fracture as described above.
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Generate impression based on findings.
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Reason: pulm lesion seen on CT a/p, needs f/u History: pt has no pulm symptoms LUNGS AND PLEURA: Rounded, smoothly marginated soft tissue nodule in the lingula contiguous with the left cardiac border measuring 14 x 15 mm, unchanged since the previous scan from more than two months ago. No reliable evidence of fat or calcification is present. Mild focal opacity inferior to the nodule is compatible with adjacent atelectasis or scarring.Very mild bronchiectasis in both lower lungs.MEDIASTINUM AND HILA: Severe coronary and aortic calcification.No significant lymphadenopathy.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small nonspecific hepatic hypodensities consist with cysts.
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Stable 15 mm soft tissue nodule in the lingula with morphology suggestive of a benign etiology such as hamartoma. If previous outside CT scans can be obtained to demonstrate stability, no further follow-up may be required.Otherwise, a follow-up CT examination is recommended in approximately 9 to 12 months to confirm stability.
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Generate impression based on findings.
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61-year-old female with ongoing pain in the setting of patellofemoral syndrome, pain and bony prominence at base of left thumb evaluate for degenerative joint disease, spur or tendinitis Hand: Mild osteoarthritis affects the basilar joint. Alignment is anatomic. No discrete soft tissue abnormality is noted.Knees: Four views of each knee are essentially within normal limits for the patient's age.
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Mild basilar joint osteoarthritis and normal appearing knees.
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Generate impression based on findings.
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77-year-old female, evaluate fracture A side plate with screws including two syndesmotic screws affixes a distal fibular fracture in near-anatomic alignment without evidence of complication. A healing posterior malleolus fracture is noted. The bones are demineralized.
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Orthopedic fixation and ankle fractures as described above without evidence of complication.
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Generate impression based on findings.
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45 year old female with history of JIA. Left foot: There is mild osteoarthritis affecting the midfoot. Moderate degenerative changes affects the tibiotalar joint.Left ankle: There are deformities of the distal fibula and tibial diaphyses compatible with healed fractures. Moderate osteoarthritis affects the tibiotalar joint. There is heterotopic bone noted in the anterior distal lower leg.Right foot: There is a plate and screw device at the distal fibula as well as two orthopedic screws through the medial malleolus affixing old fractures. There is mild osteoarthritis affecting the midfoot.Right ankle: There is a plate and screw device at the distal fibula as well as two orthopedic screws through the medial malleolus affixing old fractures. No evidence of hardware complication. Mild osteoarthritis affects the tibiotalar joint.
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Postsurgical changes and degenerative disease as above.
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Generate impression based on findings.
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Again seen are postoperative changes from laminectomies involving C6 to T3. There is redemonstration of a circumscribed area of CSF signal intensity along the dorsal aspect of the cord likely relating to the surgical cavity, extending from C5-C6 through T3-T4. 2 mm focus of enhancement at the left T1-2 level (axial postgad image 36/39) is unchanged since 12/26/2013 and may be postsurgical. No masses or other suspicious enhancement. There is relative focal kyphosis centered at T3, similar to prior. There is exaggerated cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The remainder of the spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis.
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1. Stable postoperative changes of cervicothoracic ganglioglioma resection. No definite evidence of residual or recurrent tumor. 2 mm nodular focus of enhancement in the surgical bed at the left T1-T2 level is unchanged since 12/26/2013 and may be postsurgical. Recommend continued attention on follow-up.2. Stable focal kyphosis centered at T3-4.
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Generate impression based on findings.
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70 year-old female with knee and left hip pain Mild osteoarthritis affects the left hip. Degenerative arthritic changes affect the visualized lower lumbar spine.Moderate osteoarthritis affects the right knee, particularly the patellofemoral joint.
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Osteoarthritis as described above.
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Generate impression based on findings.
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35-year-old male with right leg pain Femur: An intramedullary rod affixes a mid diaphyseal fracture. The proximal interlocking screw is intact, but the two distal interlocking screws are fractured. There is extensive callus formation about the mid diaphyseal fracture indicating attempted healing.Knee: The distal aspect of the femoral intramedullary rod with fractured screws is again visualized. The proximal aspect of the intramedullary tibial rod and screws is intact. A healing/healed proximal fibular fracture is noted.Tibia-fibula: An intramedullary rod with proximal and distal interlocking screws appears intact, affixing a healed distal tibia fracture.
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Orthopedic fixation of femoral and tibial fractures as described above with fractured distal interlocking femoral screws.
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Generate impression based on findings.
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Exam is limited due to streak artifact from the surrounding stereotactic frame. The previously identified electrodes have all been removed, with remaining burr holes. Focal abnormal low density is seen in right greater than left occipital lobes and right frontal lobe relating to previous electrode tracts. There are minimal areas of associated punctate hyperdensity likely relating to trace parenchymal blood products. There is trace left greater than right extra-axial hyperdensity along the occipital lobes, consistent with presumed post procedural subdural blood products on recent MRI. On subsequently obtained series 7, there is an air-filled tract just lateral to the right parietal occipital approach electrode tract, presumably relating to the laser fiber. The tip extends into the mesial right temporal lobe.The ventricles and sulci are stable. There is no midline shift or mass effect. There is no significant intracranial hemorrhage. There is mild patchy opacification of bilateral ethmoid air cells.
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1. Interval removal of depth electrodes with placement of a right parietal occipital region approach laser fiber placement with tip in the mesial right temporal lobe.2. Trace left greater than right subdural presumed postprocedural blood products.3. Areas of abnormal low density within the brain periphery in areas of previous electrode placement, with trace petechial blood products.
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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 almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications are seen in the left breast. 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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T3N2c HPV+ left tonsillar squamous cell carcinoma on OPTIMA trial. Head: There is no evidence of intracranial mass or abnormal enhancment. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is partial opacification of the maxillary sinuses with suggestion of air-fluid levels. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Neck: There is interval decrease in size and attenuation of the left palatine tonsillar mass that now measures up to approximately 10 mm, although dental amalgam streak artifact partly obscures this region. There is no evidence of significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable. There is a right thyroid nodule that measures up to 10 mm and a left thyroid nodule that measures up to 15 mm. The major cervical vessels are patent. There is multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. Interval decrease in size of the left palatine tonsillar mass, indicating treatment response.2. No evidence of significant cervical lymphadenopathy.3. No evidence of intracranial metastases.4. Nonspecific bilateral thyroid nodules.5. Suggestion of acute sinusitis.
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Generate impression based on findings.
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Reason: head and neck cancer/ post induction scans History: see above CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases, or other significant pulmonary abnormality. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Mild coronary calcifications are present, the heart and pericardium otherwise unremarkable.Stable small thyroid cysts.Mild upper esophageal wall thickening possibly esophagitis.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cystlike hypodensities.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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13-year-old female with ankle painVIEWS: Right ankle AP, oblique, lateral (3 views) and right tibia-fibula, AP/lateral (two views) 01/15/15 No acute fracture or malalignment is evident. Minimal soft tissue swelling over the lateral malleolus.
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Minimal soft tissue swelling without evidence of acute fracture or malalignment
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Generate impression based on findings.
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Male 32 years old; Reason: H/o DLBCL s/p chemotherapy. Now returns 6 months later. Will consider to be initial staging for lymphoma History: RUQ pain, fatigue, night sweats, fevers, weight lossRADIOPHARMACEUTICAL: 15 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 92 mg/dL. Today's CT portion grossly demonstrates bilateral borderline enlarged axillary lymph nodes. There are mildly enlarged upper abdominal lymph nodes, specifically the portohepatic and cardiophrenic lymph nodes. There are two biliary stents noted. Today's PET examination demonstrates near complete resolution of the previously described hypermetabolic activity of the hepatic and right perihilar tumor foci, with the right perihilar focus completely resolved. There is a region of mild residual FDG activity in the medial left hepatic lobe with an SUV value of 4.3.There is symmetric mild FDG activity of the bilateral axillary lymph nodes, slightly increased from previous with an SUV value of 2.8, previously 2.0. There is mild to moderate FDG activity of the upper abdominal lymph nodes, specifically the cardiophrenic and portohepatic lymph nodes, also slightly progressed from previous (SUV value of 4.7, previously 4.5).Intense activity surrounding the two biliary stents with an SUV value of 11.3 and is noted.
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1.Interval resolution of the right perihilar tumor focus with near complete resolution of the tumor foci in the liver without new significantly FDG avid activity noted. Region of mild FDG activity in the medial left lobe may reflect mild residual tumor vs. inflammation. 2.Mild, slightly increased FDG activity involving borderline enlarged bilateral axillary and upper abdominal lymph nodes. Given the fairly mild uptake and symmetry, this may reflect systemic inflammation/infection such as that related to HIV, however mild tumor activity cannot be excluded. 3.Intense activity surrounding the two biliary stents is likely inflammatory, although again tumor cannot be entirely excluded.
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Generate impression based on findings.
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40 year-old female, history of proximal forearm fracture There is a comminuted intra-articular radial head fracture with approximately 1 mm cortical step off and mild impaction of the fracture fragment. A joint effusion is noted. The ulna appears intact.
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Intra-articular radial head fracture as described above.
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Generate impression based on findings.
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54-year-old male with dysphagia, weight loss. New diagnosis of distal esophageal cancer. Esophageal stent recently placed and removed yesterday.RADIOPHARMACEUTICAL: 7.094 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 52 mg/dL. Today's CT portion grossly demonstrates a large, circumferential distal esophageal mass at the gastroesophageal junction, consistent with known esophageal carcinoma. Multiple enlarged periesophageal, gastrohepatic, and retroperitoneal lymph nodes as well as additional subcentimeter mediastinal and retroperitoneal lymph nodes are identified.Today's PET examination demonstrates a large, markedly hypermetabolic distal esophageal mass (SUV 44.4), consistent with known esophageal carcinoma. There are multiple markedly hypermetabolic lower paraesophageal lymph nodes, extending from the carina to the gastroesophageal junction, consistent with regional lymph node metastases (maximum SUV of 21.7). Numerous additional hypermetabolic lymph nodes within the upper abdomen include gastrohepatic, retrocrural, right diaphragmatic, celiac chain, and aortocaval lymph nodes, extending from the hiatus to the level 4 cm above the aortic bifurcation, consistent with additional regional lymph node metastases (maximum SUV of 37.2). There are also right paratracheal lymph nodes with abnormal FDG uptake, though less intense than other FDG avid lymph nodes mentioned above, they remain very suspicious for additional sites of metastasis (maximum SUV of 6.5).
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1.Markedly hypermetabolic distal esophageal soft tissue mass, consistent with known esophageal carcinoma.2.Numerous markedly hypermetabolic thoracic and abdominal lymph nodes extending from the level of the carina to 4 cm above the aortic bifurcation, consistent with regional lymph node metastases.3.Additional right upper paratracheal hypermetabolic lymph nodes are very suspicious for additional metastatic lymph nodes although not quite as definitive given their lower levels of uptake.
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Generate impression based on findings.
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Reason: Patient with hx of SCCA of the left buccal mucosa. Treated with CRt, then had ORN. S/P resection and flap reconstruction. Neck tightness and dysphagia History: Patient with hx of SCCA of the left buccal mucosa. Treated with CRt, then had ORN. S/P resection and flap reconstruction. Neck tightness and dysphagia LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases. Mild scarring in the right upper lobe is unchanged over the last two years.Mild lower lung zone bronchial wall thickening bronchiectasis is unchanged. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Severe native coronary artery calcifications, status post CABG, the heart and pericardium otherwise unremarkable.Diffuse aortic calcifications, worse in the upper abdomen. CHEST WALL: Degenerative abnormalities affect the thoracic spine.Status post median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Accessory splenule noted, but no significant abnormality. Extensive vascular calcifications are seen.
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1. No evidence of metastases or other significant abnormality.2. Severe native coronary artery calcifications, status post CABG.3. Stable basilar bronchial wall thickening with bronchiectasis.
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Generate impression based on findings.
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34-year-old male, evaluate for osteomyelitis of second metatarsal and second proximal phalanx Interval decrease in soft tissue swelling. The previously noted periosteal reaction involving the proximal phalanges of the second and third toes has resolved. There is no osteolysis or other evidence of osteomyelitis.
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No evidence of osteomyelitis.
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Generate impression based on findings.
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58-year-old female with history of pain. Left knee: There are tricompartmental osteophytes and joint space narrowing worse in the medial compartment with near bone-on-bone apposition compatible with moderate to severe osteoarthritis. There is a mild varus deformity. There are scattered arterial calcifications.Right knee: There are tricompartmental osteophytes and joint space narrowing worse in the medial compartment compatible with severe osteoarthritis. There is a mild varus deformity. There are scattered arterial calcifications.Left tibia/fibula: No acute fracture or dislocation. Moderate to severe osteoarthritis at the knee. Scattered arterial calcifications. There is a plantar calcaneal spur.Right tibia/fibula: No acute fracture or dislocation. Severe osteoarthritis at the knee and mild osteoarthritis at the tibiotalar joint. Scattered arterial calcifications. There is a plantar calcaneal spur.
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Severe degenerative arthritic changes and other findings as above.
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Generate impression based on findings.
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Reason: pulmonary nodule eval History: pulmonary nodule seen on liver CT LUNGS AND PLEURA: 6-mm nodule noted within the superior segment of the left lower lobe (image 33 series 4).Micronodule identified within the right middle lobe (image 59 series 4).6-mm subpleural nodule identified posteriorly in the right lower lobe.Minimal dependent atelectasis.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.The thyroid gland is not identified. No surgical clips are noted in the region of the thyroid bed.CHEST WALL: Partial collapse of the T9 vertebrae of indeterminate age.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Several nonspecific pulmonary nodules and micronodules. In the absence of a known primary neoplasm these most likely are postinflammatory. However, follow up examination in 6 months to one year is recommended.
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Generate impression based on findings.
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50 year-old female with history of multiple call backs from screening examinations presents for routine annual mammogram. No current breast related complaints. No family history of breast cancer. Family history of breast carcinoma in her mother at age 61. Three standard views of both breasts and a spot compression view of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An asymmetry was seen within the central left breast on MLO view, and disperses on compression views, compatible of normal, overlapping fibroglandular tissue. Additional areas of bilateral focal asymmetry appear stable. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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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: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Male; 56 years old. Reason: re-assess interval improvement of loculated empyema, with pigtail catheter History: SOB LUNGS AND PLEURA: Small loculated right pleural effusion has mildly decreased since prior, particularly at the posterior costophrenic angle. Scattered small locules in the posterior right mid lung are not significantly changed. Interval decreased air within the collection with only a single small locule of air seen inferiorly. Interval removal of chest tube and placement of Pleurx catheter with tip at the inferior lateral right pleural space. The density of the pleural fluid is again primarily water density. No significant adjacent pleural thickening or increased enhancement to suggest empyema. Minimal right basilar subsegmental atelectasis, decreased since prior.New mild predominantly groundglass centrilobular nodules with some tree-in-bud opacities in the left lower lobe and right middle lobe, suggestive of aspiration or infectious bronchiolitis.Severe upper lobe predominant emphysema with bronchial wall thickening, similar to prior.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Marked coronary artery calcifications. Stable prominent right retrocrural lymph node or possibly the normal cisterna chyli (image 13, series 3).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable hypoattenuating hepatic lesions.
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1. New left lower lobe and right middle lobe opacities suggestive of aspiration or infectious bronchiolitis.2. Small loculated right pleural effusion has mildly decreased since prior study status post Pleurx catheter placement.3. Severe emphysema.
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Generate impression based on findings.
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Frontal sinus: The frontal sinuses are developmentally diminutive. There is trace mucosal thickening in the frontoethmoidal recesses.Anterior ethmoids: There is moderate patchy opacification of anterior ethmoid air cells.Maxillary sinuses: There is mild mucosal thickening in both maxillary sinuses. The right ostiomeatal unit is patent. There is opacification of the left.Posterior ethmoids: There is moderate patchy opacification of bilateral posterior ethmoid air cells.Sphenoid sinus: There is moderate thickening in the sphenoid sinuses. There is partial opacification of the left sphenoethmoidal recess. The right sphenoethmoidal recess is clear although slightly narrowed.There is minimal leftward nasal septal deviation. The nasal turbinate morphology is within normal limits. Specifically, determine are relatively well delineated. There is a small amount of nonspecific soft tissue density extending from the lateral wall of the nasal cavity to abut the head of the left middle turbinate, although this could represent adherent secretions as well. No definite polypoid mass is identified within the nasal cavity.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.
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1. Mild-moderate scattered paranasal sinus disease as detailed above, with opacification of the left sphenoethmoidal recess and ostiomeatal unit.2. No significant polyploid abnormality identified within the nasal cavity. Nasal turbinates are relatively well visualized, with only minimal nonspecific density noted abutting the head of the left middle turbinate.
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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. 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 medial left breast is stable when compared to priors. 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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17 year old, with sudden onset chest pain, evaluate for thorax.VIEWS: Chest AP/lateral (two views) 1/15/2015 No pneumothorax, pleural effusion or displaced rib fractures evident. No focal air space opacity. The aortic arch, cardiac apex the stomach a left-sided. Cardiothymic silhouette is normal.
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Normal examination.
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Generate impression based on findings.
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Postoperative changes are again seen from previous anterior surgical fusion of C5 and C6. Resultant susceptibility artifact limits evaluation of surrounding structures. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body are well-maintained. There is mild to moderate disk narrowing at C4-C5. Disk desiccation is present down to the C6-C7 level. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C4-C5, there is a shallow left paracentral disk protrusion which flattens the left ventral thecal sac and left ventral cord. There is minimal left uncovertebral hypertrophy.At C6-C7, as the increased prominence of a right paracentral protrusion with annular fissure which indents the ventral thecal sac and ventral cord. There is mild to moderate central spinal canal stenosis. There may be slight progression of a smaller left paracentral disk protrusion.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There is irregular opacity in the left lung apex with associated volume loss, consistent with areas of suspected scarring seen on recent CT chest.
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Postoperative changes from previous C5-C6 fusion. No significant interval change in minimal spondylotic changes at C4-C5 and C6-C7, except for possible mild interval progression of a left paracentral component of disk protrusion at C6-C7. Indentation of the ventral thecal sac and ventral cord at C6-C7 in the right paracentral location. Trace flattening of the left ventral thecal sac and cord at C4-C5.
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Generate impression based on findings.
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Female; 72 years old. Reason: follow up post radiation treatment History: follow up CHEST:LUNGS AND PLEURA: No significant interval change. Postsurgical changes status post right lower and left upper lobectomy. Radiation fibrosis in the right paramediastinal region is unchanged. Scattered nonspecific micronodules are also unchanged. No new suspicious pulmonary nodules or masses. No pleural effusions or focal areas of consolidation. Mild basilar scarring/subsegmental atelectasis. Moderate centrilobular and paraseptal emphysema, most pronounced in the right upper lobe.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Moderate aortic and coronary calcifications. No mediastinal or hilar lymphadenopathy. Mildly enlarged main pulmonary artery caliber is again suggestive of PA hypertension. Small hiatal hernia.CHEST WALL: Previously seen left supraclavicular lymph node is not included in the field-of-view. Stable partial collapse of T9 vertebral body. ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating lesion in the inferior right lobe is too small to characterize but most likely a benign cyst. aNo biliary ductal dilatation. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small cyst right kidney anterior mid pole. Scattered renal cortical calcifications are stable.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal and gastrohepatic lymph nodes are stable. Moderate atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No suspicious osseous lesions identified. OTHER: Stable fat-containing umbilical hernia.
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No evidence of metastatic disease or significant interval change.
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Generate impression based on findings.
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5 lumbar-type vertebral bodies are designated for numbering purposes. The bone marrow signal intensity is unremarkable throughout. There is low termination of the cord at the L3-L4 level appearing similar to the prior exam. Again seen are adhesions including at the surgical site at of lower cord/neural placode to the posterior surgical site at L4 level and has not changed in the last exams. No syrinx or new cord signal abnormality is seen. A subtle increased signal intensity is noted on T1 sagittal images within the spinal canal located just posterior to the L3-4 level which is likely artifactual. A nodular enhancing focus at the L5-S1 level is likely related to scar tissue and is unchanged. Multiple T1 hyperintense foci are visualized in the vertebral bodies at multiple levels are are either focal fat or benign hemangiomas. Cauda equina nerve roots are seen clumped as well less plastered to the margins thecal sac peripherally compatible with arachnoiditis.Post-surgical changes of prior lipomyelomeningocele repair and bilateral laminectomies are noted from L2 through S2 levels and appear similar to the prior exam. No significant spinal canal stenosis or neuroforaminal narrowing are noted from the T12-L1 to the L3-4 levels. Mild facet hypertrophy is noted of the L4-5 level but no spinal canal stenosis is noted. Mild right L4-5 neuroforaminal narrowing is again noted and unchanged. Mild to moderate facet hypertrophy of the L5-S1 level with mild AP narrowing of the spinal canal which is unchanged. There is severe narrowing of the right L5-S1 level which appears congenital and is unchanged. When sagittal T2 weighted images obtained on prone position compared with sagittal T2 weighted images obtained on supine position no detectable change in the position of the cord is identified.
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Again seen is evidence of prior lipomyelomeningocele repair and cord untethering. Again seen is termination of cord at L3-L4 level with adhesions/arachnoiditis involving the cauda equina nerve roots. No anterior motion of the distal cord or cauda equina is seen on the prone sequence. Enhancing tissue at the L5-S1 level is compatible with scar. Imaging findings again raise suspicion for retethering but not significantly changed since 7/31/2011.
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Generate impression based on findings.
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Brain injury, 3 month follow up. There is extensive encephalomalacia in the right cerebral hemisphere with associated Wallerian degeneration and ex vacuo dilation of the right lateral ventricle. There is no evidence of acute intracranial hemorrhage or mass. There is no significant midline shift or herniation. The imaged mastoid air cells are clear. There is persistent sinonasal opacification with polypoid opacities.
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1. Extensive right cerebral hemisphere encephalomalacia related to prior hemorrhage and infarction.2. Suggestion of sinonasal polyposis.
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Generate impression based on findings.
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13 year old female with chest pain and dysphagia evaluate for pneumomediastinum.VIEWS: Chest AP/lateral (two views) 1/15/2015 No focal air space opacities seen. No pneumothorax or displaced rib fracture is evident. There is no evidence of pneumomediastinum.
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Normal examination.
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Generate impression based on findings.
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Reason: pulmonary nodule on recent chest CT, and enlarged hilar LN History: asymptomatic LUNGS AND PLEURA: Interval clearing of the right middle lobe subsegmental atelectasis.Persistent elevation of the right hemidiaphragm.5-mm groundglass nodule in the superior segment left lower lobe is almost completely resolved and now measures 3 mm (image 30 series 5).No pleural effusions.MEDIASTINUM AND HILA: Stable enlarged right hilar lymph node (image 35 series 3) measuring 18 mm.No mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary calcification.Enlarged pulmonary artery compatible with arterial hypertension.CHEST WALL: Dextroscoliosis of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Dense sub-diaphragmatic with hepatic and splenic subcapsular calcification. Or
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Interval resolution of right middle lobe subsegmental atelectasis and near resolution of a left lower lobe ground glass nodule which most likely was inflammatory in origin.
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Generate impression based on findings.
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27-year-old female with history of chronic diarrhea and fat malabsorption with history of prolonged travel to the tropic. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Normal parenchyma without atrophy. Pancreatic duct is not dilated. No abnormal calcifications. No abnormal masses. No peripancreatic fluid.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach is well distended and normal in appearance. Duodenum is normal. Proximal jejunum is collapsed a semi-distended but shows no diagnostic abnormalities. The remainder of the mid and distal jejunum and the ileum are well distended and appear normal. No evidence of wall thickening, strictures, masses or abnormal foci of enhancement are seen. Colon is filled with fecal material throughout and has a normal appearance. No free mesenteric fluid. No mesenteric inflammatory change is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Intrauterine device with expected position and appearance. Physiologic changes in the left adnexa. BLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: Proximal jejunum is collapsed a semi-distended but shows no diagnostic abnormalities. The remainder of the mid and distal jejunum and the ileum are well distended and appear normal. No evidence of wall thickening, strictures, masses or abnormal foci of enhancement are seen. Colon is filled with fecal material throughout and has a normal appearance. No free mesenteric fluid. No abnormal mesenteric inflammation.BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd
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No abnormality seen to account for patient's symptomatology.
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Generate impression based on findings.
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83-year-old male with history of right lower back pain. Lumbar spine: There is moderate to severe degenerative disc disease affecting the lumbar spine. There is a grade 1 anterolisthesis of L4 on L5. There is moderate facet hypertrophy. There is a mild dextroscoliosis. Scattered arterial calcifications are present.Left hip: Mild osteoarthritis affects the left hip. Scattered arterial calcifications are present.
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Degenerative arthritic changes as above.
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Generate impression based on findings.
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88-year-old female with abdominal pain status post Gram patch for perforated duodenal ulcer, January 10, 2015. ABDOMEN:LUNG BASES: Marked cardiomegaly seen. Right pleural effusion and atelectasis with milder left basilar atelectasis.LIVER, BILIARY TRACT: Heterogeneous parenchymal enhancement pattern with dilated hepatic veins and IVC indicative of passive hepatic congestion. No parenchymal mass lesions are seen in the liver. Gallbladder and biliary tract are no diagnostic abnormalities.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No parenchymal mass lesions are seen. There is a greater than expected high density material seen diffusely in the collecting systems of both kidneys which may reflect early excretion of contrast material but bilateral extensive stone disease cannot be differentiated. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterolateral to the duodenum the mesenteric fat is stranded most likely representing postoperative changes. At the superior margin there is a 2.6-cm diameter low density fluid collection (series 15, image 48). This abuts the duodenum, gallbladder and posterior segment 4 of the liver. CT cannot characterize fluid collections although there are no signs such as contained air in this collection to suggest infection. Free mesenteric fluid is seen about the liver laterally, which contains several small foci of evidence of pneumoperitoneum (series 15, image 12). In light of recent surgery, this small amount of air most likely relates to prior surgery. However, if symptoms persist, follow-up CT could confirm the air continues to decrease. The orally administered contrast delineates well the stomach, duodenum, and traversed through the small bowel to the colon without evidence of obstruction and no evidence of leak of high density orally administered contrast material. No intrinsic bowel abnormality is seen in the small bowel. Colon appears normal. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted in the pelvic small bowel or colon. No free mesenteric fluid is seen although presacral edema is seen.BONES, SOFT TISSUES: Subcutaneous edema without other significant abnormality.OTHER: No significant abnormality noted
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1. Postoperative changes about the duodenum with small, 2.5-cm fluid collection in hepatoduodenal ligament without other associated signs to suggest infection, although CT cannot definitively characterize fluid collections. 2. Small amount of ascites about the liver with several foci of pneumoperitoneum, two levels seen 5 days postop. Please see above discussion 3. High density foci outlining the calyceal/pelvic kidney which may reflect early excretion of contrast versus stone formation. 4. Right pleural effusion and atelectasis. 5. No other abnormalities seen.Findings discussed with Dr. Mikati at 3:20 PM.
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Generate impression based on findings.
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55 year old female with history of left rib pain. Radiopaque skin markers overlie the left rib cage. There is no evidence of displaced rib fracture. There are surgical clips in the left axilla and chest wall. Scattered tiny radiopaque fragments project over the abdomen.
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No evidence of displaced rib fracture.
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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. 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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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. A benign mass is again present in left breast, unchanged. Additionally, focal asymmetry within the right lateral breast is also unchanged.
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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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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. There has been interval decrease in size of the largest asymmetry on the left, suggesting an involuting cyst. Other bilateral asymmetries are unchanged. 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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13 year old female, evaluate for scoliosis.VIEWS: Thoracolumbar spine AP and lateral (two views) 1/15/2015 There is 56 degrees of levoscoliosis between L1 and T8, and 26 degrees of dextroscoliosis between T7 and T2. Postoperative changes related to resection of the spinous processes of L3 through L5 and L4 laminectomy evident. There is a moderate stool burden distributed throughout the colon.
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1.Scoliosis as above.2.Postoperative changes of the lumbar spine.
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Generate impression based on findings.
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100-year-old female with history of elbow fracture. The bones are demineralized. Redemonstrated is a displaced supracondylar fracture with medial displacement of the distal fracture fragment without significant interval change. The radiocapitellar and ulnar-trochlear articulations are maintained.
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Distal humerus fracture without significant interval change.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in her sister at age 64. 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. Bilateral breast masses, some of which are partially calcified, are unchanged. 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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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. An asymmetry is present within the far posterior slightly outer lower left breast. 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 views, and ultrasound if necessary, is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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Reason: eval for small bowel mass or AVM History: chronic iron def anemia, EGD and colonoscopy negative ABDOMEN:LUNG BASES: Intrathoracic stomach results in left lower lobe atelectasis and volume loss.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Intrathoracic stomach with rotation around the short axis such that the gastric antrum lies above the gastroesophageal junction consistent with mesentero-axial gastric volvulus. There is no gastric wall thickening, fluid, or other specific findings to suggest ischemia. BONES, SOFT TISSUES: Severe multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Calcified soft tissue foci in the gluteal subcutaneous fat likely represent sequela of prior medication injection.OTHER: No significant abnormality noted
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Intrathoracic stomach and findings consistent with mesentero-axial gastric volvulus.
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Generate impression based on findings.
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57-year-old male with history of knee pain. There are tricompartmental osteophytes, subchondral cyst formation, and joint space narrowing worse in the lateral compartment compatible with severe osteoarthritis. There is a mild valgus deformity. No evidence of acute fracture. Severe osteoarthritis affects the left knee as seen on the frontal views.
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Severe osteoarthritis as above.
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Generate impression based on findings.
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42-year-old male status post left total hip arthroplasty Hardware components of a total left hip arthroplasty device are situated in near-anatomic alignment without evidence of complication. A drain and foci of gas in the soft tissues reflect recent surgery.
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THA without evidence of complication.
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Generate impression based on findings.
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Seven month old male status post ETT repositioning.VIEW: Chest AP (one view) 1/15/2015, 15:10 Endotracheal tube tip in the proximal right mainstem bronchus. Nasogastric tube with tip in the body of the stomach. New complete left upper lobe collapse secondary to endotracheal tube positioning. Additional right-sided atelectasis slightly improved. The cardiothymic silhouette is normal.
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Right mainstem intubation with complete left upper lobe collapse.
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Generate impression based on findings.
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65-year-old female with pain and lateral elbow swelling There is minimal osteoarthritis affecting the elbow. No effusion or fracture is evident.
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Minimal osteoarthritis without joint effusion or fracture.
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Generate impression based on findings.
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23 year-old female, pain, with weight-bearing Alignment is anatomic. No fracture is evident.
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No fracture or malalignment.
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Generate impression based on findings.
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Male 77 years old Reason: restaging CT stomach cancer recurrent in liver, evaluate interval change prior to starting palliative chemotherapy. History: none CHEST:LUNGS AND PLEURA: Stable8mm groundglass nodule in the left upper lobe. Stable calcified micronodules. Fibrotic changes in the lung bases are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Right hepatic hypodense lesion measures 2.9 x 1.9 cm on image number 85, series number 3, increased in size compared to previous study. No other liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index gastrohepatic lymph node is unchanged measuring 1 cm in diameter on image number 94, series number 3.BOWEL, MESENTERY: Postsurgical changes secondary to partial gastric resection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.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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Slight interval increase in the size of hepatic lesion.
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Generate impression based on findings.
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57 year-old female, evaluate for shoulder dislocation Severe degenerative changes affect the glenohumeral joint with remodeling of the glenoid appearing similar to prior exams. A large joint effusion is noted containing calcific debris within the axillary recess. There is a cortical defect or erosion along the inferior humeral head. There is a large right pleural effusion and anasarca.
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1. Severe glenohumeral osteoarthritis as described above without acute dislocation.2. Cortical defect involving the inferior humeral head may represent erosion or possible small cortical fracture.3. Moderate glenohumeral joint effusion.4. Large right pleural effusion.5. Anasarca.
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Generate impression based on findings.
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As demonstrated by recent ultrasound there is severe enlargement of the right greater than left air gland, including the isthmus. This is due to the presence of numerous masses which are heterogeneous in appearance and better delineated on ultrasound. There are few punctate calcifications as well as areas of more focal hyperdensity within the masses. The right lobe measures 4.9-cm transverse by 4.2 cm AP by 8.9 cm CC. The left lobe measures approximately 3.4 cm transverse by 2.7-cm AP by 6.7 cm CC. The isthmus measures 4.0 cm in greatest thickness. There is significant associated tracheal deviation to the left measuring approximately 1.5-cm, as well as deviation of the pharynx/larynx. There is partial effacement of the vallecula and the right piriform sinus due to the mass-effect. No significant airway narrowing is noted. Due to the enlarged thyroid, the hyoid bone is slightly rotated to the right, while the laryngeal cartilages are rotated to the left. There is no definite substernal extension.PHARYNX/LARYNX: Multiple bilateral tonsilliths are present. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There is no abnormal soft tissue mass.GLANDS: The submandibular, sublingual, and parotid glands have an unremarkable noncontrast appearance.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: There is minimal atherosclerotic calcification of the carotid bifurcations. Mild-moderate degenerative changes are present along the cervical spine, with moderate right foraminal narrowing and C5-C6.
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Large heterogeneous multinodular thyroid goiter. Associated mass effect upon the patent airway, with tracheal deviation to the left.
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Generate impression based on findings.
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Neuroendocrine carcinoma of the lung,establish baseline prior to new systemic therapy. Head: There are postsurgical changes of prior right frontoparietal craniotomy. There is area of nodular enhancement involving the right posterior frontal lobe precentral gyrus measuring 15x12 mm in the axial plane. There is surrounding hypoattenuation which may represent edema or gliosis related to treatment. Remainder of the brain demonstrates no abnormal enhancement, mass, or mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Aside from postsurgical changes, calvarium appears intact and without destructive osseous lesions.Spine:Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. There are areas of lucency at multiple levels, such as the posterosuperior C4 vertebral body which are nonspecific and can be seen with ostepenia. No destructive lesions are seen. There is a tiny sclerotic foci involving the left T5 transverse process and L1 vertebral body and right lamina which are nonspecific and may represent bone islands.Mild degenerative changes are seen without significant spinal canal or neural foraminal stenosis. There is thoracic dextro scoliosis and exaggerated kyphosis. No significant spinal canal or neural foraminal stenosis is appreciated.
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1. Abnormal enhancement involving the right posterior frontal lobe which may represent sequela of prior treatment versus residual tumor. No prior CT or MRI studies of the brain are available for comparison. Otherwise no other mass or mass effect is seen in the remainder of the brain. 2. No definite evidence of osseous metastatic disease in the cervical, thoracic, or lumbar spine. Small scattered areas of lucency in the spine may be related to osteopenia. Small sclerotic foci at left T5 transverse process and L1 vertebral body and right lamina are unchanged since 9/16/2014 and may represent bone islands. Consider correlation with MRI or bone scan if clinically indicated.3. Please refer to separate CT report for findings in the chest, abdomen, and pelvis.
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Generate impression based on findings.
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Male, 66 years old, history of metastatic prostate cancer to the bone, now with new left sided swelling and numbness along the jaw line. Evaluation of the visualized soft tissue structures of the neck is within normal limits. No evidence of significant stranding, soft tissue thickening or fluid is detected. No pathologically enlarged lymph nodes are seen.The mandible is intact with no evidence of fracture or lytic lesion. Sclerotic lesions are seen within the mandibular condyles, right side worse than left, and perhaps to some degree within the mandibular rami.Sclerosis and thickening affects the right greater sphenoid wing and lesser sphenoid wing/anterior clinoid process. Mild patchy sclerosis is seen within the left greater sphenoid wing as well.The bones of the calvarium are diffusely sclerotic. Patchy sclerosis is seen within the occipital condyles and through the visualized cervical spine.Soft tissue thickening is evident within the right maxillary sinus. The remaining paranasal sinuses, mastoid air cells and middle air cavities are clear. No tumor or osseous destruction of the sinuses is evident.Visualized orbital and intracranial soft tissues are unremarkable.
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1. The mandible is intact with no evidence of fracture or lytic lesion. Sclerosis is seen compatible with metastatic disease within the mandibular condyles, right side more than left, and perhaps the mandibular rami.2. Sclerosis compatible with metastatic disease is evident within the greater and lesser sphenoid wings on the right, and the greater sphenoid wing on the left. Patchy sclerosis within the occipital condyles and the cervical spine is also seen. Findings are compatible with metastatic disease.3. Relatively diffuse sclerosis of the calvarium can sometimes be normal, but given the context, the presence of metastatic disease is suspected.
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Generate impression based on findings.
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63 year old female status post lumpectomy right for carcinoma in 2009 followed by radiation therapy, presents today for routine follow up. No current breast complaints. Family history of breast carcinoma in her maternal grandmother. Three standard views of both breasts with additional left CC and MLO 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 has been placed on the scar overlying the central upper right breast with expected underlying surgical changes including surgical clips. Additionally, linear marker has been placed scar overlying the right far posterior upper chest wall from prior port removal. A ribbon clip is present within the upper central right breast. Scattered benign calcifications are present bilaterally. 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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Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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3-year-old male with elevated IgE, evaluate for possible pneumatoceleVIEWS: Chest AP/lateral (two views) 01/15/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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58 years, Female. Reason: check if contrast still in GI tract History: study with contrast on 1/11/15, needs to be clear for next test Nonobstructive bowel gas pattern. Moderate stool burden. No retained contrast noted in the bowels. Cholecystectomy clips noted.
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Nonobstructive bowel gas pattern. No retained contrast.
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Generate impression based on findings.
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Patient with squamous cell carcinoma of the left buccal mucosa treated with chemoradiotherapy, then osteoradionecrosis, status post resection and flap reconstruction. There are post-treatment findings in the neck, including partial left mandibulectomy and flap reconstruction. There is osteolysis of the remaining left mandibular ramus and left maxillary alveolus. The two most posterior screws are not anchored in bone. Likewise, there is lucency surrounding the two most anterior screws of the mandibular plate system. Otherwise, there is no definite evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria, although the assessment is limited by the lack of intravenous contrast. The remaining salivary glands are unremarkable. The thyroid gland appears to be atrophic. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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Extensive post-treatment findings in the neck with osteolysis of the remaining left mandibular ramus and left maxillary alveolus is compatible with osteoradionecrosis, although superimposed infection or underlying neoplasm cannot be entirely excluded based on imaging alone. Associated loosening of the mandibular surgical screws is also apparent.
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Generate impression based on findings.
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Female 91 years old Reason: 2 year BL hx knee pain, eval OA History: same Right knee: Bone mineralization is decreased. Moderate to severe osteoarthritis affects the right knee worse in the lateral and extensor compartments. No acute fracture or malalignment.Left knee: Bone mineralization is decreased. Moderate to severe osteoarthritis affects the left knee worst in the medial and extensor compartments. No acute fracture or malalignment. There is a small left knee joint effusion.There are vascular calcifications in the soft tissues.
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Moderate to severe bilateral knee osteoarthritis.
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Generate impression based on findings.
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63-year-old male with hip pain Mild osteoarthritis affects both hips without evidence of inflammatory arthritis. Surgical clips project over the pelvis.
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Osteoarthritis without evidence of inflammatory arthritis.
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Generate impression based on findings.
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55-year-old male status post THA Hardware components of a left hip hemiarthroplasty are situated in near-anatomic alignment. Heterotopic bone formation is noted about the hip. No fracture is evident.
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Left hip hemiarthroplasty as described above.
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Generate impression based on findings.
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68-year-old male with RCC, new back pain Spinal alignment is within normal limits. A left chest wall ICD is noted. Bilateral nephroureterostomy catheters extend to the pelvis. Vertebral body height is maintained. No discrete lytic lesion is identified. Mild degenerative disease affects the thoracic and lumbar spine.
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Mild degenerative changes without lytic lesion visualized to indicate osseous metastasis.
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Generate impression based on findings.
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Male 22 years old Reason: severe pain after basketball injury History: knee pain Surgical changes in the medial aspect of the right tibia with sideplate and screws affixing a bone graft.Portion of the medial femoral condyle has been resected. There are chronic changes in the medial tibial plateau.Moderate to severe degenerative changes are noted in the medial compartment.The patella is low lying. No significant joint effusion.
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Postsurgical changes as detailed above.
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Generate impression based on findings.
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36-year-old male, history of shoulder dislocation, now with pain There is apparent anterior dislocation of the humeral head without discrete fracture visualized.
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Anterior dislocation of the humeral head.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are right breast ultrasound dated November 20, 2014, and screening mammogram dated November 17, 2014 performed at Methodist Hospital in Merrillville, Indiana. For comparison, screening mammogram dated September 16, 2013 is available. Bilateral Screening Mammogram (11/17/2014): Three standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A new 9-mm mass is present within the central inner right breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Other bilateral benign morphology masses and asymmetries are stable. Benign appearing lymph nodes are projected over both axillae.Right Breast Ultrasound (11/20/2014): Targeted right ultrasound at the 3 o'clock position demonstrates a 0.9-cm cluster of cysts. No solid mass is identified.
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Benign appearing cluster of cysts at the 3 o'clock position of the right breast, corresponding to the mammographic finding. A 6-month follow-up ultrasound may be considered to ensure stability. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Female 71 years old; Reason: RT breast cancer s/p chemo, now scheduled lumpectomy, no masses palpable-Need T-99 for SLbX procedure on 1-15-2015-patient wt =138 1bs History: Right breast cancer-surgery in DCAM 1-15-15 at 10:00 amRADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.476 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 right breast injection for intraoperative identification of sentinel lymph node.
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Generate impression based on findings.
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There is mild leftward convexity of the lower lumbar spine with apex of curvature at L2-L3. There is mild left lateral translation of L4 on L5 There is 5-mm grade 1 anterolisthesis of L4 on L5. The scout lateral view and the sagittal reformatted images demonstrate the lumbar spine to be otherwise in normal alignment, with a normal lumbar lordosis. There is moderate disk space narrowing at L4-L5 especially anteriorly, with a vacuum phenomenon. The vertebral body and disk space heights are otherwise well-maintained.There is no acute fracture.At L1-L2, there is no significant disk pathology or stenosis.At L2-L3, there is a mild posterior osteophyte disk complex with superimposed left foraminal/far lateral disk protrusion. Minimal bilateral facet arthropathy contributes to overall mild central spinal canal stenosis and moderate left foraminal narrowing.At L3-L4, there is a mild disk bulge with prominent bilateral facet arthropathy. There is mild to moderate central spinal canal stenosis as well as moderate-severe right and moderate left foraminal narrowing.At L4-L5, there is uncovering of the disk with a superimposed disk bulge. There is moderate-severe central spinal canal stenosis. Severe bilateral facet arthropathy contributes to moderate-severe right and moderate left foraminal narrowing.At L5-S1, there is a trace disk bulge with minimal bilateral facet arthropathy.Limited views through the retroperitoneum demonstrate no gross abnormalities.
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1. Degenerative grade 1 anterolisthesis of L4 on L5. Uncovering of the disk with superimposed disk bulge at this level resulting in moderate-severe central spinal canal stenosis as well as moderate to severe right and moderate left foraminal narrowing.2. Additional moderate to severe right foraminal narrowing at L3-L4.3. Mild leftward convexity of the mid lumbar spine.
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Generate impression based on findings.
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Male 56 years old; Reason: assess blood flow without Diamox History: Strokes There is a small to medium-sized region of mild decreased perfusion involving the right posterior frontal/right anterior parietal lobes. There is a minimally decreased perfusion involving the majority of the right temporal lobe. There are no additional significant perfusion defects identified.
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Mild decreased perfusion involving the right posterior frontal and anterior parietal lobes as well as minimally decreased involving the majority of the right temporal lobe. Consider follow up exam with Diamox for evaluation of potential diminished cerebrovascular flow reserve.
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Generate impression based on findings.
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Female 60 years old Reason: right knee pain History: right knee pain Severe osteoarthritis affects the right knee particularly in the lateral and extensor compartments where there is moderate to severe joint space narrowing.There are tricompartmental osteophytes.Genu valgus is suggested on the AP view. There is a small joint effusion. No acute fracture or malalignment.
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Severe right knee osteoarthritis.
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Generate impression based on findings.
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Female; 50 years old. Reason: mets lung cancer, s/p adrenalectomy for mets. s/p cycle 34 of Nivolumab, bones mets. Pls c/w previous study and evaluate tx response. History: lung cancer CHEST:LUNGS AND PLEURA: Right apical spiculated nodule with some internal calcifications measures 11 x 10 mm (image 17/116), unchanged. Additional scattered micronodules are unchanged. No new suspicious nodules.Emphysema. MEDIASTINUM AND HILA: Reference right hilar lymph node stable at 12 mm, unchanged (image 46/151).CHEST WALL: Subtle right T5 transverse process metastatic lesion stable in size and appearance (image 33/151).ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic hypodensities are too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy. Grossly stable 10 x 8 mm left adrenal nodule (image 102/151).KIDNEYS, URETERS: Presumed right renal cyst is unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Subtle right T5 transverse process metastasis unchanged.OTHER: No significant abnormality noted.
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1. No significant change in right apical nodule.2. Other findings including subtle T5 lesion are also stable with no new sites of disease evident.
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Generate impression based on findings.
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Ms. Najieb is a 53 year old female presenting for a short-term follow-up for a right breast asymmetry. 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. Focal asymmetry in the right inferior breast, previously characterized as a complicated cyst on ultrasound, is stable when compared to prior exams. Bilateral ductal ectasia is also stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable right asymmetry and bilateral ductal ectasia. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 12 months, and if stable at that time, the patient could probably thereafter return to routine screening. 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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Reason: ILD, compare to 2011 History: worsening shortness of breath LUNGS AND PLEURA: Focal patchy areas with linear scar like opacities ground glass components, slightly improved from previous.Mild bilateral lower lobe bronchiectasis with associated ground glass opacity, also slightly improved.Intervening areas of the lungs are completely normal.Surgical staples in the right middle lobe and micronodule in the right upper lobe, unchanged.MEDIASTINUM AND HILA: Mildly enlarged nonspecific mediastinal lymph nodes.No visible coronary artery calcifications no pericardial effusion.Patulous distal esophagus.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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Patchy mainly peri-bronchovascular reticular and groundglass opacities with traction bronchiectasis but no sign of honeycombing, with slight interval improvement in the ground glass components compared to the previous examination. The pattern is nonspecific but consistent with the previous pathological diagnosis of fibrosing NSIP.
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Generate impression based on findings.
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Reason: evaluate ILD History: cough soboe fibrosis LUNGS AND PLEURA: Moderate to severe interstitial lung disease present throughout the lungs, with only a mild basilar predominance if present at all.Extensive peripheral honeycombing is present as well as subpleural reticular opacities and traction bronchiectasis.Although there is no groundglass opacity, there is a distinct mosaic attenuation pattern suggestive of air trapping or abnormal pulmonary perfusion which does not change much between inspiration and expiration series.MEDIASTINUM AND HILA: No significantly enlarged mediastinal or hilar lymph nodes.The main pulmonary artery diameter is normal.Moderate coronary artery calcifications are present, heart and pericardium otherwise unremarkable.Extensive aortic calcifications extend into the upper abdomen.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Vascular calcifications, otherwise unremarkable limited upper abdomen study.
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Moderate to severe interstitial lung disease, but the pattern consistent with UIP although consideration should be given to hypersensitivity pneumonitis given the presence of a distinct mosaic attenuation pattern.
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Generate impression based on findings.
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Female; 47 years old. Reason: evaluate for PE History: SOB, hypoxia PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Significant interval increase in multifocal groundglass and mixed density airspace consolidations, greatest in the right upper lobe; findings suspicious for hemorrhage, possibly infection. Increased left basilar subsegmental atelectasis. Stable basilar predominant interlobular septal thickening, which may be due to lymphangitic spread of tumor. New small right pleural effusion.Multiple bilateral pulmonary metastases are again seen and not significantly changed, with reference measurements as follows:Right lower lobe nodule (series 10, image 76) measures 22 x 20 mm, previously 21 x 20 mm.Left upper lobe nodule (series 10, image 71) measures 11 x 10 mm, previously 11 x 9 mm.A right middle lobe nodule demonstrates new internal air collections, suggestive of necrosis from treatment change (series 10, image 91).MEDIASTINUM AND HILA: Confluent mediastinal and bilateral hilar lymphadenopathy has increased with increased encasement and new marked narrowing of the distal bronchus intermedius. There is also encasement and narrowing of an inferior right pulmonary vein. Stable heterogeneous appearance of the thyroid gland. Right chest wall Port-A-Cath tip in SVC. Normal heart size without pericardial effusion. No visible coronary calcifications.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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1. Marked multifocal groundglass and mixed density air space consolidations, suspicious for hemorrhage or possibly infection. 2. No acute pulmonary embolus.3. interval increased confluent mediastinal and bilateral hilar lymphadenopathy causing new marked narrowing of the bronchus intermedius.4. Numerous pulmonary metastases are overall not significantly changed aside from a single right middle lobe nodule demonstrating new internal air foci, possibly due to necrosis from treatment effect.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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36-year-old female with relapsed Hodgkin's lymphoma in the mediastinum and right supraclavicular nodes status post XRT tear this is worse once.RADIOPHARMACEUTICAL: 14.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 86 mg/dL. Today's CT portion grossly demonstrates new bilateral paramediastinal lung densities, compatible with postradiation changes. 1 cm left upper lobe scarlike opacity is stable. 8-mm right lower lobe pulmonary nodule has increased in size, measuring 8 mm from previously 4 mm. Left chest wall port catheter tip lies in the SVC.Today's PET examination demonstrates complete interval resolution of markedly hypermetabolic right supraclavicular and right mediastinal lymph nodes. No suspicious FDG activity is present to suggest residual tumor in these regions. There is new bilateral patchy pulmonary parenchymal FDG uptake in a paramediastinal distribution, compatible with postradiation inflammation.There is new FDG activity associated with an right posterior lung base pulmonary nodule (SUV max 2.8), significantly increased in size from the previous exam on CT. This finding is nonspecific, and while may represent an inflammatory nodule, tumor activity is not entirely excluded.Tubular foci of activity in the right pelvis likely reflect benign physiologic activity, and may represent bowel or adnexa, and is not significantly changed.
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1.Complete interval resolution of previously markedly hypermetabolic lymph nodes in the right upper thorax, without convincing FDG avid lymphoma currently. New bilateral paramediastinal pulmonary parenchymal FDG activity correlating with pulmonary opacities on CT is compatible with postradiation inflammatory changes.2.Small right posterior lung base pulmonary nodule is increased in size with new hypermetabolic activity. Given the patient's age and location of the lesion, this may represent an inflammatory nodule, although tumor activity, including primary lung neoplasm or lymphoma, is not entirely excluded. Additional follow-up is recommended.
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Generate impression based on findings.
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66 years Female with history of seizure, rule out intracranial bleed. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes. A more focal hypodensity in the left thalamus likely represents a chronic lacunar infarct.Mild mucosal thickening of the paranasal sinuses, most pronounced in the right ethmoid sinus. Mild opacification of the right ostiomeatal complex. Fracture of the right lamina papyracea, which is likely chronic. The mastoid air cells are clear. Calvarium is intact.
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No evidence of intracranial hemorrhage. Age-indeterminant small vessel ischemic changes Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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35-year-old female, assess lateral calcaneal and medial cuneiform fusion A side plate and screws affix the calcaneus fracture with cystic changes and sclerosis noted about the fracture site. A single proximal screw is fractured with the screw head displaced within the lateral soft tissues. There is adjacent lateral soft tissue swelling and thickening of the peroneal tendons near the site of the fractured screw head. A side plate and screws affix the medial cuneiform, which appears intact. Anchors are noted within the navicular.
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Postoperative fixation as described above with fractured proximal calcaneal plate screw and adjacent lateral soft tissue swelling and thickening of the peroneal tendons near the displaced screw head.Sclerosis and cystic changes at the fracture line of the calcaneus.
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Generate impression based on findings.
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Male 61 years old Reason: eval for gouty erosions History: gout Right hand: There is joint space narrowing at the interphalangeal joints. Findings of a possible small erosion is noted at the distal aspect of the middle phalanx of the third digit. There are multiple areas of soft tissue swelling about the metacarpophalangeal joints and interphalangeal joints. Three no acute fracture or dislocation.Left hand: This diffuse joint space narrowing at the interphalangeal joints. There is associated soft tissue swelling at the interphalangeal joints. There is erosive change at the second proximal interphalangeal joint.There is severe joint space loss at the first metacarpophalangeal joint. There is diffuse soft tissue swelling along the dorsum of the hand and at the metacarpophalangeal joints. There is a small erosion involving the proximal aspect of the fifth distal phalanx.
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Soft tissue swelling and erosive changes as detailed above.
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Generate impression based on findings.
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Reason: 45 F w/ pulmonary infiltrate, immunosuppression, ?vasculitis - did it resolve History: hypoxia LUNGS AND PLEURA: Several linear and scarlike opacities are present laterally, unchanged or slightly decreased from previous.A focal area of ground glass and nodular opacities described on the previous scan in the right upper lobe has resolved during the interval, compatible with infection.No new abnormalities.MEDIASTINUM AND HILA: No lymphadenopathy or pericardial effusion. No visible coronary artery calcification.CHEST WALL: Vertebral compression fractures and associated degenerative disease, unchanged. Degenerative disk disease throughout the thoracic spine. No axillary lymphadenopathy visualized.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Interval resolution of focal nodular and ground glass opacity, likely due to infection.Mild residual scarlike opacities but no sign of active disease.
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Generate impression based on findings.
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36-year-old male, assess reduction Interval shoulder reduction with the glenohumeral joint alignment now appearing anatomic. Irregularity of the inferior glenoid is suggestive of a Bankart lesion.
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Reduction glenohumeral joint with humeral head now in anatomic alignment. Findings are suggestive of an associated Bankart lesion, consider follow up dedicated imaging.
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Generate impression based on findings.
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Reason: 63f, cachexia, hx of pacreatitismelena with ulcer but no active upper gib, assess for malignancy History: melena, weight loss ABDOMEN:LUNG BASES: Subsegmental scarring/atelectasis in the lung bases.LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilation. Partially collapsed gallbladder with cholelithiasis incompletely evaluated.SPLEEN: Splenic calcifications suggesting prior granulomatous diseasePANCREAS: Coarse calcification in the pancreatic head suggests chronic pancreatitis. There is mild multifocal pancreatic ductal prominence distally and the pancreatic duct is not as well visualized in the pancreatic head. ADRENAL GLANDS: Mild nonspecific nodularity of the adrenal glands may reflect hyperplasia.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes, reference left para-aortic node measures 1.4 x 0.8 cm (series 3 image 46).Mildly enlarged gastrohepatic lymph nodes, with reference lymph node measuring 1.1 x 0.7 cm (series 3 image 32).Severe atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: The bowel is normal in caliber without obstructionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: Foley catheter in place. Air in the bladder likely postprocedural.LYMPH NODES: As aboveBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild-moderate pelvic ascites.
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1. Pancreatic head calcification and multifocal ductal prominence may represent sequela of chronic pancreatitis and/or stricture. MRI/MRCP is recommended for further evaluation and to exclude a small occult malignancy. 2. Pelvic ascites and borderline enlarged mesenteric and retroperitoneal lymph nodes are of unknown etiology. A malignant process cannot be excluded on this study, and continued follow up is recommended.
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Generate impression based on findings.
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Male 66 years old Reason: establishing baseline for participation in a clinical trial, IRB 13-0936. Please provide bi-dimensional measurements per RECIST v1.1 History: neuroendocrine carcinoma of the lung ABDOMEN:LUNG BASES: Chest section will be dictated separately.LIVER, BILIARY TRACT: Several hypodense lesions in the liver which cannot be optimally characterized on this single phase CT but are unchanged from previous study. However, there are also some new hypodense lesions suspicious for metastatic disease. An index lesion measures 1.5-cm in diameter image number 94, series number 3.SPLEEN: No significant abnormality notedPANCREAS: 2.5 x 3.3 cm mass in the head of the pancreas, best seen on image number 111, series number 3. This has not significantly changed from previous study where it measures 3.1 x 2.6 cm on image number 192, series number two. Pancreatic duct duct is also mildly dilated.ADRENAL GLANDS: Left adrenal mass measures 7.3 x 5.4 cm on image number 93, series number 3. The mass is enlarged compared to previous study where it was measuring 5 x 4.9 cm on image number 177, series number two.KIDNEYS, URETERS: Large right renal mass measuring 5.9 x 6.8 cm in image number 123, series number two. This lesion was previously measuring 5.6 x 4.9 cm on image number 23, series number two.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. Index left paraortic node measures 1.9 x 1.5 cm image number 110, series number 3. This lymph node is new from previous study.BOWEL, MESENTERY: Interval increase in the right lower quadrant mesenteric mass measuring 3.4 x 2.3 cm on image number 149, series number 3. This lesion was measuring 2.2 x 2 cm image number 192, series number two. Mild wall thickening of the distal ileal loops, again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval progression of disease with interval development of hepatic and retroperitoneal metastases interval increase in the size of the left adrenal, right renal and right lower quadrant mesenteric adenopathy.Heterogeneous mass in the pancreas is grossly unchanged.
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Generate impression based on findings.
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88-year-old female with a history of right heart strain. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No evidence of acute pulmonary embolus. Pulmonary arterial web in the right lower lobe pulmonary artery consistent with prior episodes of pulmonary embolism. Pulmonary artery measures 30 mm which may suggest borderline pulmonary arterial hypertension with evidence of right heart strain. Marked RA enlargement and LV hypertrophy.LUNGS AND PLEURA: Left lower lobe scarring. Bilateral pleural effusion, right greater the left, with atelectasis.MEDIASTINUM AND HILA: Aortic atherosclerotic disease with mild 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. Small amount perihepatic ascites with foci of pneumoperitoneum in a patient with recent abdominal surgery. Reflux of contrast into the hepatic veins.
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1. No evidence of acute pulmonary embolism.2. Pulmonary arterial hypertension and right heart strain likely secondary to prior episodes of pulmonary embolism.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive.
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Generate impression based on findings.
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7 month old male, ex-preemie, with history of prolonged intubation and NICU course now with adenovirus infection with abdominal distentionVIEW: Abdomen AP (one view) 1/15/15 Enteric tube tip terminates in the stomach. Right lower extremity central venous catheter is at the confluence of the iliac veins.Nonobstructive bowel gas pattern. Left basilar opacity persists.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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76-year-old male status post endovascular aortic repair. Assess for Endo leak. ABDOMEN:LUNG BASES: Diffuse emphysematous changes without other significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign cortical cysts seen bilaterally without other solid, worrisome mass lesions. Prompt and symmetric excretion of contrast material is seen on the 3 minute delay imaging. No perinephric abnormalities seen. No calcifications to suggest stone disease.RETROPERITONEUM, LYMPH NODES: Giant infrarenal aortic aneurysm is seen achieving a maximal cross-sectional diameter of 9.3 x 9.2 cm (series 7, image 124). Endovascular rib pair is seen with the superior margin of stent beginning just below level of renal arteries with a by iliac artery extension. Stent is patent and enhances homogeneously. No evidence of enhancement in the sac is seen to suggest Endo leak.Ectatic common iliac arteries are seen bilaterally which bifurcate into normal diameter in internal and external iliac arteries. No other mass lesions are abnormality seen. BOWEL, MESENTERY: No significant abnormality noted in the stomach, abdominal small bowel or abdominal colon. Sigmoid colon diverticulosis is seen in the pelvis without complication. No free mesenteric fluid is seen..BONES, SOFT TISSUES: Degenerative changes seen throughout the lumbar spine without focal other abnormality seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Extensive sigmoid diverticulosis without complication. No other significant abnormality seen. No free mesenteric fluid.BONES, SOFT TISSUES: Left total hip arthroplasty with streak artifact obscuring some details of the pelvis.OTHER: No significant abnormality noted
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1. Endovascular repair of abdominal aortic aneurysm with aorto bi-iliac endovascular stent.. No evidence of Endo leak. 2. Sigmoid diverticulosis without complication.
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Generate impression based on findings.
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2 year old female with colonic dysmotilityVIEW: Abdomen AP (one view) 1/15/15 Gastrostomy tube is present and unchanged. Disorganized, featureless, air distended bowel loops. No evidence of obstruction. No free intraperitoneal air, pneumatosis intestinalis, or portal venous gas.
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Nonspecific bowel gas pattern. No evidence of obstruction.
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