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Generate impression based on findings.
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follow up, right frontal lobe acute ischemic infarction. Re-demonstration of the right frontal lobe pre central gyrus acute ischemic infarction, no change since prior exam.There is no evidence of hemorrhagic conversion.No evidence of new ischemic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No interval change of the right frontal lobe pre central gyrus acute ischemic infarction.No evidence of hemorrhagic conversion.Otherwise unremarkable head CT scan.
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Generate impression based on findings.
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3-year-old female with NF1 for evaluation if there is a retroperitoneal lesion.EXAMINATION: MR of the abdomen and pelvis 1/16/15 No pleural effusion. No focal hepatic lesions. There is no hydronephrosis or perinephric inflammation. The spleen is within normal limits. The gallbladder is within normal limits. There is a large amount of stool within the rectum. The bladder is well distended and within normal limits. No mass lesions are evident within the abdomen and pelvis. The osseous structures are within normal limits. No abnormal foci of T2 hyperintensity.
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1.No retroperitoneal mass as clinically questioned. 2.Large amount of stool within the rectum.
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Generate impression based on findings.
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51-year-old male with chest pain, subtherapeutic INR PULMONARY ARTERIES: No pulmonary embolus. Enlarged pulmonary arterial tree similar to previous may represent pulmonary arterial hypertension.LUNGS AND PLEURA: Subtle clustered nodular opacities in the left lung base may represent sequela of aspiration. Subsegmental atelectasis/scarring. Scattered micronodules measuring less than 4 mm.MEDIASTINUM AND HILA: Mild cardiomegaly with right ventricular enlargement. Mild atherosclerotic/coronary calcifications.CHEST WALL: Median sternotomy wires.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic cyst appears unchanged. Left upper pole renal cyst also appears unchanged. IVC filter partially imaged.
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1. No pulmonary embolism or other acute findings to account for the patient's symptoms. 2. Other chronic findings as described above. PULMONARY EMBOLISM: PE: NegativeChronicity: 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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65 years, Male. Reason: NG tube placement Enteric tube tip in the gastric fundus. Incompletely imaged bowel loops. There appears to be mild distension of small bowel measuring up to 3.0 cm. Stool filled presumed transverse colon is also seen. Left lung base atelectasis/consolidation. Please see dedicated chest radiography report for additional details.Status post cholecystectomy and sternotomy.
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Enteric tube tip in the gastric fundus. Mild distension of small bowel measuring up to 3 cm, incompletely imaged.
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Generate impression based on findings.
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Ms. Doke is a 71 year old female with a personal history of right breast lumpectomy in 2011 for DCIS. She also had a benign biopsy in the right breast in 2011 for fibroadenomatoid changes with microcalcifications and a benign biopsy in the left breast in 2013 for fibroadenomatoid changes with microcalcifications. Family history of breast cancer in twin sister (diagnosed at the age of 64). Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A rod-shaped clip is seen in the right medial breast and an S-shaped clip is seen in the left upper outer breast, both at sites of prior benign breast biopsies. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion and increased density present within the right lumpectomy site. Diffusely scattered calcifications have progressed in a benign type fashion in both breasts. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign appearing lymph nodes are projected over both axillae.
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Scattered benign calcifications in both breasts and stable postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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History of cardiac arrest. Evaluation limited by patient motion artifact.PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Severe centrilobular emphysema. Lung volumes with basilar consolidation/atelectasis, and a small right subpleural effusion.MEDIASTINUM AND HILA: Endotracheal tube with tip above the carina. Enteric tube with tip in the stomach and patulous air-containing esophagus. Multinodular thyroid partially imaged. Moderate cardiomegaly with visible coronary artery calcifications; aortic calcifications are present. IVC temporary pacemaker terminates in the right ventricle. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous hepatic hypodensities, the largest of which measure simple fluid attenuation and may represent cysts but are incompletely characterized.
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1.No pulmonary embolus.2.Severe centrilobular emphysema with low lung volumes and bibasilar consolidation/atelectasis.3.Support devices as described above. PULMONARY EMBOLISM: PE: NegativeChronicity: 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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76-year-old female with dizziness. Assess the posterior circulation. CT HEAD: There is a right frontoparietal convexity arachnoid cyst that measures up to approximately 3 cm in width with associated mass effect upon the underlying brain parenchyma. There is no evidence of intracranial hemorrhage. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There are multiple dental caries. An opacity in the right external auditory canal likely represents cerumen.CTA HEAD: There is marked decrease in the caliber of the left vertebral artery distal to the left AICA origin. There is also mild narrowing of the distal right vertebral artery and proximal basilar artery. There is focal stenosis of the P2 segment of the left posterior cerebral artery and to a lesser degree the P2 segment of the right posterior cerebral artery. There is focal stenosis of the distal M1 segment of the right middle cerebral artery. There are calcifications of the bilateral carotid siphons. There is no evidence of cerebral aneurysms or vascular malformations. The venous structures opacify normally.CTA NECK: There is a two-vessel aortic arch in which the left common carotid artery originates from the brachiocephalic artery. There is atherosclerotic plaque at the proximal left internal carotid artery with mild stenosis. There is a retropharyngeal course of the bilateral internal carotid arteries. There is no significant stenosis of the cervical vertebral arteries.
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1. No evidence of acute intracranial hemorrhage or mass lesions.2. Marked decrease in the caliber of the left vertebral artery distal to the left AICA origin and mild narrowing of the distal right vertebral artery and proximal basilar artery. 3. Focal stenosis of the P2 segment of the left posterior cerebral artery and to a lesser degree the P2 segment of the right posterior cerebral artery. 4. Focal stenosis of the distal M1 segment of the right middle cerebral artery.5. Mild stenosis of the proximal left internal carotid artery and a retropharyngeal course of the bilateral internal carotid arteries.6. Multiple dental caries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Neck pain, evaluate for fracture or dislocation. The cervical vertebral bodies are appropriate height. Alignment is maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disk bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Mild disk bulge with partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disk bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissues are unremarkable.
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1. No evidence of fracture or subluxation within the cervical spine.2. Minimal degenerative changes including disk bulge at the C4-C5 level with partial effacement of the ventral thecal sac, which can be further assessed with MRI if clinically indicated.
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Generate impression based on findings.
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56 year old male with colon cancer. Follow-up examination. Lack of IV contrast enhancement limits evaluation of the organs.CHEST:LUNGS AND PLEURA: Again noted are multiple bilateral pulmonary nodules. Reference left upper lobe nodule measures 1.2 x 1.1 cm (series 5, image 48), previously measuring 1.4 x 1.2 cm. Reference right lower lobe nodule measures 2.5 x 2.1 cm (series 5, image 73), previously measuring 2.3 x 1.9 cm. Multiple additional bilateral pulmonary nodules are again noted, some of which have increased in size (for example series 5, images 43, 52, and 64). No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Right anterior chest port with tip in the distal SVC.ABDOMEN:Lack of IV contrast enhancement limits evaluation of the organs.LIVER, BILIARY TRACT: Status post right hepatectomy with two stable hypoattenuating foci within the residual liver which are stable. Postoperative cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postoperative changes about the sigmoid colon. No evidence of bowel obstruction or colitis.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: Postoperative changes about the sigmoid colon without findings to suggest disease recurrence. No evidence of bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Mild interval worsening of pulmonary metastatic disease.2.Stable disease in the abdomen and pelvis.
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Generate impression based on findings.
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Headache after craniotomy. There has been interval evolution of the postoperative findings related to left frontal craniotomy for resection of a left frontal lobe tumor, with interval layering of hyperattenuating material in the resection cavity. There is persistent edema in the left frontal lobe. There are mixed solid and cystic tumors in the right frontal lobe with extensive vasogenic edema. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is persistent scalp swelling overlying the craniotomy flap.
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1. Interval evolution of the postoperative findings related to left frontal craniotomy for resection of a left frontal lobe metastasis, with interval layering of hemorrhage in the resection cavity and persistent surrounding vasogenic edema. Otherwise, assessment for residual tumor is limited on non-contrast CT.2. Unchanged right frontal lobe metastases and vasogenic edema.
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Generate impression based on findings.
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Male 58 years old Reason: status of liver transplant History: volume overload LIVER: The liver contour is mildly nodular. Liver measures 16.4 cm in length. The parenchyma is moderately coarse and echogenic . No suspicious hepatic lesions.BILIARY TRACT: The gallbladder is absent. Common duct measures 4mm. PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 13.5 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Cyst in the interpolar region measures 6.6 cm.The left kidney measures 13.9 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 21.3 cm. in length. OTHER: Trace ascites.
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1.Echogenic coarsened hepatic suggestive of chronic liver disease.2.Patent hepatic vasculature.
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Generate impression based on findings.
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11 year old male with known radial fracture. Evaluate healing.VIEWS: Right wrist AP lateral and oblique (3 views) 1/16/2015 Overlying cast material obscures fine bone detail. Incomplete transverse fracture identified through the distal radial metaphysis, with sclerotic margins consistent with healing. Focal lucency seen along the posterior aspect of the ulnar diaphysis may reflect an additional incomplete fracture, although this is equivocal.
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Radial fracture and questionable ulnar fracture as above.
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Generate impression based on findings.
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Aborted left lower lobe wedge resection for bleeding during intubation. History of T3 N0 squamous carcinoma of left tongue and T1N0 squamous cell carcinoma of right tonsil status post chemo RT. S.O.B. and fatigue. History of infiltrating lobular breast carcinoma. LUNGS AND PLEURA: Emphysema. Subpleural fibrosis anterior right lung suggestive of prior chest wall radiation therapy. Lipid containing (- 5HU) but poorly marginated left lower lobe nodule increased in size, measuring 10 mm, previously 4-mm. A metallic fiducial marker is seen superolateral to the lesion.No pleural fluid. Scarring in the right middle lobe. No new nodules.MEDIASTINUM AND HILA: Right tracheoesophageal /paratracheal region lymph node measures 6 mm, unchanged (3/10). Additional small mediastinal lymph nodes unchanged. Mild cardiomegaly. Trace pericardial fluid or thickening, unchanged. Atherosclerotic calcification of the aorta and its branches, coronary arteries and aortic valve.CHEST WALL: Chunky calcification in the left breast surrounded by soft tissue unchanged. Numerous additional calcified nodules and surgical clips elsewhere in left breast appear unchanged, very poorly assessed by CT. Degenerative changes of the glenohumeral joints.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Numerous cysts in the kidneys bilaterally. Extensive vascular calcifications.
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1. Interval increase in size of poorly marginated lipid containing nodule in the left lower lobe, now 10-mm.2. No new nodules.3. No suspicious enlarging mediastinal lymph nodes. The index trachea esophageal lymph node has been stable over multiple prior studies, consistent with a benign lesion.4. Breast findings incompletely assessed by CT.
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Generate impression based on findings.
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Newborn male, status post UVC placement.VIEW: Chest and abdomen AP (two view) 1/16/2015, 08:44 The UVC catheter has been advanced, now at the level of the pulmonary veins, likely traversing a patent foramen ovale. UAC catheter position unchanged. New focus of gas in the peripheral right upper quadrant concerning for pneumoperitoneum, etiology of which is uncertain, but possibly iatrogenic. Increased right middle lobe opacity likely reflects atelectasis. Disorganized non-obstructive bowel gas pattern. No evidence of portal venous gas or pneumatosis intestinalis.
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1.New focus of gas in the peripheral right upper quadrant concerning for pneumoperitoneum, the etiology of which is uncertain. 2.UVC catheter, at the level pulmonary veins. 3.Increased right middle lobe opacity likely atelectasis.These findings were discussed with Dr.Lenus via telephone at 11:09 1/16/2015.
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Generate impression based on findings.
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50 year-old female with history of wrist fracture. There is a comminuted intra-articular fracture of the distal radius with approximately 20% dorsal angulation of the distal fracture fragment. There is a mildly displaced fracture of the ulnar styloid.
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Distal radius and ulnar styloid fractures as above.
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Generate impression based on findings.
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17-year-old male with history of hip pain. Evaluation of the acetabulum is slightly limited due to patient rotation. There appears to be an acetabular crossover sign on the left and to a lesser extent on the right which can be seen with cranial acetabular retroversion. There is no acute fracture or cam deformity. There is minimal irregularity along the margins of the pubic symphysis which is of uncertain clinical significance.
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1.Acetabular crossover sign suggestive of cranial acetabular retroversion which can be associated with pincer femoroacetabular impingement in the correct clinical context.2.Slight irregularity along the margins of the pubic symphysis of uncertain clinical significance.3.If patient care warrants further imaging, MRI may be obtained.
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Generate impression based on findings.
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History of endocarditis, rule out septic emboli. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. There is hypodensity with volume loss and calcifications involving the right posterior inferior cerebellar hemisphere which may be related to prior PICA infarct or other injury. No abnormal enhancement. No evidence of intracranial abscess or empyema.Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.There is mild mucosal thickening involving the bilateral, left greater than right, maxillary sinuses. Mastoid air cells are clear. Calvarium is intact.
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1. No evidence of intracranial hemorrhage, abscess, or empyema. If there is continued suspicion for emboli, MRI would be more sensitive.2. Calcifications and hypodensity in the right cerebellum likely related to remote PICA infarct or other chronic injury.
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Generate impression based on findings.
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Ms. Spornberger is a 65 year old female with a personal history of left breast lumpectomy in May 2013 for IDC followed by chemoradiation therapy and AI. Three standard views of both breasts and two left spot magnification 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. Linear markers were placed on scars overlying the left breast and axilla. There are stable postsurgical changes including architectural distortion and increased density within the left lumpectomy site. Skin thickening and trabeculation have decreased when compared to prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes in the left breast with decreased skin thickening/trabeculation. 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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39-year-old female with history of pain. Evaluate for fracture. There is no acute fracture or subluxation. Mild degenerative disc disease affects C3-4. Severe degenerative disc disease affects C4-5 and moderate degenerative disc disease affects C5-6 and C6-7. Osteophytes project from the anterior aspect of the cervical spine. There is a slight kyphosis. Evaluation of the neuroforamina is limited due to patient positioning, although there is narrowing of the neuroforamina bilaterally at C5-6 and C6-7.
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Degenerative disc disease and neuroforaminal narrowing as above. No evidence of acute fracture. If patient care warrants further imaging, MRI may be considered.
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Generate impression based on findings.
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58-year-old female with history of fall. Evaluate for acute fracture or dislocation. There is no acute fracture or dislocation. Tricompartmental osteophytes indicate moderate osteoarthritis. There is a moderate-sized joint effusion.
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Osteoarthritis and joint effusion as above without acute fracture.
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Generate impression based on findings.
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Pulmonary nodules, PTLD. NHL. LUNGS AND PLEURA: Interval improvement in size and number pulmonary nodules.Left upper lobe nodule at the level of the AP window (/33) measures 6 x 9 mm, previously 14 x 18 mm.Right lower lobe nodule abutting the fissure and right hilum (5/49) measures 6 x 6 mm, previously 9 x 9 mm.Previously seen lobulated nodule in the posterior aspect of the right lower lobe no longer measurable, now with a flat scarlike lesion in its place (5/76).Left lower lobe peripheral nodule also has been replaced by a linear scarlike abnormality (5/73), not accurately measurable given its curvilinear appearance and course in relation to the scanning plane.Interval worsening of groundglass opacity and subsolid nodular opacities in the posterior medial left lower lobe ranging from 2-5-mm. Some of the opacities have a tree-in-bud configuration (5/77).Subtle groundglass nodule also with probable internal tree in bud opacities within the posterior aspect of the right upper lobe (5/46) new from previous but beyond the resolution of CT for accurate characterization.No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Surgical clips in the anterior mediastinum are new since the previous examination. The native coronary arteries are heavily calcified. Prosthetic mitral valve. Fat-containing hiatal hernia. Mild cardiomegaly, unchanged. No lymphadenopathy.CHEST WALL: Interval median sternotomy with wires in place. Osseous nonunion of the manubrium.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Bilateral renal atrophy. Cystlike lesions in the liver are unchanged.
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Interval improvement in size and number of pulmonary nodules which were present previously. However, new and worsening groundglass opacity and small sub-solid nodular opacities are seen in the left lower lobe, nonspecific, and could represent additional sites of disease.
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Generate impression based on findings.
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42 year-old female with diffuse abdominal pain, UTI, CVA tenderness to palpation, as well as diffuse body pain. Evaluate for kidney stone versus diverticulitis. Lack of IV contrast enhancement limits evaluation of solid organs.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without pericholecystic inflammatory changes. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Stable nonspecific 1.5-cm hypodensity in the posterior inferior spleen which may be a cyst.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephrolithiasis or ureteral calculus. No hydroureteronephrosis. No perinephric fat stranding or fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis. Appendix is 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 evidence of small bowel obstruction, colitis, or diverticulitis. Appendix is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No nephrolithiasis or ureteral calculus. No hydroureteronephrosis. 2.Cholelithiasis without pericholecystic inflammatory changes.3.No specific findings to account for patient's pain.
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Generate impression based on findings.
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Ms. Jeffries is a 68 years year old female with a personal history of left breast lumpectomy in 2012 for IDC/DCIS followed by chemoradiation therapy. Personal history of lung cancer. Three standard views of both breasts and two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, skin retraction and surgical clips present within the left lumpectomy site. Stable benign intramammary lymph node is present in the right upper outer quadrant. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over both axillae.
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Stable postsurgical changes in the left 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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Headache after craniotomy. There has been interval left frontal craniotomy for resection of a left frontal lobe tumor. There is hyperattenuating material in the resection cavity and a small amount of extraaxial air and fluid deep to the craniotomy flap. There is persistent edema in the left frontal lobe, but decreased effacement of the lateral ventricles. There are mixed solid and cystic tumors in the right frontal lobe with extensive vasogenic edema. There is no significant midline shift or herniation. The mastoid air cells are clear. There is persistent scalp swelling overlying the craniotomy flap. Skin staples are present.
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1. Interval to left frontal craniotomy for resection of a left frontal lobe metastasis, with a small amount of hemorrhage in the surgical bed and persistent surrounding vasogenic edema. Otherwise, assessment for residual tumor is limited on non-contrast CT.2. Unchanged right frontal lobe metastases and associated vasogenic edema.
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Generate impression based on findings.
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5-year-old male with Li-Fraumeni syndrome. LIVER: The liver measures 11.3 cm in length and demonstrates appropriate parenchymal echogenicity. No focal mass lesion or intrahepatic biliary duct dilatation is evident. The main portal vein is patent demonstrating hepatopetal flow with a velocity of 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There is no evidence of gallbladder wall thickening, pericholecystic fluid or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 6.9 cm in length.KIDNEYS: The right kidney measures 8.2 cm in length and the left kidney measures 8.4 cm in length, both of which demonstrate appropriate echogenicity. There is no evidence of hydronephrosis or focal mass lesion within the renal parenchyma. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.
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Normal examination.
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Generate impression based on findings.
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There is no diffusion abnormality to suggest acute infarct. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Bilateral proptosis is noted. No retrobulbar lesions are evident.MRA HEAD
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1. No evidence of acute infarct, intracranial mass, or mass effect.2. Mild chronic small vessel ischemic changes.3. Mild bilateral proptosis.
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Generate impression based on findings.
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BRAIN:There is a moderate degree of periventricular and subcortical white matter changes in a pattern suggestive of MS. A few of these lesions seen previously are slightly less prominent. There is a new lesion in the left posterior medulla which shows enhancement. No abnormal enhancement or diffusion is seen throughout the remainder of the brain. There is global atrophy including thinning of the corpus callosum.The ventricles are unchanged in morphology. The cisterns remain patent. There is no midline shift or mass effect. Mild mucosal thickening of the left maxillary sinus. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Cervical spine:Vertebral body heights are preserved with straightening of the cervical spine, unchanged. No abnormal marrow signal. There is a large lesion of increased T2 signal in the posterior cord extending from C5 to C6 as well as a smaller more focal lesion within the left hemicord at C7 level. These lesions are similar to prior.C2-C3: No significant spinal canal or neural foraminal stenosis.C3-C4: No significant spinal canal or neural foraminal stenosis. C4-C5: Disk osteophyte complex producing mild effacement of the ventral thecal sac and mild left-sided neuroforaminal stenosis, unchanged.C5-C6: Disk osteophyte complex protruding into the left neuroforaminal producing moderate left neural neuroforaminal stenosis. No central canal stenosis. C6-C7: No spinal canal or neuroforaminal stenosisC7-T1: No spinal canal or neuroforaminal stenosis.
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1.Multiple T2 hyperintense lesions involving the supra- and infratentorial white matter are consistent with known demyelinating disease. Compared to 10/16/2014, there is development of a new lesion in the left dorsal medulla with enhancement suggestive of active demyelination.2.Multiple T2 hyperintense lesions within the cervical cord remain unchanged and are consistent with chronic demyelinating plaques. No new cervical lesions.3.Degenerative changes of the cervical spine with left-sided neural foraminal stenosis at C4-C5 and C5-C6 are unchanged.
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Generate impression based on findings.
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77-year-old male with history of right radical nephrectomy and left partial nephrectomy. Evaluate for disease. ABDOMEN:LUNG BASES: Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: Diffuse hepatic parenchymal calcifications are likely sequela of prior granulomatous disease.SPLEEN: Splenic calcifications, likely sequela of prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval right nephrectomy and partial left nephrectomy. No soft tissue within the right postoperative bed or left kidney to suggest residual disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland measuring 6 x 6 cm again noted. Prominently right-sided mass at the bladder base is again noted and may be a median lobe.BLADDER: Thickened bladder wall is likely post obstructive. Prominently right-sided mass at the bladder base is again noted and may be a median lobe. However, it is indistinguishable from a bladder mass given mildly irregular margins as best appreciated on coronal series, image 57.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Postoperative changes of right radical and partial left nephrectomy without evidence of residual disease.2.Bladder wall thickening with a right-sided mass which may be a prominent prostatic median lobe; however, cystoscopy is recommended to exclude of primary bladder mass.
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Generate impression based on findings.
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14-year-old male with painVIEWS: Right hand PA, oblique and lateral (3 views) 01/16/15 No acute fracture or malalignment is evident.
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No acute fracture or malalignment is evident.
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Generate impression based on findings.
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14 year old female with Li-Fraumeni syndrome. LIVER: The liver measures 13.4 cm in length and demonstrates appropriate parenchymal echogenicity. No focal mass lesions are identified. There is no evidence of intrahepatic biliary ductal dilatation. The main portal vein is patent, demonstrating hepatopetal flow with a velocity of 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There is no evidence for extrahepatic biliary ductal dilatation or gallbladder wall thickening.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 10.0 cm in length.KIDNEYS: The right kidney measures 11.2 cm in length and the left kidney measures 11.2 cm in length, both demonstrating appropriate cortical echogenicity. There is no hydronephrosis or mass lesion within the renal parenchyma.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.
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Normal examination.
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Generate impression based on findings.
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Male 51 years old; Reason: bone scan abnormalities with a history of RCC History: as above There is persistent increased radiotracer uptake in the posterior right and left sixth ribs, as well as the anterolateral seventh rib which correlate with the nonspecific sclerotic rib lesions seen on same day CT study, however appearance is unchanged compared to prior bone scan. There is also persistent radiotracer uptake in the right parietal bone of the skull also not significantly changed. Uptake in the mid to lower thoracic spine correlates with degenerative changes seen on same-day CT study and are stable compared to prior bone scan. Uptake in the lower lumbar vertebral bodies also correlates with degenerative changes on CT and are stable compared to prior bone scan.There has been interval right knee arthroplasty.
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Right skull and bilateral ribs lesions are equivocal and may represent osseous metastatic disease or a benign process. However, the appearance is stable and there are no new suspicious osseous lesions. FDG-PET may be useful for further evaluation for potential osseous and soft tissue metastatic disease if clinically warranted.
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Generate impression based on findings.
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Ms. Graves is a 84 year old female with a personal history of left breast lumpectomy in 2001 for IDC followed by radiation therapy. Family history of breast cancer in her sister diagnosed at the age of 50. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and minimal skin retraction present within the left lumpectomy site. Right retroareolar asymmetry is stable when compared to prior exams. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the left 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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Seven year old female status post corrective osteotomy.VIEWS: Left forearm AP and lateral (two views) 1/16/2015 Interval removal of the cast. Compression plate and screw devices again traverse bilateral osteotomies of the mid radial and ulnar diaphyses, with increasing indistinctness of the osteotomy lines and associated periosteal reaction compatible with healing. The bones of the forearm are in near-anatomic alignment.
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Interval removal of the cast with healing osteotomies in near anatomic alignment.
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Generate impression based on findings.
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Alignment is lordotic. 5 lumbar type vertebrae are noted. There is slight increase in the grade 1 anterolisthesis of L4 on L5 compared to the previous exam. The marrow signal is benign. Diffuse disc desiccation is noted, most prominent at the L4-5 and L5-S1 levels where there is persistent slight decrease in disc height. The conus is normal in signal and morphology and terminates at the superior aspect of L1. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: No evidence of a disk bulge. No significant spinal canal or neuroforaminal stenosis. This is unchanged compared to previous exam.L2/3: No evidence of a disk bulge. No significant spinal canal or neuroforaminal stenosis. This is unchanged compared to previous exam.L3/4: There is mild broad disk bulge with facet arthrosis and ligamentum flavum thickening, which narrows bilateral neuroforamina, right more prominent than left. Note is made of a new small right facet effusion. The bulging disk indents the ventral aspect of the thecal sac without evidence of central canal stenosis. This is unchanged compared to previous exam.L4/5: There is grade 1 anterolisthesis of L4 on L5 which has slightly progressed. Disk bulge along with extensive ligamentum flavum thickening causes moderate to severe spinal canal stenosis, measuring 6 mm in AP direction which has progressed slightly compared to the previous exam. The prominent bilateral ligamentum flavum thickening and facet hypertrophy cause bilateral lateral recess stenosis and moderate neuroforaminal stenosis, left more prominent than right.L5/S1:There is diffuse disk bulge and smaller posterior central disk protrusion without compromise of the central canal. Bilateral ligamentum flavum thickening and facet hypertrophy along with bulging disk cause narrowing of bilateral neural foramina.SI Joints: The sacroiliac region is unremarkable.
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Degenerative disease of lumbar spine as described above which has progressed slightly at the L4-5 level with a slight increase in the grade 1 anterolisthesis and slight progression of the spinal canal stenosis/neuroforaminal narrowing.
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Generate impression based on findings.
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Reason: h/o lung and rectal ca, now s/p 6 cycles platinum therapy and 3 cycles "maintenance" therapy eval response to chemo, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Small nonspecific solid and non-solid nodules in the apical regions, unchanged from previous.Persistent right pleural effusion, mainly subpulmonic and possibly loculated, with a pleural drain in place, not significantly changed. The pleura is thickened and enhanced which may be due to tumor or inflammation.Status post right upper lobectomy and increased atelectasis in the right middle lobe compared to previous.New masslike soft tissue opacity medially at the right base contiguous with a cardiac border and anterior chest wall, measuring approximately 24 x 66 mm (series 3/76), suspicious for tumor recurrence. Adjacent reticulonodular interstitial opacity is suggestive of lymphangitic spread of tumor.MEDIASTINUM AND HILA: No significant lymphadenopathy.Catheter tip at the SVC/RA junction.Mild coronary artery calcification.No pericardial effusion.CHEST WALL: Sclerotic focus in the left pedicle of T9, T4 and in the medial left fourth rib, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: 8mm nonspecific hypodensity in the right lobe, unchanged. Additional smaller hypodensities are also unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Previously described sclerotic lesions in the sacroiliac joints are not included in the current scan.OTHER: No significant abnormality noted.
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New masslike opacity medially at the right lung base suspicious for tumor recurrence, and less likely infection, with adjacent interstitial opacity compatible with lymphangitic spread of tumor.
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Generate impression based on findings.
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Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or right neural foramina. There is moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C3-4: Small disk osteophyte complex with left uncovertebral hypertrophy. There is moderate to severe left neural foraminal stenosis. Mild spinal canal stenosis with effacement of the left ventral thecal sac. No right neural foraminal narrowing.C4-5: No significant spinal canal narrowing. Mild bilateral neural foramina narrowing, relatively worse on the left related to facet arthropathy.C5-6: No significant spinal canal stenosis. Mild bilateral neural foramina stenosis.C6-7: Disk osteophyte complex with bilateral uncovertebral hypertrophy. There is severe bilateral neural foraminal. There is mild spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. Minimal bilateral foramina narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.THORACIC SPINE
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1. Degenerative changes in the cervical, thoracic, and lumbar spine as detailed above.2. Mild cervical spinal canal stenosis at C3-4 and C6-7. There is severe neural foraminal stenosis at C6-7 bilaterally.3. Mild narrowing of the spinal canal in the thoracic spine at T10-T11 on the right.4. Congenital spinal stenosis in the lumbar spine with superimposed degenerative changes. At L2-3, there is a left paracentral disk protrusion and annular fissure. There is associated effacement of the left lateral recess and mild to moderate central canal stenosis. Multilevel lumbar mild to moderate neural foraminal narrowing as above.
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Generate impression based on findings.
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Thymic neuroendocrine carcinoma, status post resection. There are postoperative findings in the upper mediastinum and subtotal thyroidectomy. There is a right lower paratracheal lymph node that measures approximately 8 mm in short axis. The salivary glands are unremarkable. There are tonsilloliths. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures and orbits are unremarkable. There is interval consolidation of the lung apices.
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1. Postoperative related to thymic tumor resection and subtotal thyroidectomy with an unchanged lower right paratracheal lymph node that corresponds to the pathology-proven metastatic lymph node. 2. Interval consolidation of the lung apices suggestive of radiation fibrosis. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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Ms. Bell is a 55 year old female with a personal history of right breast lumpectomy in 2011 for IDC followed by radiation and hormonal therapy. She has no current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear markers were placed on scars overlying the right breast and axilla. There are stable postsurgical changes including architectural distortion, increased density, skin retraction and surgical clips present within the right lumpectomy site. Focal asymmetry in the right retroareolar region is stable when compared to prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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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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Female 17 years old; Reason: bone scan of lumbar. Per patient, has chronic low back pain, repetitive stress from competitive dancing. No abnormal osteoblastic activity was identified to suggest significant osseous pathology; specifically no abnormal activity was identified in the lumbar spine.Thank punctate focus in the left hemipelvis correlates to scan artifact in the left gluteal region.
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Unremarkable exam. No evidence of spondylolysis or other explanation for the patient's low back pain.
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Generate impression based on findings.
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Pain. Rule out fracture. There is swelling of the soft tissues of the lateral aspect of the ankle. I see no underlying fracture. Small spurs project from the talus, likely degenerative in etiology. There may be a small tibiotalar joint effusion. There is a large os peroneum, a normal variant.
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Soft tissue swelling and other findings as above, without fracture evident.
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Generate impression based on findings.
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Cough, shortness of breath LUNGS AND PLEURA: Subtle reticulonodular subpleural opacities with slight basilar predominance. Very small subpleural cysts consistent with traction bronchiectasis secondary to fibrosis. No focal air space opacities or pleural effusions. No significant air trapping. MEDIASTINUM AND HILA: Severe coronary calcifications. Scattered atherosclerotic calcifications of the aortic arch. Small hiatal hernia. CHEST WALL: T7 vertebral body hemangioma.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatomegaly and hepatic steatosis partially imaged.
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1.Mild subpleural reticulonodular opacities with small subpleural cysts consistent with traction bronchiectasis secondary to fibrosis. These findings are suggestive of mild UIP and less likely fibrosing NSIP. 2.Hepatomegaly and hepatic steatosis partially imaged.
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Generate impression based on findings.
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3-year-old female with NF1 for evaluation if there is a retroperitoneal lesion.EXAMINATION: MR of the abdomen and pelvis 1/16/15 No pleural effusion. No focal hepatic lesions. There is no hydronephrosis or perinephric inflammation. The spleen is within normal limits. The gallbladder is within normal limits. There is a large amount of stool within the rectum. The bladder is well distended and within normal limits. No mass lesions are evident within the abdomen and pelvis. The osseous structures are within normal limits. No abnormal foci of T2 hyperintensity.
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1.No retroperitoneal mass as clinically questioned. 2.Large amount of stool within the rectum.
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Generate impression based on findings.
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55-year-old male with history of metastatic renal carcinoma. Evaluate for progression of disease. Additional history of VATS and left chest exploration with mediastinal dissection. Left lower lobe resection. CHEST:LUNGS AND PLEURA: Right lower lobe reference nodule (5/64) is unchanged in size, currently 5 x 6 mm. Post operative findings of left lower lobectomy are again noted, and there has been interval increased rim enhancing pleural based nodularity, some of which demonstrate chest wall invasion. A representative left lower thorax chest wall lesion (3/57) measures 26 x 29 mm. Minimal pleural fluid on the left. Left upper lobe nodule (5/33) is unchanged in size at 5 mm.MEDIASTINUM AND HILA: Reference AP window lymph node (3/43) is unchanged in size, measuring 12 x 8 mm.Additional mediastinal lymph nodes are unchanged in size. Heart size within normal limits, and no pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Aforedescribed left lower lung pleural based lesions with invasion of the chest wall. Degenerative changes affect the visualized spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postoperative findings of left nephrectomy. No convincing evidence of tumor recurrence in the left nephrectomy bed. Small right midpole renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Progression of disease, with left lung base enhancing pleural nodules, and chest wall invasion as above.
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Generate impression based on findings.
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Female 26 years old; Reason: subclinical hyperthyroidism and thyroid nodules, evaluating for toxic nodules The thyroid images demonstrate mild uniform inappropriately elevated uptake in a gland of normal size and configuration. The 4-hour radioactive iodine uptake is 14.4% and the 24-hour uptake is 34.1% (normal range 10-30% at 24-hours). No hot or cold nodules are identified.
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1. Uniform mildly increased uptake in the thyroid gland, which particularly in the setting of suppressed TSH levels is inappropriately elevated and suggestive of mild Graves' disease.2. No hot or cold nodules are visualized, therefore the known nodules seen on prior ultrasound remain indeterminate for malignancy.
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Generate impression based on findings.
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Pain after ski injury Four views of the left knee are provided. I see no fracture, malalignment or joint effusion.The right knee appears normal as seen on the frontal views.
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No findings to account for patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered.
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Generate impression based on findings.
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Right facial swelling, pain, blurry vision, 1 month of sinus drainage. There are caries involving ADA # 2, 4, 12, 15, 29, 30, 31, many of which have associated periodontal lucencies. The salivary glands are unremarkable. There is no significant lymphadenopathy in the upper neck. There are small probable retention cysts in the left maxillary and right frontal sinuses. The paranasal sinuses are otherwise clear. There is nasal septal deviation directed to the right. The nasal cavity is otherwise clear. The orbits and imaged intracranial structures are unremarkable.
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1. Multiple dental caries many of which are associated with periodontal disaease, but no evidence of soft tissue abscess.2. Small probable retention cysts in the left maxillary and right frontal sinuses. The paranasal sinuses are otherwise clear.
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Generate impression based on findings.
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History of movement disorder. Evaluate for thymoma. LUNGS AND PLEURA: Left basilar scarring/atelectasis. No focal air space opacities, suspicious nodules/masses, or pleural effusions.MEDIASTINUM AND HILA: Small amount of nodular soft tissues present in the anterior mediastinum has significantly decreased in comparison with the 2010 examination, consistent with minimal residual thymic tissue. No discrete nodules or masses to suggest thymoma. No lymphadenopathy. Severe coronary calcification.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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Fatty involution of the thymus since the prior examination from 2010, with minimal residual thymic tissue. No evidence of thymic hyperplasia or thymoma.
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Generate impression based on findings.
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Status post prostalac for infected left total shoulder. Evaluate hardware. Components of a left total shoulder arthroplasty device are situated in near anatomic alignment. Thin lucency at the interface of the glenoid component with the underlying bone appears similar to that seen on prior studies and is of doubtful clinical significance. Mild osteoarthritis affects the acromioclavicular joint.
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Total shoulder arthroplasty as above.
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Generate impression based on findings.
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Postop Again seen is deformity of the right hip joint with absence of the femoral head and neck and disarticulation of the proximal femur with respect to the acetabulum. Multiple foci of heterotopic bone are again noted in the right hip region, a couple of which may have been resected when compared with the prior study. The margins of one of the foci of heterotopic ossification along the medial aspect of the proximal femur are slightly indistinct, and hence I cannot exclude the possibility of osteomyelitis of this fragment. There are skin staples along the lateral aspect of the hip with irregularity of the underlying soft tissues that presumable represents wound. Deformity of the obturator ring and acetabulum appears similar to prior study likely representing sequela of prior osteomyelitis.
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Right hip disarticulation with heterotopic bone formation and postoperative changes as described above. The margins of one fragment of heterotopic bone along the medial aspect of proximal femur are slightly indistinct and hence I cannot exclude the possibility of osteomyelitis of this fragment. If further imaging evaluation is clinically warranted CT of the hip could be considered.
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Generate impression based on findings.
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Reason: Assess reported small aneurysm MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 3mm broad necked right PCOMA infundibulum present. It is stable since the 11/20/2013 CTA. The right PCOMA is tiny.There is extracranial origin of the left posterior inferior cerebellar artery. The posterior communicating arteries are identified a very small. The anterior communicating artery is medium sized. The vertebral arteries are similar in diameter. The left A1 segment is larger than the right A1 segment There are focal areas of narrowing along the intracranial portion of the right vertebral artery with 60% narrowing.There is extra-cranial origin of the left PICA.
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1.60% focal narrowing of the distal right vertebral artery intracranially.2.There is a 3mm broad necked right PCOMA infundibulum present. It is stable since the 11/20/2013 CTA. The right PCOMA is tiny.
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Generate impression based on findings.
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51-year-old male with a history of renal cancer who presents for follow up. Evaluate. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Few scattered micronodules are unchanged. Mild bilateral basilar atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: Severe compression deformity of T8 is unchanged. Additional few mild compression deformities involving the thoracic spine are stable.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy without soft tissue within the post surgical bed to suggest disease recurrence. No hydroureteronephrosis on the left.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent retroperitoneal and iliac chain lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe compression deformity of T8 is unchanged. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Nonspecific mildly prominent retroperitoneal and iliac chain lymph nodes are stable.BOWEL, MESENTERY: Postoperative changes about the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of disease recurrence or metastatic disease.
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Generate impression based on findings.
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44-year-old female status post left shoulder revision. Overlying splint material limits fine osseous detail. Hardware components of a total shoulder arthroplasty are in gross anatomic alignment without radiographic evidence of hardware complication. There is a cortical step off along the proximal humerus which may reflect fracture or osteotomy. Catheter tubing overlying the upper chest likely represents an intrascalene nerve block.
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Postoperative changes of total shoulder arthroplasty as above.
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Generate impression based on findings.
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24 years, Female. Reason: assess stool burden History: constipation Large stool burden, increased from prior study. Nonobstructive bowel gas pattern. Surgical clips noted at right abdomen. Degenerative changes of the symphysis pubis.
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Large stool burden, increased from prior study. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Female 73 years old; Reason: Focal uptake? History: Multinodular goiter, tracheal deviation, low TSH The thyroid images demonstrate an enlarged gland with multiple hot and cold nodules bilaterally. No dominant suspicious cold nodule is seen. 4-hour radioactive iodine uptake is 10% and the 24-hour uptake is 15% (normal range 10-30% at 24-hours). Although the global uptake is within normal limits, in the setting of a suppressed TSH level, this is inappropriately elevated.
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1. Findings consistent with toxic multinodular goiter.2. No dominant cold nodule is seen on scintigraphy, although correlation with ultrasound and physical exam is suggested if there is concern for malignancy.
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Generate impression based on findings.
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55-year-old male with cough, shortness of breath. Evaluate interstitial lung disease. LUNGS AND PLEURA: Innumerable small pulmonary nodules throughout both lungs in an overall random and uniform distribution. The vast majority of these nodules measure a few millimeters in diameter. There is some consolidation in both lung bases most prominent on the left, where there is also interposed groundglass opacity. There are no pleural effusions. There is no significant air trapping on expiratory images. MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes, with reference paratracheal node measuring 10 mm in short axis (series 3 image 22). Mild coronary calcification. 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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1. Innumerable small bilateral pulmonary nodules as described above with a wide differential diagnosis. Considerations include granulomatous infection including mycobacterial and fungal etiologies, sarcoidosis, and varicella pneumonia. Less likely possibilities include inhalational disease/pneumoconiosis or metastatic disease, especially in the absence of a known primary malignancy. 2. Basilar consolidation and groundglass opacities greater on the left may represent superimposed infection or aspiration, depending on the clinical presentation.
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Generate impression based on findings.
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Reason: Patient w/ fever, leukocytosis, ?aspiration, h/o pancreatic ca, eval for pneumonia vs mass History: sob, cough, fever, leukocytosis LUNGS AND PLEURA: Patchy bilateral basilar opacities, with consolidation containing air bronchograms in the lingula region of the left upper lobe, and in the left lower lobe.Subsegmental atelectasis is seen in both lower lung zones.No significant sized pleural effusion. Focal pleural calcification is seen anteriorly on the right.MEDIASTINUM AND HILA: Multiple mediastinal lymph nodes remain within normal size limits and are unchanged.Severe coronary artery calcifications are present, the heart and pericardium otherwise unremarkable in appearance.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Surgical clips from cholecystectomy, and clips related to pancreatic resection are present.
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Basilar opacities suggestive of infection involving the lingula and left lower lobe, although aspiration could be another possible etiology.
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Generate impression based on findings.
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Shoulder pain Mild osteoarthritis affects the glenohumeral joint, and moderate osteoarthritis affects the the acromioclavicular joint. There is spurring of the anterior aspect of the acromion process. The bones appear slightly demineralized.
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Osteoarthritis.
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Generate impression based on findings.
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77 years, Male. Reason: Evaluate for gastric distention History: pain with tube feeds Gastrostomy tube noted overlying the gastric body without significant gaseous distention, minimal gas seen in the fundus. Small to moderate stool burden. Nonobstructive bowel gas pattern. Degenerative disease of the spine.
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Gastrostomy tube in region of gastric body.
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Generate impression based on findings.
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Hip pain status post total hip replacement Components of a total hip arthroplasty device are situated in near anatomic alignment without specific radiographic evidence of hardware complication. Mild cortical thickening along the tip of the femoral component is of doubtful significance, as is thin lucency along the tip of the prosthesis. A couple of small foci of heterotopic ossification have formed above the greater trochanter.
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Total hip arthroplasty in near-anatomic alignment.
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Generate impression based on findings.
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6 year old male with pain and discoloration of the 3rd finger after car door slammed onto his handVIEWS: Right 3rd finger AP, oblique, lateral (3 views) 1/16/15 No acute fracture or malalignment is evident.
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No acute fracture or malalignment is evident.
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Generate impression based on findings.
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Tx(3,4)N2cM0 supraglottic squamous cell carcinoma status post treatment. There are post-treatment findings in the neck, with diffuse mucosal edema and patchy enhancement at the site of the treated supraglottic tumor, with mild airway narrowing. However, there is no discernible measurable tumor in the supraglottic region. There is no evidence of significant cervical lymphadenopathy by size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. There are retention cysts in the bilateral maxillary sinuses. There is biapical pulmonary scarring.
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Post-treatment findings in the neck, but no evidence of measurable residual supraglottic tumor or significant lymphadenopathy in the neck.
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Generate impression based on findings.
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There are no areas of abnormal signal. No intracranial mass or mass-effect. No evidence of heterotopic gray matter or cortical dysplasia. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or herniation. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Images of the temporal lobes demonstrate normal size, signal, and preserved internal architecture involving the hippocampi without evidence of mesial temporal sclerosis.
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MRI of the brain appears within normal limits for age. No findings to suggest seizure focus.
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Generate impression based on findings.
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Status post fixation Again seen is an intramedullary rod and screw device affixing a comminuted oblique fracture of the distal femoral metadiaphysis in near anatomic alignment. There has been progression of callus formation along the fracture indicating some healing. I see no hardware complications. Moderate osteoarthritis of the knee.
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Fixation of healing distal femoral fracture.
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Generate impression based on findings.
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Ms. Rucker is a 64 year old female with a strong family history of breast cancer in sister, mother, maternal aunt, and maternal grandmother. She has no current breast related complaints. Dense tissue noted on exam, but no focal palpable area of concern in stated. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. A few scattered benign calcifications are seen.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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61 year-old male with history of thymic neuroendocrine cancer status post resection and chemoradiation two years ago. Recent recurrent disease with completion of proton radiotherapy and chemotherapy on 8/27/2014. CHEST:LUNGS AND PLEURA: Interval development of left upper lobe radiation fibrosis with associated volume loss. The left upper lobe fibrosis obscures the previously seen lingular and left upper lobe nodules. Right-sided paramediastinal radiation fibrosis is slightly increased and obscures the previously seen right apical nodule. Left paramediastinal radiation fibrosis is similar in appearance to prior exam. Calcified granuloma in the left upper lobe. No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Stable postsurgical changes in the thyroid bed. Normal cardiac size without evidence of pericardial effusion.CHEST WALL: Marked degenerative changes in the thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis unchanged.SPLEEN: Multiple calcified granulomasADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable hypodense renal lesions likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Post surgical changes at the gastroesophageal junction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Expected progression of bilateral radiation fibrosis which obscures the previously seen bilateral upper lobe nodules.Postsurgical changes without definite evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.Right lower lobe micronodules remain unchanged.Mild apical scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No coronary calcifications are seen, the heart and pericardium otherwise unremarkable.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic cyst like hypodensities, too small to characterize but likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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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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55-year-old male with history of foot wounds. Evaluate for osteomyelitis. Left foot: Overlying bandage material is present which slightly limits evaluation. There is no specific radiographic evidence of acute osteomyelitis. There has been a fourth toe amputation. There are deformities at the bases of the second and third metatarsals, the fifth metatarsal diaphysis, the cuneiform bones as well as the navicular which may reflect old trauma or perhaps the sequela of neuropathic arthropathy. There is mild diffuse soft tissue swelling. Arterial calcifications are present.Right ankle: Overlying bandage material is present which slightly limits evaluation. There is mild soft tissue swelling about the ankle. There is no specific radiographic evidence of acute osteomyelitis. There has been amputation through the mid fifth metatarsal diaphysis. Mild osteoarthritis affects the ankle and midfoot. Small ossicles adjacent to the medial malleolus may represent chronic fractures. Widening of the lateral aspect of the ankle mortise on the oblique view may represent ligamentous laxity, but we see no acute fracture. There are scattered arterial calcifications.
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No specific radiographic features of acute osteomyelitis. Postoperative/posttraumatic changes and other findings as above.
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Generate impression based on findings.
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Reason: Eval new RUL pulmonary nodule History: CXR with new pulm nodule LUNGS AND PLEURA: Diffuse severe centrilobular emphysema, most severe in the right lower lobe.Spiculated subpleural right upper lobe nodule measuring 16 x 14 mm with adjacent pleural retraction, highly suspicious for primary lung carcinoma (series 5/27).Smoothly marginated but slightly irregular solid nodule further inferiorly in the right middle lobe measuring 13 x 12 mm (series 5/45).Small bilateral pleural effusions, partially loculated in the left major fissure.MEDIASTINUM AND HILA: Enlarged right lobe of the thyroid gland. Calcified lower paratracheal and subcarinal lymph nodes.Enlarged lymph node measuring 10 mm in short axis in the right cardiophrenic angle, adjacent to the inferior vena cava (series 3 slice 67).Severe coronary artery calcification.Enlarged main pulmonary artery measuring 36 mm, suggestive of pulmonary hypertension.No pericardial effusion.CHEST WALL: Superior end plate depression at L1 and otherwise very mild degenerative spinal disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation showing vascular calcification and partially visualized kidneys with irregular cortical margins and adjacent fat stranding.
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1.Highly suspicious 16mm subpleural right upper lobe spiculated nodule, most compatible with primary carcinoma. 2. More smoothly marginated indeterminate 13-mm nodule in the right upper lobe which is also moderately suspicious for primary carcinoma though the differential diagnosis includes hamartoma and metastasis.3. Enlarged lymph node in the right cardiophrenic angle, and no other specific evidence of metastatic disease, though a PET scan is recommended for further evaluation.
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Generate impression based on findings.
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Pain Three views of the right shoulder are provided. The glenohumeral joint appears normal. The acromioclavicular joint appears slightly widened, with small osteophytes along the distal end of the clavicle, appearing similar to prior studies. Cyst formation in the superior aspect of the humeral head is similar to that seen on prior studies. A tiny focus of mineralization along the greater tuberosity may represent residual calcification at the rotator cuff insertion, but is of questionable current clinical significance. Note is made of broken sternotomy wires, with a fragment projecting over the clavicular head. Leads of a the cardiac conduction device are incompletely imaged on this study.Three views of the left shoulder are provided. The glenohumeral joint appears normal. Small cysts are noted in the humeral head. The acromioclavicular joint appears slightly widened, with small osteophytes projecting from the distal end of the clavicle. Portions of the shoulder are obscured by an overlying cardiac conduction device.
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Degenerative arthritic changes of the shoulders and other findings as described above.
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Generate impression based on findings.
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Follow-up of metastatic thyroid carcinoma, BRAF +, on vemurafenib. Neck: There are stable postoperative findings related to total thyroidectomy. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The salivary glands are unchanged. The left internal jugular vein is absent, but the other major cervical vessels are patent. The osseous structures are unchanged. The left vocal cord has an unchanged appearance. The airways are patent. The imaged intracranial structures are unremarkable. There are multiple micronodules in the partially imaged lungs, which appear unchanged. There is an unchanged small left cheek excrescence. There are bilateral lens implants.Head: There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Stable findings related to thyroidectomy without evidence of measurable tumor recurrence or significant lymphadenopathy in the neck.2. Multiple micronodules in the partially-imaged lungs. Please refer to the separate chest CT report for additional details.3. No evidence of intracranial metastases.
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Generate impression based on findings.
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Abnormal PFTs, evaluate for ILD. History of dyspnea. LUNGS AND PLEURA: Motion artifact degrades image quality, somewhat limiting evaluation. Within this limitation, no pulmonary masses or nodules are appreciated. Compressive atelectasis in the left lower lobe, both in the posterior costophrenic angle region (4/85) and anteriorly abutting the left hemidiaphragm (4/77), lobe is sure lesion in the Chance fracture is a of a air in the the right base resolves upon prone positioning. Single thin-walled cysts in the lower lobes bilaterally (4/74). Minimal centrilobular emphysema. No pleural fluid or pneumothorax. No honeycombing.Expiration sequence produces intermittent collapse of segmental level airways in the lower lobes (7/53), while the posterior tracheal membrane is bowed anteriorly. The cervical trachea appears narrowed above the level of hyoid bone, incompletely included within the scanning range.MEDIASTINUM AND HILA: Mildly prominent lytic or nonspecific calcification in the left thyroid lobe. Left subclavian ICD with leads in the right atrial appendage and right ventricular apex.Severe multichamber cardiomegaly. Enlargement of the main pulmonary artery to 4.2-cm in transverse dimension.Upper normal to mildly enlarged mediastinal lymph nodes bilaterally, some of which contain calcifications, suggestive of healed granulomatous disease. For reference, a low left paratracheal lymph node measures 16mm (3/35). The native coronary arteries appear heavily calcified.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. The spleen is small and contains multiple calcifications consistent with granulomas. Mild hepatomegaly. Chunky calcification in the liver near the IVC. Heterogeneous attenuation of the peripheral right hepatic lobe, incompletely characterized. The stomach is markedly dilated and filled with debris. Ventral hernia contains mesenteric fat, neck of the hernia is 3-cm (3/11). Enlarged gastrohepatic lymph node, 17-mm (3/91). Large cystic lesion in the posterior right kidney, incompletely characterized.
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1. No evidence of idiopathic interstitial lung disease. 2. Intermittent collapse of the distal airways on the expiration phase sequence may indicate bronchomalacia.3. Severe multichamber cardiomegaly with signs of pulmonary hypertension.4. Ventral hernia containing mesenteric fat.5. Nonspecific mild lymph node enlargement, most likely a result of healed granulomatous disease.6. Bone heterogeneous attenuation pattern in the right hepatic lobe, incompletely assessed. If characterization assessment is required, a hepatic ultrasound may be of use as an initial step.
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Generate impression based on findings.
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Reason: s/p 9 yrs after LUL for management of a T2N0M0 Stage IB adenocarcinoma History: annual f/u LUNGS AND PLEURA: Postoperative changes of left upper lobectomy. Scarlike opacity in the left apex (series 4 image 27) not significantly changed since 2011.Improved left lower lobe consolidation since the recent abdominal CT from 1/8/14. Faint interstitial/ground glass opacities in the left lung base remain with small areas of nodularity such as 7-mm nodular subpleural focus on series 4 image 75. 8mm right upper lobe nodule (series 4 image 35) is increased in size since 2011. Other scattered micronodules appear stable. Right basilar atelectasis/scarring.MEDIASTINUM AND HILA: Severe atherosclerotic and coronary calcification. No new lymphadenopathy.CHEST WALL: Median sternotomy wires. Healed left rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatic and splenic granulomata. Severe atherosclerotic calcification of the aorta and branches.
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1. Improved left lower lobe consolidation since the recent abdominal CT from 1/8/14 suggests resolving infection. Interstitial and mild nodular opacities are likely postinfectious or postinflammatory, however continued follow up is recommended to confirm stability. 2. 8 mm indeterminate subsolid right upper lobe nodule has increased in size since 2011. 12 month CT follow up is recommended. 3. Stable scarlike opacity in the left apex and other chronic findings as described above.
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Generate impression based on findings.
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Ms. Flennoy is a 78 year old female with a personal history of right breast mastectomy in 1981 for cancer. She has no current breast-related complaints. Three standard views of the left breast (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. Scattered benign calcifications, including arterial calcifications, are seen. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. Benign lymph nodes are projected over the left axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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12-year-old female with shoulder pain status post osteomyelitisVIEWS: Left shoulder, internal and external rotation; right knee AP, oblique, lateral; left humerus AP, lateral (7 views) 01/16/15 Left shoulder: No acute fracture or malalignment is evident. Deformity and periosteal reaction of the proximal humerus. Osseous changes related to chronic osteomyelitis of the proximal humeral metadiaphysis.Left humerus: No acute fracture or malalignment is evident. Deformity and periosteal reaction of the proximal left humerus is unchanged.Left knee: No acute fracture or malalignment is evident. No osseous erosions to suggest osteomyelitis. Osseous changes related to chronic osteomyelitis is seen in the distal femoral metaphysis and proximal tibial metaphysis.
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Healing chronic osteomyelitis as described above.
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Generate impression based on findings.
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Low back pain status post MVA For this study I will designate 5 lumbar vertebrae with small hypoplastic ribs at L1. Severe degenerative disk disease affects L5/S1. There is slight loss of height of the L5 vertebral body, but I suspect that this is chronic in etiology as I see no angular deformities to suggest an acute fracture. The remaining intervertebral disk spaces and vertebral body heights are preserved. There is straightening of the lumbar spine, but otherwise alignment is within normal limits.
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Degenerative disk disease.
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Generate impression based on findings.
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Pain Again seen is a comminuted fracture of the distal radius involving the metaphysis and radial styloid. The radial styloid fracture remains visible. Sclerosis along the distal metaphyseal fracture suggests an attempt at healing. There is also a minimally displaced fracture of the ulnar styloid that appears similar to that seen on the prior study accounting for slight positional differences. A fracture of the proximal diaphysis of the fourth metacarpal likewise appears similar to that seen on the prior study accounting for slight positional differences. A previously suspected fracture of the base of the fifth metacarpal is not well seen on the current study. The bones appear demineralized. There is mild diffuse soft tissue swelling. Three views of the left hand reveal the aforementioned fractures. I see no additional fractures. The bones appear demineralized.
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Multiple fractures as described above.
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Generate impression based on findings.
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Reason: reevaluation f/u for LLL cavitary lesion, pulm nodule History: no symptoms LUNGS AND PLEURA: Interval partial resolution of multiple small clustered subpleural nodular and groundglass opacities, likely secondary to infection.A small cavitary nodule at the left base has almost completely resolved with a small scar like residual measuring 9 x 5 mm (series 4/68).Moderately severe upper zone centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.Severe coronary artery and aortic valve calcification.Small sliding hiatal hernia.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Interval decrease or resolution of multiple subpleural nodular opacities, suggestive of infection.2.Stable left lower lobe nodule.3.No new findings.
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Generate impression based on findings.
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50 year old female unable to bear weight. There is mild soft tissue swelling along the lateral aspect of ankle, as well as a tibiotalar joint effusion. On the oblique view, there is slight cortical irregularity along the medial aspect of the distal fibular diaphysis which likely simply represent syndesmotic attachment and is of doubtful current clinical significance. While I see no displaced fracture, a hairline lucency is noted within the distal fibular diaphysis that could conceivably represent a nondisplaced fracture if this corresponds to the site of the patient's pain, but this is equivocal.
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Equivocal hairline fracture of the distal fibular diaphysis as described above. This was discussed with Dr. Jones in the ED by phone at the time of dictation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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12-year-old male status post fracture, evaluate healingVIEWS: Left tibia-fibula AP/lateral (two views) 01/16/15 Interval removal of cast material. Again seen is a spiral fracture through the distal tibial diaphysis. Periosteal reaction and indistinctness of the fracture line is indicative of interval healing. There is apparent bridging at the mid distal tibial physis.
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1.Healing spiral fracture of the distal tibial metaphysis.2.Apparent bridging of the distal tibial physis. If this is true, this may cause leg length discrepancy. Close follow up is recommended.
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Generate impression based on findings.
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56 year-old female with history of lung CA, laryngeal CA, and IgG/lambda monoclonal proteinemia. SKULL: No evidence of lytic lesion.CERVICAL SPINE: No evidence of lytic lesion. There are surgical clips present within the lower neck.THORACIC SPINE: No evidence of lytic lesion. LUMBAR SPINE: No evidence of lytic lesion. Mild degenerative disc disease affects L5-S1. There is facet joint osteoarthritis affecting the lower lumbar spine.RIBS: No evidence of lytic lesion. There is a deformity of the right fifth rib which likely represents a healed fracture.PELVIS: No evidence of lytic lesion. Mild osteoarthritis affects either hip.UPPER EXTREMITY: No evidence of lytic lesion. Mild osteoarthritis affects the acromioclavicular joints bilaterally.LOWER EXTREMITY: No evidence of lytic lesion. There is a small herniation pit present within the left femoral head.
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No lytic lesions are present to suggest osseous metastatic disease. Osteoarthritis and other findings as above.
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Generate impression based on findings.
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Respiratory distress, unilateral effusion question pneumonia. LUNGS AND PLEURA: Bilateral pleural fluid collections, moderate on the right and large on the left. Air space opacities in the superior segment of the right lower lobe (series 5, image 41) consistent with pneumonia. There is a large volume of debris within and near complete occlusion of the left main bronchus and its branches, with resultant compressive atelectasis of much of the left lung. Additionally, there is consolidation within the nondependent aspect of the left lower lobe (5/71 which is suspicious for postobstructive pneumonia. Scattered small 2-3 mm micronodules (noncalcified) noted on the right.MEDIASTINUM AND HILA: Dependent debris in the trachea, left main bronchus and its branches, near occlusive on the left.The thoracic esophagus appears enlarged from approximately the level of the top of the aortic arch to the left main bronchus level, measuring 2.3 by 2.8-cm in transaxial dimensions. The esophageal lumen is unopacified. There is mass effect upon the trachea which is displaced slightly anteriorly by the esophagus.Atherosclerotic calcification of the aorta and its branches. Moderate volume of pericardial fluid. Mitral annulus calcification. Aortic valve calcification. Severe coronary artery calcification.CHEST WALL: Thoracic kyphosis and degenerative changes of the spine. Severe degenerative changes of the right humeral head and glenohumeral joint.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Heterogeneous appearance of the spleen with bandlike areas of hypoattenuation suspicious for infarcts but incompletely assessed. Granulomas in the liver and spleen.
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1. Extensive endoluminal debris within with near complete occlusion of the left main bronchus and its branches.2. Bilateral areas of pneumonia, both within the right lower and left lower lobes, appearing more acute on the right.3. Masslike proximal to mid thoracic esophageal enlargement; an underlying esophageal neoplasm or esophagitis may produce this appearance and should be excluded when feasible.4. Moderate right and large left pleural fluid collections.5. Hypoattenuation within the spleen in a pattern suspicious for infarcts.6. Cardiomegaly with moderate volume of pericardial fluid.Above findings and recommendations discussed with and acknowledged by Dr.Xiao (4174) on 1/16/2018 at 11: 25 a.m.
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Generate impression based on findings.
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62-year-old female with history of pain. Left hip: Mild osteoarthritis affects the left hip. There is no acute fracture.Pelvis: The bones are demineralized suggesting osteopenia/osteoporosis. Mild degenerative disc disease affects the visualized lower lumbar spine. There is a single surgical clip projecting over the left aspect of the pelvis.Left knee: There are tricompartmental osteophytes and medial joint space narrowing compatible with moderate osteoarthritis. Moderate osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis of the hip and knee.
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Generate impression based on findings.
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Reason: 16 years s/p LUL History: 16 years s/p LUL LUNGS AND PLEURA: Postoperative changes of left upper lobectomy. Interstitial and nodular opacities throughout the residual left lung are not changed since the prior study and are most consistent with postoperative/postinflammatory etiologies. Previously measured nodular opacity in the left upper lung zone measuring 6 mm is not significantly changed (series 4 image 29). No new suspicious nodules or masses are identified. Scattered micronodules in the right lung and right basilar atelectasis are also unchanged. Right basilar pleural calcifications. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild coronary arterial calcifications.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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Status post left upper lobectomy with stable nodular and interstitial opacities which are most likely postinflammatory and/or postoperative in etiology.
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Generate impression based on findings.
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Female 18 years old Reason: Liver with doppler, hepatic veins and portal vascular History: abnormal LFTs LIVER: The liver has a smooth contour. Liver measures 14.9 cm in length. The parenchyma is mildly echogenic. No focal hepatic lesions.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 3 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.2 cm. in length. OTHER: No significant abnormalities noted.
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1.Mild echogenic hepatic parenchyma possibly due to fatty infiltration. 2.Patent hepatic vasculature with appropriately directed flow.
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Generate impression based on findings.
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Difficulty defecating, history of fibroid uterus There is prompt opacification of the rectum of normal static morphology. Apparent circumferential narrowing at level of rectosigmoid colon most likely normal peristalsis (series 5). Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed appropriate passage of rectal contents, no significant rectal prolapse seen, no rectocele seen.
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No significant rectal prolapse.
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Generate impression based on findings.
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Reason: post op day 3 s/p duodenal fistula repair, please evaluate repair, assess for a leak Scout radiograph shows postsurgical changes. Nasogastric tube side port in first portion of the duodenum, tip located in third portion of duodenum. Bilateral nephrostomy tubes are partially seen. Prompt contrast opacification of portions of duodenum and proximal jejunum, no evidence of abnormal contrast extravasation to suggest a leak, no fistula seen. Reported site of surgery (in distal duodenal area/near duodenojejunal junction) satisfactory in appearance. TOTAL FLUOROSCOPY TIME: 1:02 minutes
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Prompt contrast opacification of duodenojejunal junction, no evidence of leak or fistula.
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Generate impression based on findings.
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63-year-old male with history of pain. Right ankle: No acute fracture or dislocation. There is a small plantar calcaneal spur. There are scattered arterial calcifications. There is a small tibiotalar joint effusion.Pelvis: Mild osteoarthritis affects the left hip. There are arterial calcifications present within the pelvis.Right hip: The right hip appears normal for age.
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Minimal degenerative changes as above, but otherwise we see no radiographic findings to account for the patient's pain.
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Generate impression based on findings.
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74-year-old male with history of ankle ulceration. Evaluate for osteomyelitis. There is mild soft tissue swelling about the ankle extending to the dorsum of the foot. There is no frank osteolysis to suggest acute osteomyelitis. There is a mild hallux valgus deformity. Mild osteoarthritis affects the first MTP and interphalangeal joints. Note is made of an accessory navicular bone and os peroneum, both normal variants.
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Degenerative changes and soft tissue swelling without radiographic findings of acute osteomyelitis. If there is clinical suspicion of medial or lateral malleolar osteomyelitis, dedicated ankle radiographs are recommended.Results text paged to pager number 6876 at 1130 on 1/16/15.
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Generate impression based on findings.
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7-year-old female with tracheostomy for evaluation of lung expansion, concern for inadequate tidal volumeVIEWS: Chest AP (one views) 01/16/15 Tracheostomy tube is in position. Severe dextroscoliosis of the thoracic spine.Cardiothymic silhouette is enlarged. No pleural effusion. Left lower lobe atelectasis is likely chronic.
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Likely chronic left lower lobe atelectasis.
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Generate impression based on findings.
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Abnormal ABR bilaterally. ABR test results indicate elevated neural synchrony to air conducted clicks and 4000 Hz in the left ear and at 4000 Hz in the right ear. Results indicate at least a severe hearing loss in the left ear and normal sloping to mild hearing loss in the right ear. Right: There are opacities in the external auditory canal, which may represent cerumen. The middle ear is well-pneumatized and clear. However, there is partial opacification of the mastoid air cells. There is also an apparent air-fluid level in a pneumatized right petrous air cell. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: There are opacities in the external auditory canal, which may represent cerumen. The middle ear is well-pneumatized and clear. However, there is partial opacification of the mastoid air cells. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There is partial opacification of the paranasal sinuses.
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1. No evidence of inner ear or ossicular chain structural abnormalities. However, please also refer to the concurrent temporal bone MRI report.2. Partial opacification of the bilateral mastoid air cells and an apparent air-fluid level in a pneumatized right petrous air cell may represent effusions or secretions related to infection or inflammation.3. Partial opacification of the paranasal sinuses may represent sinusitis.
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Generate impression based on findings.
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59 year-old with clinical history of palpable retroareolar mass of the left breast. The patient cannot currently note any palpable area of concern. Three standard views of both breasts and right retroareolar spot 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. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable normal sized intramammary lymph node in the left lower breast.ULTRASOUND
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Correlation with physical examination is recommended to ensure these benign findings are concordant. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Ms. Yancey is a 58 year old female with a personal history of right breast lumpectomy in 2006 for IDC followed by radiation and letrozole therapy. Personal history of benign right biopsy for sclerosing adenosis/apocrine metaplasia. Family history of breast cancer in paternal aunt and cousin. Three standard views of both breasts with an additional right CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear markers were placed on scars overlying the right breast and axilla. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also present in the left axilla. Ribbon clip from prior benign breast biopsy is present in the right upper outer breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign 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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"Metastatic lung cancer status post multiple chemo." Pathology record states additional history of mesothelioma. CHEST:LUNGS AND PLEURA: Diffuse pulmonary groundglass opacity with nodular thickening of the fissures and septa, consistent with edema due to lymphangitic tumor and vascular congestion, with resolution in previously seen acute edema. Moderate right pleural fluid collection slightly smaller. Trace pleural fluid on the left.Left lower lobe index lesion measures 37 mm, previously 28-mm (4/63). Some of the contralateral nodules continue to slightly increased in size.Improving compressive atelectasis in the right lower lobe.Right pleural thickening at the 4 o'clock position, level of the aortic arch (3/23) 8mm compared to 19 mm previously.Thickening of the right diaphragmatic crus with lesion at the right costophrenic 5 o'clock position measuring 15 mm, previously 17 mm (3/106).MEDIASTINUM AND HILA: Mild diffuse mediastinal and hilar lymphadenopathy not significantly changed. Reference lower right paratracheal lymph node measures 13 mm, previously 15 mm (3/35). Reference lower right subcarinal lymph node measures 14 mm, previously 16mm (3/15). A right subclavian venous catheter terminates at the SVC just above the right atrium. Coronary artery calcifications. No pericardial fluid.CHEST WALL: Axillary, supraclavicular, intercostal and subpectoral lymphadenopathy on the right not significantly changed. Internal mammary chain lymphadenopathy unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Fluid adjacent to the tip of the right hepatic lobe has resolved.SPLEEN: Splenomegaly. Poorly defined areas of hypoattenuation in the spleen seen previously have resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Abdominal lymphadenopathy not significantly changed. Atherosclerotic disease.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Thickening of the posterior pararenal fascia on the right is unchanged. Right lower quadrant subcutaneous fat stranding presumably iatrogenic.OTHER: No significant abnormality noted.
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1. Increase in size of left lower lobe index nodule and nonindex nodules.2. Slight improvement in right pleural thickening, fluid and pulmonary edema.3. No significant change in diffuse thoracic/ abdominal lymphadenopathy.
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Generate impression based on findings.
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16-year-old male status post open reduction internal fixation of the volar plate fracture.VIEWS: Left fourth digit AP oblique and lateral (3 views) 1/16/2015 Interval removal of the fixation wires. There is indistinctness of the avulsion fracture line, compatible with healing, with persistent and unchanged deformity of the proximal interphalangeal articular surface.
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Healing/healed volar plate avulsion fracture with interval removal of the fixation hardware.
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Generate impression based on findings.
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Metastatic medullary thyroid carcinoma. Neck: There are postoperative findings related to thyroidectomy and neck dissection. There thyroidectomy bed appears unchanged. However, there has been continued interval increase in size of lower neck and partially-imaged mediastinum. For example, a left lower neck mass now measures 20 x 16 mm, previously 16 x 20 mm. The partially-imaged upper mediastinal lymph nodes also appear to have increased in size. In addition, there has been interval increase in size of multiple pulmonary nodules in the partially imaged lungs. The salivary glands are unremarkable. Thre is mass effect upon the proximal left common carotid artery from the adjacent mass lesions. Much of the right internal jugular vein is inapparent, which is unchanged. The osseous structures are unchanged. The airways are patent. There is streaky hyperattenuation in the bilateral facial subcutaneous tissues, which likely represents cosmetic filler.Head: There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Continued tumor progression in the lower neck and upper mediastinum, as well as slight increase in size of metastases in the partially-imaged lungs. Please refer to the separate chest CT report for additional details.2. No evidence of intracranial metastases.
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Generate impression based on findings.
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Male 9 years old Reason: eval femur healing History: s/p removal of implantVIEWS: Femur name of views (number of views views) AP and lateral Interval removal of the plate and screw device, with residual screw tracts evident. Periosteal reaction again seen, but the fracture line is indistinct compatible with healing.
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Interval removal of the plate and screw fixation device, with healing/healed femoral fracture.
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Generate impression based on findings.
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Adenocarcinoma of the lung. CHEST:LUNGS AND PLEURA: Postoperative changes of left lower lobe wedge resection and left apical posterior segmental resection Right paramediastinal and right lung base postradiation changes. Trace pleural effusions.Numerous 1 to 2-mm semisolid micronodules predominantly in the right upper lobe with poorly defined, groundglass density borders have been present on prior examinations. Groundglass density spherical nodule in the right upper lobe increased in size and partially in density, now measuring 6 x 6-mm, previously 6 x 4 mm (4/27). On 1/10/14 it measured 5-mm. Additional groundglass density lesions are not significantly changed.MEDIASTINUM AND HILA: Postoperative and post-therapeutic architectural distortion. Small but new 7-mm left paratracheal lymph node (3/26). A small (6-mm) right posterior paraesophageal lymph node is slightly larger, previously 4-mm (3/65).Heart size is normal without pericardial effusion. Moderate to severe coronary artery calcifications.CHEST WALL: Moderate degenerative changes about the visualized spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Small new left lower paratracheal lymph node and slight enlargement of a right distal paraesophageal lymph node should be monitored on subsequent studies, of unclear clinical significance.2. Right upper lobe ground glass/sub-solid nodule minimally increased in size and density. Other numerous lesions without significant change.3. Interval postsurgical changes.
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Generate impression based on findings.
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Reason: lung cancer History: s/p LLL wedge and s/p LLL lobectomy LUNGS AND PLEURA: Left upper lobectomy and left lower lobe wedge resection.Left lower lobe well marginated nodule 5 mm, unchanged as far back as 8/8/2012.Scattered foci of scarring unchanged. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. A is not a pericardial effusion Moderate coronary artery calcifications are present, the heart and pericardium otherwise unremarkable.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Accessory splenule, otherwise unremarkable.
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Status post left upper lobectomy and left lower lobe wedge resection. Stable benign appearing left lower lobe nodule, with no evidence of metastases or other significant abnormality.
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Generate impression based on findings.
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Morning headache. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage, mass, or cerebral edema.
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Generate impression based on findings.
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Fall, atrial fibrillation and CVA, supratherapeutic INR, mechanical fall and struck face one week ago. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. No hydrocephalus. No extra-axial collections. Again seen are chronic infarcts involving the bilateral cerebellar hemispheres. Additional areas of hypoattenuation in the periventricular and subcortical white matter are compatible with chronic small vessel ischemic changes.Calvarium is intact. There is a soft tissue hematoma in the right malar region.
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1. No evidence of intracranial hemorrhage or mass effect.2. Multiple chronic infarcts involving the bilateral cerebellar hemispheres.3. Soft tissue hematoma in the right malar region. No fracture seen in the calvarium or visualized maxillofacial bones.
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