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Generate impression based on findings.
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Reason: follow up for urothelial cancer History: hx of urothelial cancer LUNGS AND PLEURA: Scattered benign appearing micronodules, but no evidence of pulmonary metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Only mild coronary artery calcifications are present, the heart and pericardium otherwise normal. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post right nephrectomy, with bowel in the renal fossa.
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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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Osteoarthritis Severe osteoarthritic changes are observed bilaterally including bone-on-bone narrowing involving all 3 compartments and moderate lateral subluxation. Sclerosis, osteophytes and subchondral cysts are also observed. No appreciable left effusion, however a small fluid collection in the right is noted.In addition multiple small ossific densities are observed behind the right knee, presumably loose bodies within a Baker's cyst
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Severe tricompartmental osteoarthritic changes with suspected loose bodies on the right
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Generate impression based on findings.
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Lymphoma status post stem cell transplant now admitted for fever of unknown origin. Restaging exam for possible recurrent lymphoma.RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 127 mg/dL. Today's CT portion grossly demonstrates shotty bilateral jugular adenopathy. Small bilateral pleural effusions and a trace pericardial effusion is present. Right chest Port-A-Cath with tip in right atrium. Shotty retroperitoneal lymph nodes are also noted.Today's PET examination demonstrates the following abnormalities:NECK: Multiple hypermetabolic bilateral anterior and posterior jugular lymph nodes are present (SUV max = 4.1), new from previous and consistent with recurrent lymphoma.THORAX: Extensive markedly hypermetabolic mediastinal, bilateral hilar, and left internal mammary lymph nodes are present (SUV max = 9.8). More mildly FDG avid bilateral axillary lymph nodes are also present (SUV max = 3.1). These findings are all new from previous and consistent with recurrent lymphoma.ABDOMEN: Extensive markedly hypermetabolic gastrohepatic, portacaval, mesenteric, and retroperitoneal lymph nodes (SUV max = 10.2), new from previous and consistent with recurrent lymphoma. Diffusely markedly hypermetabolic and enlarged spleen is also new from previous and indicates diffuse splenic tumor involvementPELVIS: Multiple significantly hypermetabolic bilateral iliac, obturator, and inguinal lymph nodes (SUV max = 5.5) are new from previous and consistent with recurrent lymphoma.Diffusely increased marrow activity could represent diffuse lymphoma or benign marrow stimulation.
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Widespread markedly hypermetabolic lymph nodes in the neck, chest, abdomen and pelvis as well as enlarged diffusely markedly hypermetabolic spleen are all new from previous and compatible with recurrent lymphoma.
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Generate impression based on findings.
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Reason: assess for effusion/empyema, infection History: sob LUNGS AND PLEURA: Large bilateral pleural effusions with underlying compressive atelectasis, greater on the left, markedly increased from previous. Absence of intravenous contrast material precludes evaluation for pleural thickening and enhancement, such as may occur in empyema.Septal lines and groundglass opacity in the upper lungs consistent with edema, accentuated by atelectasis.MEDIASTINUM AND HILA: Nonspecific moderately enlarged lymph nodes in the lower paratracheal and AP window regions ranging up to 12 mm in short axis diameter.No visible coronary artery calcification.Cardiomegaly with no peri-cardial effusion.And edema.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation with no gross abnormalities.
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Large bilateral pleural effusions with underlying pulmonary edema and atelectasis. No specific evidence of infection on this nonenhanced scan.
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Generate impression based on findings.
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Lumbago Severe osteoarthritic changes of the left hip with bone-on-bone narrowing and minimally interval increasing subchondral cysts observed especially superiorly. Gross preservation of femoral head shape remains, however increased density which may represent superimposed fractures, raises concern for possible early AVN
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Severe osteoarthritis minimally progressed
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Generate impression based on findings.
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Check fracture healing Interval continued healing of the humeral neck fracture with gross anatomic preservation of alignment and interval increasing callus formation. Diffuse demineralization limits sensitivity. No new superimposed acute or interval abnormalities
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Healing right humeral neck fracture
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Generate impression based on findings.
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The right portal vein was embolized using 500-700 micron Embospheres until near stasis was achieved. A post-embolization venogram confirmed these findings.The distal right portal vein was then embolized using three 10 mm push-able coils and two 12 mm push-able coils. The catheter was then repositioned in the main portal vein, exchange was made for a pigtail catheter, and post-embolization venogram was performed. POST EMBOLIZATION PORTAL VENOGRAM: Successful occlusion of the right portal vein, the left portal vein and branches are patent.The catheter was removed, the sheath was pulled back, and the tract was embolized with a Gelfoam pledget. The sheath was removed and hemostasis was achieved. Sterile bandage was placed.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 17.4 MinutesAIR KERMA: 2016.90 mGyESTIMATED BLOOD LOSS: Less than 5cc.
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Successful embolization of the right portal vein.
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Generate impression based on findings.
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Follow-up of NHL. There is interval enlargement of the bilateral lower neck cervical lymphadenopathy. For example, a left supraclavicular lymph node measures 25 x 19 mm, previously 17 x 14 mm and a right paratracheal lymph node measures 15 x 9 mm, previously 13 x 7 mm. Bilateral axillary lymph nodes appear to have increased in size. There is a hypoattenuating right thyroid nodule that measures up to 8 mm. The salivary glands are unremarkable. The major cervical vessels are patent. There is a right internal jugular venous catheter. There is mild degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There is a partially-imaged nodule in the right anterior chest wall subcutaneous tissue at the site of the prior port device, which may represent scar tissue. The imaged portions of lungs are emphysematous. There is a cardiac pacer device.
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1. Interval progression of the lower neck cervical and axillary lymphadenopathy related to lymphoma. 2. Nonspecific subcentimeter hypoattenuating right thyroid nodule.
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Generate impression based on findings.
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Reason: lung CA, headaches, evaluate for brain mets History: headaches, and left eye "Floater" The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.No abnormal mass lesions are appreciated intracranially.
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Generate impression based on findings.
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Reason: hx of head and neck cancer/ per protocol follow up History: see above CHEST:LUNGS AND PLEURA: Numerous metastatic pulmonary nodules bilaterally.Index left lower lobe nodule (series 6/58) measures 11 x 17 mm, not significantly changed from 12 x 16 mm previously.Index right lower lobe nodule (series 6/64) measures 8 x 9 mm, unchanged.No pleural effusion.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcifications.No pericardial effusion.CHEST WALL: A previously described soft tissue nodule in the left anterior chest wall has almost completely resolved and may have been a sebaceous cyst.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right lobe consistent with a cyst, unchanged.Cholelithiasis.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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Stable disease.
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Generate impression based on findings.
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Altered mental status No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.There is moderate opacification of the paranasal sinuses including the frontal, ethmoid, maxillary, and sphenoid sinuses. Mastoid air cells are clear. Calvarium is intact. Evidence of bilateral intraocular lens replacement.
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1. No evidence of acute intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Moderate pansinus disease, worse since 11/4/2014.
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Generate impression based on findings.
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Male 77 years old Reason: prostate cancer, restaging History: Castrate resistant prostate cancer CHEST:LUNGS AND PLEURA: Dependent atelectasis at the lung bases.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Index subcarinal node measures 2 x 1.2 cm image number 50, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Index left paraortic node measures 1.8 x 2.8 cm on image number 110, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous subcentimeter sclerotic foci throughout the skeleton suspicious for metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Eccentric, asymmetric wall thickening of the bladder. Bladder carcinoma cannot be excluded. Correlation with endoscopy is recommended.LYMPH NODES: Pelvic adenopathy. An index right inguinal lymph node measures 1.3 by 0.8 cm on image number 173, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Numerous subcentimeter sclerotic foci throughout the skeleton suspicious for metastatic disease.OTHER: No significant abnormality noted
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Extensive bone metastases, retroperitoneal and pelvic and possibly mediastinal metastatic adenopathy.
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Generate impression based on findings.
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Elbow pain Extensive osteoarthritic degenerative changes throughout the elbow with poor visualization of the olecranon notch. Bulky osteophytes with sclerosis and subchondral cysts are observed in questionable mild deformity of the radial head representing possible old prior remote injury and/or fracture with deformities. Please correlate with patient history.Currently no findings to support an acute superimposed process, however serial imaging and/or compares with prior imaging if available would increase sensitivity. No effusion
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Extensive deformity and bulky osteophytes and degenerative changes, suggesting old prior remote injury and repair. See detail and recommendation above
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Generate impression based on findings.
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30 year-old female with hydrocephalus and ventriculostomy shunt catheter, evaluate for change in ventricular sizes Redemonstrated is a left parietal approach ventriculostomy shunt catheter which is unchanged in position. There is also a right parietal burr hole and tract extending from the burr hole into the right lateral ventricle presumably representing a prior ventriculostomy shunt, stable in appearance. The lateral ventricles remain near slitlike, unchanged. However, the third and fourth ventricles as well as the foramina of Luschka and cerebral aqueduct remain dilated, yet stable. The fourth ventricle again measures 26 mm in the AP dimension. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable.
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1.The lateral ventricles remain near slitlike, unchanged.2.The third and fourth ventricles as well as the foramina of Luschka and cerebral aqueduct remain dilated, yet stable.
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Generate impression based on findings.
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Pain, deformity, swelling. Fracture? There is diffuse soft tissue swelling, particularly along the lateral aspect of the ankle. There is a short oblique fracture of the distal fibula extending to the level of the tibiotalar joint, with minimal postero-lateral displacement of the distal fracture fragment. I see no additional fractures on this study. Mild osteoarthritis.
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Distal fibular fracture as above.
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Generate impression based on findings.
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Lung cancer surveillance. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema. Multiple right sided pulmonary nodules are again identified. Right upper lobe nodule (4/47 difficult to measure approximately 14 mm, previously 11-mm when measured in similar fashion. The solid component of the nodules just above the reference level measures 12-mm, previously 11-mm but appears larger.Nodule in right upper lobe azygoesophageal recess region now contains internal solid elements (4/25), measuring 14 x 16 mm, previously 12 x 9 mm. Lesion in the posterior right lower lobe measures 3.2 x 1 cm, previously 3.0 x 1.3 cm (4/57). Within the superior segment of the right lower lobe adjacent to the suture line, there is increased size and number of nodular densities (4/57, 4/65, 4/66-75). These are now highly suspicious for localized recurrence.Scarring and postsurgical changes in the right lower lobe with progressive volume loss. No pleural effusions. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Severe aortic and coronary calcification involves the entire thoracic aorta and great vessels. Fusiform descending aortic aneurysm is unchanged in size. Calcified right hilar nodes compatible with prior granulomatous infection. No visible at the images and mediastinal or hilar lymphadenopathy. Debris in airways.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic lesions. Unchanged mild biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal artery calcifications. Bilateral hypodense renal lesions likely represent cysts and are unchanged. No hydronephrosis. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm with an aortobi-iliac stent graft in place, unchanged. No suspicious lymphadenopathy. Severe calcification and stenosis of superior mesenteric artery, branches of the celiac axis and the renal arteries.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: Stable rectus diastases with anterior small bowel herniation without incarceration.
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1.Increased size and number of solid nodular densities in the right lower lobe, highly suspicious for recurrent disease.2.Right upper lobe lesions increased in the size and density, compatible with neoplasm.
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Generate impression based on findings.
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Shoulder pain Severe degenerative changes throughout the left shoulder with bone-on-bone narrowing and deformity observed along the glenoid and correlating humeral head. Specifically there is superimposed density along the medial aspect of the humeral head representing a suspected bulky large osteophyte given that clear separation from the humeral head cannot be confirmed. Overall appearance may represent extensive post traumatic change from a prior remote injury and if prior imaging is available, this may increase sensitivity for subtle interval change.
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Severe osteoarthritic changes with bulky osteophytes, see description and recommendation above
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Generate impression based on findings.
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Male 71 years old Reason: Re-evaluation of metastatic pancreatic cancer, undergoing chemotherapy History: none CHEST:LUNGS AND PLEURA: Index left upper lobe nodule is enlarged measuring 1.3 x 1.2 cm on image number 20, series number 5. Index right upper lobe pleural-based lung nodule measures 1.2 by 1.1-cm image number 26, series number 5. Other nodules are also increased in size throughout the lungs.MEDIASTINUM AND HILA: Index aortopulmonary lymph node measures 1.4 by 1.1-cm image number 33, series number 3, not significantly changed from previous study. Other mediastinal lymph nodes are also grossly unchanged. Index left hilar lymph node measures one .3 x 1.3 cm on image number 41, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Pneumobilia is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple surgery. Index soft tissue posterior to SMA slightly increased now measures 2 x 1.3 cm on image number 102, series number 3. Additional soft tissue foci within the small bowel mesentery have also increased in size within the interval. Hepatic hilar adenopathy is also slightly increased in size within the interval.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal cysts are 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: Lytic/permeative changes in the left iliac bone, slightly more prominent compared to previous study. Metastatic disease cannot be excluded. Bone scan may be helpful for further evaluation.OTHER: No significant abnormality noted
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Interval increase in the size of the lung nodules and retroperitoneal soft tissue.Bone scan may be helpful for further evaluation of the left iliac bone.
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Generate impression based on findings.
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Pain. Fracture classification. There is a comminuted fracture of the proximal humerus. This consists of a fracture through the surgical neck with mild impaction but little if any displacement/angulation. Although a fracture of the greater tuberosity was suspected on the basis of the radiographs, I see no discrete vertical plane disrupting the tuberosity. There is, however, a nondisplaced intra-articular fracture of the the anterior aspect of the humeral head coursing in the oblique coronal plane that appears to terminate medial to the lesser tuberosity. I see no additional fractures. Glenohumeral joint alignment is within normal limits. Moderate osteoarthritis affects the acromioclavicular joint. Heterogeneous hypodensity within the joint represents effusion/hemarthrosis. There appears to be mild fatty atrophy of the teres minor muscle. The soft tissues of the shoulder otherwise are unremarkable.
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Humeral head/neck fracture as described above.
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Generate impression based on findings.
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Mandible pain along the right aspect Irregularity and suspected recent loss of the right lower first molar, please correlate with patient history. Otherwise diffuse demineralization is observed. Mild mottled appearance does appear in the mid right mandibular body underlying this recently suspected lost dentition, if there is continued concern for infection, serial imaging is indicated to confirm stability and/or improvement.No additional discrete mandibular focal abnormalityVisualized portions of the sinuses are clear
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Suspected recent extracted or lost right lower molar, see detail provided
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Generate impression based on findings.
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The thoracic spine is in normal alignment. The vertebral body heights are maintained. There is no definite disc pathology. Redemonstrated is hypertrophy of the posterior elements and thickening of the ligamentum flavum at several levels, most prominent at T6-T7, stable in appearance. There is no significant spinal canal or foraminal stenosis within the thoracic spine. Specifically, there are no pathologic lesions at the T5/6 level to explain the patient's radicular symptoms.Redemonstrated is a diffusely heterogeneous yet benign appearing marrow signal. There is no pathological enhancement. No destructive osseous lesion is identified. The spinal cord is of normal caliber and signal. Previously demonstrated scar like soft tissue in the right lung apex, a small right pleural effusion, small right renal cyst, and a gallbladder filled with multiple gallstones are not visualized on the current exam secondary to saturation band placement.
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There is no significant spinal canal or foraminal stenosis within the thoracic spine. Specifically, there are no pathologic lesions at the T5/6 level to explain the patient's radicular symptoms.
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Generate impression based on findings.
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Female 41 years old Reason: evaluate for sigmoid mass and any possible mets History: sigmoid mass on colonscopy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrolithiasis..RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index left iliac node measures 8-mm in diameter image number 134, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Complex cystic left adnexal mass with solid component measuring 8.5 x 5 cm on image number 150, series number 3 suspicious for an ovarian neoplasm. This mass cannot be separated from the sigmoid colon.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid colon demonstrates significant eccentric wall thickening on a long segment. This is suspicious for a primary sigmoid carcinoma versus less likely invasion of the sigmoid by the ovarian neoplasm. This mass likely invades the adjacent small bowel segments.There is a soft tissue mass invading the cecum and ileocecal junction measuring 4.2 x 2.7 cm on image number 149, series number 3. This mass extends the right adnexa. This may represent a peritoneal deposit versus a right adnexal mass.BONES, SOFT TISSUES: There is a large enhancing soft tissue invading the anterior abdominal wall and left rectus muscle extending to the subcutaneous fat measuring 6.3 x 4.5 cm image number 147, series number 3. This mass likely represents the adjacent small bowel segments.OTHER: No significant abnormality noted.
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Complex left adnexal mass suspicious for cystic ovarian malignant neoplasm. There is also significant wall thickening of the sigmoid colon, an ill-defined right lower quadrant mass invading the cecum and extending into the right adnexa and anterior abdominal wall mass invading the surrounding small bowel loops. Exact etiology of these masses is unknown but they may represent a primary sigmoid cancer and/or ovarian carcinoma.
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Generate impression based on findings.
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Reason: Eval for PE, SOB sudden onset History: SOB sudden onset PULMONARY ARTERIES: No evidence of pulmonary embolism. No evidence of pulmonary artery enlargement. No sign of right heart strain.LUNGS AND PLEURA: Basilar subsegmental atelectasis or scarring is nonspecific, and there is no evidence of infection or edema.MEDIASTINUM AND HILA: Small pericardial effusion, heart itself unremarkable in appearance.There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post splenectomy. No other significant abnormality.
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1. No evidence of pulmonary embolism, or other significant abnormality. 2. Left base scarring or subsegmental atelectasis is seen, and the patient has undergone splenectomy.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Reason: lung nodule History: Hx cough /sob LUNGS AND PLEURA: Interval resolution of a small focal area of right lower lobe consolidation.Moderate bilateral pleural effusions, larger on the left, not significantly changed.Mildly spiculated nodule contiguous with the right inferior pulmonary vein, measuring approximately 13 mm in the axial plane and 20 mm in the sagittal plane, unchanged from previous (series 3/61). This is incompletely evaluated in the absence of contrast material.Diffuse moderate bronchial wall thickening, compatible with bronchitis, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Moderate cardiomegaly with a biventricular ICD device in place.Severe coronary artery calcifications.No pericardial effusion.CHEST WALL: Status post median sternotomy. Severe degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation showing multiple hypodensities in the liver, most compatible with cysts.
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Indeterminate nodule in the right lower lobe, which remains moderately suspicious for primary lung carcinoma in spite of its stability since the previous scan. A follow-up CT scan is recommended in approximately 12 months to confirm continued stability.
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Generate impression based on findings.
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Reason: L4-5 bipsy to assess for discitis History: low back painOPERATORS: Greg ChristoforidisEBL < 5ml Serial CT images obtained during the biopsy procedure demonstrate needle placement within the L4-5 vertebra. Following needle removal images obtained that demonstrate no complications.
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L4-5 disk biopsy under CT guidance. A total of nine biopsy specimens were delivered to microbiology and pathology for analysis.
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Generate impression based on findings.
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Reason: follow LLL nodule and PE History: dyspnea PULMONARY ARTERIES: No evidence of pulmonary embolism. Previously seen extensive thrombus has completely resolved without web formation or other residual findings. The pulmonary artery is of normal caliber, and previously seen right heart strain is no longer present. LUNGS AND PLEURA: The previously noted anteriorly located left lower lobe pulmonary nodule has near completely resolved, with only a small residual scar like opacity.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.There no coronary calcifications visible, and the heart and paracardial normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Complete resolution of prior extensive pulmonary emboli without residual web formation, with resolution of prior right heart strain.2. Near resolution of the previously noted left lower lobe anterior segment subpleural nodule, which likely was a pulmonary infarct. PULMONARY EMBOLISM: PE: Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Recurrent cutaneous squamous cell carcinoma of left ear, status post multiple excisions and chemotherapy. There are postoperative findings in the left preauricular region. There is skin thickening in the left preauricular region that measures up to 10 mm in thickness. The underlying calvarium appears to be intact. There is no evidence of significant cervical lymphadenopathy. A separate focus of mild skin thickening in the left cheek may represent actinic keratosis. There is no evidence of intracranial metastases. The thyroid and major salivary glands appear unchanged. Aside from mild atherosclerotic plaque predominantly at the carotid bifurcations, the major cervical vessels are patent. The airways are patent. There is mild nonspecific patchy cerebral white matter hypoattenuation. There are bilateral lens implants. There is multilevel degenerative spondylosis. There is mild left maxillary sinus mucosal thickening. There is partial opacification of the left mastoid air cells. There are prominent interstitial marking in the lung apices.
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1. Post-treatment findings in the left preauricular region with nonspecific skin thickening.2. No evidence of significant cervical lymphadenopathy. 3. Interval thrombosis of the catheterized right inferior internal jugular vein.4. Partial opacification of the left mastoid air cells.
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Generate impression based on findings.
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NSCLC restaging XRT to left hilum CHEST:LUNGS AND PLEURA: Motion artifact degrades image quality. Left hilar mass appears smaller, measuring 10 x 12-mm (7/52), previously 21 x 25 mm.Postsurgical and post-therapeutic changes on the right. Small area of subpleural consolidation anteriorly on the right (4/29) unchanged and most likely post therapeutic but can be monitored on subsequent examinations. Emphysema. Trace pleural fluid on the right. Pleural thickening at the right lung base similar to previous.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and its branches, including the coronary arteries. No enlarged lymph nodes. AP window lymph node reported on PET measures 6-mm, previously 8-mm (7/38).CHEST WALL: Small right supraclavicular lymph nodes incompletely included with this scanning range but appear smaller ( 7/9-10).ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Significant artifact was produced by contrast material extravasation in the right antecubital fossa.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Patient appears cachectic.OTHER: No significant abnormality noted.
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Decreased size of left hilar mass, small lymph nodes in the AP window and right supraclavicular region. Right antecubital fossa contrast extravasation, please refer to the separately reported safety report in the patient's chart.
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Generate impression based on findings.
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Female 47 years old; Reason: abdominal left side/ hx lupus concern vasculitis History: pain ABDOMEN:LUNGS BASES: New small left pleural effusion with basilar atelectasis.New small pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Subcentimeter hypodensity in the spleen is too small to characterize but may represent a hemangioma, unchanged. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodensity in the left kidney is too small to characterize, but likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: Numerous retroperitoneal lymph nodes are noted, not pathologically enlarged by CT criteria (less than 1 cm in short axis) and unchanged.BOWEL, MESENTERY: No evidence of bowel dilatation however, there is diffuse arterial narrowing and early venous drainage of small bowel vasculature in the left upper quadrant suggesting an active median or small vessel vasculitis (image 103; series 8 and images 36-44; series 30637). The SMA and SMV are patent.BONES, SOFT TISSUES: Sclerotic focus in the right femoral neck and pelvis likely benign bone islands, unchanged. OTHER: Calcification in left breast as noted previously. Correlation with recent mammography is recommended.PELVIS:UTERUS, ADNEXA: Calcifications are noted in the uterus, likely from degenerating fibroids are unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy not essentially changed compared to prior. For reference purposes, a right external iliac lymph node measures 2.8 x 4.0 cm (image 198; series 8).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Probable medium or small vessel vasculitis (presumably SLE) most prominent in the small bowel of the left upper quadrant. Unchanged pelvic lymphadenopathy. New left pleural effusion with overlying compressive atelectasis. New pericardial effusion. Findings discussed with Dr. Konda at the time of dictation.
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Generate impression based on findings.
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Male 64 years old Reason: hx of bladder cancer s/p radical cystectomy, evaluate for metastatic disease with delayed imaging History: see above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, not significantly changed. Cholelithiasis, unchanged. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst, not significantly changed.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat containing anterior wall hernias, unchanged.OTHER: No significant abnormality noted
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No significant change from previous study.
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Generate impression based on findings.
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Male 63 years old Reason: Hx of FCL History: Evaluate extent of disease CHEST:LUNGS AND PLEURA: Mild paraseptal emphysema in the lung apices, unchanged. Scattered bilateral micronodules are unchanged.MEDIASTINUM AND HILA: Index mediastinal lymph node measures 10-mm image number 50, series number 3, not significant changed.CHEST WALL: Index left supraclavicular lymph node measures 2.5 by 1.8 cm, slightly enlarged on image number 14, series number 3.Bilateral axillary adenopathy is also enlarged. The index left axillary node now measures 1.8 x 1.5 cm on image number 32, series number 3. Previously, this lymph node was measuring 11 x 9 mm on image number 38, series number 4. The number of the bilateral axillary nodes have also increased within the interval.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the liver is unchanged.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aortocaval lymph node is increased in size and now measures 2.6 x 1.8 cm on image number 121, series number 3. Other retroperitoneal lymph nodes are also increased in size in the interval.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: Index left external iliac lymph node measures two by 1.1 cm on image number 183, series number 3, increased in size compared to previous study. Other pelvic lymph nodes are also significantly increased in size compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild compression fracture of L2 vertebral body, new from previous study.OTHER: Bilateral fat containing inguinal hernias. Small amount of colon is also included in the left inguinal hernia.
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Interval progression of disease with interval increase in the size of index lymph nodes.Mild compression fracture of L2 vertebral body, new from previous study.
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Generate impression based on findings.
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65 years, Female. Reason: unspecified abdominal pain History: abdominal pain Residual contrast material noted in the colon. Nonobstructive bowel gas pattern. Status post cholecystectomy. Left iliac stent present. Elevated right hemidiaphragm noted. Degenerative disease of spine.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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There is a CSF density extra-axial collection just lateral to the left cerebellar hemisphere with mild flattening of the underlying folia, however without mass effect upon the fourth ventricle. This measures up to 8 mm in maximal depth.There is slight asymmetric atrophy of left frontal gyri, more prominently evident about the left sylvian fissure, compared to prior.There are no findings of ventricular obstruction or hydrocephalus. There are no masses, mass effect or midline shift. There is no evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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1.There is a CSF density extra-axial collection just lateral to the left cerebellar hemisphere with mild flattening of the underlying folia, however without mass effect upon the fourth ventricle. This measures up to 8 mm in maximal depth. The differential diagnosis most likely includes a chronic subdural hematoma versus subdural effusion.2.There is slight asymmetric atrophy of left frontal gyri, more prominently evident about the left sylvian fissure, compared to prior.
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Generate impression based on findings.
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72-year-old male with history of a renal mass. Evaluate. CHEST:LUNGS AND PLEURA: Scattered pulmonary nodules and micronodules. Reference right lower lobe nodule measures 5 mm (series 8, image 55). Reference left upper lobe nodule measures 5 mm (series 8, image 60). No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Nonspecific subcentimeter mediastinal lymph nodes. For example high right paratracheal lymph node measures approximately 9 mm in short axis (series 6, image 23). Heart size is normal without pericardial effusion. Severe coronary artery atherosclerotic calcifications. Severe atherosclerotic disease affects the thoracic aorta. Low density small eccentric plaque in the mid thoracic aorta (series 6, image 49) is noted. Moderately enlarged and heterogeneous right thyroid gland.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Fat containing right adrenal gland lesion measures 1.7 x 1.7 cm (series 6, image 98), consistent with myolipoma. KIDNEYS, URETERS: There is a right midpole hypoattenuating lesion with peripheral high attenuating rim measuring 2.6 x 2.2 cm (series 6, image 115), previously measuring 4.2 x 3.7 cm. There is surrounding fat stranding and inflammatory changes extending to the level of the inferior margin of the liver, which are improved compared to the prior outside examination. An additional hypoattenuating lesion in the right kidney is compatible with a cyst (series 6, image 125). No hydroureteronephrosis. RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific subcentimeter soft tissue nodule posterior to the liver at the level of the right adrenal gland (series 6, image 103).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes affect the visualized spine.OTHER: No significant abnormality noted
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1.Interval decrease in size of the right midpole lesion as described above with interval regression of the associated inflammatory changes. Findings are more consistent with inflammatory lesion such as an infection rather than a neoplastic process but continued imaging is suggested until resolution. Findings relayed to Matt Galocy, APN, over the phone at approximately 2:50 p.m.2.Right adrenal myolipoma.3.Nonspecific left upper and right lower lobe 5-mm pulmonary nodules. Follow up in 6 to 12 months to document stability versus resolution is recommended.
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Generate impression based on findings.
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64 years, Male. Reason: evaluate enteric tube placement History: extubation Interval removal of one of the enteric tubes. Tip of remaining tube seen near the duodenojejunal junction.
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Enteric tube as above.
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Generate impression based on findings.
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Seven month old female status post liver transplant.VIEW: Chest AP (one view) 1/16/2015, 12:51 Central line terminates at the right atrium. Feeding tube is noted, with the tip terminating out of the field of view. Right upper abdominal quadrant surgical clips and IVC stent again seen. ET tube terminates below thoracic inlet and above the carina. Cardiac silhouette size is normal. Right upper lobe atelectasis has resolved.
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Improved right upper lobe atelectasis.
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Generate impression based on findings.
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Multiple spot images demonstrated smooth transit of the contrast cephalad and caudad with patient repositioning.
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Successful fluoroscopic guided intrathecal injection of contrast for subsequent CT myelogram.
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Generate impression based on findings.
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Ms. Manuel is a 45 year old female returning for a short term followup for bilateral masses. Of note, she was scheduled to return on 10/2013 for the short-term followup, but did not show up. She has had a right nipple milky discharge for the past 18 years. 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. Round circumscribed mass in the right retroareolar region is stable and compatible with the previously characterized fibroadenolipoma on ultrasound. There has been an interval decrease in size of a focal asymmetry in the left outer breast, compatible with an involuting cyst as previously seen on prior ultrasound. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Bilateral benign intramammary lymph nodes are seen in the upper outer breasts.
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Stable fibroadenolipoma in the right breast and involuting cyst in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: h/o met medullary thyroid ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Bilateral pulmonary metastases are not significantly changed in size or number. Reference lesions in the posterior right upper lobe measuring 7 x 5 mm (series 4 image 41) and spiculated lesion in the right middle lobe measuring 7 x 6 mm (image 68) are unchanged in size. No pleural effusions. MEDIASTINUM AND HILA: Extensive coalescent lymphadenopathy throughout the mediastinum has increased in size. The reference subcarinal lesion now measures 4.4 x 3.6 cm (series 3 image 41) previously 3.8 x 3.2 cm. The trachea and mainstem bronchi remain patent, however the bronchus intermedius is attenuated measuring 4 mm in transverse dimension. There is compression of the right main pulmonary artery resulting in mild narrowing. The SVC is patent but narrowed. Stable small amount of pericardial fluid. No visible coronary calcification. Distal esophageal varices.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small peripheral areas of low hepatic attenuation may reflect perfusion related differences. No discrete lesions. 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: Anterior abdominal wall surgical staples with associated streak artifact. Chronic right 10th rib fracture. OTHER: No significant abnormality noted.
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1. Interval increase in size of mediastinal lymphadenopathy with compression of SVC and bronchus intermedius, though they remain grossly patent. 2. Stable appearance of pulmonary metastases.
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Generate impression based on findings.
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30 day old male evaluate pneumothorax.VIEW: Chest AP (one view) 1/16/2015, 13:00 Three chest tubes are again seen. The chest tube previously directed most superiorly on the prior examination is now directed more inferiorly, crossing the midline. The two additional chest tubes are unchanged.Persistent large right anterior pneumothorax, unchanged. Background interstitial emphysematous changes in the right lung again seen. Leftward mediastinal shift with atelectatic left lung. Lucent focus in the inferomedial left lung may represent a pneumatocele.
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1.Anterior right pneumothorax unchanged. 2.The chest tube previously directed most superiorly on the prior examination is now directed more inferiorly, crossing the midline. The two additional chest tubes are unchanged.
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Generate impression based on findings.
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Please note that FLAIR sequences are degraded by motion and therefore the evaluation for FLAIR signal abnormalities is unreliable. A small enhancing focus is seen within the left tegmentum at the pontine midbrain junction near the expected location of the medial longitudinal fasciculus (1001/19). There is suggestion of a vessel extending to the lesion. There is an enhancing focus in the left frontal periventricular white matter with a draining vein which is likely represents a developmental venous anomaly. There are additional tiny vessels within the left parietal lobe (1001/51) and cerebellum (1001/7) which also likely represent developmental venous anomalies. A focus of enhancement in the left lateral thalamus is of indeterminate etiology (1001/34).The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.
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A small enhancing focus within the expected location of the left medial longitudinal fasciculus may account for the patient's reported internuclear ophthalmoplegia. There is perhaps a small vessel associated with this focus. The differential for this small lesion would include vascular, inflammatory or demyelinating etiologies.There are several additional developmental venous anomalies within the left cerebrum and cerebellum as well as a nonspecific subtle focus in the left thalamus. It is unclear whether these lesions are related to the left tegmentum lesion described above.
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Generate impression based on findings.
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Male 65 years old Reason: pt with a history of renal cell cancer please assess for disease progression History: renal cell cancer CHEST:LUNGS AND PLEURA: Left lower lobe linear atelectasis, not significantly changed from previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst is unchanged. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Subcentimeter cyst in the left kidney is unchanged. Previously measured hypodense lesion in the resection bed abutting the left hemidiaphragm now measures 2.4 x 2.4 cm on image number 100, series number 3, slightly increased in size compared to previous study. The fluid collection adjacent to this lesion has decreased in size and now measures 1.1 x 1.1 cm image number 103, series number 3.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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Stable to minimally increased left nephrectomy bed, peripherally enhancing hypodense lesion. The fluid adjacent to this lesion has slightly decreased within the interval.
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Generate impression based on findings.
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Reason: S/p roux en y gastric bypass, evaluate j-j anastomosis through g tube History: abdominal pain s/p s/p roux en y gastric bypass Scout radiograph showed a nonobstructive bowel gas pattern with postoperative changes. Small amount of residual contrast material seen in right abdomen.Fluoroscopic evaluation showed contrast opacification of the biliopancreatic limb with subsequent transit into the more distal small bowel/common channel. Mild prominence of proximal jejunum seen, may be due in part to normal peristalsis, particularly given reported patency of jejunojejunal anastomosis per operative report. A small amount of contrast was seen in the colon by approximately 45 minutes, with a much larger amount since by 90 minutes, indicating biliopancreatic limb and jejunojejunal anastomotic patency. TOTAL FLUOROSCOPY TIME: 4:53 minutes
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Patent biliopancreatic limb/jejunojejunal anastomosis, see above.
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Generate impression based on findings.
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Male, 9 years old, with increased ICP, assess for hydrocephalus or herniation. Hyperdense blood product is redemonstrated layering dependently within the occipital horns. The quantity of blood on the right is approximately unchanged, while on the left it is reduced. A small amount of blood product remains vaguely discernible within the interpeduncular and suprapancreatic cisterns, improved from prior. Hyperattenuation within the occipital sulci bilaterally may also correspond to the presence of subarachnoid blood product. While there is no correlation for this finding on prior CT, this does correlate with sulcal FLAIR hyperintensity seen on prior MRI. There may also be a thin layer of subdural blood product along the posterior interhemispheric falx and tentorium versus artifact.Patchy white matter hypoattenuation is seen in the frontal and parietal periventricular regions which correlates to FLAIR signal abnormality on prior MRI. No loss of gray-white distinction, edema or mass effect is seen. Ventricular size is stable to at most mildly enlarged, on the order of 1 to 2 mm.
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Evolution of intracranial blood product is seen with reduction in blood in the left occipital horn as well as the interpeduncular and suprachiasmatic cisterns, and stable blood product in the right occipital horn. Findings compatible with subarachnoid blood product in the occipital sulci have also not significantly changed relative to the prior MRI. No evidence of significant or new mass effect is detected. Ventricular caliber is stable to at most mildly increased.
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Generate impression based on findings.
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Ms. Lestikow is a 70 year old female presenting for routine mammography. Family history of breast cancer in mother and maternal cousin. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign coarse calcifications are present bilaterally. Focal asymmetry in the central left breast (best seen on the CC view) 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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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually (rather than screening given that she comes from a long distance away for this imaging). Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Reason: 72 y/o male with HCC and recent imbalance. Please exclude brain metastases. History: imbalance The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.As the lobe is a developmental venous anomaly present in the left centrum semiovale.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for intracranial mass lesion. 2.No evidence for acute intracranial hemorrhage mass effect or edema.3.Please note that MR is more sensitive in the detection of intracranial metastases than CT.
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Generate impression based on findings.
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Female 19 years old Reason: Follow-up scan. S/P right nephropexy History: right hydronephrosis BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 2 Left: 0 Length*** Right: 11.3 cm Left: 10.1 cm Mean for age: 11.0 cm Range for age: 9.5 - 13.0 cmADDITIONAL OBSERVATIONS: The right kidney is in the expected anatomic location.
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Grade 2 right-sided hydronephrosis. Right kidney in the expected anatomic location.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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Head:Enhancing lesion within the left superior frontal gyrus is increased in size with increasing surrounding edema. No new enhancing lesions are evident. A blush of contrast in the left basal ganglia is unchanged from the prior exam and likely represents vessels as seen on prior MRI. Old left basal ganglial lacunar infarct is unchanged. No evidence of acute hemorrhage or extra-axial fluid collection. No midline shift. Ventricles are normal in appearance morphology. Right lens is thin, likely due to cataracts.Neck:There are posttreatment findings including diffuse pharyngeal and supraglottic mucosal thickening appearing similar to the prior exam. Infiltration of the fascial planes bilaterally throughout the neck is unchanged and likely treatment related. No evidence of tumor recurrence or significant cervical lymphadenopathy. Nonspecific sclerotic focus within the right anterior mandible is unchanged from 7/12/2011 and likely benign. The left thyroid is heterogeneous and larger than the right with multiple nodules. Salivary glands are unremarkable. Atherosclerotic calcifications at the carotid bifurcations bilaterally. The inferior aspect of the right internal jugular vein is not opacified, similar to the prior exam. Severe degenerative changes of the cervical spine. For findings in the chest, including a large right apical metastasis invading the right anterior first rib and chest wall, and a left apical mass, please see dedicated chest CT performed on the same day.
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1.Metastatic lesion in the left superior frontal gyrus has increased in size with increasing surrounding edema. This would be better assessed on MRI.2.Treatment related findings within the neck without evidence of recurrent disease or significant lymphadenopathy.3.For findings in the lungs, please see dedicated chest CT performed on the same day.
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Generate impression based on findings.
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Male 77 years old; Reason: prostate cancer, castrate resistant History: prostate cancer, assess for disease response There are numerous osteoblastic lesions involving the bilateral ribs, cervical/thoracic/lumbar spine and pelvis.
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Multiple osseous metastatic foci as described above.
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Generate impression based on findings.
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Redemonstration of a left frontal parenchymal hematoma which is unchanged in size measuring 3.7 x 2.6 x 3.3 cm (oblique AP x TR x CC) with similar edema and local mass effect compared to prior exam. There is 5 mm of rightward subfalcine herniation measured at the level of the foramen of Monro. Within this hematoma there is a round low attenuation focus measuring 9 x 9 mm (series 20388, image 18); underlying malignancy is not excluded. There are no other sites of intraparenchymal hemorrhage. Posterior wire fixation is noted at C1-2.
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1.Left frontal hematoma as described above with no significant change in the size, mass effect and edema. 2.Round low-attenuation nodule within left frontal hematoma; malignancy is not excluded. Correlate with outside MRI.
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Generate impression based on findings.
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66 year old male with history of metastatic prostate cancer, evaluate response to therapy. CHEST:LUNGS AND PLEURA: Minimal bibasilar dependent atelectasis. Left upper lobe (5/122) groundglass opacity is stable, nonspecific. No pleural effusion or consolidation.MEDIASTINUM AND HILA: Scattered mediastinal and hilar calcified lymph nodes, with no significant mediastinal or hilar lymphadenopathy. The heart is normal in size, with no pericardial effusion. No coronary artery calcifications.CHEST WALL: Multiple sclerotic foci throughout the visualized skeleton, consistent with metastases. Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic foci, unchanged and likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific left adrenal gland thickening, unchanged.KIDNEYS, URETERS: Bilateral renal cysts are again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air, the appendix is visualized within normal limits.BONES, SOFT TISSUES: Patchy sclerosis, consistent with metastatic disease appears stable. Refer to today's bone scan for additional evaluation of bone involvement. OTHER: No significant abnormality notedPELVIS: Evaluation is limited by streak artifact from bilateral hip prosthetics.PROSTATE, SEMINAL VESICLES: History of prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Bilateral pelvic lymph node dissection, unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted. Refer to today's bone scan for additional evaluation of bone involvement.OTHER: No significant abnormality noted
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1.Unchanged findings of metastatic prostate cancer, without evidence of new metastases.2.Left upper lobe ground glass opacity is nonspecific, and unchanged since 2012, so indolent process such as atypical adenomatous hyperplasia is on the differential.
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Generate impression based on findings.
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52-year-old male with history of prostate cancer and PSA of 125. Assess for metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Few scattered right hepatic lobe subcentimeter hypoattenuating lesions are too small to characterize but statistically likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left midpole hypoattenuating focus compatible with a cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy with a reference left paraaortic lymph node measuring 1.4 x 1.2 cm (series 3, image 50).BOWEL, MESENTERY: Mild nonspecific rectal wall thickening (series 3, images 93 through 97).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneously enhancing prostate gland measures 5.4 x 4.7 cm (series 3, image 96) consistent with stated history of prostate cancer.BLADDER: Mildly thickened bladder wall is likely postobstructive.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild nonspecific rectal wall thickening (series 3, images 93 through 97).BONES, SOFT TISSUES: Mildly enlarged pelvic lymph nodes including external iliac chain bilaterally. Reference right internal iliac lymph node measures 9 x 8 mm (series 3, image 88).OTHER: No significant abnormality noted
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1.Heterogeneously enhancing prostate gland consistent with stated history of prostate cancer. 2.Retroperitoneal and pelvic lymphadenopathy. 3.Mild nonspecific rectal wall thickening. Evaluation with colonoscopy is recommended if patient has not had a colonoscopy.4.No CT evidence of osseous metastases. Please refer to concurrent nuclear medicine bone scan report for details regarding the osseous structures for more sensitive evaluation.
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Generate impression based on findings.
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Metastatic renal cancer assess for progression. CHEST:LUNGS AND PLEURA: Severe emphysema. Smoothly marginated 16 x 13 mm solid nodule in the left lower lobe posterior to the descending thoracic aorta (4/45).No pneumothorax or fluid.MEDIASTINUM AND HILA: Left interlobar lymph node appears prominent (4/53), not reliably measurable given lack of IV contrast. Normal heart size. No pericardial effusion. Mild coronary artery calcifications. Upper normal sized subcarinal lymph nodes.CHEST WALL: Thoracolumbar scoliosis.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter. Multiple indeterminate cysts and nodules in the kidneys bilaterally, incompletely assessed on this unenhanced exam. The largest indeterminate lesions are as follows for reference:Solid nodule posterior aspect of left kidney upper pole measures 4.5 x 4.2 cm (3/110). This lesion extends posteriorly, abutting but not definitely extending through the posterior pararenal fascia. Second solid nodule at the apex of the left kidney measures 2.6-cm (3/103).Large multi-lobulated mixed density lesion arising from the lower pole of the left kidney may reflect a single or two adjacent lesions (3/130).Indeterminate nodule in the right kidney interpolar region medially (3/115), 2.5-cm. 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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1. Single indeterminate pulmonary nodule in the left lower lobe measuring 16mm; a metastasis cannot be ruled out, consider PET scan for further characterization unless the referring clinical service can obtain and submit outside prior studies for comparison.2. Assessment of the patient's known renal tumor or characterization of renal lesions cannot be accurately provided given lack of intravenous contrast. For reference, measurements of the largest indeterminate lesions are provided. Although no contour abnormalities are identified of the adrenal glands, renal veins or IVC and no conclusive local lymphadenopathy is identified, assessment for disease in these structures cannot be accurately provided without IV contrast.
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Generate impression based on findings.
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pT3N0 left parotid high grade salivary duct carcinoma status post treatment. There are postoperative findings related to left parotidectomy with persistent ill-defined stranding in the region of the surgical bed, but no discrete measurable mass lesion. The previously demonstrated right parotid mass is now inconspicuous. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild calcified plaque at the carotid bifurcations. The major cervical vessels are otherwise patent. There is subcutaneous stranding and emphysema surrounding the right upper chest wall port device related to recent insertion. There is torus mandibularis. There is a subcentimeter incisive canal cyst. There is mild degenerative spondylosis at C6-T1. The airways are patent. There is mild opacification of the maxillary sinuses. There is partial opacification of the mastoid air cells. The imaged intracranial structures are unremarkable. There are emphysematous changes in the lungs. The previously demonstrated right cheek subcutaneous stranding has now resolved.
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1. Postoperative findings related to parotidectomy without discernible discrete measurable mass lesion, within the limits of CT.2. A previously demonstrated right parotid lesion is now inconspicuous.
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Generate impression based on findings.
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Initial staging of newly diagnosed mid-esophageal cancer. Past history of laryngeal cancer status post chemoradiation.RADIOPHARMACEUTICAL: 11.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates right apical consolidation with bronchiectasis. Bilateral emphysematous changes are also present. Right jugular central line with tip in the SVC. Right ICD is noted. Tracheostomy tube is present. Gastrostomy tube is also seen. Dobbhoff tube has tip in the stomach. Extensive atherosclerotic calcifications are present with aneurysmal dilatation of the left iliac artery.Today's PET examination demonstrates a small hypermetabolic subcarinal mediastinal focus (SUV max = 3.9) which is in the region of the mid-esophagus and could represent the primary tumor versus an adjacent hypermetabolic lymph node.An additional hypermetabolic focus at the gastroesophageal junction (SUV max = 4.7) could also represent a primary esophageal cancer focus or inflammation.Multiple fairly symmetric small to medium-sized moderate to markedly hypermetabolic bilateral hilar and mediastinal lymph nodes are present (SUV max = 5.4). Given their locations and symmetry these may reflect inflammatory lymph nodes although metastatic tumor is also a possibility.In the right lung apex there is markedly hypermetabolic region of consolidated lung with bronchiectasis (SUV max = 9.8), as well as hypermetabolic lymph nodes in the adjacent right axilla. These pulmonary findings are suggestive of an infectious etiology based on CT and fairly rapid appearance from recent prior CT, also suggestive of interval infection for a lesion of this size. Tumor cannot be entirely excluded, however.No suspicious FDG lesion is seen within the abdomen, pelvis, or skeleton. Hypermetabolic soft tissue activity symmetrically in the periphery of both hips, consistent with inflammation. Expected inflammatory activity surrounds the tracheostomy and gastrostomy tubes.
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1.Two focal hypermetabolic mid and distal esophageal lesions which could represent primary esophageal tumor versus inflammatory sites.2.Numerous fairly symmetric hypermetabolic bilateral hilar and mediastinal lymph nodes suggestive of inflammation although metastatic lymph nodes is also a possibility.3.Hypermetabolic right apical consolidative process more suggestive of infection/inflammation than tumor, although the latter cannot be entirely excluded.4.No suspicious FDG avid lesion within the abdomen, pelvis, or the visualized skeleton.
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Generate impression based on findings.
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Reason: lung cancer 7 yrs ago, s/p chemo and RT. Pls c/w previous study and evaluate dz status. History: lung ca CHEST:LUNGS AND PLEURAMEDIASTINUM AND HILA: Moderate coronary arterial calcifications. Unchanged small mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged right adrenal adenomaKIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aneurysmal dilation of the infrarenal abdominal aorta measuring 2.8 cm in AP dimension unchanged. Extensive atherosclerotic calcifications with eccentric mural thrombus.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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1. Stable postradiation changes without evidence of recurrent or metastatic disease. 2. Other chronic findings as described above.
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Generate impression based on findings.
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Male 65 years old; Reason: Lung Transplant Evaluation History: as above Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 50.8 % of peak activity (normal >70 %)1 hour: 41.1 % of peak activity (normal 30-90 %) 2 hours: 40.3 % of peak activity (normal <60 %) 4 hours: 2.0 % of peak activity (normal <10 %)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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31-year-old male with right chest pain. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No evidence of pulmonary embolism. The pulmonary artery measures 28 mm without right heart strain.LUNGS AND PLEURA: Left lower lobe atelectasis. No focal opacities or suspicious lung nodules. No pleural effusion.MEDIASTINUM AND HILA: Mild to moderate cardiomegaly with pericardial thickening consistent with pericarditis. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No evidence of pulmonary embolism.2. Cardiomegaly with pericardial thickening consistent with pericarditis. Further characterization with an echocardiogram is recommended.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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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: Mildly increased peripheral subpleural basilar predominant reticulonodular opacities. Focal pleural-based nodular density measuring 1.0 x 1.0 cm (series 5 image 65) is new. No pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes unchanged. No new lymphadenopathy. Severe coronary and atherosclerotic calcifications.CHEST WALL: Severe degenerative changes affect the visualized thoracolumbar spine. Healed ninth right rib fracture unchanged. Right chest port with tip in the cavoatrial junction. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities too small to characterize are unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged renal cysts.PANCREAS: Pancreatic calcifications consistent with chronic pancreatitis unchanged.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the abdominal aorta and branches. Aneurysmal dilation of both common iliac arteries partially imaged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative changes affect the visualized thoracolumbar spine.OTHER: No significant abnormality noted.
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1. 1.0 cm left lower lobe nodular opacity is new since the prior study. While it does not have an appearance typical of metastatic disease, a 3 month CT follow up is recommended to confirm stability to exclude a new primary lung neoplasm. 2. Increased subpleural reticulonodular opacities since the prior study, which are now suspicious for interstitial lung disease.
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Generate impression based on findings.
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Left otalgia. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. 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. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. 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 irregularity and subchondral cyst formation in the left mandibular condyle.
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1. Unremarkable temporal bones.2. Degenerative changes of the left temporomandibular joint.
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Generate impression based on findings.
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2-year-old male for assessment of osteomyelitisVIEWS: Left and right ankle AP, oblique, lateral (6 views) 01/16/15 Right ankle: Wrap or skin staples are seen along the lateral aspect of the ankle with associated soft tissue swelling. No cortical erosions to suggest osteoarthritis. Left ankle: No cortical erosions to suggest osteomyelitis.
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Lateral soft tissue swelling about the right ankle without evidence of osteomyelitis.
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Generate impression based on findings.
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Alignment is anatomic. There are no fractures or subluxations. The visualized intracranial and paraspinal contents are unremarkable. Note is made of postsurgical changes from ACDF placement at the C3-4 and C4-5 level as well as intravertebral disk prostheses placement between the C5-6 and C6-7 levels which obscures full evaluation of these levels but there appears to be no complications or fracture.C2/3: No significant spinal canal narrowing or neuroforaminal stenosis.C3/4: Prominent posterior disk osteophyte complex with a focal right paracentral ossified component. Bilateral uncovertebral hypertrophy with mild to moderate central spinal canal stenosis. There is unchanged moderate-severe left and moderate right neuroforaminal narrowing.C4/5: Moderate diffuse posterior osteophyte disk complex with right-sided prominence with moderate spinal canal stenosis. Bilateral uncovertebral hypertrophy contributing to moderate bilateral neuroforaminal narrowing.C5/6: Mild to moderate diffuse posterior osteophyte disk complex with focal left paracentral component resulting in moderate to severe central spinal canal stenosis. There is also bilateral uncovertebral hypertrophy contributing to moderate left foraminal narrowing.C6-C7: There is left paracentral ossific density extending cranially which may be associated with a small disk osteophyte. There is mild to moderate central spinal canal stenosis. Minimal bilateral uncovertebral hypertrophy contributes to moderate left and mild-moderate right foraminal narrowing.At C7-T1, there is no significant disk pathology or stenosis.There is partially visualized emphysematous changes at the lung apices with possible minimal ground glass opacities. There is mild scattered mucosal thickening within the visualized paranasal sinuses.
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1.Exam is limited by hardware.2.Postsurgical changes from ACDF placement at the C3-4 and C4-5 levels and intravertebral disk prostheses placement at the C5-6 and C6-7 levels without complications or fracture3.Multiple persistent spondylitic changes with severe central spinal canal stenosis at the C5-6 level and moderate stenosis at the C4-5 levels.
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Generate impression based on findings.
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50-year-old female with abdominal pain of unclear etiology. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypoattenuating foci in segment 6 and dome of the liver are nonspecific. Additional subcentimeter hypoattenuating foci in the left hepatic lobe are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis or obstructing stone.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis. Small fat containing anterior abdominal wall hernia. 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 or colitis. Appendix is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No specific acute findings to account for patient's pain. 2.Hepatomegaly with a few nonspecific hypoattenuating foci.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. In retrospect, on the exam dated 12/12/2014, there was mild increased attenuation along the left tentorium which may have represented a small subdural hematoma or could have been related to artifact, however this finding is no longer seen. There is no acute intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Mild mucosal thickening of the ethmoid sinuses, otherwise the paranasal sinuses and mastoid air cells are clear.
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1.No acute intracranial abnormality.2.In retrospect, there was a small amount of density along the left tentorium on the prior exam which may have been due to a small subdural hematoma or artifact. This is no longer present on the current exam.3.An MRI may be considered if clinically warranted for a more sensitive evaluation.
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Generate impression based on findings.
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16-year-old male status post right derotational osteotomyVIEWS: Pelvis AP/lateral (two views) 01/16/15 Spinal stabilization rod and screw device is again seen affixing the lower lumbar spine and sacroiliac joints. Intrathecal pump device overlies the upper pelvis.A left proximal femoral plate and screw device is again noted with femoral head directed towards the left acetabulum. A right proximal femoral plate and screw device is noted affixing an osteotomy in non-anatomic alignment. The femoral head is dislocated from the acetabulum with a coxa valga deformity. Heterotopic ossification surrounding the osteotomy is suggestive of attempted healing.
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Posterior femoral dislocation with coxa valga deformity of the postoperative right femur.
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Generate impression based on findings.
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59-year-old male with history of foot fractures. The bones are demineralized. Again seen are transverse fractures through the necks of the second through fifth metatarsals with mild lateral angulation of the heads of the second through fourth metatarsals. New callus formation indicates some interval healing. There is a hallux valgus deformity with osteoarthritis at the first MTP joint. There is also a pes planus deformity with mild osteoarthritis at the midfoot.
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Healing metatarsal fractures as described above.
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Generate impression based on findings.
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Fell down 17 steps today with brief LOC and dizziness. History of traumatic brain injury in 1993. There is no evidence of acute intracranial hemorrhage or mass. There is bilateral parieto-occipital encephalomalacia. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged mastoid air cells are clear. There is partially-imaged subcutaneous stranding and swelling in the right nasal ala contusion and possible fracture of the right nasal skeleton. There is a small retention cyst in the right maxillary sinus. There is unchanged mild diffuse calvarial thickening and dolichocephaly. However, there is no evidence of skull fracture. The orbits appear unremarkable.
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1. No evidence of acute intracranial hemorrhage or skull fracture.2. Partially-imaged right nasal ala contusion and possible fracture of the right nasal skeleton.3. Bilateral parieto-occipital encephalomalacia is likely related to remote traumatic brain injury.
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Generate impression based on findings.
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31-year-old male with history of pain. There is moderate osteoarthritis affecting the left hip with osteophyte formation along the anterolateral femoral head/neck. The right hip appears normal. The remainder of the pelvis is unremarkable.
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Osteoarthritis as above.
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Generate impression based on findings.
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2-year-old female first-time wheezerVIEWS: Chest AP (one views) 01/16/15 Cardiothymic silhouette is normal. No pleural effusions or pneumothorax. No focal pulmonary opacities. Mild peribronchial cuffing is suggestive of reactive airway disease/bronchiolitis pattern
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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54-year-old female with history of humerus fracture. Again seen is a fracture through the greater tuberosity with mild superior displacement. There is adjacent callus formation indicating some interval healing. There is a band of sclerosis incompletely traversing the surgical neck of the humerus likely representing a healing nondisplaced fracture.
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Proximal humerus fracture as above.
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Generate impression based on findings.
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Esophageal cancer status post chemoradiation. CHEST:LUNGS AND PLEURA: No pleural fluid or pneumothorax. No suspicious pulmonary nodules or masses. Mild paramediastinal fibrosis consistent with history of radiotherapy. MEDIASTINUM AND HILA: Left paratracheal lymph node 14 mm, previously 15-mm (3/32). Small pericardial fluid collection increased in volume. No suspicious areas of esophageal thickening are appreciated.CHEST WALL: There appears to be stenosis involving the lower cervical spine, incompletely included in the scanning range.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Hypoattenuating lesion in the spleen unchanged.ADRENAL GLANDS: Right adrenal gland nodule 18 x 16 mm, previously 23 x 15 mm (3/83). Nodular appearance in the more caudal aspect of the right adrenal gland not conclusively changed. Left adrenal gland nodular thickening difficult to measure in a similar fashion, 14 mm compared to 17-mm previously (3/91).KIDNEYS, URETERS: Cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Circumaortic left renal vein with suggestion of the narrowing of the branch anterior to the abdominal aorta (3/98).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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1. Unremarkable appearance of the thoracic esophagus.2. Decrease size of small left paratracheal lymph node.3. Increased volume of pericardial fluid which may be related to radiation therapy.4. Decreased size of right adrenal gland nodule and left adrenal gland thickening. PET scan was reviewed by Dr. Applebaum and it is felt that this is most likely of benign etiology.5. Circumaortic left renal vein; the anterior branch of the left renal vein as it crosses the aorta is small in size and may be narrowed by PA superior mesenteric artery, correlate for signs of "nutcracker/SMA syndrome".
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Generate impression based on findings.
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Ms. Densmore is a 85 year old female presenting with a palpable left breast mass. Per patient's daughter, she had noticed left breast swelling/redness since Nov 2014. She was placed on a course of antibiotics which did improve the swelling, but the lump is still present. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A triangular marker is placed at site of palpable area of abnormality in the left upper outer breast. No discrete mass is present underneath the marker. However, there is diffuse skin thickening present bilaterally (left greater than right) with a dense trabeculation pattern, likely from underlying edema. Bilateral coarse ductal calcifications are seen in both breasts. LEFT BREAST ULTRASOUND
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Asymmetric left breast skin thickening and edema with no mammographic/sonographic correlate for patient's area of concern. A surgical consultation is recommended at this time for further evaluation of these findings. Differential considerations include cellulitis/mastitis, unusual manifestation of CHF or potentially inflammatory breast cancer. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.
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Generate impression based on findings.
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85-year-old female with history of colon cancer, evaluate disease status. CHEST:LUNGS AND PLEURA: Reference left upper lobe pulmonary nodule (4/23) measures 2.4 x 1.6 cm, increased from previous 1.6 x 1 cm.Other non-reference lesions have increased in size, and there is a new small right pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, no significant pericardial effusion. Moderate coronary artery calcifications. Scattered mildly enlarged mediastinal and hilar lymph nodes are again seen (3/42), some of which have slightly increased in size.CHEST WALL: Left chest dual lumen Port-A-Cath with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneously hypo-attenuating left liver lesion (3/80) has increased in size or the interval, currently measuring 91 x 69 mm, previously 78 x 39 mm. Additional hypodensities adjacent to this lesion are seen, consistent with progression of metastases.SPLEEN: Scattered splenic calcified granulomata.PANCREAS: Mild pancreas atrophy.ADRENAL GLANDS: No significant abnormality.KIDNEYS, URETERS: Unchanged atrophic left kidney with hypoattenuating foci most consistent with cysts but is not completely evaluated on this exam.Right kidney unchanged in appearance.RETROPERITONEUM, LYMPH NODES: Interval increased retroperitoneal lymphadenopathy, with a reference right periaortic lymph node at the level of the diaphragm (3/87) measuring 22 x 11 mm, previously 5 x 9 mm.BOWEL, MESENTERY: Right mid abdomen ostomy site is unchanged and appears intact.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New small amount of abdominal/pelvic ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral hernia, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Findings consistent with progression of disease in the lungs, liver and lymph nodes, with reference measurements given above.
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Generate impression based on findings.
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Reason: Assess for stricture/ adhesion History: abdominal pain, nausea, delayed gastric emptying, began after appendectomy Scout radiograph showed a nonobstructive bowel gas pattern. Double contrast visualization of the esophagus showed no morphologic abnormality. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. No hiatal hernia. The stomach was normal in size, shape, and position. The visualized gastric mucosa was within normal limits. Spontaneous emptying of contrast into the duodenal sweep was observed, there was no delay in gastric emptying with prompt progression of contrast through the stomach and into the small bowel. Right lower quadrant postsurgical material. Transit time to the colon was normal and was one hour. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, no fixed narrowing or stricture of obstructing adhesions seen. The visualized terminal ileum and ileocecal valve were unremarkable. The visualized ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 4:20 minutes
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Unremarkable exam, normal bowel transit time.
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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: Mild centrilobular emphysema.New atelectasis involving the lateral segment of the right middle lobe, probably from aspiration, since aspirated material was seen in the airways to this region.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Right port catheter tip in SVC.There are no coronary calcifications, the heart and pericardium appear normal.No mediastinal or hilar lymphadenopathy noted.Aspirated material is seen in central airways.CHEST WALL: Mild degenerative abnormalities of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cystlike hypodensities are unchanged, likely benign; one cyst image 82 series 3 is of slightly higher attenuation but is stable, and could be evaluated by dedicated hepatic imaging. SPLEEN: No significant abnormality noted although there is a small accessory splenule. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology. Left bottle of hernia.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left Bochdalek hernia.
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No evidence metastases, or other significant abnormality except for aspirated secretions on the right leading to partial right middle lobe atelectasis.
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Generate impression based on findings.
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Reason: renal cancer with metastasis on therapy. Eval for change History: renal cancer on therapy The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowel. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule has been resected. Two additional micronodules in the right middle lobe (image 50; series 5) have both decreased in size. Other bilateral micronodules have all decreased in size or resolved.MEDIASTINUM AND HILA: Reference right hilar lymph node which is indistinguishable from the right pulmonary artery has decreased in size and measures approximately 2.2 x 1.8 cm (image 45; series 3). Coronary artery calcifications and vascular stent are again noted.CHEST WALL: Left chest wall pacemaker is again noted. Slight interval regression of the right chest wall reference nodule which currently measures 2.7 x 2.0 cm (image 72; series 2).ABDOMEN:LIVER, BILIARY TRACT: Granulomas are unchanged. Sub-centimeter hypodense lesion in the right lobe appear stable (image 81; series 3).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney is absent. Right renal nodules are stable in size. Hyperdense nodule appears unchanged at the upper pole.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine and levoscoliosis are stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval regression of disease with reference measurements given above.
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Generate impression based on findings.
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Reason: HNSCC. Compare to previous. 13-0311 protocol. History: as above CHEST:LUNGS AND PLEURA: Redemonstration of multiple pulmonary masses with reference measurements as follows:Right upper lobe 7.2 x 6.3 cm (series 6 image 29) previously 7.1 x 6.2 cm.Left upper lobe 4.2 x 3.1 cm (image 39) previously 4.2 x 3.1 cm.lingula 7.0 x 6.7 cm (image 55) previously 6.9 x 6.6 cm.MEDIASTINUM AND HILA: Right upper lobe mass inseparable from the anterior pleural surface. Lingular mass inseparable from the pericardium. Mildly prominent subcarinal lymph nodes not significantly changed in size. No visible coronary arterial calcifications. CHEST WALL: Right chest port with tip at the cavoatrial junction. Opacification of venous collateral branches in the left breast and chest wall. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Absent right kidney. Left renal hypodensities are unchanged and most compatible with cysts but some too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent mesenteric lymph nodes without significant interval change in size since the prior study.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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1. No significant interval change in size of pulmonary metastases since the prior study. 2. Other chronic findings as described above.
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Generate impression based on findings.
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Ms. Jackson is a 45 year old female presenting with a left breast mass that been present for several months. She denies any focal pain or history of trauma. Three standard views of both breasts with three left spot compression views 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. A triangular marker is placed at the patient's area of palpable concern in the left upper outer breast. Underneath this marker is a dominant focal asymmetry with suggestion of architectural distortion. Just anterior to this focal asymmetry is an additional asymmetry. Bilateral coarse ductal calcifications and arterial calcifications are present. There is no mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. LEFT BREAST ULTRASOUND
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Two irregular solid masses in the left upper outer breast with suspicious sonographic features. An US-guided biopsy of the larger mass is recommended for histologic sampling. Recommendations for the second mass can be made pending the results from the biopsy.The patient is on daily aspirin for her multiple other comorbidities. An Epic message has been sent to the patient's primary care physician Dr. Yasmin Karimi on 1/16/2016 at 4:10pm for further recommendations on holding her blood thinning medications 5 days before biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.
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Generate impression based on findings.
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Fibular fracture Stress view demonstrates the oblique distal fibular fracture without evidence or change in alignment. Ankle mortise remains intact and symmetric. Minimal soft tissue swelling.
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Distal fibular fracture in alignment
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Generate impression based on findings.
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Fibular fracture Single projection again demonstrates the distal fibular fracture with minimal displacement laterally. Overlying moderate soft tissue swelling with Morse minimal diffuse swelling. Specifically the ankle mortise remains intact and symmetric under stress
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Distal fibular fracture the absence of interval change or evidence of ligamentous injury involving the medial side
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Generate impression based on findings.
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Olecranon fracture follow-up Two K wires with figure 8 fixation appears unchanged without evidence of interval new abnormality. Fracture planes are indistinct compatible continued and essentially complete healing. Soft tissues unremarkable.
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Post fixation hardware without evidence of interval complication. Underlying healed olecranon fracture
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Generate impression based on findings.
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Left knee pain Moderate tricompartmental osteoarthritic changes with narrowing, sclerosis and osteophytes greater in the medial aspects. Moderate knee effusion. Alignment otherwise preserved
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Moderate osteoarthritis
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Generate impression based on findings.
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Right knee pain Moderate tricompartmental osteoarthritic changes with fixation of the medial tibial plateau. No hardware complications. No change in alignment. No distinct effusion or additional soft tissue abnormality
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Post tibial plateau fracture repair without evidence of new complication superimposed upon moderate osteoarthritis
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Generate impression based on findings.
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Pain Oblique and mildly posterior displacement of a distal fibular fracture with a small additional adjacent linear fragment. Additionally a posterior tibial fragment minimally displaced and irregularities underlying the medial malleolus collectively suggests an SER 4 injury. No evidence of mid and distal hindfoot appearances.There is however mild increased density in the talar dome, concerning for possible AVN. If prior imaging is available for comparison this would be helpful.
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SER 4 injury and questionable talar dome AVN
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Generate impression based on findings.
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History rheumatoid arthritis, evaluate for lung disease. LUNGS AND PLEURA: 7 x 5 mm pleural based left lower lobe nodule. There is mild subpleural basilar fibrosis and basilar predominant bronchiectasis without bronchial wall thickening. MEDIASTINUM AND HILA: Mildly enlarged main pulmonary artery measures 3.2 cm, which may be seen in pulmonary hypertension. ICD generator and leads in place. No visible coronary calcifications. Mild atherosclerotic calcifications of the aortic arch. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Nonspecific adrenal gland thickening.
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1. 7 x 5 mm pleural based left lower lobe nodule, for which 6 month follow up is recommended. 2. Mild subpleural basilar fibrosis and basilar predominant bronchiectasis is nonspecific and may represent rheumatoid related interstitial lung disease.
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Generate impression based on findings.
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Prostate cancer. Gleason 9. ABDOMEN:LUNG BASES: Minimal scarring at the lung bases. Coronary artery calcifications.LIVER, BILIARY TRACT: 1.7-cm indeterminate hypodense lesion in the inferior right lobe (image 73; series 3).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous prostate compatible history of prostate carcinoma.BLADDER: No significant abnormality notedLYMPH NODES: Scattered subcentimeter lymph nodes can be followed.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes of the right hip.OTHER: No significant abnormality noted
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Solitary indeterminate 1.7-cm liver lesion.
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Generate impression based on findings.
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20-year-old female with history of pain. There is no acute fracture or dislocation. Alignment is anatomic. The soft tissues are unremarkable.
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No radiographic findings to account for the patient's pain.
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Generate impression based on findings.
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Right upper lobe mass rule out lung cancer. Tobacco use. LUNGS AND PLEURA: Irregularly marginated right apical nodule containing an internal air bronchogram measures 11 x 10 x 9-mm mm, previously 10 x 7 x 7 mm. Spiculated appearance of the borders could be due to an adjacent emphysema or cellular infiltration. The nodule extends to the right apical pleural surface which is slightly tented.Centrilobular paraseptal emphysema, moderate to severe. No pleural fluid or pneumothorax. 5-mm micronodule right lower lobe (5/157) occurs in an area which was previously atelectatic. Therefore, this is of unclear chronicity.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches, including a moderate coronary artery calcification. No pericardial fluid. No enlarged lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcifications, but no other significant abnormality noted.
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1. Interval enlargement of right apical nodule, suspicious for primary pulmonary neoplasm. Recommend correlation with PET scan. This was discussed with the referring clinical service (GI fellow) prior to time of dictation.2. Nonspecific 5-mm right lower lobe nodule is of unclear chronicity as the area was previously atelectatic, nonspecific. This lesion may be followed by CT in 6 months.
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Generate impression based on findings.
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31-year-old female with history of pain and stiffness. Left foot: There is a mild hallux valgus deformity. Mild pes planus. There is no evidence of inflammatory arthritis.Right foot: There is a mild hallux valgus deformity. Mild pes planus. There is no evidence of inflammatory arthritis.Left knee: There are tricompartmental osteophytes compatible with mild osteoarthritis. There is no evidence of inflammatory arthritis.Right knee: There are tricompartmental osteophytes compatible with mild osteoarthritis. There is no evidence of inflammatory arthritis.Left hand: There are boutonniere deformities of the third, and fourth and fifth fingers. There is no evidence of active erosions. There is deformity and irregularity of the distal ulna with secondary degenerative changes of the distal radial ulnar joint. There is what appears to be abnormal bridging between the scaphoid and lunate. There is ulnar subluxation of the carpus.Right hand: There are boutonniere deformities of the second through fifth fingers. There is no evidence of active erosions. There is deformity and irregularity of the distal ulna. There is ulnar subluxation of the carpus.
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1.Constellation of findings suggestive of rheumatoid arthritis in the hands, left greater than right.2.Mild bilateral hallux valgus and pes planus deformities.3.Mild osteoarthritis at the knees.
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Generate impression based on findings.
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65-year-old male with altered mental status Redemonstrated are stable periventricular and subcortical low attenuation white matter foci most likely reflecting age indeterminate small vessel ischemic stroke without CT evidence of acute territorial, cortical infarct. There is no acute no hemorrhage, mass, mass effect, or midline shift. Basilar cisterns are maintained. Fluid within the nasopharynx, paranasal sinuses, as well as the bilateral mastoid air cells and middle ear cavities are consistent with the patient's intubated status.
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No acute intracranial process.
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Generate impression based on findings.
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History of systemic lupus erythematosus, tongue dysplasia, and new enlarged fixed lymph nodes right cervical chain. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid appears unremarkable. The submandibular glands appear to be atrophic. The parotid glands are unremarkable. The major cervical vessels are patent. The airways are patent. There is diffuse paranasal sinus opacification with suggestion of air-fluid levels. There is nonspecific patchy stranding in the anterior right lower neck subcutaneous tissues. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable. There are a few micronodules in the partially-imaged lungs.
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1. No evidence of measurable mass lesions or significant cervical lymphadenopathy.2. Findings suggestive of acute sinusitis.3. Nonspecific micronodules in the partially-imaged lungs. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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History of rheumatoid arthritis, evaluate for lung disease. LUNGS AND PLEURA: Scattered benign appearing calcified micronodules. Basilar atelectasis/scarring. No focal airspace opacities, pleural effusions, or evidence of fibrosis. No evidence of bronchiectasis, although there is mild basilar bronchial wall thickening.MEDIASTINUM AND HILA: Mild pericardial fluid/thickening and moderate cardiomegaly. Severe coronary calcifications. CHEST WALL: The bones appear demineralized. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatic and splenic granulomata. Hypoattenuating lesion in the right hepatic lobe with a peripheral small calcification is incompletely characterized, and correlation with dedicated hepatic imaging may be considered as warranted clinically.
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1. No evidence of rheumatoid related lung disease as clinically questioned.2. Other findings as described above.
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Generate impression based on findings.
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Male 66 years old; Reason: prostate cancer History: evaluate the right ribs as pt had a fall, r/o mets. Patient, history of multiple recent falls. Patient also noted falling today in the parking lot of the hospital, landing on his right knee, denies head trauma, dizziness or pain. Exam was unremarkable, with mild skin abrasion of the right knee and left hand, able to bear weight, ambulating well, no imbalance. There is increased osteoblastic activity involving the anterior aspect of the adjacent 3rd-6th ribs which are focal and vertically oriented. This is a highly typical appearance for benign rib fractures.In the left posterior aspect of the 10th rib, there is increased activity along the axis of the rib with features more suspicious for metastatic disease, and corresponds with a nonspecific sclerotic focus seen on comparison CT. More medially at the costovertebral junction at this same level, there is an additional focus of activity which corresponds with the degenerative osteophyte on comparison CT. There is mild increased activity along L4/L5, and L5/S1 disk space which correlates with the ninth facet arthropathy seen on CT study.
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1. Benign fractures of the right anterior 3rd-6th ribs.2. A single additional focus in the left posterior 10th rib with somewhat more suspicious features on both bone scan and comparison CT could represent a single focus diastasis. However, given history of recent fracture and multiple recent falls, an atypical appearance of an additional benign rib fracture is also a possibility. Findings were discussed with Dr. Chadi Nabhan by telephone on 1/16/2015 at 3:10 PM.
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Generate impression based on findings.
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Reason: follow up for prostate cancer History: prostate cancer CHEST:LUNGS AND PLEURA: Apical scarring. Previously described nodular opacities in the right lower lobe (series 4, image 59) and right middle lobe (series 4, image 72) are unchanged. Right upper lobe granuloma unchanged. Reference subpleural nodule in the left lower lobe measures are 0.7 x 0.3 cm (series 4; image 72), unchanged. Multifocal pleural-based calcifications are not changed.MEDIASTINUM AND HILA: Index precarinal lymph node measures 1.6 x 1.3 cm (series 3, image 42), unchanged. Index paraesophageal lymph node measures 2.6 x 1.4 cm (series 3, image 50), probably unchanged and difficult to separate from the esophagus. Index right hilar lymph node measures 3.2 x 2.4 cm (series 3, image 56), roughly stable. Aneurysmal descending aorta measures up to 5.0 cm in diameter (series 3, image 56), unchanged. Coronary artery and thoracic aorta calcifications as noted previously.CHEST WALL: Stable thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: Well defined bilobar hepatic hypodensities compatible with cysts, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, stable.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Atherosclerotic calcification of the abdominal aorta and its branches with mild ectasia is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. Reference soft tissue density in the prostate bed measures 2.5 x 1.7 cm (image 192; series 3), stable to equivocally smaller.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enlarging left acetabular (image 169; series 3) and left femoral neck sclerotic metastases (image 111; series 8023); correlate with bone scan. Other lesions are roughly stable.OTHER: No significant abnormality noted.
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Most of the reference lesions are stable although the left acetabular and left femoral bone lesions appear larger on today's examination. Correlate with bone scan.
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Generate impression based on findings.
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Male, 59 years old, with stroke. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The ventricular system is normal in size and morphology. The visualized paranasal sinuses and mastoid air cells are clear. The bones of the calvarium and skull base are intact.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Reason: s/p 4 yrs after s/p LUL for management of T1aN0 stage IA adenocarcinoma History: annual f/u LUNGS AND PLEURA: Severe paraseptal and centrilobular emphysema with surgical changes consistent with left upper lobectomy. Basilar scarring/atelectasis unchanged. No new suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Diffuse thyroid enlargement unchanged and partially imaged. Moderate coronary arterial calcifications. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Stable postoperative changes of left upper lobectomy with emphysema and basilar scarring/atelectasis. No evidence of recurrent disease.
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Generate impression based on findings.
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26 year old female with sacral pain. Evaluate for fracture. There are postsurgical changes in the lumbar spine and left sacrum with bone graft material present . Pedicle screws extend through the L4 and L5 vertebral bodies with additional hardware in the right sacrum, right ilium, and left ilium. Additionally, there is a defect within the left aspect of the sacrum which is postsurgical in etiology. There is no evidence of hardware complication. No evidence of acute fracture. There is mild asymmetry of the pubic symphysis.
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Postsurgical changes without evidence of acute abnormality.
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Generate impression based on findings.
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There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout with significant disc height loss at L2/3, mild disc height loss at L3/4, and moderate disc height loss at L4/5. Schmorl's nodes are present involving both endplates at L2/3 and L4/5. Edematous discogenic reactive endplate changes (Modic type I) are noted at L2/3 and L4/5.T12/L1: UnremarkableL1/2: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L2/3: Grade 1 anterolisthesis L2 on L3, right foraminal/lateral disc protrusion with superimposed asymmetric bulge to the right, ligamentum flavum thickening, mild to moderate left facet hypertrophy, and severe right facet hypertrophy. There is mild to moderate right lateral recess and moderate right neural foraminal stenosis.L3/4: Asymmetric bulge to the right, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is moderate left lateral recess and mild to moderate right neural foraminal stenosis.L4/5: Asymmetric bulge to the left, ligamentum flavum thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central, mild bilateral lateral recess, and moderate left neural foraminal stenosis.L5/S1: Mild disc bulge and mild bilateral facet hypertrophy without significant stenosis.Note is made of Tarlov cysts expanding the sacral canal.
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1.L2/3: Mild to moderate right lateral recess and moderate right neural foraminal stenosis.2.L3/4: Moderate left lateral recess and mild to moderate right neural foraminal stenosis.3.L4/5: Mild central, mild bilateral lateral recess, and moderate left neural foraminal stenosis.
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Generate impression based on findings.
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65-year-old male with history of L3/4 radiculopathy. There is lumbarization of S1. There is no acute fracture or subluxation. There is moderate degenerative disk disease especially at L5-S1. There is moderate facet hypertrophy most notably in the lower lumbar spine.
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Degenerative arthritic changes as above. If patient care warrants further imaging, an MRI may be obtained.
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Generate impression based on findings.
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History of mantle cell lymphoma status post chemotherapy, last in 1998. Recent CT showed a mildly enlarged lymph nodes, stable. Undergoing heart transplantation evaluation. Restaging exam to define disease activity and possible biopsy planning.RADIOPHARMACEUTICAL: 14.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly demonstrates left ICD and left ventricular assist device, grossly intact. Right chest Port-A-Cath with tip in the SVC/RA junction. Multichamber cardiomegaly is noted.Today's PET examination demonstrates multiple symmetric mildly hypermetabolic bilateral axillary lymph nodes. These have increased slightly in size, number, and metabolic activity from previous but are still mild (SUV max = 1.9 previously, = 3.0 currently).Multiple small fairly symmetric mildly hypermetabolic mediastinal and bilateral hilar lymph nodes are similar in uptake although slightly increased in size and number number compared with previous (SUV max = 4.0).Multiple small symmetric mildly hypermetabolic bilateral inguinal lymph nodes are also similar in uptake with slight increase in size and number from previous (SUV max = 2.7).There has been interval resolution of previous diffuse hypermetabolic abnormal splenic activity. There has also been resolution of previous right upper lobe hypermetabolic pulmonary focus.
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1.No significantly FDG avid tumor currently. There are symmetric mildly hypermetabolic lymph nodes in the axilla, mediastinal, and inguinal locations which, while slightly more pronounced than previous, are still mild and considered more likely a manifestation of systemic inflammation. Tumor activity cannot be entirely excluded, however. No dominant focus for biopsy is detected as questioned.2.Interval resolution of previous diffuse splenic activity.
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