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Generate impression based on findings.
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Chronic constipationVIEW: Abdomen AP 1/17/15 There is a large amount of fecal burden predominantly at the rectosigmoid region. There is a dilated loop of bowel in the midline. No pneumatosis or pneumoperitoneum.
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Large amount of fecal burden.
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Generate impression based on findings.
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10 month old female status post Dobbhoff tube placementVIEW: Abdomen AP (one view) 1/16/2015, 19:50 There is a Dobbhoff tube with its tip at the level of the GE junction. Disorganized nonobstructive bowel gas pattern. Moderate stool burden distributed throughout the colon. Multiple clips are seen over the proximal right thigh.
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Dobbhoff tube with tip at the level of the GE junction.
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Generate impression based on findings.
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16 year old male with pain and swelling after eversion injury.VIEWS: Left ankle AP lateral and oblique (3 views) 1/16/2015 There is marked soft tissue swelling about the ankle, predominantly affecting the lateral malleolus. There is a moderate/large joint effusion. There is marked edema of Kager's fat pad worrisome for underlying soft tissue injury. Well corticated ossific density seen just inferior to the medial malleolus is likely chronic in etiology.
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1.Marked soft tissue swelling and joint effusion. 2.Edema of Kager's fat pad is worrisome for underlying soft tissue injury and further evaluation with MRI is recommended.
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Generate impression based on findings.
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TachypneaVIEW: Chest AP 1/17/15 Feeding tube, left central line and IVC stent again noted. Multiple surgical sutures project over the right upper quadrant. Cardiothymic silhouette normal. Patchy atelectasis in the left upper lobe and left lower lobe. No pleural effusion or pneumothorax.
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Patchy atelectasis in the left lung not significantly changed.
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Generate impression based on findings.
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62-year-old female with history of COPD, CHF, pulmonary hypertension LUNGS AND PLEURA: There is moderate centrilobular emphysema. There is a small, 4 mm, nodular scar like opacity in the left upper lobe (series 5, image 41). There is bibasilar scarring/atelectasis. No pleural effusions. Small 1-2 mm calcified and noncalcified micronodules in the right lung. No suspicious pulmonary nodules or masses. No additional focal opacities. No pneumothorax. MEDIASTINUM AND HILA: Mild cardiomegaly with small pericardial effusion. There are severe atherosclerotic calcifications of the aorta and coronary arteries. There are enlarged right paratracheal and pretracheal lymph nodes measuring up to 1.1 cm (series 3, image 26 and 36).CHEST WALL: Mild degenerative changes affect the thoracic spine particularly T6 to T10 are there is disk space narrowing and endplate sclerosis. No suspicious lesions are identified.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Small soft tissue nodules adjacent to the spleen may represent splenules.
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1.Moderate centrilobular emphysema.2.Mild cardiomegaly with small pericardial effusion.
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Generate impression based on findings.
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Headache and no shunt output. There has been interval removal of the right transparietal ventricular catheter and interval insertion of a left transfrontal ventricular catheter that terminates in the body of the corpus callosum, rather than within the ventricular system. There has been slight interval increase in size of the third and lateral ventricles. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Interval insertion of a left transfrontal ventricular catheter that terminates in the body of the corpus callosum and slight increase in size of the ventricular system.2. No evidence of acute intracranial hemorrhage.Discussed with Dr. Frim at 9AM on 1/17/15.
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Generate impression based on findings.
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ET placementVIEW: Chest AP 1/17/15 ET tube tip immediately above the carina. Feeding tube and right femoral line again noted. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe, lingula and left lower lobe increased in the interval. No pleural effusion or pneumothorax. Mildly dilated loops of bowel in the upper abdomen.
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Bilateral patchy atelectasis increased in the interval.
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Generate impression based on findings.
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58 day old female, rule out causes of green tinged residuals.VIEW: Abdomen AP (one view) 1/16/2015, 20:41 NG tube with tip in the body of the stomach. There is a disorganized nonobstructive bowel gas pattern. No portal venous gas, pneumatosis intestinalis or pneumoperitoneum is seen. Partially imaged right basilar opacity. Persistent body wall edema.
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Disorganized nonobstructive bowel gas pattern.
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Generate impression based on findings.
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There is no acute fracture or traumatic subluxation. The last well-formed disc space is referred to as L5-S1. There is minimal grade 1 anterolisthesis of L3 on L4, and mild grade 1 anterolisthesis of L4 on L5 with uncovering of discs. The lumbar spinal canal is slender on a developmental basis with superimposed degenerative findings causing moderate to severe spinal canal stenosis at multiple levels. There is mild to moderate spinal canal stenosis at L1-2, severe spinal canal stenosis at L2-3 and L3-4, and moderate to severe spinal canal stenosis at L4-5 due to degenerative disc bulges, bilateral facet arthropathy and ligamenta flava thickening. There is moderate bilateral neural foramen stenosis at L1-2. There is severe left and mild to moderate right neural foramen stenosis at L2-3 and L3-4. There is mild to moderate bilateral neural foramen stenosis at L4-5. There is cortical irregularity of the abutting L2 and L3 spinous processes, suggestive of Baastrup's disease. There are metallic clips in the right external iliac region. There is extensive atherosclerotic calcification in the abdominal aorta and pelvic vasculature.
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Extensive degenerative spondylosis of the lumbar spine superimposed on a developmentally narrow spinal canal associated with moderate to severe spinal canal and neural foramen stenoses from L1-2 through L4-5 as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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ET placementVIEW: Chest AP 1/17/15 ET tube tip below thoracic inlet and above the carina. Feeding tube and left chest port in place. Cardiothymic silhouette normal. Right lower lobe opacity minimally increased in the interval. Patchy atelectasis left lower lobe. No pleural effusion or pneumothorax.
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Right lower lobe opacity minimally increased and may represent infection and follow-up recommended.
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Generate impression based on findings.
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15 year old female, rule out fracture/dislocation. Tender right lateral malleolus.VIEWS: Right ankle AP lateral and oblique (3 views) 1/16/2015 Marked soft tissue swelling of the ankle, predominantly affecting the lateral malleolus. Small/moderate joint effusion. No acute fracture or malalignment seen. Nonspecific sclerotic focus in the anterior talus is may represent a bone island.
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Marked soft tissue swelling and joint effusion without underlying fracture or malalignment.
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Generate impression based on findings.
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13-year-old male with ankle pain, tender to palpation over the medial malleolus.VIEWS: Right ankle AP lateral and oblique (3 views) 1/16/2015 No acute fracture or malalignment evident. No significant soft tissue swelling or joint effusion is seen.
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Normal examination.
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Generate impression based on findings.
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49-year-old female with history of pain. Left ankle: There are mild degenerative changes affecting the midfoot and tibiotalar joint. We see no fracture.Left knee: There is no acute fracture or dislocation. Tricompartmental osteophytes and joint space narrowing worse in the lateral compartment with near bone on bone apposition compatible with moderate to severe osteoarthritis. Small joint effusion. Scattered arterial calcifications are present.Right knee: There is no acute fracture or dislocation. Tricompartmental osteophytes and joint space narrowing worse in the lateral compartment with near bone on bone apposition compatible with moderate to severe osteoarthritis. Small joint effusion. Scattered arterial calcifications are present.
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Osteoarthritis as above, but we see no acute fracture.
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Generate impression based on findings.
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20-month-old female with fifth finger edema.VIEWS: Left fifth finger PA lateral and oblique (3 views) 1/17/2015 Mild soft tissue swelling affects the fifth digit, but no underlying fracture or malalignment is seen.
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Mild soft tissue swelling without underlying fracture or malalignment.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage or mass. There is nonspecific patchy periventricular and subcortical white matter hypoattenuation with mild interval progression from the prior exam, likely representing indeterminate small vessel ischemic changes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is atherosclerotic calcification in the bilateral cavernous carotid arteries and the left vertebral artery. The imaged paranasal sinuses and mastoid air cells are clear. There is a right frontal burr hole. The extracranial soft tissues are unremarkable.
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No acute intracranial hemorrhage. Probable age-indeterminate small vessel ischemic changes that appears to have progressed slightly since 2007. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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17 year-old male status post NG tube placement.VIEW: Chest AP (one view) 1/16/2015, 18:56 Interval advancement of the NG tube with the tip now terminating in the body of the stomach. Partially imaged ventriculoperitoneal shunt catheter again seen. Orphaned shunt catheter tubing seen in the right hemithorax. Persistent left lower lobe atelectasis.
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NG tube with tip terminating in the body of the stomach.
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Generate impression based on findings.
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17 year-old male status post NG tube placement.VIEW: Chest AP (one view) 1/16/2015, 16:59 There is a nasogastric tube in place, which is coiled in the distal thoracic esophagus with the tip terminating in the midthoracic esophagus. Partially imaged ventriculoperitoneal shunt catheter again seen. Orphaned shunt catheter tubing seen in the right hemithorax. Persistent left lower lobe atelectasis.
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NG tube with tip terminating in the body of the stomach.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is a small old left basal ganglia infarct. There is mild periventricular and white matter hypoattenuation. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral cavernous carotid and vertebral artery atherosclerotic calcifications. The imaged paranasal sinuses and mastoid air cells are clear. There is no focal calvarial lesion. There is a stable subcentimeter lipoma in the right parietal scalp. There is a partially-imaged hypoattenuating right carotid space mass.
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1. Chronic-appearing microvascular ischemic changes, but no acute intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Partially-imaged right carotid space mass, which likely represents a schwannoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. However, there appears to be mild disproportionate prominence of the sulci of the cerebellar vermis. There is no midline shift or herniation. There is a subcentimeter retention cyst in the right maxillary sinus. The imaged mastoid air cells are clear. The orbits and skull, appear unremarkable. However, there is a right occipital scalp lipoma that measures 12 mm in width.
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1. No evidence of acute intracranial hemorrhage or mass. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Apparent mild cerebellar vermis volume loss may be related to alcohol abuse.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Evaluate ETVIEW: Chest AP 1/17/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. There are three chest tubes on the right and left PICC in place. Cardiothymic silhouette cannot be evaluated. The large right pneumothorax is not significantly changed in size. Left lung atelectasis unchanged.
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Large right pneumothorax not significantly changed in size.
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Generate impression based on findings.
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54-year-old male with new enlarging pulmonary consolidation CHEST:LUNGS AND PLEURA: No pleural effusion. Focal pulmonary opacity in the right upper lobe and additional focal opacities in the right lower and middle lobe is suspicious for infection. Small right pleural effusion Subsegmental left lingular atelectasis. MEDIASTINUM AND HILA: Right internal jugular central venous catheter tip is at the superior cavoatrial junction. Heart size is normal. No pericardial effusion. Minimal coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. No suspicious osseous lesions.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extra hepatic biliary ductal dilatation. Gallstones are present.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged simple cyst in the upper pole of the right kidney.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 suspicious osseous lesions. Mild degenerative changes chest structures.OTHER: No significant abnormality noted.
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Right upper lobe opacity with additional focal opacities in the right lower and middle lobe suspicious for multifocal infection.
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Generate impression based on findings.
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Status post coiling of a basilar tip aneurysm. Evaluate for SAH or edema. There is a large basilar aneurysm coil mass, which produces extensive streak artifact that obscures surrounding structures. Within this limitation, there is persistent intraventricular hemorrhage and scattered areas of hypoattenuation within the cerebral white matter. There has been interval removal of the right transfrontal ventriculostomy catheter. There is slight slight interval increase dilatation of the lateral ventricles. There is residual hypoattenuation along the prior shunt catheter tract. There is unchanged left cerebellar hemisphere encephalomalacia and hypoattenuation within the bilateral basal ganglia. There are vertebral and carotid siphon vascular calcifications. There is opacification of the bilateral mastoid air cells. There is pansinus opacification with air-fluid levels.
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1.The evaluation is limited by extensive metallic artifact from the basilar tip aneurysm coil mass. 2.Interval removal of the ventriculostomy catheter with slight interval increase dilatation of the lateral ventricles with residual interventricular hemorrhage.3.No significant change in the presumed small vessel ischemic disease and chronic-appearing left cerebellar and bilateral basal ganglia infarcts. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarctDiscussed with Dr. Ardelt on 1/17/2015 at 11:50 AM by Michael Veronesi, MD.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Subarachnoid hemorrhage related to aneurysm rupture. There has been interval coiling of a basilar tip aneurysm. Streak artifact related to the coil mass partly obscures the surrounding anatomy. Nevertheless, the subarachnoid hemorrhage centered in the basal cisterns appears to be less conspicuous, but hemorrhage appears to have redistributed into the ventricular system, which has substantially increased in size diffusely, along with sulcal effacement. In addition, there is development of mild periventricular white matter hypoattenuation, which likely represents transependymal CSF flow. There is no midline shift or herniation. There is a partially empty sella. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Interval coiling of a basilar tip aneurysm. 2. The subarachnoid hemorrhage centered in the basal cisterns appears to be less conspicuous, but hemorrhage appears to have redistributed into the ventricular system, which has substantially increased in size diffusely, which indicates communicating hydrocephalus. The findings were conveyed to Dr. Kak at 11 AM on 1/17/15.
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Generate impression based on findings.
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Bleeding versus venous thrombus. History of headache and vertigo. There is persistent apparent apparent linear hyperattenuation along the tentorial apex. There is no evidence of intracranial mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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Persistent apparent linear hyperattenuation along the tentorial apex may represent a prominent vascular structure versus acute extra-axial hemorrhage, or venous thrombosis. Follow up imaging, perhaps with MRI and MRV may be useful if clinically warranted.
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Generate impression based on findings.
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Wrist and hand pain/effusion. Bilateral ankle and foot effusions. Evaluate for signs of crystal arthritis. Three views of the left hand are provided. Evaluation of the hand is slightly limited due to inability to optimally position the patient for the examination. The bones appear demineralized suggesting osteopenia. There is deformity of the distal radius compatible with an old healed fracture, with associated positive ulnar variance and dorsal subluxation of the distal ulna. Ossicles situated distal to the ulna may also be posttraumatic in etiology. There is narrowing of the radiocarpal joint and midcarpal joint which I suspect is also posttraumatic in etiology, although the possibility of a chronic inflammatory arthritis is considered less likely. Small cysts in the lunate are likely degenerative, less likely representing chronic erosions. Apparent narrowing of the metacarpophalangeal joints and interphalangeal joints is likely in part due to inability to optimally position the patient, although may reflect mild cartilage loss. There are scattered arterial calcifications in the soft tissues. I see no specific radiographic features of crystalline arthropathy.Three views of the right hand are provided. The bones are demineralized, suggesting osteopenia/osteoporosis. There is mild soft tissue swelling along the radial aspect of the wrist and dorsum of the hand, extending into the fingers. There is slight narrowing of the radioscaphoid articulation and slight widening of the scapholunate articulation, perhaps reflecting scapholunate ligament laxity or disruption. I otherwise see no specific radiographic features of crystalline arthropathy. A couple of small ossicles along the radial aspect of the scaphoid may reflect old trauma but are of uncertain current clinical significance. There is mild narrowing of the interphalangeal joints and perhaps the metacarpophalangeal joints as well, which I suspect is degenerative in etiology.Three views of the left foot are provided. The bones are demineralized. There appears to be a cavus deformity of the foot, although this may be an artifact of positioning for the examination. There is mild diffuse soft tissue swelling. I see no specific radiographic features of crystalline arthropathy.Three views of the right foot are provided. The bones are demineralized. There appears to be a cavus deformity of the foot, although this may be an artifact of positioning for the examination. I see no specific radiographic and features of crystalline arthropathy. A small ossicle distal to the fibular tip may reflect old trauma.
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Arthritic changes as described above appear predominantly degenerative etiology, and I see no specific radiographic features of crystalline arthropathy. Other findings as described above.
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Generate impression based on findings.
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Pain. Evaluate fracture. Two views of the right femur are provided. The bones appear demineralized. There is a complete fracture of the femoral neck with slight superolateral displacement of the diaphyseal fracture fragment. There may also be a slight rotational malalignment, but this is difficult to assess on these radiographs.Two views of the right hip reveal the aforementioned femoral neck fracture. Mild osteoarthritis affects the hip.The AP view of the pelvis reveals the aforementioned right femoral neck fracture. Mild osteoarthritis of both hips. The bones appear demineralized. Severe degenerative disk disease affects the lower lumbar spine.
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Right femoral neck fracture.
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Generate impression based on findings.
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32-year-old female with a headache status post fall. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of acute intracranial hemorrhage or skull fracture.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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53-year-old female with idiopathic bilateral vocal cord paralysis, anosmia, left tongue atrophy and foot tingling. Evaluate for intracranial etiology. There is a hyperattenuating mass centered in an expanded left jugular foramen with extension into the left cerebellopontine angle cistern, with slight mass effect upon the brainstem, and into superior carotid space. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is opacification of the right mastoid air cells. No evidence of a parenchymal enhancing lesion.
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1. A mass centered in the left jugular foramen may represent a glomus jugulare. 2. Nonspecific opacification of the right mastoid air cells.Discussed with Dr. Langerman at 1:30 PM on 1/17/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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There is moderate bilateral maxillary and left sphenoid sinus mucosal thickening. There is mild opacification of scattered bilateral ethmoid air cells. There is trace left and mild right frontal mucosal thickening. There is moderate mucosal thickening in the left sphenoid sinus. There is mild sclerosis an thickening of many of the paranasal sinus walls. The infundibulae and sphenoethmoidal recesses are patent. There is a normal variant ager nasi cell on the left. The nasal cavity is clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.
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Chronic-appearing paranasal sinus opacification in a sporadic pattern.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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19-year-old female status post shunt two weeks ago now with headache and nausea. Rule out hydrocephalus. There is a right transparietal ventricular catheter that terminates in the left lateral ventricle. The lateral and third ventricles demonstrate an unchanged nearly collapsed configuration. 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 skull and extracranial soft tissues are unremarkable.
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1. Right transparietal ventricular catheter that enters the lateral ventricles with no significant change in the nearly collapsed ventricular system. 2. No evidence of intracranial hemorrhage or mass.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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CT BRAIN: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is encephalomalacia in the right middle and inferior frontal gyri from old infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are bilateral V4 vertebral artery and cavernous carotid arthroscopic calcifications. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA BRAIN: There is calcification with mild-to-moderate stenosis of the bilateral cavernous carotid arteries. The anterior and posterior circulation is otherwise intact without flow limiting stenosis. The anterior and posterior committing arteries are not definitively visualized and may be hypoplastic.CTA NECK: There are postoperative findings by the ascending aorta and aortic arch which are incompletely imaged. There is atherosclerotic calcification by the aortic arch and the origin of the brachiocephalic artery and left common carotid artery. There is a 4-cm long occlusion of the left subclavian artery at the proximal aspect just beyond the origin. There is opacification of the left subclavian artery at and distal to the origin of the left vertebral artery. The right vertebral artery is dominant. There are scattered mild atherosclerotic plaques in the bilateral common carotid arteries. By NASCET criteria, there is approximately 60% stenosis of the right carotid bulb region and at least 90% stenosis of the left internal carotid artery origin associated with calcified atherosclerotic plaque. There are scattered foci of atherosclerotic calcification in the bilateral V3 and V4 vertebral artery segments without flow limiting stenosis. There are extensive anterior bridging osteophytes and small posterior disc osteophyte complexes without high-grade spinal canal stenosis, although evaluation is limited due to beam hardening artifact. There is a partially calcified right thyroid nodule. There is a right neck posterolateral subcutaneous cystic lesion that measures up to approximately 20 mm with rim calcification, which is nonspecific and may represent a sebaceous cyst. There are emphysematous changes and micronodules in the imaged lung apices. There are prominent mediastinal lymph nodes. There is a cardiac pacer device.
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1.Chronic right frontal lobe infarct with encephalomalacia, but no evidence of acute intracranial hemorrhage or mass-effect. 2.Mild to moderate bilateral cavernous carotid calcified atherosclerotic steno-occlusive lesions without flow limiting stenoses in the intracranial circulation.3.Multifocal calcified atherosclerotic steno-occlusive lesions in the neck, particularly at the carotid bifurcations, where there is a critical stenosis of the left internal carotid artery origin and moderate stenosis or the proximal right internal carotid artery.4.Occlusion of the proximal left subclavian artery with reconstitution at the origin of the left vertebral artery presumably from retrograde flow.5.Partially calcified right thyroid nodule. A thyroid ultrasound may be useful for further evaluation. 6.Nonspecific micronodules in the imaged lung apices and prominent mediastinal lymph nodes. A dedicated chest CT may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Altered mental status after fall. There is encephalomalacia in the right occipital lobe with mild ex vacuo dilatation of the occipital horn of the right lateral ventricle. There is mild patchy cerebral white matter hypoattenuation. There is no evidence of intracranial hemorrhage or mass. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is no evidence of skull fracture. There is a subcentimeter sclerotic focus in the right clivus and a a lucency in the left parietal calvarium that measures up to 12 mm.
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1. No evidence of acute intracranial hemorrhage or skull fracture.2. Chronic right occipital lobe fracture and mild probable small vessel ischemic disease.3. A subcentimeter sclerotic focus in the right clivus and a a lucency in the left parietal calvarium that measures up to 12 mm are nonspecific.
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Generate impression based on findings.
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The intracranial dural reflections appear hyperattenuating, but smooth and thin. Additionally, there is a small focus of hyperattenuation in the left occipital lobe medially without surrounding vasogenic edema. There is otherwise no evidence of acute hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a mild salt-and-pepper appearance of the skull, which appears slightly sclerotic overall. The extracranial soft tissues are unremarkable. The right lens appears absent and the left lens appears diminutive.
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1.Hyperattenuation of the dura and an area of hyperattenuation in the left occipital lobe likely represent calcifications related to secondary hyperparathyroidism and calcium deposition. This can be further investigated with MRI without contrast, if clinically indicated.2. Findings suggestive of renal osteodystrophy.Findings were discussed with Dr. Ardelt over the telephone at 2:50 p.m. today.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Subacute onset of OCD/psychosis and recent pneumonia. There is no evidence of intracranial hemorrhage or mass. There is encephalomalacia in the left frontoparietal region with ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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Chronic left middle cerebral artery infarction, but no evidence of intracranial hemorrhage or mass. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.
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Generate impression based on findings.
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Headache in Chiari patient. There are postoperative findings related to Chiari decompression. The cerebellum extends to the level of the tip of the dens. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles appear to be within normal limits in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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Postoperative findings related to Chiari decompression, without evidence of intracranial hemorrhage or hydrocephalus. However, MRI with a CSF flow study may be useful for further evaluation.
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Generate impression based on findings.
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Tonsillitis. Evaluate for abscess/Ludwig's angina, dental abscess in the setting of neck swelling and pain. There is diffuse enlargement of the cervical lymph nodes, particularly in levels 1 and 2 bilaterally. In addition, the Waldeyer ring structures are diffusely enlarged and there is mild pharyngeal airway narrowing. There are malaligned maxillary and mandibular teeth with braces in position. However, there are no discernible caries or evidence of abscess. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The paranasal sinuses and mastoid air cells are clear. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. Diffuse cervical lymphadenopathy and enlargement Waldeyer ring structures are compatible with adenotonsillitis and associated reactive changes, perhaps of viral etiology. 2. No evidence of Ludwig angina.3. Malaligned maxillary and mandibular teeth with braces in position, but no discernible dental caries.
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Generate impression based on findings.
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Head trauma. There is a right frontal subgaleal hematoma that measures up to 5 mm in thickness. There is no evidence of skull fracture or acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The orbits appear unremarkable.
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Right frontal subgaleal hematoma, but no evidence of skull fracture or acute intracranial hematoma.
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Generate impression based on findings.
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Unwitnessed seizure and right parietal tenderness. There is a small amount of subcutaneous stranding in the right parietal scalp. The skull appears to be intact. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear.
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Right parietal scalp contusion, but no evidence of intracranial hemorrhage.
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Generate impression based on findings.
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Reason: 33M with HIV and suppressed CD4 count presenting with hemoptysis, fever, and RUL cavitary lesion on CXR. Also with thoracic level tenderness to percussion of the spine. History: hemoptysis, lung cavitary lesion, back pain LUNGS AND PLEURA: Thick walled cavitary lesion in right posterior upper lobe segment measuring roughly 5 cm though the majority of this measurement includes air centrally. The wall is irregularly thick. There are multiple surrounding nonspecific groundglass centrilobular nodules. The right middle lobe and lingula also contain multiple centrilobular nodules and some areas of tree in bud oapcity. There is a very small cavitary nodule right middle lobe on image 53/101. In the left lower lobe there are more solid clustered nodules posteriorly measuring up to 2 cm implant image 54/101. No pleural effusion.MEDIASTINUM AND HILA: Mildly enlarged paratracheal, subcarinal, and right hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple hypodense splenic lesions are incompletely visualized but are grossly unchanged versus 10/20/2014 abdomen CT.
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Cavitary right upper lobe lesion with surrounding nodules. Scattered areas of centrilobular nodules and tree in bud opacity. Additional more solid opacities are seen in the left lower lobe. While the findings are nonspecific they are highly suggestive of infection such as TB. Nontuberculous mycobacterial infections and other opportunistic infections may appear similarly. This is unlikely to represent malignancy though follow up to resolution is recommended. Findings were communicated to the ED by the radiology resident on call at the time of exam.
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Generate impression based on findings.
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Reason: r/o PE History: chest pain, sob, lower extremity swelling PULMONARY ARTERIES: No evidence of saddle embolus or thrombus in the main right or left pulmonary artery. The study is not diagnostic beyond this due to technical factors.LUNGS AND PLEURA: Linear atelectasis or scarring at the left lung base. Linear scarring with calcification and bullet fragments at the left apex presumably from prior gunshot wound.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bullet fragments in posterior soft tissues and spinal canal. Chronic presumably post traumatic deformity of left clavicle.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific nodularity of right adrenal gland.
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No evidence of saddle embolus or thrombus in the main right or left pulmonary artery. The study is not diagnostic beyond this due to technical factors. Consider V/Q scan or lower extremity doppler study for further evaluation of PE/VTE.PULMONARY EMBOLISM: PE: Indeterminate. No evidence of saddle embolus or thrombus in the main right or left pulmonary artery. The study is not diagnostic beyond this due to technical factors.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: CVA History: CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is hypodensity involving the gray and white matter at the posterior aspect of the left insular cortex as well as the adjacent supramarginal gyrus and subcentral lobule measuring 32x37 mm axial dimensions.There is a hyperdense MCA sign within the left sylvian fissure.There are hypodense foci measuring up to 10mm involving the left caudate and adjacent internal capsules as well as right putamen and adjacent internal capsule.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 demonstrate medial deviation of the medial walls bilaterally suggestive of prior medial blowouts.Atherosclerotic calcifications are present along the distal internal carotid arteries.
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1.There is a subacute infarction centered along the left supramarginal gyrus and extending to the adjacent tissues as described above. There is associated hyperdense MCA sign within the left sylvian fissure.2.Hypodense lesion suspicious for lacunar infarcts are present involving basal ganglia as described above are of indeterminant age.3.No evidence for acute intracranial hemorrhage.
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Generate impression based on findings.
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Reason: altered mental status History: altered mental status, tremors The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subcortical hypodensities along the frontal lobes bilaterally -mostly but not exclusively along the middle frontal gyri - as well as the inferior parietal lobules.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.Subcortical white matter lesions along the frontal and parietal lobes are non-specific. This could represent treatment effect, PML, vascular related pathology or other process. Additional investigation with MRI may be of benefit.2.No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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Reason: ? os odontoideum s/p MVA neck pain History: neck pain The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.A calcified nodule is present along the left lung apex.
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1.There is no evidence for cervical spine fractures, subluxation or os odontoideum.2.Left upper long calcified lung nodule likely is related to old granuloma.
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Generate impression based on findings.
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Reason: change in mentation History: change in mentation The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. These are stable since the prior exam.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.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These are stable since the prior exam.3.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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Reason: fall, on coumadin, presumed head trauma. There is a 15mm left sided subdural collection of varying density adjacent to the left parietal, frontal lobes and temporal lobes associated with 8mm shift of the septum pellucidum. There is subfalcine, uncal and transtentorial herniation.A hypodense focus in the right basal ganglia is present which is unchanged wince the prior exam.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.Subacute left subdural hematoma associated with marked midline shift with subfalcine, uncal and transtentorial herniation.2.Right basal ganglia lesion is likely an old lacunar infarction.
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Generate impression based on findings.
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Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex, aortic arch and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax.
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Bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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Reason: r/o bleed, ETOH and fall History: ETOH and fall 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.
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No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right upper lobe and left lower lobe. No pleural effusion or pneumothorax.
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Bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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Pain lateral aspect of the footVIEWS: Left foot AP, oblique and lateral No acute fracture or dislocation. Minimal soft tissue swelling at the lateral aspect of the foot.
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No acute fracture or dislocation.
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Generate impression based on findings.
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Feeding tube placementVIEW: Abdomen AP 1/17/15 NG tube tip in the stomach. Retained contrast within the large bowel. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Patchy atelectasis left lower lobe. Feeding tube has been removed in the interval.
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NG tube tip in the stomach.
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Generate impression based on findings.
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Bruising and tenderness to palpationVIEWS: Right forearm AP and lateral No acute fracture or dislocation.
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Normal examination.
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Generate impression based on findings.
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Trauma painVIEWS: Left hand AP, oblique and lateral No acute fracture or dislocation.
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Normal examination.
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Generate impression based on findings.
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Abdominal distentionVIEW: Abdomen AP 1/17/15 NG tube tip in the stomach. Multiple dilated loops of bowel not significantly changed from prior study. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Multiple dilated loops of bowel not significantly changed from prior study.
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Generate impression based on findings.
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WheezingVIEWS: Chest AP and lateral 1/18/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right middle lobe. No pleural effusion or pneumothorax.
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Bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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Fall on iceVIEWS: Right shoulder internal and external rotation No acute fracture or dislocation.
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Normal examination.
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Generate impression based on findings.
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CoughVIEWS: Chest AP and lateral 1/18/15 Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax.
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Bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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Bloody stoolVIEW: Abdomen AP 1/18/15 NG tube tip in the stomach. Disorganized nonobstructive bowel gas pattern. The previously noted dilated loops of bowel have resolved in the interval. No pneumatosis or pneumoperitoneum.
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No definite evidence of NEC.
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Generate impression based on findings.
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Apnea episodes desaturationVIEW: Chest AP and abdomen AP 1/18/15 NG tube tip in the stomach. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Minimal patchy atelectasis in the left lower lobe.
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Generate impression based on findings.
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Increased work of breathingVIEW: Chest AP 1/18/15 Cardiothymic silhouette normal. Minimal peribronchial wall thickening with patchy opacities in the right middle lobe and left lower lobe. There is patchy atelectasis in the right lower lobe. No pleural effusion or pneumothorax.
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Patchy opacities bilaterally likely atelectasis and the overall appearance representing bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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Prematurity evaluate line placementVIEW: Chest AP and abdomen AP 1/18/15 ET tube tip below thoracic inlet and above the carina. The umbilical venous catheter tip in the left portal vein. The umbilical arterial catheter tip at T5/6. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Diffuse atelectasis bilaterally without pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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The appearance of the lung representing respiratory distress syndrome.
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Generate impression based on findings.
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Female 72 years old Reason: LLQ pain, h/o divertic, colon resection History: abd pain, vomiting ABDOMEN:LUNG BASES: Mild emphysema.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated proximal small bowel loops measuring up to 3 cm. Distal small bowel loops in the right lower quadrant are decompressed. These findings are compatible with a distal small bowel obstruction transition point being in the right lower quadrant. Trace amount of ascites. Appendix is unremarkable. There are multiple borderline enlarged present in lymph nodes in the right lower quadrant.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Distal small bowel obstruction, the transition point being in the right lower quadrant.
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Generate impression based on findings.
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FeverVIEW: Chest AP 1/18/15 Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right middle lobe, right lower lobe, lingula and left lower lobe. No pleural effusion or pneumothorax. The stomach is mildly distended.
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Bronchiolitis or reactive airway disease.
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Generate impression based on findings.
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VSD closureVIEW: Chest AP 1/18/15 Right central line in place. The epicardial pacing leads are unchanged. Cardiomegaly unchanged. Minimal atelectasis left lower lobe improved from prior study. No pleural effusion or pneumothorax.
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Minimal left lower lobe atelectasis improved in the interval.
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Generate impression based on findings.
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Respiratory distress on BiPAPVIEW: Chest AP 1/18/15 Multiple embolization coils, vascular coils, pulmonary and SVC stents again noted. Cardiothymic silhouette normal. The patchy atelectasis in the right lower lobe has resolved in the interval. Minimal blunting right costophrenic angle representing small right pleural effusion.
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Right lower lobe atelectasis resolved in the interval.
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Generate impression based on findings.
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Prematurity increased oxygen requirementVIEW: Chest AP and abdomen AP 1/18/15 ET tube tip above the thoracic inlet. NG tube tip in the stomach. The umbilical venous catheter tip in the SVC. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Diffuse atelectasis bilaterally representing respiratory distress syndrome. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. The bladder is distended.
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Malpositioned ET and UVC.
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Generate impression based on findings.
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TachypneaVIEW: Chest AP 1/18/15 Gastrostomy tube in place. Amplatzer occlusion devices project over the heart. Right upper extremity PICC with tip in the right atrium. Cardiothymic silhouette at the upper limits of normal. Bilateral atelectasis improved in the interval. Multiple spinal segmentation and fusion anomalies are seen in the thoracic spine. PDA clip in place, position unchanged.
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Bilateral atelectasis improved in the interval.
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Generate impression based on findings.
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Male 51 years old Reason: pt with melanoma please eval disease status and compare to previous imaging History: melanoma CHEST:LUNGS AND PLEURA: Right upper lobe scarring is unchanged. Right upper lobe nodule measuring 9 by 6 mm on image number 36, series number 5 is unchanged compared to previous CT. However another more lateral nodule in the right upper lobe there are multiple other bilateral scattered nodules. The rest of the scattered bilateral small nodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, nonspecific hypodense lesion in the right lobe of the liver, best seen on image number 107, series number 3. This lesion is too small to accurately characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.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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Bilateral scattered nodules. Majority of the nodules are stable. One of the nodules in the right upper lobe has resolved within the interval.Nonspecific, subcentimeter hypodense lesion in the liver.
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Generate impression based on findings.
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Feeding intoleranceVIEW: Abdomen AP 1/18/15 Feeding tube tip in the stomach. Gastrostomy tube again noted. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Left lower lobe opacity unchanged. Dysplastic left hip unchanged.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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37 years old, Female, Reason: r/o PE History: chest pain severe l sided, bilat leg pain PULMONARY ARTERIES: Technically adequate study to the segmental level. No evidence of pulmonary embolism. The main pulmonary arteries is within normal limits. No definite evidence of right heart strain.LUNGS AND PLEURA: Severe and extensive bronchiectasis in the lingula and left lower lobe with bronchial wall thickening and retained secretions appearing very similar to the prior exam. Similar changes are seen on the right to a lesser degree with bronchial wall thickening and scattered mucous plugging. Associated consolidation patchy airspace opacities are seen bilaterally.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes, unchanged. A prevascular lymph node is unchanged measuring 12 mm (series 7, image 76). No visible coronary artery calcification on this non gated study.CHEST WALL: Mild degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Presumed right upper pole renal cyst only partially visualized but unchanged
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1.No evidence of pulmonary embolism to the segmental level.2.Bronchiectasis with mucus plugging, most severe in the lingula and left lower lobe which may represent post infectious bronchiectasis, although the differential includes atypical cystic fibrosis. Associated consolidation patchy airspace opacities are suspicious for superimposed infection, appearing similar to prior exam.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: CVA History: RUE weakness sudden onset 0630 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.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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IntubatedVIEW: Chest AP 1/18/15 ET tube tip immediately above the carina. Feeding tube and right femoral line again noted. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe, lingula and left lower lobe improved in the interval. No pleural effusion or pneumothorax.
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Patchy atelectasis bilaterally improved in the interval.
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Generate impression based on findings.
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Increased work of breathingVIEW: Chest AP and abdomen AP 1/17/15 Tracheostomy tube in place. NG tube tip in the stomach. Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette normal. Bilateral atelectasis increased in the interval. The umbilical venous catheter has been removed in the interval. Multiple dilated loops of bowel without obstruction. No pneumatosis or pneumoperitoneum.
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Bilateral atelectasis increased in the interval.
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Generate impression based on findings.
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Evaluate pneumothoraxVIEW: Chest AP 1/17/15 ET tube tip below thoracic inlet and above the carina. The umbilical lines are unchanged. There are three chest tubes on the right with one of the chest tubes sidehole within the subcutaneous tissue. Cardiothymic silhouette normal. There is a small right subpulmonic pneumothorax unchanged. Patchy atelectasis bilaterally not significantly changed.
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Right subpulmonic pneumothorax unchanged.
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Generate impression based on findings.
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46 years old, Female, Reason: tachycardia, low O2 saturdaion History: tachycardia, low O2 saturdaion PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary arteries within normal limits.LUNGS AND PLEURA: Significant bibasilar subsegmental atelectasis with mucus plugging of the airways. Centrilobular nodules and tree in bud opacity in the posterior right upper lobe, presumably secondary to aspirate though infection could appear similarly. Calcified granuloma on the left. Small bilateral pneumothoraces are present. A left-sided chest tube is present.MEDIASTINUM AND HILA: There are extensive postoperative changes of a gastric pull up. Questionable extraluminal air along the left aspect of the trachea appears to connect to the neo-esophagus and may reflect the gastric fundus (series 11, image 25 through 53). This relatively cervical location of the pull up was confirmed b y the clinical service. Residual mediastinal hematoma.CHEST WALL: Mild degenerative changes thoracic spine. Post chest tube findings on the right. Right chest port tip in SVC.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postoperative changes in the abdomen with a small focus of free air, likely postoperative. Cholecystectomy clips. Portions of a J tube are seen.
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1.No evidence of pulmonary embolism.2.Significant bibasilar atelectasis with mucus plugging and nodular opacities in the posterior upper lobe consistent with aspirate and/or pneumonia. 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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Toxic megacolonVIEWS: Abdomen supine and upright There are minimally dilated small bowel loops in the midline. No evidence of obstruction, pneumatosis or pneumoperitoneum. No evidence of dilated large bowel. Patchy atelectasis left lower lobe. Right femoral line in place.
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Minimally dilated small bowel loops in the midline without evidence of dilated large bowel.
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Generate impression based on findings.
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Female 29 years old Reason: Abdominal pain, s/p colonoscopy, rule out free air/perforation History: abdominal pain Nonobstructive bowel gas pattern. No free air.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Male 65 years old Reason: dobhoff placement History: post pyloric? Enteric tube is in superposition to prior projecting over the gastric antrum. Additional hardware is unchanged.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Abdominal distentionVIEW: Chest AP and abdomen AP 1/17/15 ET tube tip immediately above the carina. Umbilical lines unchanged. There are three chest tubes on the right with one of the chest tubes sidehole within the subcutaneous tissue. Cardiothymic silhouette normal. The right subpulmonic pneumothorax minimally increased in size. Patchy atelectasis in the right upper lobe and left lower lobe. Paucity of bowel gas within the abdomen. No pneumatosis or pneumoperitoneum.
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Paucity of bowel gas within the abdomen. The right subpulmonic pneumothorax has minimally increased in size.
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Generate impression based on findings.
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Abdominal distentionVIEW: Chest AP and abdomen AP 1/18/15 Tracheostomy tube, left upper extremity PICC and NG tube again noted. Cardiothymic silhouette normal. Diffuse atelectasis minimally improved. No pleural effusion or pneumothorax. The previously noted dilated loops of bowel have improved in the interval. There is a dilated loop of bowel at the right lower quadrant. No pneumatosis or pneumoperitoneum.
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The previously noted dilated loops of bowel has improved in the interval.
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Generate impression based on findings.
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Female 51 years old Reason: Confirm NG tube placement History: Confirm NG tube placement The tip of the NG tube is in the proximal stomach. Nonobstructive bowel gas pattern.
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No free air.
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Generate impression based on findings.
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Female 58 years old Reason: 58yo F w/ HIV, cirrhosis w/ progressive abdominal distension History: as above Significant distention of the colon and small bowel loops with air-fluid levels. This has slightly progressed compared to previous study. Although these findings most likely represent an ileus, and obstruction cannot be excluded. CT of the abdomen and pelvis is recommended for further evaluation.
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Interval progression of distention of the abdominal bowel loops. CT of the abdomen and pelvis is recommended for further evaluation..
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Generate impression based on findings.
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Abdominal distentionVIEW: Chest AP and abdomen AP 1/18/15 ET tube tip at the level of the thoracic inlet. Umbilical lines unchanged. There are three chest tubes on the right with one of the chest tubes sidehole within the subcutaneous tissue. Cardiothymic silhouette normal. The right subpulmonic pneumothorax minimally decreased in size. Patchy atelectasis in the right upper lobe and left lower lobe improved in the interval with hyperinflation of the left lung. Absent bowel gas within the abdomen. No pneumatosis or pneumoperitoneum.
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Right subpulmonic pneumothorax minimally decreased in size. Absent bowel gas within the abdomen without pneumoperitoneum.
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Generate impression based on findings.
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Male 64 years old Reason: eval ngt, njt placement History: abdominal distension The tip of the NG tube is in the proximal stomach. Nonobstructive bowel gas pattern. No free air. The tip of the second enteric tube is near the duodenojejunal junction, unchanged from previous study.
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The tip of the NG tube is in the proximal stomach.
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Generate impression based on findings.
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Male 64 years old Reason: eval ngt placment History: ngt placed The tip of the NG tube is in the proximal stomach. Nonobstructive bowel gas pattern. No free air. The tip of the second enteric tube is near the duodenojejunal junction, unchanged from previous study.
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The tip of the NG tube is in the proximal stomach.
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Generate impression based on findings.
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Male 64 years old Reason: eval njt placement History: tube coiled in mouth . Nonobstructive bowel gas pattern. No free air. The tip of the enteric tube is near the duodenojejunal junction, unchanged from previous study.
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The tip of the enteric tube is near the duodenojejunal junction, unchanged from previous study.
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Generate impression based on findings.
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Female 53 years old Reason: eval for changes in position of NJT History: NJT not working The tip of the enteric tube is not visualized on this study but is likely in the left lower quadrant. Nonobstructive bowel gas pattern.
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The tip of the enteric tube is not visualized on this study.
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Generate impression based on findings.
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47 years old, Female, Reason: s/p right VATS pleurodesis for recurrent spontaneous pneumothorax History: FU CT scan LUNGS AND PLEURA: Respiratory motion limits sensitivity. No evidence of pneumothorax. There is right pleural and fissural thickening appearing similar to the prior exam consistent with prior produces. No significant areas of air space opacity.A punctate nodule in the left upper lobe (series 4, image 41), is unchanged since prior exam. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Scattered mediastinal lymph nodes not meeting size criteria for lymphadenopathy. Small calcifications in the right breast appearing similar to the prior exam.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Unchanged pleural and fissural thickening consistent with prior produces. No significant pleural effusion or pneumothorax.
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Generate impression based on findings.
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Female 40 years old Reason: 40F with nausea and emesis, assess for SBO versus ileus History: as above Bilateral extensive renal stones, more on the right side compared to the left. Nonobstructive bowel gas pattern. No free air.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Female 58 years old Reason: 58yo F w/ HIV, cirrhosis w/ progressive abdominal distension History: as above Significant distention of the colon and small bowel loops with air-fluid levels. These findings are stable compared to previous study. Although these findings most likely represent an ileus, and obstruction cannot be excluded. CT of the abdomen and pelvis is recommended for further evaluation.
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Distention of the abdominal bowel loops. CT of the abdomen and pelvis is recommended for further evaluation..
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Generate impression based on findings.
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Male 29 years old Reason: 29yo M with abnl transaminases, hyperbili, eval for obstruction, mass History: - LIVER: Liver measures 16 cm. slightly coarse echotexture of the liver without any focal lesions.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No evidence of intra-or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Both kidneys are significantly echogenic and cannot be optimally evaluated. Bilateral renal cysts without evidence of hydronephrosis.OTHER: No significant abnormalities noted.
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Slightly coarse echotexture of the liver without evidence of biliary dilatation.Significantly echogenic kidneys.
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Generate impression based on findings.
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Male 60 years old Reason: Rule out infection source in biliary system s/p bacteremia with persistent infection despite IV abx History: s/p prostate biopsy at outside hospital LIVER: Multiple simple appearing hepatic cysts. No evidence of intra-or extrahepatic biliary dilatation. Gallbladder is unremarkable.BILIARY TRACT: No evidence of intra-or extrahepatic biliary dilatation. Gallbladder is unremarkable.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: There is a 2.2-cm heterogeneous lesion on the outside CT in the upper pole of the right kidney, best seen on image number 58, series number two. This lesion cannot be well seen on today's ultrasound but remain suspicious to be a solid neoplasm. Further evaluation of this lesion with renal mass protocol is recommended. Limited evaluation of the left kidney demonstrates a simple lower pole cyst. No hydronephrosis. OTHER: Significantly enlarged and heterogeneous prostate. Prostate MRA may helpful to evaluate for a possible abscess.
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Unremarkable biliary tract.Suspicious lesion in the right kidney on the outside CT for a solid neoplasm. Further evaluation of this lesion with renal mass protocol CT or MR is recommended.Significantly enlarged heterogeneous prostate. Prostate MR or transrectal ultrasound may be helpful to exclude an abscess in the prostate.
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Generate impression based on findings.
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s/p SCT with significant abdominal pain and hypotension when on right side--raising concerns for IVC compression. LIMITED ABDOMEN: Borderline hepatomegaly with coarse echotexture. The liver measures approximately 20 cm. No intrahepatic or extrahepatic biliary duct dilation. The partially visualized pancreas is normal. The gallbladder is normal. The common bile duct is normal. Both the kidneys are normal. The spleen is normal.
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Patent hepatic vasculature including the IVC.
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Generate impression based on findings.
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There are postoperative findings related to anterior C4-6 fusion with plates, screws and interbody fusion device and bone graft material with incomplete interbody osseous fusion. There is no evidence of hardware failure. There is no acute fracture. There is mild bilateral neural foramen narrowing at C5-6 secondary to uncovertebral hypertrophy. There is no significant cervical spinal canal stenosis, although evaluation is limited at the postoperative levels due to artifact. The paraspinal soft tissues are unremarkable.
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Postoperative findings related to anterior C4-6 fusion with incomplete interbody osseous fusion and mild neural foramen stenosis bilaterally at C5-6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Female 58 years old Reason: 58 y/o with history of esophageal carcinoma s/p stent and g-tube presenting with persistent nausea and vomiting. ?gastric outlet obstruction History: nausea, vomiting, abdominal pain ABDOMEN:LUNG BASES: Metallic stent in the distal esophagus. Incompletely imaged thick walled distal esophagus compatible with patient's known history of esophageal cancer. Lymph nodes in the posterior mediastinum around the GE junction, again noted. Index lymph node measures 10 x 7 mm on image number 20, series number 4, not significantly changed from previous study.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: Para-aortic enlarged lymph node measuring 1.5 x 1.1 cm number 48, series number 4 is likely metastatic and slightly smaller compared to previous study.BOWEL, MESENTERY: G-tube is in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Distal esophageal and NG tube are in place. There is pooling of the contrast material within the stent. Patency of the stent cannot be evaluated with this study.
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Generate impression based on findings.
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s/p total abdominal colectomy. Tachycardia, fever, abdominal pain. ABDOMEN:LUNG BASES: Patchy atelectasis in the dependent portions of the right lower lobe.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes with surgical sutures and Hartmann pouch are noted. There is an ostomy at the right lower quadrant. The majority of the small bowel loops are dilated with some approaching 4 cm in diameter. There is a transitional area at the right lower quadrant approximately 16 cm from the stoma. This transitional area measures approximately 2 cm in length. There is abnormal enhancement of the bowel wall of the small bowel loops diffusely and the differential diagnosis include ischemia, infectious and inflammatory changes. There is moderate amount of free fluid within the abdomen. No evidence of abscess or pneumoperitoneum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: NG tube tip in the stomach.PELVIS:UTERUS, ADNEXA: 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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Partial small bowel obstruction with a transitional area at the right lower quadrant as described above.
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Generate impression based on findings.
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Female 63 years old Reason: metastatic renal cancer; on everolimus, assess for progression History: weight loss, left LE edema CHEST:LUNGS AND PLEURA: Index left upper lobe nodule measures 9-mm in diameter image number 22, series number 5 not significantly changed in size compared to previous study. There has been interval increase in the amount of bilateral pleural effusions. There has been interval development of airspace opacities predominantly in the lower lobes but also extending to the upper lobes. Previously described left lower lobe nodule cannot be identified due to these new air space opacities. The etiology of these diffuse air space opacities is unknown and may represent a combination of infection and pulmonary edema.Solid enhancing mass in the right apex measures 2.6 by 2.5 cm on image number 11, series number 3, not significantly changed from previous study.MEDIASTINUM AND HILA: Very heterogeneous thyroid mass likely representing metastatic disease is also grossly stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined lesion with central hypodensity in the liver is again noted. The borders of this lesion is difficult to define and the measurements are suboptimal. Within the limitations the lesion measures 4.3 x 3.8 cm on image number 71, series number 3, minimally smaller compared to previous study. MRI may be helpful for accurate measurement of the size of this lesion.SPLEEN: No significant abnormality noted.PANCREAS: Multiple solid pancreatic lesions are grossly unchanged.ADRENAL GLANDS: Left adrenal mass measures 2.4 by 2 cm on image number 86, series number 3, slightly smaller compared to previous study.KIDNEYS, URETERS: Again noted multiple solid lesions arising from the left kidney. Index lower pole lesion is unchanged measuring 1.7 by 1.8-cm image number 115, series number 3. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant hernia containing mildly dilated colon segment and nonobstructed small bowel segments are unchanged. Numerous peritoneal small deposits representing metastatic disease, grossly unchanged.BONES, SOFT TISSUES: Multiple soft tissue masses in the subcutaneous tissue are again noted. Index right posterior lateral wall mass now measures 5.7 by 3.8-cm on image number 118, series number 3, slightly increased in size compared to previous study. Some of the other numerous masses in the abdominal wall muscles have also slightly increased in size within the interval.Left scapular destructive lesion is incompletely imaged on today's study.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Again noted polypoid lesions in the bladder likely representing a urothelial neoplasm.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destructive mass involving the sacrum and extending into the spinal canal is again noted. Postsurgical changes secondary to lower thoracic vertebral body fixation, stable.Several enhancing masses in the posterior paraspinal muscles are either stable to minimally increased in size compared to previous study.Lytic lesion in the left iliac bone, unchanged.OTHER: No significant abnormality noted.
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Interval development of bilateral air space opacities in the lungs. Exact etiology of these lesions is unknown and may represent a combination of infection and edema, neoplasm less likely. Stable two interval increase in the size of the index lesions for extensive metastatic disease, as described above
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Generate impression based on findings.
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Female 54 years old Reason: evaluate for progression History: metastatic chondrosarcoma CHEST:LUNGS AND PLEURA: Postsurgical changes in the right apex. Again noted, multiple alternating lesions along the suture lines. Index right apical lesion measures 7.5 by 4.6 cm in image number 21, series number 3, increased in size compared to previous study.Second index lesion in the right lower lobe measures 5.1 x 4.2 cm or image number 39, series number 3, increased in size compared to previous study. The third index lesion in the costophrenic angle is also increased in size and measures 2.5-cm diameter image number 56, series number 3.MEDIASTINUM AND HILA: Mediastinal adenopathy is again noted. Right paratracheal node measures 1.1 x 0.8 cm image number 23, series number 3, unchanged. Index subcarinal node measures 1.3 x 1.4 cm in image number 34, series number 3. Index right hilar node measures 9 mm in diameter image number 31, series number 3.CHEST WALL: Right axillary node measures 9 mm in short axis on image number 24, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal thickening is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval increase in the size of the index lesions in the right lung.
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Generate impression based on findings.
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CT HEAD: There is no evidence of acute intracranial hemorrhage or mass. There is an unchanged small area of encephalomalacia in the right superior frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild bilateral maxillary sinus mucosal thickening. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is extensive dental disease with periapical lucencies and carious disease of bilateral scattered maxillary and mandibular molars. There are small areas of possible scar tissue in the scalp.CTA HEAD: The anterior and posterior circulation are intact with no flow limiting stenosis or aneurysm. The anterior communicating artery is patent. The posterior communicating arteries are not apparent and may be hypoplastic. The vertebrobasilar system is intact.CTA NECK: The great vessel origins are widely patent. There is no flow limiting stenosis or significant calcified atherosclerotic plaque in the carotid bulbs. The right vertebral artery is dominant. There are mild degenerative changes in the cervical spine, with disc degeneration at C6-7 and C7-T1, but no significant spinal canal stenosis. There are emphysematous changes in the lung apices.
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1.No acute intracranial hemorrhage or mass effect. However, CT is insensitive for detection of early nonhemorrhagic stroke.2.No significant steno-occlusive lesions in the head or neck.3.Extensive dental disease with periapical lucencies and carious disease affecting scattered maxillary and mandibular molar teeth.
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Generate impression based on findings.
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80 years old, Female, Reason: ? fracture/dislocation History: shoulder pain No fracture or dislocation. The bones appear slightly demineralized, similar to prior exam. There is mild spurring of the acromion process appearing similar to the prior exam.
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No fracture or dislocation. Degenerative changes as described above.
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Generate impression based on findings.
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54 years old, Female, Reason: rule out fx History: pain and swelling s/p injury Soft tissue swelling without evidence of fracture or dislocation.
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Soft tissue swelling without evidence of fracture or dislocation.
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