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Generate impression based on findings.
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Three old female with right hip pain, rule out fracture/dislocation.VIEWS: Pelvis AP and frog leg lateral (two views) and right knee AP lateral and oblique (3 views), 1/18/2015 PELVIS: No fracture or malalignment is evident. No large joint effusions are seen. There is a moderate stool burden distributed throughout the imaged colon.RIGHT KNEE: Incomplete fracture of the proximal tibial metaphysis compatible with a buckle fracture. No additional fracture or malalignment is evident. There is no joint effusion.
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Buckle fracture of the proximal tibial metaphysis.
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Generate impression based on findings.
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38-year-old female with flank pain and hematuria. Evaluate for nephrolithiasis. ABDOMEN:LUNG BASES: Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: The liver shows mild hepatomegaly without other abnormality.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydronephrosis and proximal hydroureter to the level of the iliac vein without an obstructing calculus evident. Mild asymmetric right perinephric fat stranding. No other findings to suggest stone disease seen, and no mass lesions, although limited by lack of IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic submucosal fat deposition is nonspecific and is most likely chronic in etiology. No evidence to suggest acute colitis. No evidence of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Small amount of free pelvic fluid likely physiologic in etiology. Nonspecific bulbous appearance of the uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic submucosal fat deposition is nonspecific and is most likely chronic in etiology. No evidence to suggest acute colitis. No evidence of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Mild right hydroureteronephrosis and asymmetric right perinephric fat stranding without obstructing calculus. Findings are nonspecific but commonly seen with a recently passed stone. However, other etiologies for these findings cannot be excluded, such as stricture or inflammatory etiology.2.Mild hepatomegaly.
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Generate impression based on findings.
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Status post MVA, upper back/right posterior neck pain and numb sensation to right upper extremity. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spine which may be in part positional. Alignment is otherwise maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disk osteophyte complex. No significant compromise to the spinal canal or neural foramina.C5-6: Small disk osteophyte complex. No significant compromise to the spinal canal or neural foramina.C6-7: Small disk osteophyte complex. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissues are unremarkable.
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1. No evidence of acute fracture or subluxation in the cervical spine.2. Mild degenerative changes in the cervical spine.
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Generate impression based on findings.
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1-day-old male , former 28 week gestation, intubated, evaluate ET tubeVIEW: Chest AP (one view) 01/19/15, 0450 ET tube tip is below the thoracic inlet and above the carina. NG tube tip is in the stomach. Umbilical venous catheter tip is in the right atrium.Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Lung volumes are top normal. No focal pulmonary opacities. Improvement of bilateral diffuse atelectasis.
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ET tube tip is below thoracic inlet and above the carina.
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Generate impression based on findings.
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Evaluate feeding tubeVIEW: Abdomen AP 1/18/15 The feeding tube tip in the stomach. Retained contrast within the large bowel. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Diffuse body wall edema.
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Feeding tube tip in the stomach.
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Generate impression based on findings.
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Chest tube placementVIEW: Chest AP 1/19/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left PICC unchanged. Again noted left chest tube with sidehole in the subcutaneous tissue. Cardiothymic silhouette normal. Bilateral atelectasis increased in the interval. Bilateral small pleural effusions unchanged. No pneumothorax.
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Malpositioned left chest tube without pneumothorax.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. Scattered benign calcifications are present in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Mammogram works best when searching for changes. Submission of prior mammogram is, therefore, recommended for future reference. If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Male; 62 years old. Reason: r/o PE, rt chest pain and hemoptysis History: right sided chest pain PULMONARY ARTERIES: No evidence of pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Patchy and nodular opacities in the right upper and middle lobes have an appearance suggestive of endobronchial spread of infection. Moderate surrounding hazy ground glass opacity in the right upper lobe, suggestive of hemorrhage. Mild to moderate paraseptal and centrilobular emphysema. No pleural effusions. MEDIASTINUM AND HILA: No mediastinal or left hilar lymphadenopathy. A mildly enlarged right hilar lymph node measures 13 mm (image 125, series 7), most likely reactive. Normal heart size without pericardial effusion. Left anterior descending artery stent.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No acute pulmonary embolus.2. Patchy and nodular opacities in the right upper and middle lobes, most compatible with infection. Moderate surrounding hazy ground glass opacity, suggestive of hemorrhage. Given the patient's age, follow up to resolution is recommended.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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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Reason: assess right middle opacification on CXR History: CCU pt on 3 pressers LUNGS AND PLEURA: Bibasal atelectasis versus aspirate with trace pleural fluid.MEDIASTINUM AND HILA: Right jugular catheter tip at RA/SVC junction. Mild coronary calcification. Scattered small lymph nodes. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild diffuse gastric wall thickening versus edema.
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Bibasal atelectasis versus aspirate with trace pleural fluid.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Occasional benign calcifications are unchanged in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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2-year-old male with history of posterior urethral valve BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Observed. Left: Observed.KIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 6.3 cm Left: 6.7 cm Mean for age: 7 cm Range for age: 6 - 8 cmADDITIONAL OBSERVATIONS: A 3mm hyperechoic focus in the right renal parenchyma without demonstrable twinkle artifact or color Doppler flow may represent focal fat and is likely of no clinical significance.
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Normal examination without hydronephrosis.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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Reason: 39 y/o F with h/o fundoplication in 2011, now with recurrent heartburn. 2013 EGD (elsewhere) noted possible paraesophageal hernia. UGI requested to further evaluate. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild esophageal dysmotility with breakup of primary peristaltic wave.During the exam, there was gross large volume reflux with patient turning.There was pseudotumor effect indicating intact Nissen fundoplication and small paraesophageal hernia measuring 2.4 x 4.0 cm comprised of a lip of fundus above the wrap. There was no filling of the fundoplication wrap per se and little intraabdominal segment of esophagus. Given the lack of wrap filling, little intraabdominal esophagus, and gross reflux, wrap loosening cannot be excluded. There is no evidence of slipped Nissen. There was no evidence of esophagitis. No gastric mucosal abnormality was noted. Spontaneous emptying of contrast into the duodenal sweep was observed. Jejunum was almost completely opacified with contrast without evidence of obstruction or adhesions. TOTAL FLUOROSCOPY TIME: 7:29 minutes
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1. Moderate esophageal dysmotility with breakup of primary peristaltic wave.2. Large volume reflux with patient turning.3. Intact Nissen fundoplication with small paraesophageal hernia.4. Given the lack of Nissen wrap filling, little intraabdominal esophagus, and gross reflux, wrap loosening cannot be excluded. 5. Signs of esophagitis or Barrett's were not seen.
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Generate impression based on findings.
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51-year-old male with history of hip arthroplasty. Right hip: Hardware components of a right total hip arthroplasty are situated in anatomic alignment without radiographic evidence of hardware complication. There is a new focus of heterotopic bone along the lateral aspect of the supraacetabular ilium. There are scattered arterial calcifications.Pelvis: Again seen are the aforementioned postoperative changes of the right hip. There is a left hip hemiarthroplasty without evidence of hardware complication. The distal aspect of the hardware is not visualized. There are scattered vascular calcifications within the pelvis.
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Total hip arthroplasty as above.
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Generate impression based on findings.
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49-year-old female with metastatic lung cancer. Evaluate disease status. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy. No intrahepatic biliary ductal dilatation. Mild common bile duct dilatation is likely related to the cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: There is an enlarged portacaval lymph node measuring 3.1 x 2.5 cm (series 8, image 45), previously measuring 3.4 x 2.5 cm on the outside examination (series 6, image 27) and demonstrated increased activity on the outside PET examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Enlarged pelvic collateral vessels may be related to pelvic congestion.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable enlarged portacaval lymph node most likely metastatic disease as above.2.Please refer to concurrent CT chest report for details regarding disease in the chest.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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20-year-old female with history of fracture. There is a comminuted fracture of the distal diaphysis of the fifth metatarsal. The fracture line is less distinct indicating some healing.
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Healing 5th metatarsal fracture.
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Generate impression based on findings.
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Nine year old female with edema, evaluate for fracture.VIEWS: Right third finger PA, lateral and oblique (3 views) 1/18/2015 Bandlike soft tissue swelling is evident just proximal to the proximal interphalangeal joint of the third digit without underlying fracture or malalignment seen.
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Soft tissue swelling without underlying fracture or malalignment.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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54-year-old female with history of knee surgery. Hardware components of a left total knee arthroplasty are situated in near anatomic alignment without radiographic evidence of hardware complication. Moderate osteoarthritis affects the right knee as seen on the frontal view.
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Left total knee arthroplasty as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered benign calcifications are unchanged in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Reason: 40 yo M w/ necrotizing pancreatitis, hilar mass found on CXR History: further evaluation of hilar mass LUNGS AND PLEURA: Multilobulated mass measuring 46 x 38 mm on image 54/111 in the left upper lobe highly suggestive of primary lung cancer.Severe emphysema. Linear scarring or atelectasis at the bases.MEDIASTINUM AND HILA: Left PICC tip in SVC.A left hilar or interlobar node measures 18 mm in short axis on image 64/111. Smaller nodes are seen elsewhere.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. 26-mm left adrenal mass (image 107/111) incompletely visualized. Enteric tube extends beyond the field of view of study.
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1. Left upper lobe mass highly suggestive of primary lung cancer.2. Left hilar lymphadenopathy.3. Left adrenal mass incompletely characterized but may represent metastatic disease.4. Severe emphysema.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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One day old male, ex 28 weeker, status post intubation and line placementVIEWS: Chest and abdomen AP (2 views) 01/18/15, 1132 ET tube tip is below thoracic inlet and above carina. NG tube tip is in stomach. UVC has been retracted and tip is in the right atrium.Cardiothymic silhouette is normal. Interval decrease in lung opacity with mild persistent haziness. No pleural effusion or pneumothorax.There is increased distention of the bowel with development of disorganized bowel gas pattern. The bladder is distended.
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1.UVC tip is in the right atrium. ET tube tip is above the carina. 2.Interval improvement of bilateral diffuse atelectasis.3.Interval development of disorganized bowel gas pattern.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A focal asymmetry in the left breast is unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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History of left lumpectomy and sentinel lymph node biopsy in 2011 for IDC and DCIS. She completed radiation and chemotherapy. History of right lumpectomy for carcinoma in 1997. History of breast cancer in sister, maternal cousin and paternal cousin. States recent right breast firmness. Three standard views of the right breast were performed digitally with additional spot compression views and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear markers were placed on the scar overlying the right breast. Increased amorphous density is noted in the right upper outer quadrant of the breast, which persists with compression. Postsurgical architectural distortion is present. Benign appearing calcifications are present throughout the right breast, including amorphus calcifications in the right upper outer quadrant.RIGHT DIAGNOSTIC MAMMOGRAM
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Indeterminate palpable right breast upper outer quadrant lesion. Surgical consultation is recommended. If tissue is not obtained by palpable guidance, then ultrasound guided biopsy should be performed. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable multiple subcentimeter benign masses in both breasts. Benign calcification in the right upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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ET placementVIEW: Chest AP 1/18/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Umbilical lines unchanged. There are three chest tubes on the right with the sideholes likely within the subcutaneous tissue. There is recurrence of the moderate size right subpulmonic pneumothorax. Cardiothymic silhouette normal. Patchy atelectasis in the right lung.
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Malpositioned chest tubes with recurrence of the moderate size right subpulmonic pneumothorax.
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Generate impression based on findings.
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Reason: hematoma formation History: new left neck swelling in setting of anti-coagulation Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left vertebral artery is tortuous proximally and mildly narrowed.. The right vertebral artery is not readily identified proximally where it is occluded and is reconstituted via collaterals at the V3 segment .Atherosclerotic calcifications are present at the right carotid bifurcation.There is a 40 x 43-mm mass in the left parotid gland centered along the superficial portion of the left parotid gland.There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels narrowing the spinal canal and neural foramina . There is also facet hypertrophy present worse on the right side at C3-4 and C4-5.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The anterior communicating artery is small. The posterior communicating arteries are very small. There is extracranial origin of the left posterior inferior cerebral artery. The right vertebral artery is diminutive distally and ends in vasculature supplying the spinal cord appeared the right posterior inferior cerebellar artery is not readily identified. The intracranial right vertebral artery appears to be occluded. The left vertebral artery is mildly narrowed at the vertebrobasilar junction.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is encephalomalacia involving the inferior and medial aspect of the right cerebellar hemisphere. In general the brainstem is small. Focus of encephalomalacia is also present in the right precentral gyrus. A hypodense focus is present in the right basal ganglia which is associated with mild mass effect. A hypodense focus in the left basal ganglia is present which is associated with volume loss.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate small opacities in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
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1.The right vertebral artery appears to be occluded intracranially as follows at its origin.2.There is a left parotid gland mass present. This is suspected to be neoplastic. Although most likely this is benign, malignancy cannot be excluded on this exam.3.Subacute infarction along the right basal ganglia4.Right cerebellar encephalomalacia is suspected to be due to old infarction.5.Older lacunar infarction along the left basal ganglia.6.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 7.No evidence for aneurysm.8.Findings were discussed with Dr Dellaria at the time of this dictation.
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Generate impression based on findings.
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The ventricles and sulci are appropriate for patients age. There is no acute intracranial hemorrhage, mass-effect or midline shift. Redemonstrated is patchy periventricular and subcortical white matter hypoattenuation which is nonspecific, and is likely vascular related. Previously demonstrated mastoid fluid has resolved. There remains trace left sphenoid sinus air-fluid level. There a heterogeneous nonspecific lucencies with calvarium without a dominant focal lesion, stable in appearance.
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No acute intracranial hemorrhage. Nonspecific white matter hypoattenuation which is likely vascular related of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. Multiple dilated veins are present in both breasts. Arterial calcifications are seen in both breasts. A round asymmetry is seen in the anterior lateral aspect of right breast.No suspicious microcalcifications or areas of architectural distortion are present.
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A round asymmetry in the anterior lateral aspect of right breast. Spot compression view and possible ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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67-year-old female with history of fall. Right shoulder: Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. There is spurring of the anterior aspect of the acromion. We see no fracture.Right knee: Moderate osteoarthritis affects the knee especially at the patellofemoral compartment. There may be a small joint effusion, but we see no fracture.
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Degenerative changes as above without acute fracture.
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Generate impression based on findings.
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29 years, Female. Reason: ileus History: N/V Gaseous distension of colonic loops containing enteric contrast from recent CT. No evidence of acute obstruction.
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Nonobstructive bowel gas pattern. Colonic contrast from recent CT.
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Generate impression based on findings.
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Reason: h/o lye ingestion 1985, esophagectomy s/p colonic interposition, s/p laryngectomy 1/2014 and recent Provox placement 1/14/15 p/w bleeding from mouth and tracheobronchitis. History: Patient continuing to cough up blood through mouth with large clots, unable to actively visualize bleeding with scope through stoma and nasopharynx, please evaluate for bleeding source Neck CTA: The patient is status post laryngectomy and colonic interposition with placement of provox. The provox courses through the left thyroid gland lobe. Inferior thyroidal artery branches surround the paradox. no pseudoaneurysm is appreciated.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes at C5-6 with narrowing of the spinal canal and neural foramina.The appearance of the lung apices is stable.There is hyperdense material in the oropharynx.
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1.Inferior thyroidal artery branches surround the paradox. No pseudoaneurysm is appreciated to explain the patient's stomal bleeding.2.Status post laryngectomy and colonic interposition with placement of provox.3.Hypodense material in the oropharynx is suspected to represent blood products.
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Generate impression based on findings.
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Ms. Levenda is a 58 year old female with left breast cancer. She is scheduled for left breast lumpectomy and sentinel lymph node biopsy on 1/19/2015. She presents today for ultrasound guided wire localization of index cancer. On review of the prior ultrasound studies, there is an irregular, hypoechoic mass in the left inferior breast, 6 o'clock location, approximately 4 cm from the nipple. Target spiculated mass is located in the left breast in the inferior region located posteriorly at 6 o’clock. Previously placed biopsy marker clip is identified at the superior aspect of the mass.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, a 5 cm Kopans needle was placed through the lesion. Adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. The spring wire was then deployed. Two view orthogonal mammograms reveal the spring wire to be in excellent position (within the mass and adjacent to the biopsy marker clip). The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure under direct supervision of Dr. Schacht, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, spiculations, clip and spring wire to be within the specimen. An additional medial-deep margin will be re-excised per Dr. Jaskowiak.
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Successful US-guided needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Reason: eval swallow History: dysphagia. Additional clinical history of recurrent SCC of the proximal esophagus status post chemoradiation with concern for stricture. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. A right central venous catheter terminates in the SVC. A test swallow was administered which demonstrated short segment luminal narrowing of the proximal esophagus. Subsequent swallows demonstrate a stricture of the proximal thoracic esophagus correlating with the location of the patient's known esophageal tumor measuring 4-5 mm in diameter. Also noted are small probable esophageal webs. Single contrast examination of the distal esophagus, stomach, and duodenal sweep demonstrate no additional discrete lesions. A moderate motor abnormality was present without observed gastroesophageal reflux. An episode of silent aspiration was observed, which cleared with voluntary coughing. TOTAL FLUOROSCOPY TIME: 3 minutes 51 seconds.
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1. Proximal esophageal stricture measuring 4-5 mm in diameter correlating with the location of the patient's known esophageal tumor. 2. No distal esophageal or gastric lesions identified. 3. An episode of silent aspiration was observed, which cleared with voluntary coughing. 4. Other findings as described above.
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Generate impression based on findings.
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Line placementVIEW: Chest AP and abdomen AP 1/18/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The umbilical venous catheter tip within the right atrium. The umbilical arterial catheter tip at L4. Cardiothymic silhouette normal. The malpositioned three chest tubes are again noted with moderate size right subpulmonic pneumothorax unchanged. Minimal atelectasis in the right lung. Absent bowel gas within the abdomen. No pneumatosis or pneumoperitoneum.
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Malpositioned chest tubes with moderate size right subpulmonic pneumothorax unchanged.
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Generate impression based on findings.
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67 years, Female. Reason: 67F s/p cystectomy, with distention; assess for ileus vs obstruction Interval removal of vaginal packing material and enteric tube. Mild gaseous distention of the bowels consistent with generalized ileus. Scoliosis, laminectomy changes, and DJD of the spine. Skin staples noted. Partially seen pelvic JP drain, ureteral stents and clips overlying the pelvis.
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Interval removal of vaginal packing material and enteric tube. Mild gaseous distention of the bowels consistent with generalized ileus.
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Generate impression based on findings.
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The examination is limited by lack of IV contrast. There are bullet fragments in the floor of the mouth adjacent to a chronic mandibular fracture. A tracheostomy defect is noted, deep to which is an area of tracheal narrowing measuring approximately 20 x 10 x 16 mm in AP x TR x CC dimensions (series 8, image 70). There is no extrinsic compression upon the trachea at this level. The parotid glands, submandibular glands and thyroid lobes are symmetric bilaterally without masses. There is no cervical lymphadenopathy. There are no nasopharyngeal, oropharyngeal, hypopharyngeal or laryngeal masses identified. Mild carotid artery calcifications are noted bilaterally at the bifurcation. There is extensive paranasal sinus opacification with air-fluid levels in the bilateral maxillary and sphenoid sinuses. Mild degenerative changes of the cervical spine. Nonspecific ground glass opacities are noted at the right lung apex.
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1.Findings consistent with a post tracheostomy stricture with measurements as described above.2.Paranasal opacification and air-fluid levels in the maxillary and sphenoid sinuses likely related to prior intubation.3.Bullet fragments in the floor of the mouth and chronic mandibular fracture.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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LUNG BASES: Small left pleural effusion and minimal associated atelectasis. Right lower lung interlobular septal thickening, nonspecificLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with cystic and thin parenchyma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Disproportionate dilatation of proximal small bowel with collapsed distal terminal small bowel, indicative of partial small bowel obstruction. Likely transition point in the left lower quadrant/left upper pelvis, with adhesions as the most likely underlying etiology as no surrounding mass or other abnormality is seen. Small amount of abdominal/pelvic ascites, however no bowel wall thickening or pneumatosis is identified. Right inguinal hernia containing bowel and fat without upstream dilation at this level to suggest obstruction. Left fat-containing inguinal hernia.BONES, SOFT TISSUES: Abnormal sclerosis of the visualized skeleton, likely related to history of renal disease.OTHER: No aortic or iliac artery dissection is identified. Atherosclerosis affects the visualized vasculature. A right iliac vein stent is noted, however given the arterial phase of contrast the venous vasculature cannot be adequately evaluated. A right femoral artery bypass graft is noted without internal contrast opacification, suggesting occlusion.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small bilateral inguinal lymph nodes.BOWEL, MESENTERY: See abdomen discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Partial bowel obstruction in the lower abdomen likely due to adhesions. Abdominal and pelvic ascites, and differential enhancement of the bowel loops, without bowel wall thickening or pneumatosis. Unless an alternative etiology of ascites is evident,ascites raises the question of bowel injury.2.No arterial occlusion and no dissection, however the venous vasculature cannot be adequately evaluated on this exam.3.Occluded right femoral bypass graft material.4.Small, left greater than right, pleural effusions.5.Right inguinal hernia contains bowel loops and fat, although this is unlikely the cause of the aforementioned partial obstruction.
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Generate impression based on findings.
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Chest tube replacementVIEWS: Chest AP and lateral 1/18/15 ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. The umbilical venous catheter tip in the right atrium. There are two new chest tubes on the right with tips at the apex posteriorly. The moderate size right subpulmonic pneumothorax has decreased in size. Cardiothymic silhouette normal. Minimal atelectasis right lung.
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Placement of new chest tubes on the right with interval decrease in size of the moderate size right pneumothorax.
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Generate impression based on findings.
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17 year-old female status post appendectomy with persistent pain. ABDOMEN:LUNG BASES: New moderate bilateral pleural effusions are evident, left greater than right with associated compressive atelectasis. A central venous catheter is in place with the tip terminating in the high right atrium.LIVER, BILIARY TRACT: Multiple new loculated fluid collections are seen along the medial aspect of the right hepatic lobe as well as along the anterior aspect of the gallbladder, which demonstrate peripherally hyperattenuating walls. The largest collection measures up to 6.9 x 2.8 cm (image 66, series 4).There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: New diffuse retroperitoneal lymphadenopathy is presumably reactive in etiology.BOWEL, MESENTERY: There is diffuse mild small bowel wall dilatation measuring up to 3.1 cm in maximal diameter, without transition point suggestive of ileus. There is a small amount of partially organized fluid distributed along the greater curvature of the stomach as well as descending the left paracolic gutter.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Increased pelvic lymphadenopathy, presumably reactive in etiology.BOWEL, MESENTERY: Postsurgical changes about the cecum compatible with prior appendectomy. There is diffuse mesenteric fat stranding evident within the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A left lower abdominal wall approach surgical drain is in place, residing within the anterior pelvis, within a poorly organized fluid collection. There is a new loculated fluid collection in the rectouterine pouch measuring up to 6.1 x 3.0 cm, and demonstrating a peripherally hyperattenuating rim.
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1.Postsurgical changes related to appendectomy, with a surgical drain present within the midline pelvis.2.Multiple new organized and partially organized fluid collections within the abdomen and pelvis most consistent with abscesses.3.New bilateral pleural effusions with associated compressive atelectasis.4.Diffuse mild small bowel dilatation compatible postoperative ileus.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Evaluate pneumothoraxVIEW: Chest AP and abdomen AP 1/19/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The two chest tubes on the right unchanged. Umbilical lines unchanged. Cardiothymic silhouette normal. The right subpulmonic pneumothorax has decreased in size. Patchy atelectasis in the right lower lobe and left lower lobe. Absent bowel gas within the abdomen. No pneumatosis or pneumoperitoneum. There is a radiopaque catheter at the lower abdomen and may represent a surgical drain.
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Right subpulmonic pneumothorax has decreased in size.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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11-year-old male vomiting. History of malrotation.VIEWS: Chest AP, abdomen AP supine, abdomen left decubitus (3 views) 01/18/15 Cardiothymic silhouette is normal. Mild peribronchial cuffing suggestive of bronchiolitis/reactive airway disease. No focal areas of consolidation. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. No air-fluid levels. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. Scattered benign calcifications are present in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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71 years Male with AMS. Patient is intubated, please assess for acute changes. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are mildly prominent, likely age-related, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.Small retention cyst in the right maxillary sinus, and mild bilateral maxillary sinus mucosal thickening. Otherwise, the visualized paranasal sinuses and mastoid air cells are clear. Calvarium is intact.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Ms. Mitacek is a 34 year-old female presenting with left unilateral bloody nipple discharge. She recently had an MRI that showed a total of three areas of enhancement (two on the left, one on the right). The anterior enhancing lesion in the left breast was of higher suspicion. The posterior enhancing lesion in the left breast and the enhancing lesion in the right breast were of lower suspicion. The anterior enhancing lesion in the left breast was immediately identified on the initial postcontrast sequence. However, the posterior enhancing lesion in the left breast and to the enhancing lesion in the right breast were not identified. As a result, a decision to only proceed with one MR guided biopsy of the left anterior enhancing lesion was made. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 6 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral mammogram CC and ML views to locate the percutaneously placed clip. The rod-shaped clip is placed at 12 o'clock position with no evidence of any complications due to the procedure. Of note, there is a lock shaped clip in the left retroareolar region at site of biopsy proven fibroadenoma. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Sheth under direct supervision of Dr. Abe who was present throughout the procedure.
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(1) Successful MR guided core needle biopsy of the left breast 12 o'clock enhancing lesion with successful clip placement. Pathology is pending.(2) The posterior enhancing lesion in the left breast and the enhancing lesion in the right breast were not seen on today's MRI exam. A short-term 6 month MRI follow-up is recommended to confirm stability of these findings.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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59-year-old male with recent unwitnessed fall and possible head trauma. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age, without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. No significant soft tissue swelling is identified.
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No evidence of intracranial hemorrhage or mass effect. Calvarium and soft tissues are unremarkable. No specific evidence of recent head trauma.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Masses in both breasts are unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Reason: assess for tracheal stenosis History: dysphonia LUNGS AND PLEURA: Atelectasis and consolidation involving both lung bases, left greater than right. Trace associated pleural fluid. Bronchial wall thickening.MEDIASTINUM AND HILA: Focal, roughly 50% narrowing of the trachea, 6 - 7 cm above the carina. No definitive mass is identified given limits of technique.Mild coronary calcification.CHEST WALL: Mild degenerative change involving the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia
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1. Focal, roughly 50% narrowing of the trachea, 6 - 7 cm above the carina. No definitive mass is identified given limits of technique. This may be secondary to a prior endotracheal tube.2. Atelectasis and consolidation involving both lung bases, left greater than right. Trace associated pleural fluid. Bronchial wall thickening. This may be secondary to aspirate or pneumonia.
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Generate impression based on findings.
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Male; 62 years old. Reason: 62yo M with cavitary lesion on XRAY concerning for TB vs neoplasm History: - LUNGS AND PLEURA: Thick-walled cavitary lesion in the left upper lobe measures 4.1 x 4.1 cm (image 27, series 5) with internal air fluid level and mild surrounding and satellite patchy groundglass opacities, most suspicious for infection with differential including TB, fungal, or atypical etiologies. However, a primary malignancy cannot be definitely excluded. There are also mild hazy groundglass opacities in the right upper lobe, which may be post infectious or inflammatory in etiology. Mild left upper lobe bronchial wall thickening. 12 mm nonspecific nodule in the lingula (image 9, series 5). No pleural effusions.MEDIASTINUM AND HILA: Enlarged prevascular and left paratracheal lymph nodes. For future reference, a markedly enlarged left paratracheal lymph node measures 33 mm (image 36, series 4). There is a suggestion of partial calcification of an enlarged prevascular lymph node (image 36). Moderate cardiac enlargement. No pericardial effusions. Marked calcifications of the coronary arteries. Fluid in the esophagus, suggestive of reflux.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Fatty infiltration of the liver. Otherwise, no significant abnormality noted.
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Thick-walled cavitary lesion in the left upper lobe with surrounding groundglass opacity, most suspicious for infection with differential considerations as above. Enlarged mediastinal lymph nodes are most likely reactive. However, follow-up to resolution is advised for the possibility of malignancy.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Ms. Taylor Harris is a 59 year old female presenting for a routine mammogram. She was previously followed on a short term basis for calcifications in the left upper outer breast. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Calcifications in the left upper outer breast have not changed when compared to prior exams. Additional scattered benign calcifications are noted bilaterally. Biopsy marker clip is seen within the right lower breast. Benign lymph nodes are projected over both axillae and in each upper outer quadrant.
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Stable benign calcifications in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Biopsy clip is present in the posterior right 6 o'clock position. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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There is no diffusion abnormality to suggest acute infarct. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. There is moderate degree of T2/flair hyperintensity throughout the periventricular and subcortical white matter as well as the pons which is nonspecific but likely represents chronic small vessel ischemic disease. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is moderate fluid within the bilateral mastoid air cells. Changes of intraocular lens replacement noted. Focus of T1 hyperintensity in the right parietal calvarium compatible with hemangioma.MRA HEAD
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1. No evidence of acute infarct. No evidence of intracranial mass or mass effect.2. Advanced chronic small vessel ischemic disease.3. No significant stenosis in the intracranial or extracranial circulations.
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Generate impression based on findings.
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Lung Cancer. LUNGS AND PLEURA: Volume loss and bronchiectasis with consolidation medial right upper lobe, not significantly changed presumably secondary to radiation fibrosis. Scattered punctate micronodules unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant change in infiltrative right upper chest wall mass with rib destruction and permeative lesions of the 2nd and 3rd ribs. For reference the mass lateral to the 1st rib measures 34 x 22 mm on image 21/100, unchanged. A separate smaller mass just postero inferior to this one (near the 2nd rib on image 25/100) is also unchanged. Chest wall port with tip in high right atrium.Small subcentimeter right axillary lymph nodes are unchanged.A/P CT WILL BE REPORTED SEPARATELY. UPPER ABDOMINAL MASS ONLY PARTIALLY VISUALIZED.
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1. Stable CT demonstrating an infiltrative right chest wall mass and right upper lobe consolidation. The right upper lobe consolidation may represent post XRT fibrosis rather than residual disease.2. Small intrathoracic nodes are unchanged.3. See abdomen CT report for details regarding an upper abdominal mass.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephrectomy, with surgical clips in the nephrectomy bed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left colostomy site appears intact. Right ileal conduit is within normal limits. No bowel dilatation or bowel wall thickening. No small bowel obstruction.BONES, SOFT TISSUES: Small catheter within the thoracolumbar spinal canal courses through the posterior soft tissues laterally terminating in the subcutaneous fat of the right lower quadrant. Additionally, soft tissue thickening/stranding in the subcutaneous fat is noted, likely related to prior surgical wound.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postoperative findings of cystectomy and hysterectomy.BLADDER: Post cystectomy findings.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The anus/rectum have a markedly thickened wall, which is likely due to radiation or other nonspecific inflammation. At the superior margin where surgical clips are seen at the closure of the rectum, extensive soft tissue infiltration is seen and does abut the air-filled cavities described below. If fistulous communication is present between the GI tract and these air-filled pelvic cavity, it most likely occurs at the apex of the rectum near the suture line.BONES, SOFT TISSUES: Extensive pelvic fat stranding, consistent with history of pelvic radiation.OTHER: Within the pelvis is a network of air-filled cavities which course through the cystectomy and hysterectomy bed. Portions of this air filled cavitary network have fingerlike projections outward, and although no adjacent anatomical landmarks are present, this appears to involve the vaginal cuff and air is seen in the vagina. None of these air-filled cavities have enteric contrast to suggest fistula with opacified adjacent small bowel. However, these cysts superior end of these air collections does extend posteriorly toward the region of the surgical clips about the termination of the rectum, with surrounding inflammatory densities and this may be the site of fistulous communication.
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1.Pelvic air-filled cavity network in the cystectomy/hysterectomy bed as above.2.No identifiable anterior cutaneous fistula tract.3.No site of enteric fistula to pelvic air cavities is seen, however suspected site is at rectum -- if further imaging clarification would be helpful, fluoroscopic rectal contrast administration evaluate whether a fistula exists.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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15-year-old male with sickle cell disease and vaso-occlusive diseaseVIEWS: Pelvis AP/frog leg, left femur AP/lateral, right femur AP/lateral, right knee AP/lateral, left knee AP/lateral (10 views) 01/18/15 Pelvis: There is deformity and flattening of the right femoral head with lateral uncovering of approximately 20%. No acute fracture or malalignment is evident. Mild degenerative changes to the acetabulum are present. Stool is noted in the rectum.Right femur: Again noted is deformity of the right femoral head with approximately 20% lateral uncovering. No acute fracture or malalignment is evident.Left femur: No acute fracture or malalignment is evident.Right knee: No acute fracture or malalignment is evident.Left knee: No acute fracture or malalignment is evident.
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Findings suggestive of avascular necrosis of the right femoral head. No acute fracture malalignment is evident.
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Generate impression based on findings.
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2-year-old male with right leg fracture.VIEWS: Right tibia/fibula AP and lateral (two views) 1/18/2015, 23:09 Interval casting of the oblique tibial diaphyseal fracture with persistent anterior and lateral displacement of distal fracture fragment. Overlying cast material obscures fine bone detail.
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Casting of the tibial diaphyseal fracture as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. An intramammary lymph node is seen at upper outer quadrant in the right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Mammogram works best when searching for changes. Submission of prior mammogram is, therefore, recommended for future reference. If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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There is narrowing of the subglottic airway superior to the tracheostomy with surrounding soft tissue edema secondary to radiation changes, which are unchanged from the prior exam without evidence of enhancing tumor. The remaining visualized aerodigestive tract is without focal effacement or enhancement. There is no cervical lymphadenopathy. There is an unchanged 12-mm hyperattenuating focus in the left parotid gland, unchanged. The parotid glands, submandibular glands, and thyroid gland are stable in appearance without enlargement or mass. The cervical vasculature is stable in appearance. There is a right chest wall Port-A-Cath. Mild degenerative changes affect the cervical spine. Please refer to separately dictated chest CT report for thoracic findings.
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1.Post treatment changes in the neck without evidence of abnormal enhancement, mass, or lymphadenopathy.2.Please refer to separately dictated chest CT report for thoracic findings.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A biopsy clip in the right breast at 9 o'clock is unchanged in position. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Female 46 years old; Reason: Evaluate for recurrent ovarian cancer History: right upper quadrant abdominal pain CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mild calcified coronary artery disease. CHEST WALL: Bilateral axillary surgical clips, bilateral breast prostheses.ABDOMEN:LIVER, BILIARY TRACT: Common bile duct mildly prominent, measuring up to 8 mm, but distal tapering seen. No pancreatic ductal dilatation delineated. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating left upper pole subcentimeter renal lesion, too small to characterize. Right ureter traverses posterior to described retroperitoneal adenopathy, no associated hydronephroureter seen at this time.RETROPERITONEUM, LYMPH NODES: Retroperitoneal surgical clips, likely related to prior nodal dissection. Enlarged retroperitoneal lymphadenopathy seen, new from prior study and adjacent to surgical clips located in precaval area. Reference right common iliac lymph node measuring 2.5 x 1.4 cm, image 151 series 3. BOWEL, MESENTERY: Stable 1 by 0.8 cm soft tissue focus deep to umbilicus seen in ventral abdomen, image 145 series 3, may be focus of fat necrosis but nonspecific and follow-up recommended to exclude metastatic disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No definite enhancing soft tissue nodularity seen in surgical bed to suggest local tumor recurrence. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela suggested, diastases of rectus abdominis muscles with fat and bowel containing herniation seen. Right sacroiliac joint sclerosis.
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1. New retroperitoneal lymphadenopathy, appearance consistent with metastatic disease.2. Stable 1 cm focus deep to umbilicus, although nonspecific may be related to postsurgical fat necrosis, attention on followup imaging recommended to exclude additional metastatic site.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Few scattered benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Ms. Dabney is a 73 year old female with a personal history of left breast mastectomy in 2014 followed by hormonal therapy. She has no current breast related complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Scattered benign calcifications are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Stable benign mass is present in retroareolar region in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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63 year-old female with pancreatic cancer status post Whipple procedure -- please evaluate for evidence of disease recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified lymph nodes again seen from prior granulomatous disease. No other enlarged lymph nodes identified. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver parenchyma. Pneumobilia seen consistent with prior choledocho jejunostomy. Status post cholecystectomy.SPLEEN: Interval splenectomy since 10/16/14.PANCREAS: Postsurgical findings relating to prior Whipple procedure again seen. In addition, since 10/16/14 there's been resection of the remainder of the pancreas and the abnormal mass visualized in tail of pancreas. Streaky, soft tissue stranding in the postoperative bed is seen most likely relating to postoperative changes. More anteriorly anterior to the surgical clips (series 3, image 91) is a nonspecific low density 2.5 x 1.6 cm collection or mass that may also represent postoperative seroma or other changes, but recurrent or residual tumor cannot be differentiated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nonobstructing left renal stones are again seen. Presumed small cortical benign cysts in the left kidney are also unchanged. No other significant abnormalities noted. RETROPERITONEUM, LYMPH NODES: Small subcentimeter lymph nodes are again seen in the mesenteric root but these are unchanged. No new enlarged lymph nodes are seen.BOWEL, MESENTERY: Extensive postoperative changes from prior Whipple procedure and subsequent resection of the body and tail of pancreas/splenectomy are noted. No evidence of bowel obstruction is seen. No intrinsic abnormality is seen in the small bowel or colon. No free mesenteric fluid is seen. Slight nodularity is seen in the anterior omentum on the left (series 3, image 110) that may represent postoperative change but early Ho mental tumor cannot be differentiated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids unchanged. No other significant abnormality.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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1. Status post Whipple procedure with expected associated postoperative findings. 2. Interval resection of pancreatic body, pancreatic tail and spleen since 10/16/14. Anterior midline 2.5-cm either collection or low density tissue is seen which may represent postoperative change adjacent to sutures, but cannot be differentiated from recurrent tumor as we have no prior postoperative CT examinations. 3. Subtle nodularity seen in the left anterior omentum -- these may represent postoperative changes but attention to this area for potential omental deposits is recommended on future imaging.
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Generate impression based on findings.
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71 years, Male. Reason: ?feeding tube position History: None Enteric tube tip overlies the forth portion of the duodenum. Paucity of bowel gas.Patient is status post sternotomy. LVAD and ICD leads partially visualized.
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Enteric tube tip overlies the forth portion of the duodenum. Paucity of bowel gas.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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2-year-old male status post trauma, evaluate for fracture.VIEWS: Right tibia/fibula AP and lateral (two views) right ankle AP lateral and oblique (3 views) 1/18/2015 An oblique fracture of the distal tibial diaphysis is seen with anteromedial displacement of the distal fracture fragment. There is significant soft tissue swelling seen about the lower leg. No additional fracture or malalignment is evident.
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Oblique tibial diaphyseal fracture as above.
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Generate impression based on findings.
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92 years, Male. Reason: eval for signs SBO History: constipation Vascular calcifications noted. DJD of the spine, SI joints, and hips.Nonobstructive bowel gas pattern. Average stool burden.
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Nonobstructive bowel gas pattern. Average stool burden.
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Generate impression based on findings.
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Nine year old female with Langerhans cell histiocytosis of the pelvis, on chemotherapy. Evaluate disease status. EXAMINATION: MR enterography without and with IV contrast 1/19/2015 A heterogeneous, but predominantly T1 and T2 hyperintense lesion is identified within the right iliac wing, which demonstrates significant enhancement and is consistent with a reported history of Langerhans cell histiocytosis. The lesion measures approximately 0.8 x 2.2 cm in cross-sectional dimension (image 18, series 1001), and approximately 2.4 cm in craniocaudal dimension (image 18, series 1101). This lesion is significantly decreased in size from the prior examination, when it measured approximately 1.0 x 3.1 cm in cross-sectional dimension (image 16, series 10) and 3.5 cm in craniocaudal dimension (image 13, series 9). The previously seen adjacent marrow edema has also substantially decreased as well. Anterior and posterior cortical breakthrough associated with this lesion is unchanged, predominantly affecting the anterior cortex. No new enhancing lesions are identified to suggest additional sites of disease.
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Interval decrease in size of the right iliac wing lesion and improvement of the surrounding bone marrow edema consistent with treatment response, with no new foci of disease identified.
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Generate impression based on findings.
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Leg lengthening.VIEWS: Left femur AP/lateral (two views) 01/19/15 External fixator remains in place. No loosening of screws is identified. Plate and screws device in medial distal femur is again noted. Distraction at the osteotomy site measures 6 cm laterally. New bone formation in the osteotomy site appears slightly increased.Premature fusion of distal femoral physis is again noted.
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Increase in distraction at osteotomy site.
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Generate impression based on findings.
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Reason: esophageal lesion History: dysphagia for dry food, bilateral oophorectomy Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. There is trace proximal escape on one of the swallowing. Left pharyngeal diverticulum is noted of doubtful clinical significance.During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Barium pill passed freely into stomach. There was no evidence of esophagitis, esophageal stricture, or web. There was no incisional hernia. TOTAL FLUOROSCOPY TIME: 4:45 minutes
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Normal esophageal and gastric mucosa. No evidence of reflux. Minor esophageal dysmotility with trace proximal escape.
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Generate impression based on findings.
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Female; 48 years old. Reason: eval for lymphadenopathy, lung mass, outside w/u: CT chest 10/2014 with RLL opacity and LAD, s/p bronch with atypical cells, then had med which was negative. History: cough, initially with hemoptysis LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema. Very mild streaky subsegmental atelectasis and/or scarring in both lungs, similar to prior study. Few scattered nonspecific pulmonary micronodules are stable. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: Small, calcified nodule at the inferior aspect of the thyroid isthmus. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Small splenule anterior to the spleen noted.
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1. Mild centrilobular emphysema. Otherwise, no significant pulmonary abnormality.2. No mediastinal or hilar lymphadenopathy.
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Generate impression based on findings.
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Reason: tracheal polpys noted on CT chest outside History: voice hoarseness LUNGS AND PLEURA: 6 mm smoothly marginated nodule in the medial right lower lobe (image 69/110).MEDIASTINUM AND HILA: Lobulated mass involving posterior wall of distal trachea just above the carina causing roughly 50% narrowing of the airway. This measures 15 mm in thickness on image 29/110. There is an additional mass in the right bronchus intermedius measuring 11 mm on image 47/110 causing roughly 75% narrowing of the airway.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Masses involving posterior wall of distal trachea and in the bronchus intermedius. While the differential diagnosis is extensive and includes inflammatory and neoplastic etiologies, the main considerations are benign neoplasms such as squamous cell papillomas or malignant lesions such as squamous cell carcinoma, ACC or metastases. A small 6 mm nodule in the right lower lobe may be related.
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Generate impression based on findings.
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37-year-old female with history of fifth proximal phalanx fracture. Again seen is a transverse fracture through the neck of the proximal phalanx of the fifth toe. There is minimal plantar displacement of the distal fracture fragment. Overall this appears similar to the prior study.
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5th toe fracture as above.
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Generate impression based on findings.
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Female; 63 years old. Reason: History of metastatic breast cancer on treatment. Compare to prior imaging and evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging and evaluate for response and extent of disease. CHEST:LUNGS AND PLEURA: New moderate nonspecific subpleural atelectasis/consolidation in the posterior right upper lobe, with differential considerations including infection, aspiration, or infarct.Right middle lobe atelectasis is unchanged.Scattered pulmonary micronodules without significant interval change.Large right pleural effusion, increased since prior study. Stable small left pleural effusion. A small enhancing right pleural nodule has slightly increased in size and is nonspecific (image 79, series 3).MEDIASTINUM AND HILA: Interval increased size and necrotic appearance of subcarinal lymph nodes. For future reference, a subcarinal node measures 14 mm on image 46, series 3. Other scattered, small mediastinal lymph nodes are unchanged. Heart size is normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Sclerosis about the sternum and right sixth rib is unchanged. Small sclerotic focus in T6 vertebral body is unchanged, presumably a bone island. Mild to moderate degenerative changes of the visualized spine.Enhancing nodule in the right chest measures 10 mm (image 49, series 3), previously measuring 10 mm.Stable enlarged right axillary lymph nodes.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Inhomogeneous contrast distribution in the liver again noted and may reflect hepatic congestion. Stable right lobe hypervascular lesion measuring at 9 mm (image 113, series 3). Two new nonspecific right lobe hypervascular lesions are seen measuring up to 9 mm (images 108 and 112).SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal hypoattenuating focus, unchanged and likely a benign cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. New moderate subpleural atelectasis/consolidation in the right upper lobe is nonspecific with differential considerations as above. A new underlying mass cannot be excluded.2. New subcarinal necrotic lymphadenopathy could be reactive versus due to metastatic disease.3. Increased right pleural effusion. Slightly increased size of a small nonspecific right pleural nodule.4. Two new small nonspecific hypervascular liver lesions.
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Generate impression based on findings.
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Reason: hx H\T\N radiation and secondary aspiration, presenting with hemoptysis from sublaryngeal source, looking for likely pulmonary source History: Progressive hemoptysis last 24 hours LUNGS AND PLEURA: Patient is an acute diffuse air space opacities involving all lobes more pronounced in the lower lobes. This is compatible with acute aspiration/infection, as well as hemorrhage and edema.Redemonstration of the previously aspirated barium at both lung bases.No pleural effusions.Azygos pseudo-lobe noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Minimal coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Stable exophytic hypoattenuating mass emanating from the left kidney most likely representing a cyst.
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Extensive new multifocal airspace and ground glass opacities more predominant in the lung bases compatible with acute aspiration/infection. Concomitant hemorrhage may be present.
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Generate impression based on findings.
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62-year-old male with history of pT4b N1a anaplastic thyroid carcinoma status post treatment, please compare to previous with measurements. Neck: Stable appearance of postoperative findings related to total thyroidectomy, neck dissection, and right vocal cord augmentation. Stable ill-defined soft tissue within the right thyroidectomy bed which is favored to represent scar. No discrete mass is identified. There is no significant cervical lymphadenopathy. The airways are patent. The salivary glands are unchanged. Partially effaced right vallecula likely related to secretions. There is chronic thrombosis of the inferior right internal jugular vein. Mild degenerative spondylosis. Unchanged maxillary sinus mucosal thickening and retention cyst formation. The imaged portions of the lungs are clear. Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Stable posttreatment findings, without evidence of locoregional tumor recurrence or significant lymphadenopathy.2. No evidence of intracranial metastases.
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Generate impression based on findings.
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Right femur fracture.VIEWS: Right femur AP/lateral (two views) 01/19/15 A cast obscures bone detail. Plate and screws device remains in place. Oblique fracture of mid femur is in near-anatomic alignment. Callus formation has developed in the interval.
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Healing fracture of the mid femur.
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Generate impression based on findings.
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Ms. Williams is a 77 year old female with a personal history of left breast lumpectomy for IDC/DCIS in April 2013 followed by radiation therapy. She has no current breast related complaints. Three standard views of both breasts, a left laterally exaggerated CC view, and two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Linear markers were placed on scars overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. The increased density at the surgical site, likely representing a postoperative seroma, is unchanged. Skin thickening and trabecular thickening of the left breast are consistent with radiation related changes. A circumscribed mass in the central right breast, posterior depth, is unchanged and consistent with a cyst previously seen on prior ultrasound. Scattered benign calcifications are seen bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. An AICD device obscures evaluation of the right axilla. A vascular port partially obscures evaluation of the left axilla.
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Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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42 year old female with history of wrist surgery. Two orthopedic pins affix the scaphoid to the lunate and capitate in near-anatomic alignment. There is mild soft tissue swelling laterally. There are new lucencies within the lunate, triquetrum, and pisiform which are not clearly evident on the prior study. As the remaining carpal bones appear normal, we suspect that these findings represent demineralization of disuse rather than erosions due to infection.
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Orthopedic fixation of the scaphoid to the capitate and lunate. Other findings as above.
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Generate impression based on findings.
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Evaluate NG tubeVIEW: Abdomen AP Moderate amount of fecal burden. Disorganized nonobstructive bowel gas pattern. There is no NG tube identified. No pneumatosis or pneumoperitoneum.
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NG tube not identified in this radiograph.
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Generate impression based on findings.
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Reason: follow-up nodules on jan 2014 CT - active smoker History: none LUNGS AND PLEURA: Scattered ground glass and solid micronodules, the largest of which is groundglass and measures 5 mm in the left lower lobe (image 76/117).Emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Probable hepatic cysts unchanged.
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Continued stability of scattered groundglass nodules as discussed above. Despite stability small ground glass nodules are typically followed to 3 years as there is a risk of low grade slowly growing adenocarcinoma therefore continued CT follow up is recommended (first scan in our PACS is an outside study dated 10/9/2013 from Northwestern).
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Generate impression based on findings.
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FractureVIEWS: Left middle finger AP and lateral Again noted healing Salter II fracture involving the distal phalanx of the left middle finger. The alignment is not significantly changed from prior study. There is soft tissue swelling about the left middle finger.
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Healing Salter II fracture involving the distal phalanx of the left middle finger.
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Generate impression based on findings.
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10-year-old male with known Salter-Harris type II fracture.VIEWS: Great toe AP and lateral (two views) 1/19/2015, 09:49 A fracture extending through the base of the great toe distal phalanx is again seen, without significant interval change in alignment. No significant periosteal reaction or callus formation is evident.
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Salter-Harris type II fracture of the great toe distal phalanx, without significant interval change.
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