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Generate impression based on findings.
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50 year-old female with history of right shoulder pain. Tiny glenoid osteophytes indicate minimal osteoarthritis. The shoulder is otherwise unremarkable. There is an incompletely imaged orthopedic fixation device and stimulator leads projecting over the lower cervical spine.
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Minimal osteoarthritis as above.
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Generate impression based on findings.
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ConstipationVIEW: Abdomen AP There is moderate amount of fecal burden at the rectosigmoid region. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Moderate amount of fecal burden at the rectosigmoid region.
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Generate impression based on findings.
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69-year-old female with history of knee prosthesis. Hardware components of a right total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. There is heterotopic bone along the medial aspect of the joint which appears similar to prior. The silhouette of the patellar tendon appears indistinct. Severe osteoarthritis affects the left knee as seen on the frontal view.
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Total knee arthroplasty as above.
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Generate impression based on findings.
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62-year-old female with history of stage IV melanoma. Re-evaluate disease status. CHEST:LUNGS AND PLEURA: Reference right lower lobe nodule measures 0.7 x 0.6 cm (series 20584, image 50), previously measuring 0.9 x 0.8 cm. An additional reference right lower lobe nodule measures 1.1 x 0.9 cm (series 20584, image 69), previously measuring 1.3 x 1.0 cm. No new suspicious nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Heart size is normal without pericardial effusion. No visible coronary artery calcifications. CHEST WALL: Stable left breast nodule.ABDOMEN:LIVER, BILIARY TRACT: Stable hypoattenuating lesions in segments 5 and 7 of the liver consistent with simple cysts. Segment 6 too small to characterize hypoattenuating lesion (series 10279, image 110) is unchanged since September 2014 examination and is of doubtful clinical significance. Gallbladder is collapsed and the previously noted small stone versus polyp is not as conspicuous on the current examination. Attention on subsequent examinations is recommended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 1.2 x 0.7 cm (series 10279, image 96), previously measuring 1.7 x 0.7 cm.KIDNEYS, URETERS: No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Minimally prominent nonspecific infrarenal retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No findings to suggest small bowel obstruction. Colonic diverticulosis without evidence of diverticulitis or colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Unchanged fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No findings to suggest small bowel obstruction. Colonic diverticulosis without evidence of diverticulitis or colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Mild interval decrease in size of the pulmonary nodules. 2.Interval decrease in size of right adrenal nodule. 3.No new sites of disease.
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Generate impression based on findings.
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Reason: h/o vocal cord ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Stable scattered calcified and noncalcified micronodules.Mild subpleural reticulation and fibrosis similar to the prior exams.No new suspicious pulmonary masses.MEDIASTINUM AND HILA: Tracheostomy tube in place.No hilar or mediastinal lymphadenopathy.Right chest Port-A-Cath with its tip in the SVC.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Degenerative changes in the thoracic spineABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No interval change without evidence of metastatic disease. Mild pulmonary fibrosis stable.
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Generate impression based on findings.
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55-year-old female with history of pain. There is narrowing of the medial tibiofemoral compartment along with tricompartmental osteophytes indicating moderate osteoarthritis. There is no joint effusion. Mild osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis as above.
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Generate impression based on findings.
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60 year-old male with history of right knee prosthesis. Hardware components of a right total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Anterior soft tissue swelling limits evaluation of the extensor mechanism. Mild osteoarthritis affects the left knee as seen on the frontal view.
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Right total knee arthroplasty as above.
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Generate impression based on findings.
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57-year-old female with a history of a right mastectomy in 1990 with recurrent invasive carcinoma along the right chest wall in 2011. Family history of two paternal cousins with breast cancer. Three standard views of the left breast 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. A left chest wall Port-A-Cath is visualized.No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Ms. Smith is a 72-year-old female with a personal history of right breast lumpectomy in 2005 and left breast mastectomy in 2012 followed by chemoradiation therapy. Family history of breast cancer in mother and sister. Dr. Jaskowiak palpated a right breast mass at the 2:00 position. The site has been marked. Upon physical exam at the palpable area of concern, there is a subcentimeter soft, mobile lesion palpated superficially.A targeted right breast ultrasound was performed for the palpable area of concern. The site was marked. Underlying the marker, in the right breast two o'clock location (approximately 6 cm from the nipple), there is an ovoid, hypoechoic mass measuring 0.6 x 0.4 x 0.6 cm. The mass is superficially located with a possible tract extending into the skin surface. There is no vascularity associated with it. Findings are compatible with a benign sebaceous cyst. There is no solid or cystic mass identified.
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Benign sebaceous cyst in the right breast without sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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9-year-old male with history of histo, fungal ball in chest, abdomen, or pelvis CHEST:LUNGS AND PLEURA: No pleural effusion. Patchy opacity in the right lower lobe (series 4, image 33). Bibasilar atelectasis. Focal nodule measuring 6 mm (series 4, image 40) in the right lung base likely represents round atelectasis. Multiple nodules measuring up to 6 mm in the right lung may represent multifocal infection.MEDIASTINUM AND HILA: ET tube tip is above the carina. Heart size is normal. No pericardial effusion. Scattered mediastinal lymph nodes not pathologically enlarged. Chest port with tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic biliary dilatation. Common bile duct measures 5 mm. The gallbladder is within normal limits.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or perinephric inflammation. Poor corticomedullary differentiation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No significant lymphadenopathy.BOWEL, MESENTERY: Enteric tube with tip in the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter within a collapsed bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated fluid-filled colon. Fluid-filled nondilated distal small bowel. No pericolonic fat stranding. No pneumatosis intestinalis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right femoral central venous catheter with tip at the confluence of the common iliac veins.
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1.Right multifocal lower lobe pneumonia and bilateral atelectasis.2.Generalized ileus.3.Poor corticomedullary differentiation, a finding of medical renal disease.
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Generate impression based on findings.
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88 years, Female. Reason: 88 yo F AMS, SOB History: SOB Large fecal material noted in the distended rectum compatible with fecal impaction. Decreased bowel gas from prior study. No definite evidence of obstruction.DJD of the spine. Vascular calcifications noted.
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Large fecal material noted in the distended rectum compatible with fecal impaction. Decreased bowel gas from prior study. No definite evidence of obstruction.
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Generate impression based on findings.
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Ms. Gosden Pollack is a 56-year-old female called back for findings seen on 3-D whole breast ultrasound in the left breast. She has a family history of breast cancer in mother and maternal grandmother. Upon physical exam at the area of concern identified by the 3-D whole breast ultrasound, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the area of concern identified by the 3-D whole breast ultrasound. In the left breast 1 o'clock position, approximately 11 cm from the nipple, no suspicious cystic or solid mass was identified. Additional imaging throughout the upper outer quadrant detected no suspicious finding. The previously identified finding was likely due to artifactual shadowing.
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No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in Dec 2016. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: dyspnea; crackles on physical exam; possible ILD History: see above LUNGS AND PLEURA: Mild bibasilar, right greater than left, linear interstitial abnormality with borderline bronchiectasis and bronchial wall thickening. No significant air trapping, nodularity, or honeycombing. No pleural effusion. Mild paraseptal emphysema. Stable cyst in posterior left upper lobe. Scattered punctate micronodules are unchanged. LInear bands of scarring or atelectasis at the bases is unchanged.MEDIASTINUM AND HILA: Severe coronary calcification. Scattered small nodes are unchanged 3 hiatal hernia with distal esophageal thickening, unchanged.CHEST WALL: Degenerative involving the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Presumed right renal cyst is only partially visualized.
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Mild bibasilar, right greater than left, linear interstitial abnormality with borderline bronchiectasis and bronchial wall thickening. No significant air trapping, nodularity, or honeycombing. Though the appearance is nonspecific, it is likely secondary to scarring.
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Generate impression based on findings.
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Pain. Evaluate healing of "proximal phalanx" fracture. The bones appear slightly demineralized. Again seen is a fracture through the dorsal aspect of the base of the distal phalanx of the great toe. The fracture line is less distinct on the current than on the prior study dose suggesting some interval healing. I see no proximal phalangeal fracture. Mild osteoarthritis affects the interphalangeal joint. Arterial calcifications are noted in the soft tissues.
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Healing distal phalangeal fracture.
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Generate impression based on findings.
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Some thin soft tissue stranding is noted in bilateral external auditory canals. The middle ear cavities and mastoid air cells are clear. The scuta and ossicles are intact bilaterally. No erosive changes are identified. There are no soft tissue masses identified within either middle ear cavity. The roofs of the attic are intact on both sides. The oval and round window niches are patent bilaterally. The course of the seventh nerves are well defined bilaterally without positional anomalies identified on either side. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. The cochlea and vestibules are patent bilaterally. There are no dehiscences of the semicircular canals on either side. The cochlear and vestibular aqueducts and internal auditory canals are symmetric bilaterally. The carotid and jugular plates are intact on both sides.
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Some thin soft tissue stranding is noted in bilateral external auditory canals. Otherwise negative high-resolution CT scan of the temporal bones.
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Generate impression based on findings.
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Reason: h/o anaplastic thyroid ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No interval change in the residual scarring at the left lung base.No suspicious pulmonary masses or masses.MEDIASTINUM AND HILA: Status post thyroidectomy.No hilar or mediastinal lymphadenopathy noted.Cardiac size is normal evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable lesion posteriorly in the right hepatic lobe most likely is a cavernous hemangioma.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No interval change without evidence of metastatic disease.
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Generate impression based on findings.
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4-month-old male with respiratory distress and history pulmonary hypertension. New right upper lobe atelectasis on recent chest radiograph.VIEW: Chest AP (one view) 1/19/2015, 10:40 The endotracheal tube tip is below the thoracic inlet and above the carina. The nasogastric tube tip is within the stomach, with the side port below the GE junction.Improved right upper lobe atelectasis, with persistent patchy multifocal subsegmental atelectasis. Persistent and unchanged chronic lung disease. No pneumothorax is evident.
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Improved right upper lobe atelectasis on a background of persistent and unchanged chronic lung disease.
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Generate impression based on findings.
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FractureVIEWS: Left elbow AP and lateral Healing lateral condylar fracture again noted. There is minimal periosteal reaction along the distal humerus. The overlying cast has been removed in the interval. No elbow joint effusion.
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Healing distal humeral fracture as described above.
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Generate impression based on findings.
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Status post fall on right knee There is a joint effusion, but I see no fracture. Alignment is within normal limits. Mild osteoarthritis affects the knee. There is chondrocalcinosis of the menisci. Arterial calcifications in the soft tissues.
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Osteoarthritis and joint effusion, without fracture evident.
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Generate impression based on findings.
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Reason: Assess Crohn's of small bowel History: History of Crohn's; RLQ pain. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 30 minutes. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 3 minutes.
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Normal examination of the small bowel and proximal colon.
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Generate impression based on findings.
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Reason: f/u of abnl CT done while had pneumonia History: abnl chest x ray LUNGS AND PLEURA: Minimal subpleural scarring in periphery of superior segment right lower lobe. Linear scar or atelectasis in the lingula.MEDIASTINUM AND HILA: Scattered small subcentimeter lymph nodes. Minimal coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Punctate hypodensities in liver are too small to characterize.
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No significant cardiopulmonary abnormality. Minimal subpleural scarring in periphery of superior segment right lower lobe. Linear scar or atelectasis in the lingula.
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Generate impression based on findings.
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Postoperative prosthetic assessment Three views of the right hip show a components of a total hip arthroplasty device situated in near anatomic alignment. The acetabular component appears slightly more vertically oriented on the current study than on the prior study, but this may simply be an artifact of patient positioning. A small amount of heterotopic ossification is seen within the soft tissues adjacent to the trochanters.Three views of the pelvis reveal the aforementioned right total hip arthroplasty device. Components of a left total hip arthroplasty device are situated in near anatomic alignment, although the distal extent of the prosthesis is not included on the field of view of this study. Degenerative arthritic changes affect the pubic symphysis and sacroiliac joints, and severe degenerative disk disease affects the visualized lower lumbar spine. The bones of the pelvis appear demineralized. Streaky mineralization adjacent to the ischia likely represents calcific hamstring tendinosis.
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Total hip arthroplasty and other findings as above.
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Generate impression based on findings.
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Pain. Evaluation of right small finger. Again seen are two orthopedic pins affixing a large mallet fracture of the base of the distal phalanx of the fifth finger. The mallet fracture fragment appears dorsally rotated on the lateral view, resulting in a 2-mm gap of the articular surface. The volar margin of the fracture fragment is inseparable from the dorsal margin of the distal phalanx, which may reflect some healing, but this is equivocal.
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Orthopedic fixation of distal interphalangeal fracture as described above.
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Generate impression based on findings.
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55 y/o female with right breast CA; vaguely palpable left axillary node A targeted left axillary ultrasound was performed for the palpable area of concern. Several prominent lymph nodes are identified.Three large lymph nodes are noted in the lateral superior axilla, two of which have abnormal morphology. One of these nodes, with spherical morphology and without fatty hilum, measures 1.3 x 1.3 x 1.4 cm, with CT correlate identified (series 3, image 15 on 1/13/15).
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Left axillary lymphadenopathy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Right knee pain. Evaluate for osteoarthritis. Three views of the right knee are provided. There is severe osteoarthritis particularly affecting the medial compartment where there is bone on bone apposition. There is also a mild varus deformity of the knee.Mild osteoarthritis affects the left as seen on the frontal view.
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Osteoarthritis.
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Generate impression based on findings.
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Brain:No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. No large destructive lesions are seen within the calvarium. There is interval increase in density involving the right frontal and left frontal previously lytic lesions compared to 6/18/2014, and consistent with treated metastases. Evaluation of the paranasal sinuses demonstrates mild mucosal thickening involving the anterior ethmoid air cells which is improved since prior. Mild right maxillary sinus thickening seen previously is also improved. There is minimal left maxillary sinus mucosal thickening, which is slightly improved. There is also improvement in mucosal thickening within the sphenoid sinus. Frontal sinuses are clear. No findings to suggest an aggressive sinonasal process.Bilateral mastoid air cells and middle ear cavities appear well aerated without CT findings to suggest mastoiditis or otitis media.The left mandibular condyle, ramus, and angle is expanded and is diffusely sclerotic with irregular cortical margins similar to 12/29/2014.
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1. No significant paranasal sinus disease. Minimal mucosal thickening is seen in the paranasal sinuses on the current study and is improved since 12/29/2014.2. Bilateral mastoid air cells and middle ear cavities appear well aerated without CT findings to suggest mastoiditis or otitis media.3. Extensive sclerosis and expansion of the left mandibular condyle, ramus, and angle appears similar to 12/29/2014 and much more sclerotic since 6/18/2014. Finding are consistent with treated metastasis. No pathologic fracture. Treated bilateral calvarial metastatic lesions also again seen.4. No evidence of intracranial metastasis. MRI can be considered for more sensitive evaluation if clinically indicated.
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Generate impression based on findings.
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86 years, Male. Reason: ? partial obstruction History: bloating and decreased stool for 5 days Nonobstructive bowel gas pattern with average stool burden. Lumbar spine degenerative changes.
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Nonobstructive bowel gas pattern with average stool burden.
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Generate impression based on findings.
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58 year-old female with history of left nephrectomy for RCC and intra-abdominal abscess. ABDOMEN:LUNG BASES: Small left lung base focal opacity (4/19), approximately 7 mm in diameter and is decreased in size from prior.LIVER, BILIARY TRACT: Small amount of pneumobilia, unchanged. Slightly decreased perihepatic ascites. Portal vein thrombosis, and associated venous collaterals are noted in the hepatic hilum and upper abdomen.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic atrophy and coarse pancreatic tail calcification, similar to prior.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Post left nephrectomy changes are again identified. There is a residual small air filled cavity in the left retroperitoneum and a small amount of adjacent stranding, which is likely postoperative in nature, which abuts the descending colon. Previously seen gas within the psoas muscle persists, however left posterior body wall gas has resolved. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered mesenteric lymph nodes, not significant change from prior. Decreased small to moderate amount of ascites. Persistent mid pelvis loculated fluid collection (5/111), is unchanged in size measuring 4.9 x 2.2 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterine fibroids, some of which are calcified.BLADDER: Right lateral bladder wall focus of nodular enhancement (5/137), unchanged.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Post operative findings of left nephrectomy with gas-filled cavity having slightly decreased in size. Given the persistence of gas within this cavity, and the adjacent descending colon, this raises the question of fistulous connection as no additional sources of gas are identified.2.Loculated mid pelvis fluid collection is unchanged in size, and may represent abscess.3.Interval decreased moderate ascites.
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Generate impression based on findings.
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Three-year-old male with hydronephrosis, follow-up one year scan BLADDER Wall Thickness: The bladder wall is thickened at the vesicoureteral junction bilaterally. Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 1 Left: 2 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal, thinned cortex on right Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 1 Left: 2 -3 Length*** Right: 6.4 cm Left: 9.4 cm Mean for age: 7 cm Range for age: 6 - 8 cmADDITIONAL OBSERVATIONS: None.
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Grade 2-3 left hydroureteronephrosis. Scarred right kidney.*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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Male 54 years old; Reason: Metastatic pancreas cancer currently on therapy/clinical trial please assess and compare to previous imaging and follow/provide index lesion measurements for RECIST CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary metastases. Reference measurements as follows:Stable to minimally increased prominence of left upper lobe lung nodule, measuring 2.2 x 2 cm, image 20 series 5, previously measured 2.1 x 1.9 cm.Increased attenuation of additional left upper lobe reference nodule, measuring 2.3 x 1.5 cm, image 47 series 5, previously measured 2.2 x 1.8 cm.Mild interval enlargement of right upper lobe lung nodule, measuring 1.8 x 1.5 cm, image 16 series 5, previously measured 1.6 x 1.2 cm.Enlarging right middle lobe lung nodule, measuring 2.8 x 2.4 cm, image 50 series 5, previously measured 2.6 x 2.2 cm.Again seen is some scattered intralesional cavitation. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with tip near cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis, areas of focal sparing seen near gallbladder fossa. While hepatic steatosis limits evaluation for underlying liver lesion, no suspicious lesion identified.SPLEEN: No significant abnormality noted.PANCREAS: Hypodense pancreatic tail lesion seen extending into spleen, mildly more pronounced, measuring 2.1 x 1.5 cm on image 90 series 3, previously measured 2 x 1.5 cm, component seen more inferiorly also mildly enlarged, measuring 2.2 x 1.7 cm, image 102 series 3, previously measured 2.2 x 1.4 cm. Associated luminal narrowing of splenic vein noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged probable right upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: Unchanged subcentimeter periportal lymph node, image 102 series 3.BOWEL, MESENTERY: Sigmoid colon diverticulosis without evidence of acute diverticulitis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Ventral abdominal subcutaneous induration/scarring.
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1. Stable to mild interval enlargement of pulmonary metastases and pancreatic tail/splenic lesion as above.
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Generate impression based on findings.
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Increased work of breathingVIEW: Chest AP 1/19/15 Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette normal. Minimal atelectasis left lower lobe. No pleural effusion or pneumothorax. The stomach is distended.
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Minimal atelectasis left lower lobe.
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Generate impression based on findings.
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Status post fracture, check healing Hip: Three pins remain well situated without evidence of complication. Normal alignment with decreased fracture visualization compatible with interval healing and bridging material. Underlying moderate hip osteoarthritisPelvis: Moderate osteoarthritis of the right hip is also observed, mildly greater. No additional abnormalities observed
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Healed left femoral neck fracture with hardware. No complications
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Generate impression based on findings.
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There is evidence of prior bilateral uncinectomy and right-sided ethmoidectomy.Frontal sinus: Moderate opacification of the bilateral frontal sinuses and is interval worse.Anterior ethmoids: Near-complete opacification of the anterior ethmoid air cells.Maxillary sinuses: Interval worsening of moderate maxillary sinus mucosal thickening, left greater than right. Posterior ethmoids: Significant opacification of the posterior ethmoid air cells.Sphenoid sinus: Near-complete opacification of the sphenoid sinuses.There is partial opacification of the bilateral mastoid air cells. There is mild S-shaped nasal septal deviation. There is severe thinning/focal dehiscence involving the cribriform plate and fovea ethmoidalis on the left, coronal image 77 and 78 of 196 and 59/196. The lamina papyracea are intact. The imaged intracranial structures are grossly unremarkable.
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1. Moderate to severe pan-sinus disease, which is slightly worse from recent CT of the head dated 1/16/15 and much worse compared to CT 11/4/2014. 2. Focal areas of dehiscence are seen in the left cribriform plate and fovea ethmoidalis on the left. These are of uncertain age and may be developmental versus related to an aggressive infection. Consider MRI per sinus/anterior skull base protocol with contrast to exclude possibility of intracranial extension.
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Generate impression based on findings.
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FractureVIEWS: Right little finger AP and lateral Again noted fracture involving the distal aspect of the proximal phalanx of the left little finger. The examination is limited due to the overlying cast material.
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Fracture of the distal aspect of the proximal phalanx of the left little finger.
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Generate impression based on findings.
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Female 58 years old; Reason: 58y/o patient with left breast cancer; Surgery DCAM 2C 1/19/15 Left breast wire loc lump and SNBx 2pm History: 58y/o patient with left breast cancerRADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the left axilla, representing the sentinel node(s). This region was marked with an indelible marker.
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Sentinel node identified in the left axilla.
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Generate impression based on findings.
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FractureVIEWS: Right wrist AP and lateral Again noted healing buckle fractures involving the distal radius and ulna in near anatomic alignment. The overlying cast obscures fine bony detail.
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Healing buckle fractures distal forearm as described above.
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Generate impression based on findings.
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Pain Interval increased and now severe degenerative changes involving the base of the first digit with more moderate scattered degenerative changes more distally and mildly more pronounced involving the first and second digits. Alignment persists without additional soft tissue abnormalities. Wrist is otherwise intact
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Progressing and now moderate to severe degenerative changes again most pronounced involving the first carpometacarpal joint with decreased changes distally
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Generate impression based on findings.
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Reason: lung cancer, s/p resection and adjuvant chemo. Pt has been on antifungal medication for fungal infection in lung. Pls c/w previous study to evaluate disease status and infection. History: lung ca and fungal infection. 90 CHEST:LUNGS AND PLEURA: Right upper lobe part solid opacity (series 4/33) measuring 38 x 41 mm, increased in the long dimension compared to the previous scan and markedly increased since 5/9/2012, consistent with primary adenocarcinoma.Multiple additional ground glass opacities in the right upper lobe inferiorly and anteriorly, progressively increased over the past year, compatible with local extension or metastases.Right lower lobe subpleural part solid nodule (series 4/59) now 22 mm in diameter, increased from 20 mm on the previous scan, with a central component measuring 10 mm in maximum transverse diameter, increased from about 8 mm previously, highly suspicious for an independent primary adenocarcinoma.Mild upper zone predominant centrilobular emphysema.MEDIASTINUM AND HILA: High right paratracheal lymph node measuring 9 mm in short axis, unchanged.Other mildly enlarged mediastinal and right hilar nodes, also unchanged.Mild coronary artery calcification.No pericardial effusion.CHEST WALL: Stabilization device in the cervical spine.Mild degenerative disease.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative disease.OTHER: No significant abnormality noted.
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1.Slight interval progression of multiple groundglass and part solid lesions in the right lung compatible with synchronous primary and locally metastatic adenocarcinomas. 2.No specific evidence of fungal infection.
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Generate impression based on findings.
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Reason: evidence of critical stenosis History: left sided neglect, ataxia, visual field deficit 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. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery origin is tortuous proximally and mildly narrowed Atherosclerotic calcifications are present at the carotid bifurcations. There is only mild narrowing at the origin of the right internal carotid artery. The left common card artery originates from the innominate arteryBrain 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.CT head:There is encephalomalacia involving the right occipital lobe. Periventricular and subcortical white matter hypodensities of a moderate degree are present.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries.Multilevel degenerative changes present cervical spine with endplate and uncovertebral osteophytes and narrowing of neural foramina as well as some reversal of the normal cervical curvature. There appears to be fusion of the facet joints at C2-3 .
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1.No evidence for aneurysm.2.No evidence for cervicocerebral occlusive disease3.there is encephalomalacia present along the right occipital lobe4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.CT is insensitive for the early detection of hemorrhagic CVA
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Generate impression based on findings.
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Pain along medial tubercle and left fascial band Left foot: No radiographic abnormality.Right foot: Minimal degenerative changes involving the first MTP and midfoot (navicular articulations) without additional superimposed abnormality. Alignment and soft tissues otherwise intact.
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Minimal osteoarthritis without focal acute abnormality
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild asymmetry of the lateral ventricles which is likely an anatomical variant. There is a mega cisterna magna. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No acute intracranial hemorrhage or mass-effect.
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Generate impression based on findings.
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Distal radial surgery Interval increasing bridging callus formation obscuring the osteotomy lines. Underlying fixation hardware otherwise intact evidence of complication. Alignment preserved throughout with increasing callus formation. Old ulnar styloid fracture unchanged. Distal wrist and visualized portions of the hand are unremarkable
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Healing distal radial surgical repair
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Generate impression based on findings.
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Pain, check for fracture Interval decreasing visualization of the scaphoid waist fracture compatible mild minimal interval healing. Diffuse demineralization compatible with disuse. Scaphoid deviation views do not demonstrate associated displacement or malalignment
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Partial interval healing of the scaphoid waist fracture
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Generate impression based on findings.
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Female 82 years old. Left breast focal asymmetry seen in 2013. History of benign right breast biopsy. 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. The 14 mm circumscribed mixed density lobulated focal asymmetry in the left breast upper outer quadrant at mid depth is stable. A linear scar marker overlies the right breast. Asymmetric consistent with given history of right breast biopsy is stable. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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Stable focal asymmetry in the left breast upper outer quadrant. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in one year. 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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Male 65 years old; Reason: prostate cancer History: prostate cancer CHEST:LUNGS AND PLEURA: There a few scattered pulmonary nodules. The largest located in the right upper lobe (image 30/image 124) .Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are at least 4 suspicious hepatic lesions.The largest in the left hepatic lobe measuring 3.2 x 2.8 cm (image 74/series 5).Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right urinary collection system stent is in place.Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Soft tissue mass in the right prostate bed which enhances measures at least 2.2 x 1.9 cm (image 195/series 5). BLADDER: Soft tissue mass invades the right ureter which has been stented.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcentimeter indeterminate L3 vertebral body sclerotic focus.OTHER: No significant abnormality noted
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1.Findings of hepatic metastases2.Soft tissue mass in the right prostatic bed that extends into the expected location of the right ureter.
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Generate impression based on findings.
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Pain along fifth MTP Mild degenerative changes large involving the first MTP without additional superimposed foot acute abnormality. Specifically the fifth digit is well visualized and free of fracture or malalignment. No soft tissue abnormality. Small plantar heel spur and although prior exam suggested pes planus deformity, this abnormality cannot be confirmed or commented without standing views
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Mild osteoarthritic changes of the first MTP, see comments above
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Generate impression based on findings.
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Male 76 years old; Reason: metastatic prostate cancer evaluation of disease during therapy under investigation History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Upper lobe pulmonary nodule measures 0.9 x 0.4 cm (image 34/series 4) previously, 0.9 x 0.7 cm.Subjectively, the other nodules appear unchanged.MEDIASTINUM AND HILA: Left thoracic inlet lymph node measures 8 mm (image 11 series 3), unchanged.Small right hilar lymph node measures 0.8 x 0.6 cm (image 45/series 3) previously, 0.8 x 0.7 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypoattenuating liver lesions are unchanged. The larger foci are compatible with hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower lumbar spine and sacrum with metastatic deposits.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes with sclerotic lumbosacral metastases.OTHER: No significant abnormality noted
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1.Stable exam without size increase in the reference lesions.2.Please refer to same day bone scan for evaluation of the osseous metastatic disease.
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Generate impression based on findings.
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Female 47 years old; ABDOMEN:LUNG BASES: Subcentimeter bilateral lower lobe pulmonary nodules. No prior comparison available.Postsurgical changes in the breasts.Subcentimeter right chest wall lymph node (image 7 / series 2).LIVER, BILIARY TRACT: Hypodense sub-centimeter hepatic foci, the largest in segment 7 of the liver. The larger foci are are fluid attenuating and likely represent small cysts. The smaller foci are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule measures 1.3 cm. Its imaging features are indeterminate.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific small left retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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.Nonspecific subcentimeter pulmonary nodules; follow up is suggested. 2.Left adrenal nodule; follow up is suggested. 3.Subcentimeter hepatic foci, too small to fully characterize.
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Generate impression based on findings.
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40 year-old female with history of left radial head fracture Again seen is an approximately 2 mm cortical step-off along the radial head consistent with an intra-articular radial head fracture. A joint effusion is again noted.
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Radial head fracture appearing similar to the prior exam.
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Generate impression based on findings.
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5-year-old male with history of Hirschsprung's and diarrhea since October. Infectious workup negative.VIEW: Abdomen AP (one view) 1/19/2015 Large stool burden, increased from the prior examination, which is distributed throughout the entire colon. The bowel gas pattern is nonobstructive. No portal venous gas, pneumatosis intestinalis or free intraperitoneal air is evident.
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Large stool burden scattered throughout the colon, increased from the prior exam.
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Generate impression based on findings.
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There is a small subdural hematoma located along the left paramedian tentorium without significant underlying mass-effect. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The degree of myelination is appropriate for age. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem, or cerebellar infarction. Flow voids are present within the major vessels indicating patency. The mastoid air cells and middle air cavities are clear.
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There is a small subdural hematoma located along the left paramedian tentorium without significant underlying mass-effect.
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Generate impression based on findings.
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Male, 44 years old, history of tonsil cancer. Generalized nasopharyngeal thickening persists with effacement of the right fossa of Rosenmuller, unchanged. Also seen is edema of the right palatine tonsil and oropharynx, again not significantly changed from prior. Mucosal edema continues down to the supraglottic larynx, likely related to therapy. The right aryepiglottic fold is thickened and the right vocal cord is medialized, all stable findings.Infiltration of the fascial planes is seen on both sides of the neck, right more than left, likely related to therapy. Metallic fragments within the soft tissues of the right neck are compatible with bullets. Allowing for the streak artifact which these structures induce, no definite evidence of recurrent mass or pathologic adenopathy is detected. Hyperemic lymph nodes in the submental space are unchanged and may simply be reactive or inflammatory in nature.The salivary glands as visualized are unremarkable. The right IJ vein is small and then fails to opacify above the entry-point of the central venous catheter. The remaining cervical vessels opacify normally. Peripheral scarlike opacities in the lung apices are unchanged. No worrisome osseous lesions are seen. The right mastoid air cells and middle ear cavity remain opacified similar to prior. Peripheral mucosal thickening also persists in the maxillary sinuses.
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Redemonstration of treatment related findings in the neck with no evidence to suggest local disease recurrence or progressive pathologic adenopathy.
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Generate impression based on findings.
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Evaluate fecal burdenVIEW: Abdomen AP There is moderate amount of fecal burden without evidence of obstruction. No dilated loops of bowel. No evidence of pneumoperitoneum.
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Moderate amount of fecal burden.
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Generate impression based on findings.
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79-year-old male with RCC; evaluate for mets. No abnormal osseous foci are identified to indicate metastatic disease.Focal increased activity within the medial aspects of both knees, bilateral shoulders, and the bilateral first CMC joints, greater on the right compatible with degenerative changes.Physiologic activity is visualized in the kidneys and bladder.
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No evidence of bone metastases.
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Generate impression based on findings.
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49-year-old female with ampullary cancer status post resection and adjuvant chemotherapy. Recurred with liver metastases seen on CT and MRI. Evaluate interval change. CHEST:LUNGS AND PLEURA: Stable appearance to the lungs with no evidence of new foci of parenchymal lung nodules or air space disease. No pleural disease seen.MEDIASTINUM AND HILA: No adenopathy or other significant abnormality noted.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of catheter in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Homogeneous liver parenchyma without mass lesion seen. As has been noted before common MR is more sensitive for detecting liver metastatic disease than CT and if concern exists over liver parenchymal lesions, MR would be recommended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anterior abdominal wall umbilical hernia containing only mesenteric fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Myomatous uterus unchanged. No other abnormalities.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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Stable examination without metastatic lesion identified. If concern over liver lesions exists, MR may be more sensitive for evaluation and follow-up.
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Generate impression based on findings.
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Reason: 81 yo M with HCC, please evaluate for evidence of lung metastases. History: none LUNGS AND PLEURA: Mild focal scarring at the right apex.Respiratory motion artifact degrades detail at the lung bases but no suspicious nodules are visible.No pleural effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation. Previously described hepatic abnormalities are poorly visualized and better characterized on recent prior examinations.
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No evidence of pulmonary metastases.
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Generate impression based on findings.
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Reason: 69 yo F w generalized abd pain. Incomplete colonoscopy 1/2015 due to restricted mobility of colon. Pls eval for lesions, other abnormalities History: abd pain The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is no evidence of obstructing or constricting lesions. No evidence of polyps or masses. The colonic mucosa is normal in appearance with no evidence of ulceration, edema, or mass lesions. Significant tortuosity of the ascending and sigmoid colon were noted. Sigmoid diverticulosis is again noted. Diverticula were also seen in the descending colon. The appendix was visualized and is normal in appearance.
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1.Sigmoid and descending colon diverticulosis. 2.Tortuous ascending and sigmoid colon.3.No evidence of polyps or masses.
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Generate impression based on findings.
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Ms. Rojas is a 52 year old female with a personal history of left breast mastectomy in 2005 for multifocal IDC followed by chemoradiation and tamoxifen therapy. Family history of ovarian cancer in sister and breast cancer in two paternal nieces. No current breast related complaints. Three standard views of the right breast with an additional right CC view 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 and intramammary lymph nodes are present in the right breast.
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Scattered benign calcifications in the right breast. 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Reason: h/o HNC and CRT,compare to previous measurements History: none CHEST:LUNGS AND PLEURA: A moderate amount of debris in the pre-carinal trachea along its posterior wall.No suspicious nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Tracheostomy tube in place.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Stable mild anterior wedging and subchondral focus of sclerosis within the T6 vertebra.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No interval change. No evidence of metastatic disease.
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Generate impression based on findings.
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Reason: History of Head and Neck Cancer History: History of Head Neck Cancer LUNGS AND PLEURA: Emphysema and scarring in the middle lobe and lingula unchanged. Scattered punctate micronodules are unchanged and presumably postinflammatory. No new pulmonary nodules.MEDIASTINUM AND HILA: Moderate coronary calcification. Scattered small nodes unchanged.CHEST WALL: Degenerative change involving thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hepatic steatosis.
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No evidence of pulmonary metastases.
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Generate impression based on findings.
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Increased work of breathing. History of VSD repair.EXAMINATION: Chest AP (one view) 01/18/15 Sternal sutures are noted. A gastrostomy tube is present.Cardiac silhouette is mildly enlarged. Mild peribronchial thickening is seen. Subsegmental atelectasis is present in left lower lobe.
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Bronchiolitis/reactive airways disease pattern.
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Generate impression based on findings.
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Subarachnoid hemorrhage adjacent to the left occipital lobe has decreased in density consistent with expected evolution. There are no new foci of intracranial hemorrhage. Diffusion abnormality within the corpus callosum demonstrates hypodensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. Redemonstrated is a mild salt-and-pepper appearance of the skull, which appears slightly sclerotic overall, which may be normal variation. The extracranial soft tissues are unremarkable. Extensive vascular calcifications are noted of the circle of Willis vasculature.
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1.Subarachnoid hemorrhage adjacent to the left occipital lobe has decreased in density consistent with expected evolution. There are no new foci of intracranial hemorrhage. 2.Diffusion abnormality within the corpus callosum demonstrates hypodensity.
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Generate impression based on findings.
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PIP joint dislocation Persistent small chip fracture along the volar lip of the middle fifth phalanx, overall similar to 11/3/14 with Morse discrete isolation of the chip component. Mild fixed flexion again observed without change. Decreased soft tissue swelling
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Small volar minimally displaced avulsion fracture along the volar aspect of the proximal fifth phalangeal base, essentially unchanged.
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Generate impression based on findings.
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Pain Humerus and elbow: Interval surgical fixation with a side plate involving the distal humeral diaphysis and radial condyle. No evidence of hardware complication. Post alignment preserved. Minimal heterotopic bone and/or callus formation is observed largely anteriorly. Fracture plane again extends through to the intercondylar notch
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ORIF of distal humeral intra-articular fracture
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Generate impression based on findings.
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Restaging for T2N0 left retromolar trigone squamous cell carcinoma status post treatment. There are interval post-treatment findings in the left neck and oral cavity region. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. There is stranding surrounding the left submandibular gland related to treatment effects. The other salivary glands are unremarkable. The thyroid gland also appears unremarkable. The major cervical vessels are patent. There is multilevel degenerative cervical spondylosis. The airways are patent. There is a small left maxillary sinus retention cyst. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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Interval post-treatment findings without evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy.
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Generate impression based on findings.
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50 year-old female with hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Both kidneys show normal morphology and size. No abnormal calcifications are seen to suggest urinary tract stone disease. Both kidneys show normal enhancement patterns in the cortical medullary phase and delayed excretory phases without renal mass lesions. Prompt and symmetric excretion of contrast material is seen into normal pyelocaliceal systems bilaterally. The ureters are well opacified throughout nearly their entire lengths without abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Absent uterus -- presumably prior hysterectomy. No other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. No significant abnormality seen -- no abnormality seen to account for patient's hematuria. 2. Stable examination since CT examination 4/9/13
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Generate impression based on findings.
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Check for rheumatoid. Pain and decreased range of motion Minimal small punctate calcification is observed along the ulnar aspect of the third PIP articulation, presumably old traumatic injury. Four mild to moderate degenerative changes the radiocarpal joint and involving the base of the first digit. No specific focal changes to suggest inflammatory arthritis. Soft tissues are unremarkable
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Old posttraumatic changes involving the third digit and degenerative changes involving the base of the thumb and radiocarpal joint.
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Generate impression based on findings.
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Foul smelling sacral ulcer with elevated ESR/CRP. Concern for underlying osteomyelitis. Angiographic images demonstrate increased blood flow to the region surrounding the right hip. Blood pool imaging also demonstrates some increased activity in the region of the right hip.Delayed osseous phase imaging demonstrates no increased osseous activity in the region of the sacrum to indicate osteomyelitis. Two foci of activity at the pelvic midline and to the left are significantly more intense on the anterior view and overlie the bladder and are most likely related to urinary activity.On the delayed images, there is increased activity over the right hip on anterior imaging although this is not demonstrated on the posterior view. Given the focally increased blood flow and blood pool in this right hip location, these findings may reflect cellulitis possibly with a component of myositis.
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1.No evidence of sacral osteomyelitis.2.Increased blood flow, blood pool, and delayed activity in the right hip particularly anteriorly may reflect cellulitis and/or myositis in this region. Correlation clinically and with pelvic/hip radiographs may be useful.
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Generate impression based on findings.
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Pain in both knees and back Knees: Moderate tricompartmental osteoarthritic changes greater than medial compartment with osteophytes, sclerosis and narrowing. No effusions. Alignment preservedL. spine: Moderate degenerative changes of the L5-S1 disk space with narrowing, vacuum phenomena and sclerosis. The upper levels are otherwise all preserved other than mild nonspecific straightening. Alignment and vertebral body heights preserved. Posterior elements intact. Mild degenerative changes of the aorta.
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Moderate L5-S1 degenerative changes with similar mild to moderate changes of the knees
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Generate impression based on findings.
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Pain involving the great toe and right shoulder Toe: Interval increased visualization of the two previously described fractures involving the base of the middle first phalanx and base of the distal phalanx. Specifically the fracture edges are indistinct giving an appearance compatible with subacute timing and partial interval healing. Decreased soft tissue swelling. Alignment unchangedShoulder: Similar subacute fracture changes involving the right greater tuberosity without change in alignment.
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Partial interval early healing of the right shoulder and two left toe fractures
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Generate impression based on findings.
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Osteosarcoma follow-up Lower leg and knee: Longstem left total knee arthroplasty appears unchanged without evidence of new complication or tumor recurrence. Alignment maintained. Resected proximal fibula
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Left total knee arthroplasty unchanged without evidence of associated complication or plain film findings of tumor recurrence
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Generate impression based on findings.
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Lower extremity pain Interval surgical removal of the two distal fibular sideplates and I am rod. Additionally the small K wire and fixation plate of the medial malleolus also removed with minimal retention of a single broken screw in the distal metaphysis. Scattered surgical staples overlie deformity of the distal fibula and mid tibial diaphysis. Osseous structures appear similar without evidence of significant change or new tibial complication, however a subacute new fracture involving the mid fibula is observed and in alignment.
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Hardware removal with a new small mid fibular nondisplaced subacute fracture
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Generate impression based on findings.
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73 old female with left sided neglect, ataxia, visual field deficit There is encephalomalacia involving the right occipital lobe with adjacent hypodensity which may reflect evolving ischemia versus gliosis. Periventricular and subcortical white matter hypodensities of a moderate degree are present. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Atherosclerotic calcifications are present.
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1.Encephalomalacia present along the right occipital lobe with adjacent hypodensity which may reflect evolving ischemia versus gliosis. 2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of hemorrhagic CVA. 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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Pain Leg length study and knee: One degree of valgus angulation is observed along with moderate knee osteoarthritis. Tricompartmental changes include chondrocalcinosis, narrowing, sclerosis and osteophytes. Changes are greater than medial aspects.Proximal femur demonstrate a total hip arthroplasty in gross anatomic alignment. The distal lower leg otherwise demonstrates focal deformity involving the middle fibula and minimal degenerative changes distally involving ankle
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Moderate knee osteoarthritis with minimal valgus angulation and right total hip arthroplasty
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Generate impression based on findings.
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Fell and osteoporosis. Mild degenerative changes of minimal sclerosis small osteophytes and minimal disk space narrowing. Vertebral bodies, disks heights and alignment otherwise all preserved. Lower facet sclerosis and posterior elements otherwise appear intact
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Mild degenerative changes are seen involving lower facets
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Generate impression based on findings.
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Hypodensity is present throughout the white matter and pons including a focal defect within the right thalamus, not associated with mass effect. There is diffuse mild volume loss without a specific lobar predominant atrophy pattern. The are no findings of ventricular obstruction or hydrocephalus. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. A small air fluid level is present within the right maxillary sinus, otherwise the visualized portions of the paranasal sinuses and mastoid air cells are clear.
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1.Advanced small vessel ischemic disease of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended.2.Diffuse mild volume loss without a specific lobar predominant atrophy pattern.3.No acute intracranial hemorrhage.4. A small air fluid level is present within the right maxillary sinus.
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Generate impression based on findings.
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Desmoplastic small round cell tumor, pre-stem cell transplant evaluation No radiographic abnormality other than incomplete eruption of the third molars bilaterally associated with a mildly impacted left lower third molar. Visualized portions of the sinuses are clear
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No acute abnormality
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Generate impression based on findings.
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Pain Interval removal of surgical K wires affixing the comminuted and intra-articular distal middle fifth phalanx fracture. Similar deformity and mild impaction persists without evidence of new superimposed abnormality. Soft tissue swelling and fixed moderate flexion involving the DIP articulation is again observed
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K wires removed
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Generate impression based on findings.
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Neck and arm pain Moderate scattered degenerative changes with relative sparing at C4-5 and C7-T1. Alignment and vertebral body heights preserved, however sclerosis, disk space narrowing and osteophytes are identified. No evidence of instability observed on flexion or extension. Soft tissues are unremarkable
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Moderate degenerative changes without evidence of instability. See detail provided
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Generate impression based on findings.
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50 year-old female with history of metastatic colon cancer. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Central catheter line unchanged in position with tip of catheter in the right atrium. Scattered normal appearing axillary lymph nodes seen bilaterally unchanged. No other abnormality seen.ABDOMEN:LIVER, BILIARY TRACT: There is been slight reduction in size of the large right lobe liver mass (series 3, image 94) with signs of increasing capsular retraction and tumoral calcification. This now measures 11.1 x 8.3 cm compared with previous 11.4 by 10.3 cm. the prior referenced right lobe inferior satellite nodule (series 3, image 110) is unchanged in size measuring 1.9 x 1.8 cm. The inferior right lobe liver lesion noted is new on prior examination now measures 1.9 x 1.7 cm (series 3, image 120) not significantly different from the prior noted 2.2 x 1.8 cm. Or most of these lesions are stable or smaller in size, some satellite nodules are larger in size, for example in segment 8 adjacent to the superior margin of the large reference lesion is a smaller satellite nodule now measuring 4.0 x 2.8 cm (series 3, image 83) compared with 3.3 x 2.4 cm on 8/25/14. The left lobe of the liver again appears relatively spared from metastatic disease. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No change with normal-appearing right gland and slightly thickened left adrenal gland of uncertain significance.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormality seen in stomach or small bowel with no evidence of obstruction or intrinsic abnormality. Patient is status post right hemicolectomy with ileal -- transverse colostomy unchanged in appearance. Remainder of the colon shows no significant abnormalities.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy without other abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: Stable appearance to lymph nodes without evidence of lymphadenopathy. BOWEL, MESENTERY: No abnormality seen in stomach or small bowel with no evidence of obstruction or intrinsic abnormality. Patient is status post right hemicolectomy with ileal -- transverse colostomy unchanged in appearance. Remainder of the colon shows no significant abnormalities.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Majority of the metastases are stable to slightly decreased in size. However, several adjacent satellite lesions have increased in size with discordant response. No new hepatic lesions seen. 2. No other evidence of metastatic disease seen.
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Generate impression based on findings.
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Female 38 years old; Reason: ? cause of pain, - EGD and US History: LUQ abs pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are nonspecific.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No bowel obstruction.Appendix is not identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The transverse and descending colon are not distended limiting evaluation. There is slight hyperenhancement of the mucosa most pronounced in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No localizing inflammatory process in the abdomen or pelvis.2.Suboptimal evaluation of the transverse and descending colon as the colon is not distended. Slight hyperenhancement of the rectal mucosa. if colitis is a clinical concern, consider colonoscopy.
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Generate impression based on findings.
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Metastatic breast cancer restaging. Attention spine lesion.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates bilateral breast prostheses and a right axillary dissection. Anterior subpleural scarring in the mid right lung consistent with post radiation appearance. Scattered sclerotic lesions are visualized, most notably at the T6 level.Today's PET examination again demonstrates the moderately hypermetabolic T6 (when numbering from superiorly; there appear to be only 4 lumbar vertebral levels when numbering from inferiorly) lesion. It has increased slightly in size and metabolic activity from previous (SUV max = 4.9 previously, = 5.5 currently), consistent with slight metastatic progression.The smaller hypermetabolic T7 lesion centered at the base of the transverse process has progressed mild to moderately in volume and metabolic activity (SUV max = 2.7 previously, = 4.1 currently), also consistent with metabolic progression.The moderate significantly hypermetabolic left thyroid nodule is stable (SUV max = 9.4 previously, = 9.9 currently).
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1.Hypermetabolic T6 and T7 osseous metastases have slightly progressed from previous.2.No additional FDG avid metastatic disease.3.Stable markedly hypermetabolic left thyroid nodule could again represent a benign or malignant primary thyroid nodule.
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Generate impression based on findings.
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Liver transplant. Nasojejunal tube placement.VIEW: Abdomen AP (one view) 01/19/15, 1219 Feeding tube tip tip is at the duodenojejunal junction. A pelvic catheter is present. IVC stent and right upper quadrant surgical changes are noted. A drain overlies the right upper quadrant.Bowel gas pattern is disorganized.
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Feeding tube tip at duodenojejunal junction.
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Generate impression based on findings.
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Male 77 years old; Reason: colon cancer on chemotherapy. evaluate for interval change History: colon cancer CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary lesions compatible with metastatic disease. Some of the lesions form conglomerate masses, inseparable from the underlying lung.Reference left upper lobe lesion measures 6.0 x 5.9 cm (image 27/series 4) previously, 6.1 x 5.3 cm.The more inferior located lung lesion measures 4.5 x 3.0 cm (image 32/series 4) previously, 4.7 x 3.6 cm.The linear superior right lower lobe lung lesion which measures 3.9 x 1.6 cm (image 58/series 4) previously, 3.4 x 2.5 cm.The inferior right lower lobe the lesion measures 2.7 x 2.4 cm (image 71/series 4) previously, 3.1 x 2.4 cm.Trace left pleural effusion.MEDIASTINUM AND HILA: Postsurgical changes of median sternotomy. Heart size is enlarged. Moderate to severe coronary calcifications.The mediastinal lymph node adjacent to the left main pulmonary artery measures 1.0 x 0.8 cm (image 31/series 3) previously, 1.0 x 0.9 cm.CHEST WALL: The right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a right hepatic lobectomy. There is expected hypertrophy of the residual left hepatic lobe. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate to severe calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Thickening of the soft tissues of the rectum representing the patient's known rectal neoplasm.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted
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1.Near stable size measurements of the reference lesions.
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Generate impression based on findings.
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Leukemia. Lung evaluation before chemotherapy.VIEWS: Chest PA/lateral (two views) 01/19/15 Cardiothymic silhouette and pulmonary vascularity are normal. No focal lung opacity is present.
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Normal examination.
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Generate impression based on findings.
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59 female, immunocompromised, experiencing confusion. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The visualized portions of the paranasal sinuses redemonstrates opacification throughout, sparing the right maxillary sinus; prominent air-fluid levels are noted in the sphenoid sinuses. There is also opacification of right mastoid air cells. The mastoid air cells are clear.
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No evidence for acute intracranial hemorrhage, mass effect, or edema.
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Generate impression based on findings.
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Reason: h/o AVM resection History: follow up surveillance Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for vasculitis or AVM. There is partial opacification of the right PCA via the PCOMA.Right external carotid artery: There is no evidence for arteriovenous fistula or AVM. There is no angiographic evidence for vasculitis.Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is inflow of unopacified contrast from the right PCOMA into the right PCA. There is no recurrence of the AVM. Embolic material remains in right temporal branch. There is a reverse filling of the posterior communicating arteries which are small. Right vertebral artery: The inflow of unopacified blood into the basilar artery from the left vertebral artery. There is no recurrence of the AVM.
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1.No evidence for cerebral aneurysm, recurrent AVM or arteriovenous fistula.2.Status post removal of right temporal lobe AVM without recurrence.3.Status post embolization of right PCA aneurysms without recurrence.
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Generate impression based on findings.
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Crepitus, effusion. Assess for causes of pain. Four views of the right knee are provided. Moderate osteoarthritis affects the knee, particularly the patellofemoral joint. There is also a moderate-sized knee joint effusion.Moderate osteoarthritis also affects the left knee as seen on the frontal view.
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Osteoarthritis and joint effusion.
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Generate impression based on findings.
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Reason: h/o ACOM and left MCA aneurysms; both s/p coiling with MCA known recurrence History: surveillance Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries as well as partial opacification of the right posterior cerebral artery. Venous and parenchymal phases were within normal limits. The patient is status post stent assisted anterior communicating aneurysm coil embolization. There is no recurrence of the aneurysm. The parent vessels are preserved. One of the proximal markers of the stent is located at the origin of a lenticulostriate artery which continues to be patent.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries with inflowjet into the left ACA. The ACOMA aneurysm did not opacify on this injection. There is redomonstration of a 3 mm recurrence of this aneurysm at its base. There is a small aneurysm neck measuring 1.5mm. The coils are superior to the aneurysm leaving much of the periphery exposed.
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1.The patient is status post stent assisted embolic coil occlusion of an anterior communicating artery aneurysm. There is no evidence for recurrence of this aneurysm.2.There is redemonstration of a 3 mm recurrence of a left carotid terminus aneurysm originating from the proximal left a1 segment of the left anterior cerebral artery which was previously coiled. This is stable compared to the prior exam. The coils essentially cap the dome of the aneurysm. Please note that prior to coiling the aneurysm had a similar size.
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Generate impression based on findings.
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Male 55 years old; Reason: follow up abnormal US History: abnormal us ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver parenchyma is unremarkable for unenhanced technique. Gallbladder contains hyperdense gallstones.SPLEEN: Small splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of the upper pole of the right kidney. The cystic neoplasm has been resected. No definite residual disease. No hydronephrosis in either kidney.There is a subtle hyperdense lesion in the upper pole of the left kidney measuring 2.0 cm which may represent a hyperdense cyst.Second lesion within the hilum of the left kidney measuring 2.9 cm correlates to the abnormal finding by ultrasound.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula in the upper abdomen.BONES, SOFT TISSUES: Postsurgical changes in the right retroperitoneum.OTHER: No significant abnormality noted.
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1.Postsurgical changes in the right kidney without definite evidence of residual disease.2.Two lesions within the left kidney one cortically-based hyperdense lesion, the other within the hilum of the left kidney which does not fit the criteria for a cyst. Neither of the lesions can be further characterized with noncontrast CT.
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Generate impression based on findings.
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53 year-old female with known peripancreatic fluid collections, status post cyst gastrostomy. ABDOMEN:LUNG BASES: Slight increase in left basilar pleural effusion and atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Prior splenectomy. The anterior abdominal collection (series 3 , image 37) has not changed in size measuring 4.9 x 3.6 centimeters, previously 4.8 x 3.3 cm. There is been interval placement through the prior cyst gastrostomy stent with a large bore drainage catheter into this cavity, however the tip of the drainage tube lies just within the margin of the collection. Increasing air is seen within the debris in this collection.The more posterior visualized collection immediately adjacent to the cyst gastrostomy stent shows no discrete fluid but with unchanged slightly higher at near soft tissue attenuation density in its bed measuring 3.5 x 1.5 cm (series 3, image 33) not significantly changed from previous when it measured 3.3 x 1.1 cm.PANCREAS: Uncinate process, head and neck and remaining body of pancreas appear unchanged and normal. Prior distal pancreatectomy changes again seen. The inflammatory/fluid collections seen in the surgical bed described under spleen above. No changes about the pancreas otherwise seen. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Cyst gastrostomy stents seen in the stomach extending postero-laterally unchanged in position or appearance from prior examination. Since the prior exam there's been interval insertion through the gastrostomy stent of a larger bore catheter draining into the more anteriorly located loculated fluid/debris collection described in the splenic bed section above. Gastrointestinal tract contrast material rapidly progresses through the small bowel to the J. pouch anastomosis in the pelvis without evidence of obstruction.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: Gastrointestinal tract contrast material rapidly progresses through the small bowel to the J. pouch anastomosis in the pelvis without evidence of obstruction. No intrinsic abnormality of the remaining small bowel with the J. pouch is noted. The large ventral hernia containing small bowel is seen unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Slight increase in size of left pleural effusion and left basilar atelectasis. 2. Cyst gastrostomy catheter/stent into the to left upper quadrant collections. Size of the collections are unchanged with minimal residual in the smaller posterior collection, and no significant change in larger left anterior collection but increased air within the collection presumably from insertion of new drainage catheter described above.
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Generate impression based on findings.
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Ms. Kaonohi is a 52 year old female with a personal history of left breast mastectomy in 2012 for DCIS. Family history of breast cancer and maternal aunt. No current breast related complaints. Three standard views of the right breast with one right spot compression view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Focal asymmetry in the central right breast (best seen on the MLO view) disperses into normal breast parenchyma on the spot compression view. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Scattered benign calcifications are seen.
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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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Right knee pain. Concern for osteoarthritis. Significant crepitus on exam. Four views of the right knee are provided. Severe tricompartmental osteoarthritis affects the knee, with bone on bone apposition of the medial compartment as well as a varus deformity. I see no joint effusion.Severe osteoarthritis also affects the left knee as seen on the frontal view.
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Severe osteoarthritis.
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Generate impression based on findings.
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Restaging metastatic breast cancer with chemotherapy.RADIOPHARMACEUTICAL: 15.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 109 mg/dL. Today's CT portion of the neck and pelvis demonstrates scattered sclerotic lesions within the osseous pelvis. Please see diagnostic CT reports for details of the chest and upper abdomen.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate tumor activity currently. Previous residual left iliac wing uptake has entirely resolved. Benign linear activity surrounds the biliary stents.
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1.No FDG avid tumor currently in the neck, chest, abdomen or pelvis.Diagnostic CTs of the chest and upper abdomen also performed at today's visit will be reported separately.
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Generate impression based on findings.
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Status post left distal femur resection/endoprosthetic reconstruction for osteosarcoma. Evaluate for recurrence/implant failure. Again seen is resection of the distal femur and reconstruction with a longstem total knee endoprosthesis device. I see no specific radiographic features of hardware complication or tumor recurrence.
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Postoperative changes of distal femoral reconstruction without evidence of recurrence or implant failure.
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Generate impression based on findings.
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Breast cancer. Check for metastatic disease Femur: A poorly visualized permeative lucency is observed in the distal diaphysis with associated endosteal scalloping along lateral margin. More proximally a more mottled appearance is observed in the proximal diaphysis although this may represent demineralization. Small calcification or Pellegrini-Stieda lesion observed on the medial aspect of the distal condyleHumerus: Diffuse demineralization limits sensitivity. A questionable area of decreased density is observed in the proximal diaphysis with possible endosteal scalloping as well as an area of cortical thinning more distally (arrow).
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Questionable humeral and a definite distal left femoral lesion suspicious for metastatic disease. No lesion appears to represent an immediate pending fracture, however close follow-up and correlation would be recommended given weight-bearing concerns within the femur.
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Generate impression based on findings.
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History of left breast asymmetries. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. No new or suspicious focal asymmetry is seen. Several of the asymmetries seen on previous mammograms are somewhat smaller, supporting involuting cysts. Others are stable and not suspicious, supporting cysts and dense parenchyma.Benign appearing lymph nodes are projected over both axillae.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Female 63 years old; Reason: 63 y/o female with colon Ca. Reciving chemo. Compare to prior scan History: colon CA CHEST:LUNGS AND PLEURA: Right upper lobe lobe pulmonary nodule measures 1.3 x 0.8 cm (image 47/series 5) previously, 1.4 x 0.9 cm.The right middle lobe index lesion measures 1.2 x 1.2 cm (image 50/series 5) previously, 1.3 x 1.2 cm.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Mediastinal lymph node measures 1.2 x 1.0 cm (image 19/series 3) previously, 1.1 x 0.9 cm.There are calcified right hilar lymph nodes.Right chest wall port terminates at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Post right hepatic lobectomy. Reference lesion in the left hepatic lobe measures 2.1 x 1.4 cm (image 87/series 3) previously, 1.3 x 1.1 cm.Residual hepatic vasculature are patent.SPLEEN: PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node measures 3.5 x 1.9 cm (image 98/series 3) previously, 3.7 x 2.1 cm.BOWEL, MESENTERY: Postsurgical changes in the colon. There are multiple mesenteric lesions. The upper abdominal mesenteric lesion measures 3.1 x 1.8 cm (image 116/series 3) previously, 3.0 x 2.3 cm. Additional lesions are located adjacent to the ascending colon.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Near stable size measurements of the reference lesions. Only the hepatic lesion has slightly increased in size.
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Generate impression based on findings.
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Chronic nasal congestion, post-nasal drip, and anosmia. There is mild to moderate opacification of the maxillary sinuses, ethmoid air cells, and nasal cavity. There is a small retention cyst in the left frontal sinus. There is sclerosis and thickening of the affected sinus walls. There is mild nasal septal deviation with a spur that is directed to the left. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.
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Sinonasal opacification which may represent chronic rhinosinusitis, perhaps with a component of polyposis.
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Generate impression based on findings.
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Female 59 years old; Reason: Rule out worsening or new infection, bleed, or mass History: cytopenias, confusion, cough, abdominal pain CHEST:LUNGS AND PLEURA: Evaluation of pulmonary parenchyma suboptimal due to respiratory motion artifact. Stable left greater than right pleural effusions with adjacent compressive atelectasis. New and increasing areas of patchy air space disease, particularly in upper lobes, right greater than left, increasing patchy air space disease and tree in bud nodularity also noted in right upper lobe posteriorly and in right lower lobe. Stable 4-mm right-sided lung nodule, again may be infectious in etiology. Biapical scarring/nodularity. MEDIASTINUM AND HILA: Evaluation for hilar adenopathy suboptimal without IV contrast.CHEST WALL: Right central venous catheter with tip in distal SVC, left-sided central venous catheter seen with tip in proximal most SVC. Minimal calcified coronary disease. Small pericardial fluid. ABDOMEN:Evaluation of organs of abdomen pelvis suboptimal without IV contrast and secondary to diffuse ascites.LIVER, BILIARY TRACT: Nodular liver contour. Increased attenuation of noncontrast liver parenchyma seen, nonspecific but may be related to iron deposition or drug toxicity. Subcentimeter right hepatic hypoattenuating focus, too small to characterize but stable, image 121 series 3. Layering sludge in gallbladder and cholelithiasis. SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small nonobstructing intrarenal stones again seen.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes suggested but evaluation suboptimal on noncontrast study. BOWEL, MESENTERY: Hyperdense contrast seen throughout colon, likely related to recent fluoroscopic exam.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter and air are seen in bladder.BONES, SOFT TISSUES: L2 vertebral body compression deformity. Multilevel degenerative changes of spine and decreased osseous mineralization. Stable to mild interval increase in anasarca. Upper abdominal postsurgical changes. Essentially stable abdominopelvic ascites.
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1. Findings suspicious for worsening multifocal pneumonia/infectious process as described. New and increasing areas of patchy air space disease, particularly in upper lobes, right greater than left, increasing patchy air space disease and tree in bud nodularity also noted in right upper lobe posteriorly and in right lower lobe. Stable left greater than right pleural effusions. 2. Remainder of exam without significant change as above.
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