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Generate impression based on findings.
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Reason: s/p sleeve gastrectomy 11/2014 evaluate for stricture History: nausea/vomiting Spot scout view showed no significant abnormality.Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave with minimal proximal escape.There is postsurgical changes of sleeve gastrectomy. There is proximal distensible portion of the stomach with no visible gastric fold measuring 5.0 x 2.0 cm, followed by short segment of narrowing measuring 4 mm in diameter and 7mm in length (series 10). This is followed by distensible distal portion measuring 6.4 x 2.0 cm. There is free flow of the contrast into the duodenum and jejunum. Spontaneous emptying of contrast into the duodenal sweep was observed. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. TOTAL FLUOROSCOPY TIME: 5:52 minutes
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1.Postoperative changes of sleeve gastrectomy.2.Minor dysmotility with trace proximal escape.3.No obstruction of fluid flow.4.The configuration of the sleeve may explain patient's symptoms.
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Generate impression based on findings.
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NHL status post BEAM/auto-SCT, now with recurrent disease, needs restaging please. Neck: There has been interval enlargement of extensive lymphadenopathy in the neck and partially-imaged upper mediastinum and axillae. For example a left level 1B lymph node measures 26 x 35 mm, previously 10 x 11 mm, and a left level 2A lymph node measures up to 49 x 33 mm, previously 17 x 12 mm. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is kyphotic deformity and multilevel degenerative spondylosis of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial mass or abnormal enhacenemt. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is partial opacification of the right mastoid air cells. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.
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1. Interval enlargement of extensive lymphadenopathy in the neck and partially-imaged upper mediastinum and axillae, which is compatible with progression of lymphoma. 2. No evidence of intracranial lesions.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of ovarian cancer, diagnosed at the age of 58. Two standard digital views and tomosynthesis of both breasts were performed 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 suspicious masses, microcalcifications or areas of architectural distortion are present. Innumerable small stable masses, diffusely scattered benign calcifications, and bilateral ductal ectasia are again noted.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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37 year-old female with joint pain and swelling, evaluate for inflammatory arthritis Right hand: There are no erosions or other specific radiographic features of inflammatory arthritis. Note is made of slight ulnar minus variance and hypoplasia of the distal first phalanx.Left hand: Lucency with thin sclerotic margins within the second metacarpal head may represent a cyst and less likely represents a chronic erosion given that the remainder of the joint appears normal. We see no specific radiographic features of inflammatory arthritis. Hypoplasia of the distal phalanx of the thumb is noted.Right foot: We see no erosions or other specific radiographic features of inflammatory arthritis. A bipartite medial sesamoid represents a normal anatomic variant.Left foot: We see no erosions or other specific radiographic features of inflammatory arthritis. A tiny density in the soft tissues adjacent to the second toe may represent an artifact or perhaps a small foreign body. Mild pes planovalgus deformity is noted.Right knee: The right knee appears normal for the patient's age. We see no specific radiographic features of inflammatory arthritis. Cortical thickening along the proximal fibula may represent old trauma.Left knee: Small osteophytes indicate mild osteoarthritis affecting the knee. No joint effusion is noted. We see no erosions or other specific radiographic features of inflammatory arthritis.
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A single small lucency within the second metacarpal head may represent a cyst rather than a chronic erosion given that the joints otherwise appear normal without additional erosions or other evidence of inflammatory arthritis. Mild osteoarthritis affects the left knee.
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Generate impression based on findings.
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Male 15 years old; Reason: ro osteo vs. infarct in RLE History: pain Angiographic images demonstrate symmetric blood flow to the bilateral lower extremities with no evidence of hyperemia. No evidence of abnormal blood pooling on the blood pool images. On delayed osseous phase imaging there is faint uptake in the bilateral femoral heads likely related to the patient's age as well as possible prior microinfarcts or avascular necrosis.
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1. No evidence to support osteomyelitis, specifically there is no focal uptake to correlate with the abnormality noted on recent MRI.2. Faint uptake in the bilateral femoral heads likely related to prior microinfarcts or avascular necrosis.
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Generate impression based on findings.
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68-year-old male with history of fall in November, 2014. Left shoulder: There is an oblique fracture through the proximal humeral metadiaphysis in near anatomic alignment. Small amount of callus formation indicates some healing. There is an anomalous coracoclavicular articulation, a normal variant. Scattered arterial calcifications are present.Left humerus: Again seen is the aforementioned proximal humerus fracture. The distal humerus is unremarkable.Left hand: There is mild dorsal soft tissue swelling. No acute fractures are evident. Scattered arterial calcifications are present.
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Proximal humerus fracture as above.Findings discussed with Dr. Hong at 1610 on 1/19/15.
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Generate impression based on findings.
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10 month old male status post intracranial hemorrhage, evaluate for swallowing deficits.EXAMINATION: Oropharyngeal motility study 1/19/2015 Julie Eccelstone, speech and language therapist, supervised the examination.55 seconds of fluoroscopy was used.PRESENTATION: The patient was presented with thin liquids via a slow flow nipple, half strength nectar via a slow flow nipple, medium flow nipple, and cutout cup as well as stage II purée via spoon.RESULTS: The patient demonstrated oral deficits including immature oral skills and decreased labial closure around the cup. Additionally, delayed swallow onset was identified. Penetration with delayed cough resulted from thin liquids via a slow flow nipple and half-strength liquids via a standard flow nipple. No aspiration was evident.
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Penetration without aspiration.Please see the speech and language therapist's report for feeding recommendations.
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Generate impression based on findings.
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61-year-old female status post curettage and cementation of supraacetabular metastatic thyroid cancer focus Again seen is cement within the right acetabulum and ilium compatible with curettage and grafting of a metastatic thyroid cancer lesion. A metallic coil presumably represents prior embolization. A drain has been removed. Bone formation along the medial aspect of the lesion may represent an attempt at healing. The pathologic fracture line remains visible.
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Postoperative changes of right acetabular lesion grafting with pathologic fracture as described above.
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Generate impression based on findings.
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Initial staging of newly diagnosed squamous cell carcinoma right floor of mouth cT1N1.RADIOPHARMACEUTICAL: 12.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly demonstrates an enlarged right posterior jugular lymph node. Mucous retention cysts or polyps are seen in both maxillary sinuses. Left chest ICD is grossly intact. There are bilateral ureteral stents.Today's PET examination demonstrates a small to medium sized markedly hypermetabolic focus at the right floor of mouth (SUV max = 19.7), consistent with the patient's diagnosis of squamous cell cancer.A markedly hypermetabolic enlarged right posterior jugular lymph node at this same axial level (SUV max = 18.2), indicates a regional lymph node metastasis.Within the right posterior parotid gland, a punctate several millimeter in size mild to moderately hypermetabolic focus (SUV max = 3.3) is suspicious but equivocal for an ipsilateral intraparotid lymph node metastasis.No suspicious FDG avid lesion is seen within the contralateral left neck.No suspicious FDG avid lesion is seen within the chest, abdomen or pelvis.
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1.Markedly hypermetabolic right floor of mouth lesion, consistent with the patient's diagnosis of squamous cell carcinoma.2.Hypermetabolic metastatic lymph node in the ipsilateral right posterior jugular and possibly within a right intraparotid lymph node.3.No FDG avid tumor in the contralateral left neck, chest, abdomen, or pelvis.
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Generate impression based on findings.
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Female 85 years old Reason: 85 y/o F with dysphagia to solids and pills. Surgical staples are seen in the neck.The esophagus distends normally and demonstrates normal mucosal pattern without evidence of ulceration, stricture or mass. Normal appearing thin folds on mucosal relief.Silent vestibular penetration and trace aspiration demonstrated after the double contrast study did not recur, however the contrast remained coating the vestibule. Trachea barium cleared with instructed coughing.Double contrast views of the hypopharynx were normal.Dynamic evaluation of swallowing using fluoroscopy capture (30 pulses/sec.) was obtained in frontal, lateral and oblique projections. Movie loops were sent to PACS.There is mild prominence of the cricopharyngeus muscle and a small early Zenker's diverticulum developing.There was transient hangup of the barium pill at the aortic arch and then at the left main bronchus which, with additional swallowing of liquid, passed freely into the stomach.There is no evidence of gastroesophageal reflux. No evidence of hiatal hernia.Visualized portions of the stomach duodenal bulb and sweep are unremarkable except for a small duodenal diverticulum.Fluoroscopy time: 7 minutes 39 seconds.
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1.Episode of silent aspiration. Evaluation with oropharyngeal mode color the study recommended.2.Prominent cricopharyngeus muscle and early Zenker's diverticulum formation.3.Normal esophageal motility.4.Transient hangup of the barium pill the aortic arch and left main bronchus (might be related to volume of oral bolus). No morphologic mechanical obstruction.5.Dr. Kavitt was present for the exam. The finidings were reviewed with Dr. Kavitt and with Mrs. Bucksbaum.
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Generate impression based on findings.
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Male, 75 years old. RFO Trigger: Multiple surgical teams, surgery > 8 hours. Numerous pelvic staples, pelvic surgical drain, and left ureteral stent. No unexpected radiopaque foreign bodies. Nonobstructive bowel gas pattern. Bibasilar pulmonary opacities most consistent with atelectasis and low lung volumes.
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No unexpected radiopaque foreign bodies. Postoperative changes as described above. Findings discussed with the attending surgeon Dr. Lee by phone at 16:12 on 1/19/15.
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Generate impression based on findings.
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19-year-old female with history of patellar instability. There is flattening of the femoral trochlea indicating dysplasia with hypoplasia of the medial facet relative to the lateral facet. There is slight lateral translation of the patella with respect to the trochlea. The tibial tuberosity to trochlear groove distance measures 10 mm, a normal measurement. Ossicles along the inferomedial aspect of the patella perhaps represent fracture fragments from remote patellar dislocation. The Insall-Salvati ratio is normal. The soft tissues are unremarkable. There is no joint effusion.
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Femoral trochlear dysplasia and findings suggestive of prior patellar dislocation. Other findings as above.
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Generate impression based on findings.
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59-year-old male with history of multiple myeloma, post autologous SCT. SKULL: A few punched out lucent lesions within the calvarium are consistent with multiple myeloma and appear similar to the prior exam.CERVICAL SPINE: Limited exam due to inability to suboptimally position the patient with nonvisualization of the lower cervical spine. The bones are demineralized. We see no discrete lytic lesion. Degenerative arthritic changes appear similar to the prior exam.THORACIC SPINE: The bones are demineralized, likely representing widespread myelomatous involvement. Vertebral body compression fractures appear similar to the prior study. LUMBAR SPINE: Vertebral body compression fractures appear similar to the prior study. The bones are demineralized, likely representing widespread myelomatous involvement. Surgical clips project over the GE junction.RIBS: Multiple rib deformities likely representing subacute and chronic fractures of varying ages as well as scattered lucent lesions within the ribs appear similar to the prior exam. PELVIS: The bones are diffusely demineralized, likely representing widespread myelomatous involvement. Multiple more focal lucent lesions, including a destructive right ischial lesion with possible associated pathologic fracture, appear similar to the prior exam.UPPER EXTREMITY: A single view of the right humerus demonstrates lucent lesions in the scapula and within the humerus consistent with multiple myeloma appearing similar to the prior exam. A single view of the left humerus demonstrates punched out lytic lesions consistent with multiple myeloma appearing similar to the prior exam.No discrete lytic lesion is identified in the left forearm. An ovoid lucency within the mid diaphysis of the right forearm may represent myelomatous involvement, appearing similar to the prior exam.LOWER EXTREMITY: Multiple lytic lesions within the proximal right femur appear similar to the prior exam. Lateral views of the left femur are provided. Multiple lucencies within the left femur with endosteal scalloping appear similar to the prior exam. No discrete lytic lesions involve the right or left tibia and fibula.
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Findings compatible with multiple myeloma as described above appearing similar to the prior exam.
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Generate impression based on findings.
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Male, 45 years old, history of stroke 3 years ago with increased global weakness since yesterday, left worse than right. Since the prior examination, hyperattenuation involving the left caudate and putamen, and to a lesser degree the right caudate and putamen, has resolved. This change is accompanied by atrophy of the left basal ganglia resulting in ex vacuo dilatation of the left frontal horn.Elsewhere, no specific parenchymal abnormalities are detected. Gray-white distinction is preserved. No mass-effect or parenchymal edema is detected. Except as above, the ventricular system is within normal limits.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear.
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Interval evolution of findings on prior exams which were presumed to reflect nonketotic hyperglycemia. Basal ganglia hyper-attenuation, left more than right, has resolved, but there is evidence of atrophy of the left basal ganglia with ex vacuo dilatation of the left lateral ventricle.No definite evidence of any new or acute intracranial abnormality is detected. However, given the patient's history, a more sensitive evaluation with MRI may prove useful.
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Generate impression based on findings.
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And abdominal pain, fevers, chills and fatigue. Evaluate for fluid collection/abscess in the abdomen/pelvis. ABDOMEN:LUNG BASES: Right basilar atelectasis. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patient is status post prior right hemicolectomy with ileal- transverse colostomy. Just inferior to the anastomosis is a 3.5 x 3.1 cm fluid collection with small foci of air. Adjacent to this he mesenteric fat has streaky infiltrative changes. These reflect postoperative changes in light of recent surgery. CT cannot characterize fluid collections and while this fluid may reflect postoperative seroma, infection cannot be differentiated. Small amount of slightly more remote air in the mesenteric fat is seen most likely residual from recent surgery.Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant proximal to the anastomosis. Proximal to anastomosis the ileum dilates slightly with residual debris and a partial obstruction cannot be excluded. No free mesenteric fluid is seen. BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: Patient is status post prior right hemicolectomy with ileal- transverse colostomy. Just inferior to the anastomosis is a 3.5 x 3.1 cm fluid collection with small foci of air. Adjacent to this he mesenteric fat has streaky infiltrative changes. These reflect postoperative changes in light of recent surgery. CT cannot characterize fluid collections and while this fluid may reflect postoperative seroma, infection cannot be differentiated. Small amount of slightly more remote air in the mesenteric fat is seen most likely residual from recent surgery.Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant proximal to the anastomosis. Proximal to anastomosis the ileum dilates slightly with residual debris and a partial obstruction cannot be excluded. No free mesenteric fluid is seen.BONES, SOFT TISSUES: Bilateral inguinal hernias containing only mesenteric fat.OTHER: No significant abnormality notedd
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1. Postoperative changes in right abdomen following terminal ileum -- right hemicolectomy . 2. 3.5 x 3.1 cm fluid collection adjacent to the anastomosis -- whether this reflects benign fluid versus infection cannot be differentiated on CT.
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Generate impression based on findings.
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60-day-old female with pleural effusions. Chest tube repositioning.VIEW: Chest AP (one view) 1/19/2015, 16:16 Endotracheal tube tip is below thoracic inlet and above carina. The left chest tube tip is in the left apical region.Interval increased opacity in the right upper and lower lobes likely reflects atelectasis with improved left lower lobe opacity. The cardiothymic silhouette is normal. Small bilateral pleural effusions are seen, without evidence of pneumothorax. Persistent body wall edema is present.
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1.Left chest tube with tip now in the left pulmonary apical region.2.Decreased left lower lobe opacity, and increased right upper and lower lobe opacities.
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Generate impression based on findings.
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Colon is adequately cleansed and adequately distended. There is a small to moderate amount of residual fluid which is well tagged with oral contrast.No significant size polyps or masses are seen anywhere in the colon. Minimal diverticulosis sigmoid colon.Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC
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No significant size polyps or masses. *OPTIONAL C-RADS CLASSIFICATION:C-1E-2*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant.
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Generate impression based on findings.
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One day old female with polydactylyVIEWS: Left hand PA/lateral (two views) 01/19/15 Postaxial polydactyly is present. No osseous elements are present within the digit. The remainder of the hand is within normal limits with normal anatomy.
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Postaxial polydactyly without evidence of osseous elements.
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Generate impression based on findings.
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76-year-old female with ovarian cancer who needs reevaluation and comparison to previous examination. Comparison to prior examination is limited given lack of contrast enhancement on the outside examinationCHEST:LUNGS AND PLEURA: Multiple bilateral micronodules are nonspecific. Some of the micronodules are calcified likely inflammatory in etiology.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Multilevel mild degenerative changesABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Hepatic granulomata. No intra-or extrahepatic biliary ductal dilatation. There are perihepatic capsular deposits most suspicious for metastatic disease with reference deposit posteriorly measuring 3.2 x 1.6 cm (series 3, image 69), previously measuring 3.0 x 1.7 cm.SPLEEN: There are hypoattenuating splenic lesions which were present on the previous examination. Reference lesion anteriorly measures 3.1 x 2.1 cm (series 3, image 80), previously measuring 3.0 x 2.1 cm. Splenic granulomata noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate right hydroureteronephrosis with a nephroureteral stent with the proximal portion of the stent coiled in the renal pelvis and distal portion coiled within the bladder, not significantly changed. There is mesenteric nodularity adjacent to the distal right ureter measuring approximately 4.4 x 2.9 cm (series 3, image 145), previously measuring 5.4 x 3.3 cm; this is consistent with the region of extrinsic compression upon the right distal ureter resulting in moderate right hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There are multiple scattered soft tissue nodules throughout the mesentery which are decreased in size. Reference soft tissue nodule adjacent to the greater curvature of the stomach measures 3.0 x 2.4 cm (series 3, image 78), previously measuring 4.0 x 3.1 cm. Reference soft tissue nodule within the pelvis measures 3.0 x 3.4 cm (series 3, image 159), previously measuring 3.8 x 3.4 cm.No evidence of small bowel obstruction or colitis.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: There are multiple scattered soft tissue nodules throughout the mesentery which are decreased in size. Reference soft tissue nodule adjacent to the greater curvature of the stomach measures 3.0 x 2.4 cm (series 3, image 78), previously measuring 4.0 x 3.1 cm. Reference soft tissue nodule within the pelvis measures 3.0 x 3.4 cm (series 3, image 159), previously measuring 3.8 x 3.4 cm.No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Interval decrease in size of mesenteric metastatic disease.2.Stable splenic hypoattenuating lesions consistent metastatic disease.3.Stable perihepatic metastatic deposits.4.Unchanged moderate right hydroureteronephrosis secondary to metastatic disease at the level of the right mid to distal ureter.5.Diffuse pulmonary micronodules are nonspecific.
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Generate impression based on findings.
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Right-sided facial and ear pain. Rule out infection or inflammation. Multiple teeth are absent, and there are multiple dental fillings. I suspect that there are cavities of the remaining maxillary molars, but this would be better assessed with dedicated dental radiographs. Poor definition of the left coronoid processes is suspected to be artifactual; I see no definite lytic lesions of the mandible.
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Poor dentition with findings as described above.
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Generate impression based on findings.
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49-year-old male with history of MVC two weeks prior now with right neck stiffness and pain. Evaluation of the lower cervical spine on the lateral view is limited due to overlying anatomy. Given this limitation we see no fracture. There is loss of the normal cervical lordosis which may be secondary to positioning or muscle spasm. Moderate degenerative disk disease affects C5-6 and C6-7. There may be mild neuroforaminal narrowing at these levels as well.
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Degenerative disk disease without a fracture.
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Generate impression based on findings.
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60 year-old female with known transverse colon cancer diagnosed in July, 2014. Staging CT scan. CHEST:LUNGS AND PLEURA: No significant abnormality noted.No nodules, airspace disease or pleural disease seen.MEDIASTINUM AND HILA: No significant abnormality noted. No adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Low density lesion in inferior right lobe of the liver (series 3, image 112) unchanged since 4/23/14 and dates back to 2006 CT examination as well, likely benign. No new hepatic parenchymal lesions seen. Gallbladder and biliary tract appear normal. 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: Mass in the transverse colon is again seen in similar location to 4/23/14 examination. Mass has slightly increased in size and now measures 4.9 x 3.8 cm (series 3, image 115) compared with 3.6 x 3.3 cm previously. Soft tissue infiltration into the adjacent fat is again seen to a slightly greater extent than previously. Small subcentimeter lymph nodes are seen in the mesentery dorsal to the tumor with the prior noted reference node (series 3, image 114) now measuring 1.0 x 0.9 cm.BONES, SOFT TISSUES: Anterior abdominal umbilical hernia seen containing only mesenteric fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy. 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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Slight increase in size a transverse colon mass typical of colon carcinoma. 2. Slight increase in size and number of adjacent mesenteric small lymph nodes, worrisome for metastatic disease. 3. No evidence of remote metastatic disease seen.
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Generate impression based on findings.
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47-year-old male with history of ORIF. Orthopedic pins affix a comminuted fracture of the fourth proximal phalanx in near anatomic alignment with slight radial angulation of the distal fracture fragment. Additionally, two orthopedic pins affix the remaining middle and proximal phalanges of the fifth finger in anatomic alignment following resection of previously seen fracture fragments. There is amorphous density in the surrounding soft tissues of the fifth finger which presumably represents bone graft material. A cyst with sclerotic margins is identified at the proximal pole of the scaphoid.
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Orthopedic fixation of fourth and fifth fingers as above
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Generate impression based on findings.
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77-year-old male with history of reverse total shoulder arthroplasty. Overlying splint material limits evaluation of fine osseous detail. Hardware components of a left reverse total shoulder arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Surgical drain and foci of gas density within the soft tissues reflect recent surgery.
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Left reverse total shoulder arthroplasty as above.
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Generate impression based on findings.
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16-year-old male with history of osteosarcoma for surveillance LUNGS AND PLEURA: Nodular, subpleural opacities are seen in the superior segment of the right lower lobe. Left major fissure intra-fissure lymph node is unchanged (series 4 image 51).MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal with no pericardial effusion.CHEST WALL: No suspicious osseous lesions. No axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Nodular, subpleural opacities in the superior segment of the right lower lobe may be of infectious or inflammatory radiology. Short term follow-up may be considered to ensure resolution.
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Generate impression based on findings.
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46 year old female with history of left femur osteoma resection. Evaluate for recurrence. There is a plate and screw device with tension wires affixing allograft within the proximal femur. The margins are less distinct indicating interval healing. There is no radiographic evidence of hardware complication or tumor recurrence.
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Postsurgical changes as above without radiographic evidence of tumor recurrence.
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Generate impression based on findings.
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47-year-old female with neutropenia, abdominal pain and tenderness. Within the limits of a non-IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormalities are seen in the stomach or small bowel with rapid progression of orally administered contrast material to the colon without evidence of obstruction or intrinsic abnormality. Appendix is normal in appearance. Small amount of mesenteric fluid is seen the abdomen and pooling in the dependent pelvis of uncertain etiology. No loculations are seen to suggest abscess.BONES, SOFT TISSUES: Anterior umbilical hernia containing only mesenteric fat.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No abnormalities are seen in the stomach or small bowel with rapid progression of orally administered contrast material to the colon without evidence of obstruction or intrinsic abnormality. Appendix is normal in appearance. Small amount of mesenteric fluid is seen the abdomen and pooling in the dependent pelvis of uncertain etiology. No loculations are seen to suggest abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Small amount of free mesenteric fluid in the dependent lateral flanks and dependent pelvis without loculation of uncertain etiology. 2. No other diagnostic abnormality seen.
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Generate impression based on findings.
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64-year-old female with history of shoulder pain. There is widening of the AC joint and tapering of the distal clavicle which may reflect prior surgery. The shoulder is otherwise unremarkable.
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Widening of the AC joint is likely postoperative, however the shoulder is otherwise unremarkable.
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Generate impression based on findings.
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57-year-old female with history of pain. Evaluation is limited due to inability to optimally position the patient. The glenohumeral joint is in gross anatomic alignment, but this is difficult to assess given the aforementioned limitation. Mild osteoarthritis affects the acromioclavicular joint.
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Mild osteoarthritis of the acromioclavicular joint.
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Generate impression based on findings.
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45-year-old male with history of fall now with diffuse pain. Left ankle: There is an oblique fracture through the distal fibula extending to the level of the tibiotalar joint. Alignment is near-anatomic. There is lateral soft tissue swelling.Left knee: There is a moderate-sized joint effusion, however we see no fracture line. There is a 6 mm linear density overlying the medial aspect of the tibiofemoral compartment of uncertain etiology. In the presence of a joint effusion we cannot exclude the possibility of an underlying fracture.
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1.Distal fibular fracture as above.2.Joint effusion and a 6-mm linear density within the medial tibiofemoral compartment for which we cannot exclude an underlying fracture; however, we see no lucent fracture line. If patient care warrants further imaging, a CT or MRI may be obtained.
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Generate impression based on findings.
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16-year-old male with recent intubation.VIEW: Chest AP (one view) 01/19/15 ET tube tip is below thoracic inlet and above the carina. Swan-Ganz catheter tip is in the main pulmonary artery. NG tube tip is in the stomach. Left upper extremity PICC tip is at the superior cavoatrial junction.Patchy airspace opacities throughout the right lung are not significantly changed. Worsening left lower lobe opacities. No pleural effusion or pneumothorax. Cardiothymic silhouette is unchanged.
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Stable right and worsening left airspace opacities. ET tube tip is below the thoracic inlet and above the carina.
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Generate impression based on findings.
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55-year-old female with history of hardware placement and fusion. There are postsurgical changes from interspinous arthrodesis at L4-5 with an orthopedic device and bone graft material noted posteriorly. There is no evidence of hardware complications. The margins of the graft remain distinct at this time, and I see no specific radiographic features of bony fusion at this time. There is approximately 6 mm of anterolisthesis of L4 on L5 which increases by approximately 1 mm on flexion views. There is a stable grade 1 retrolisthesis of L3 on L4. Mild degenerative disc disease affects the lower lumbar spine.
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Postoperative changes of interspinous arthrodesis appearing similar to the prior study.
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Generate impression based on findings.
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New onset low back pain. Rule out fracture. There is partial sacralization of the L5 vertebra. There is a compression fracture of L2 with cement in the L2 vertebral body. Loss of height of the L2 vertebral body appears to have progressed slightly since 2008, but I suspect that this is still chronic in etiology. The remaining lumbar vertebral body heights are preserved. I see no acute fracture. The bones are perhaps slightly demineralized. There is calcification of the abdominal aorta and its branches.
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Compression fracture of L2 with cement in the L2 vertebral body. Although loss of height of the L2 vertebral body appears to have progressed when compared with the 2008 lumbar spine exam, I suspect this is still chronic in etiology. I see no definite acute fracture.
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Generate impression based on findings.
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Left knee pain Four views of the left knee are provided. There is mild medial compartment narrowing and small osteophytes indicating mild osteoarthritis.Mild osteoarthritis affects the right knee as seen on the frontal views.
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Mild osteoarthritis.
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Generate impression based on findings.
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Metatarsalgia, fifth There is flattening of the medial aspect of the first metatarsal head reflecting prior bunionectomy. There is a slight hallux valgus deformity. I see no specific findings to account for the patient's 5th metatarsal pain.
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Postoperative changes of prior bunionectomy, but no specific findings to account for the patient's fifth metatarsal pain. If there is clinical concern for stress fracture, repeat radiographs may be obtained in 10 to 14 days.
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Generate impression based on findings.
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56 year old man with a history of TIA who is being considered for a robotic atrial septal defect closure and is referred to evaluate cardiovascular anatomy for surgical planning.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has no significant tortuosity. No protruding aortic atheroma, calcification, or thrombus is noted in the thoracic aorta. No aortic coarctation is noted. Aortic Valve: The aortic valve is has no calcification.Mitral Valve: No mitral annular calcification is noted.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 158ml). There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. No LV thrombus is noted.Right Ventricle: Visually the right ventricular end-diastolic volume is within normal limits.Left Atrium: The left atrium is mildly dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is a large patent foramen ovale or a small (~3mm) atrial septal defect noted on the superior third of the interatrial septum. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is mildly dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is are no significant stenoses in the left main artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are multiple partially calcified, non-obstructive plaques (<25% stenosis) in the proximal and mid LAD. The remainder of the LAD and its branches are free of stenosis.LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is a non-calcified, non-obstructive plaque (<25%) in the proximal LCx. The remainder of the vessel is free of stenosis.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the RCA.Coronary Bypass Grafts:None present.
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1. Very small atrial septal defect (or large PFO) is noted. 2. Normal thoracic aortic anatomy. 3. No severe coronary artery stenoses. 4. Mild burden of coronary atherosclerosis, predominantly located in the proximal and mid LAD and proximal LCx.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvis CTA will be reported separately.
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Generate impression based on findings.
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Assess for fracture. Pain. Two views of the left shoulder are provided. I see no fracture or malalignment.Two views of the left humerus are provided. I see no fracture. There is perhaps mild reticulation of the subcutaneous fat suggesting mild edema.Two views of the left forearm are provided. I see no fracture.
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Possible mild subcutaneous edema; I see no fracture.
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Generate impression based on findings.
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Rule out SER4 Again seen is an oblique fracture of the distal fibula with fracture fragments in near-anatomic alignment. There is soft tissue swelling, particularly along the lateral aspect of the ankle. I see no frank widening of the medial tibiotalar gutter.
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Distal fibular fracture. I see no frank widening of the medial tibiotalar gutter.
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Generate impression based on findings.
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Pain status post fall. Rule out fracture. I see no fracture, malalignment, or joint effusion. I see no specific findings to account for the patient's pain.
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No fracture or other findings to account for the patient's pain are evident.
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Generate impression based on findings.
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Left ankle erythema on dorsal aspect. Warmth/tenderness. Concern for "osteo". Again seen is an oblique fracture of the distal fibula with fracture fragments in near-anatomic alignment. This appears similar to the prior study, although there is minimal periosteal reaction along the fracture suggesting an early attempt at healing. There is diffuse soft tissue swelling about the ankle. I see no radiographic findings to suggest osteomyelitis. Arterial calcifications are noted in the soft tissues.
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Distal fibular fracture and soft tissue swelling without radiographic evidence of osteomyelitis.
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Generate impression based on findings.
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Pain and swelling with posterior tenderness to palpation. Rule out abnormality and Baker's cyst if possible. Moderate to severe osteoarthritis affects the knee, with narrowing of the medial tibiofemoral compartment and tricompartment osteophytes. An ossicle projecting posterior to lateral femoral condyle likely represents a normal variant fabella. I see no fracture. There is a small joint effusion. I see no loose bodies within a Baker's cyst, but conventional radiography is limited in its ability to detect popliteal cysts.
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Osteoarthritis and small joint effusion.
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Generate impression based on findings.
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Pain, swelling. Rule out fracture. There appears to be swelling of the soft tissues of the ring finger, particularly along the middle phalanx. I see no underlying fracture or dislocation.
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Soft tissue swelling without fracture evident.
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Generate impression based on findings.
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1 day old term male with perinatal distress and potential seizures. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. There is fluid within the rudimentary paranasal sinuses, mastoid air cells, and middle ear cavities. There is bilateral hypodense extracranial scalp fluid collection measuring up to 15 mm in thickness. There are accessory occipital bone ossicles as well as mild 3-5 mm depression and overlap at the parieto-occipital sutures.
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1.No evidence of intracranial hemorrhage. 2.Bilateral caput succedaneum.3.Accessory occipital bone ossicles and mild 3-5 mm depression and overlap at the parieto-occipital sutures. 4.An MRI may be beneficial to evaluate for ischemia if there is clinical concern.
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Generate impression based on findings.
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The lateral, third and fourth ventricles are mildly enlarged. The cisterns remain patent. There is no midline shift or mass effect. There is severe confluent periventricular and subcortical T2 hyperintensity including the right anterior temporal pole without associated diffusion restriction. There is also increased T2 signal within the midbrain, pons and left anterior limb of the internal capsule. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is no abnormal enhancement.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Lenses are thin bilaterally. The hippocampi are symmetric without abnormal signal.
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1.No restricted diffusion to suggest acute infarct.2.Severe T2 abnormality involving the periventricular and subcortical white matter, including the right anterior temporal pole, as well as the brainstem consistent with given history of CADASIL syndrome.3.Mildly enlarged ventricles. Given clinical history of CADASIL, this may be secondary to volume loss, although normal pressure hydrocephalus may have a similar appearance and cannot be excluded.
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Generate impression based on findings.
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Left hip pain after twisting action. Hip fracture? Components of a total hip arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. I see no fracture. I see no specific findings to account for the patient's pain.
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Total hip arthroplasty without fracture or other specific findings to account for the patient's pain.
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Generate impression based on findings.
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Patient with right rib pain with known metastatic disease now status post fall. Please evaluate for rib fracture. There are sclerotic and permeative lesions affecting multiple bones compatible with the patient's diagnosis of metastatic prostate cancer. This includes an expansile lesion of the lateral aspect of the right sixth rib but I see no discrete fracture. The spine and scapula are also affected, as seen on prior studies.
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Widespread metastatic disease without fracture evident.
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Generate impression based on findings.
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65 years, Male. Reason: assess bowel gas pattern History: distended abdomen. Dobbhoff tip in gastric body. Nonobstructive bowel gas pattern. Mild nonspecific gastric distention. Scattered surgical clips and bullet fragment which projects over the right sacrum. LVAD and sternotomy wires are unchanged. Cardiomegaly, bilateral pleural effusions, and left lower lobe opacity are also noted.
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Mild nonspecific gastric distention. Overall nonobstructive bowel gas pattern.
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Generate impression based on findings.
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7 day old male with abdominal distention and emesisVIEW: Abdomen AP (one view) 01/19/15 NG tube tip is in a gas distended stomach.Nonobstructive bowel gas pattern. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Normal examination.
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Generate impression based on findings.
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Male, 14 years old.RFO No unexpected RFO identified. Nonobstructive bowel gas pattern. Diaphragm is excluded from field of view. Surgical clips noted in the bilateral pelvic soft tissue. Please seen same day chest radiograph for additional findings.
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No unexpected RFO identified. Nonobstructive bowel gas pattern. Findings discussed by on call resident Dr. Loeff, the attending surgeon, by telephone at 7:29 on 1/20/2015.
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Generate impression based on findings.
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Male 29 years old; Reason: LLQ abd pain History: LLQ abd pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly with spleen measuring 16.8 cm cephalocaudad is seen on coronal image 45.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Given limitation of contrast-enhanced scan, no definite evidence of nephrolithiasis, hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic fat stranding process extends to involve the fascia planes around the common iliac vasculature.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thickening sigmoid colon but bubbles of extraluminal gas in the adjacent mesentery indicating perforation. There is extensive fat stranding in at the entire pelvis most severe in the perisigmoid distribution. Fat stranding is extending along fascial planes in is also extending retroperitoneum and perirectal fascia. There is no evidence of mature abscess. There is no gross free intraperitoneal air except for the aforementioned bubbles of gas in the perisigmoid mesentery.On the prior exam there may have been a few diverticula in the region of the sigmoid colon.No evidence of bowel obstruction. No evidence of small bowel thickening or fibrofatty proliferation to suggest Crohn's disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Signs of sigmoid bowel perforation with extensive associated fat stranding consistent with inflammation secondary to perforation. Etiology unclear. Consider diverticulitis. Correlate clinically for underlying immunocompromised given the splenomegaly. Rule out inflammatory bowel disease although there are no other stigmata on this or on the prior scans for inflammatory bowel disease.
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Generate impression based on findings.
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Reason: 2 days of right sided facial numbness without motor deficit--eyebrows raise equally History: right facial numbness x 2 days with mild HA and dizziness 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.Periventricular and subcortical white matter hypodensities of a moderate degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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No evidence for acute intracranial hemorrhage mass effect or edema. CT is insensitive for the early detection of hemorrhagic cerebral infarction.
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Generate impression based on findings.
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Hip pain and knee pain. Two views of the right hip are provided. The bones appear slightly demineralized, perhaps representing mild osteopenia. Mild osteoarthritis affects the right hip. Components of a penile prosthesis are incompletely imaged on this study. Scattered arterial calcifications are noted.Poorly defined sclerotic foci in the distal femoral diaphysis may represent sequela of chronic bone infarction, but this is equivocal. There is perhaps mild anterior soft tissue swelling, but I see no effusion, nor do I see any frank arthritic changes. Scattered arterial calcifications are noted posteriorly.
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Mild osteoarthritis of the hip and other findings as described above.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are mammographic images of right breast (11/28/14) and ultrasound images of right breast (11/28/14) performed at Advocate Trinity Hospital. The mammographic images are compared to the prior mammograms performed at University of Chicago (11/15/13, 12/4/12). MAMMOGRAPHIC IMAGES OF RIGHT BREAST (11/28/14):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. An ill-defined mass is present at posterior 9 o'clock position. There is a stable intramammary lymph node in anterior upper outer quadrant. No suspicious microcalcifications or areas of architectural distortion are noted. ULTRASOUND IMAGES OF RIGHT BREAST (11/28/14):A hypoechoic mass measuring 10 x 6 mm with partially obscured margins is detected at 9 o'clock position, corresponding to the mass seen on the mammogram. A normal-appearing intramammary lymph node is detected at 9 o'clock position.
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Indeterminate mass in the right breast at 9 o'clock position, for which ultrasound guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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5 -year-old female with hypoxia PULMONARY ARTERIES: A patent left pulmonary artery stent is noted. No definite evidence of pulmonary embolism in the main and segmental pulmonary arteries within the limitation described above.LUNGS AND PLEURA: The posterior basal segment of the right lower lobe is collapsed. There is mucous plugging of the right bronchus intermedius.MEDIASTINUM AND HILA: A patent SVC stent is noted. No significant mediastinal or hilar lymphadenopathy. Ascending aorta is enlarged measuring 3.7 cm in its largest diameter.CHEST WALL: Extensive left body wall collaterals are seen. Multiple vascular coils, surgical clips and a sternotomy wire are noted.UPPER ABDOMEN: Reflux of contrast into the hepatic veins is noted.
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1.Suboptimal examination due to poor bolus. Within this limitation, there is no definite evidence of pulmonary embolism.2.Mucous plugging in the right bronchus intermedius with collapse of the posterior basal segment of the right lower lobe.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable normal axillary lymph nodes.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Reason: Head trauma to back of head with syncopal episode History: headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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61 years, Male. Reason: assess for obstruction History: no bowel movement x 6 days despite bowel prep Non obstructive bowel gas pattern. Large stool burden distributed throughout the colon, with paucity of stool in the rectum. Mild DJD of the lower lumbar spine.
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Non obstructive bowel gas pattern. Large stool burden distributed throughout the colon, with paucity of stool in the rectum.
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Generate impression based on findings.
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Female, 72 years old status post surgery Surgical drains and staples project over the abdomen, but we see no unexpected retained foreign body. Mild osteoarthritis affects the hips, SI joints, and pubic symphysis.
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No unexpected retained foreign body. These findings were discussed with the attending surgeon Dr. Gottlieb by phone at 20:01 1/19/2015 by the resident on call.
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Generate impression based on findings.
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Female, 60 years old s/p robotic vaginal hysterectomy and BSO.RFO trigger: Urgent change in planned procedure. No unexpected radiopaque foreign body seen. Surgical staples course down the midline of the pelvis. Nonobstructive bowel gas pattern. Interstitial gas in the pelvis is likely postoperative in etiology.
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No unexpected radiopaque foreign body. Findings were discussed with the attending physician, Dr. Goodall, via telephone on 1/19/2015 at 18:14 by the radiology resident on call.
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Generate impression based on findings.
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Reason: s/p provox placement into pt with esophagectomy w colonic transposition, laryngectomy now with bleeding History: as above . Patient noted to have pulsating bleeding from mouth with source suspected to be at the provox. Please embolize arterial source adjacent to the provox and any other source of bleeding. Left subclavian artery: No vascular pseudoaneurysm or active extravasation is identified in this distribution. No evidence for arteriovenous fistula. No evidence for vertebral dissection. Left thyrocervical trunk: No vascular pseudoaneurysm or active extravasation is identified in this distribution. No evidence for arteriovenous fistula. No evidence for vertebral dissection. Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. No evidence for carotid dissection. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Left external carotid artery: The left superior thyroidal artery is attenuated. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Left superior thyroidal artery: The right superior thyroidal artery is attenuated. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Right common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. No evidence for carotid dissection. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Right external carotid artery: The right superior thyroidal artery is attenuated. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Right superior thyroidal artery: The right superior thyroidal artery is attenuated. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection. No vascular pseudoaneurysm or active extravasation is identified in this distribution. Right inferior thyroidal trunk: No vascular pseudoaneurysm or active extravasation is identified in this distribution. Left inferior thyroidal artery: No vascular pseudoaneurysm or active extravasation is identified in this distribution. A branch of this vessel travels imediately adjacent to the patient's provox where the suspected source of pulsating bleeding was noted.Intraprocedural arteriograms:Intraprocedural arteriograms of the left inferior thyroidal arteryPostprocedural right external carotid artery: There is a residual component of vascular tumor present predominantly in the sphenoid sinus. Postprocedural left external carotid artery: The tumoral only delayed and mildtumor blush present.Postprocedural left subclavian artery: The intended branch of the left inferior thyroidal artery is occluded.Right common iliac artery: No contraindications to closure device.
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1.Embolization of branch of left inferior thyroidal artery adjacent to bleeding site at the patient's provox.2.Findings were discussed with Dr Blair.
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Generate impression based on findings.
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79-year-old male status post fall Knee: Moderate osteoarthritis affects particularly the medial joint compartment. We see no fracture. Chondrocalcinosis is noted within both the medial and lateral tibiofemoral joint compartments. Arterial calcifications are present in the soft tissues.Pelvis: The bones are demineralized suggesting osteopenia. We see no fracture. Hardware components of a left total hip arthroplasty device are situated in near-anatomic alignment although the distal aspect of the prosthesis is not visualized on this study. There is lucency and expansile remodeling of the underlying acetabulum, which may represent particle wear osteolysis. Moderate osteoarthritis affects the right hip. Severe degenerative disk disease affects the lower lumbar spine.
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Osteoarthritis and other findings as described above without fracture evident.
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Generate impression based on findings.
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27 year-old female with right ankle pain, pelvic pain, lumbar spine pain Lumbar spine: There is bilateral L5 spondylolysis with grade one anterolisthesis of L5 on S1, which we suspect is chronic. We see no definite acute fracture. The disk spaces and vertebral body heights are preserved.Pelvis: Evaluation is slightly limited due to the obliquity of the patient positioning, but we see no fracture or dislocation.Ankle: There is soft tissue swelling particularly medially about the ankle, but we see no fracture. An ossicle posterior to talus likely represents a normal variant os trigonum.
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L5 spondylolysis and spondylolisthesis as well as soft tissue swelling about the ankle.
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Generate impression based on findings.
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The lateral third and fourth ventricles are prominent. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is diffuse periventricular and subcortical hypoattenuation as well as hypoattenuation within the pons. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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1.Periventricular and subcortical hypoattenuation as well as hypoattenuation within the pons is nonspecific but likely related to patient's known CADASIL syndrome. If there is clinical concern for acute ischemia, an MRI is recommended.2.Mildly enlarged ventricles. Given clinical history of CADASIL, this may be secondary to volume loss, although normal pressure hydrocephalus may have a similar appearance and cannot be excluded.
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Generate impression based on findings.
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60 year old male s/p partial nephrectomy. RFO trigger: Urgent change in planned procedure. No unexpected radiopaque foreign body seen. Surgical staples project over the right hemiabdomen. Scattered surgical clips and bilateral JP drains are noted. NG tube tip at GE junction with distal sidehole not visualized but presumably in the distal esophagus. Pneumoperitoneum is likely postoperative in etiology. Nonobstructive bowel gas pattern. Orthopedic hardware in the proximal left femur.
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1.No unexpected radiopaque foreign body.2.NG tube tip at GE junction. Distal sidehole is not visualized but is presumably in the distal esophagus. Findings were discussed with the attending physician, Dr. Shalhav, via telephone on 1/20/2015 at 08:34.
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Generate impression based on findings.
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Prominent ventricles and sulci likely reflect a mild degree of volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. Minimal periventricular and subcortical hypoattenuation is nonspecific but unchanged from the prior exam and likely reflects minimal small vessel ischemic disease. There is no extraaxial fluid collection. Mild calcifications of the distal cavernous carotid and vertebral arteries. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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1.No acute intracranial hemorrhage.2.Periventricular subcortical hypoattenuation is nonspecific but likely is vascular related at this age.
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Generate impression based on findings.
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79-year-old female with history of fall. The bones are demineralized suggesting osteopenia.Left knee: There is a small joint effusion. A bipartite patella is present, a normal variant. Moderate osteoarthritis affects the knee. Faint densities seen on the lateral view at the anterior aspect of the knee may represent loose bodies.Sacrum/coccyx: Mild irregularity at the anterior aspect of S5 is of questionable clinical significance. We see no displaced fracture. Mild osteoarthritis affects the SI joints. There is moderate osteoarthritis at the right hip.Lumbar spine: Mild multilevel degenerative disc disease affects the lumbar spine. Alignment is within normal limits.Thoracic spine: There is no acute fracture or subluxation. Moderate to severe degenerative disc disease affects the thoracic spine extending into the visualized cervical spine.
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Degenerative arthritic changes of the thoracic spine, lumbar spine, and knee without evidence of acute fracture. Other findings as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her cousin. Two standard digital views of both breasts were performed 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 suspicious masses, microcalcifications or areas of architectural distortion are present. Unchanged right benign calcifications and left intramammary lymph node are noted. Right breast biopsy clip unchanged.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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51 years, Male. Reason: 51 y/o ESRD, HTN here with nausea and abdominal pain s/p cath History: nausea Non obstructive bowel gas pattern. Average stool burden. Pelvic vascular calcifications noted. DJD of the lumbar spine. Please see same day chest radiograph report for additional findings.
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Non obstructive bowel gas pattern. Average stool burden.
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Generate impression based on findings.
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5-year-old female with hypoxiaVIEW: Chest AP (one view) 01/20/15 Multiple embolization coils, vascular coils, pulmonary artery and SVC stents are again noted. Cardiothymic silhouette normal. Right lower lobe atelectasis.Disorganized bowel gas pattern.
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Right lower lobe atelectasis.
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Generate impression based on findings.
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56 year old female presents for routine screening mammography. Two standard digital views of both breasts with tomosynthesis were performed 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 suspicious masses, microcalcifications or areas of architectural distortion are present. Benign calcifications again noted.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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73-year-old female with shortness of breath. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No evidence of pulmonary embolism. Pulmonary artery size is within normal limits. No evidence of right heart strain. LUNGS AND PLEURA: Nonspecific left upper lobe micronodule most compatible with prior infection or intrapulmonary lymph node. No focal opacity. No pleural effusion. No suspicious lung nodule or mass.MEDIASTINUM AND HILA: Mild scattered atherosclerotic disease of the aorta and its branches with mild coronary artery calcification. No hilar or mediastinal lymphadenopathy. CHEST WALL: Moderate degenerative changes of the thoracic spine. No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Incompletely imaged mild atrophic right kidney. Hypertrophy of the caudate lobe and widening of the fissures suggestive of chronic liver disease.
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No significant cardiopulmonary abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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Generate impression based on findings.
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Abdominal distentionVIEW: Chest AP and abdomen AP 1/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis bilaterally without pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum.
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Disorganized nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Exam limited due to patient motion.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Mild mucosal thickening of the left maxillary sinus, otherwise the visualized paranasal sinuses and mastoid air cells are clear. A few well-defined lucent lesions within the calvarium are unchanged.
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No evidence of acute intracranial hemorrhage, mass effect or edema. Please note that non-enhanced CT is not sensitive for the early detection of acute ischemic stroke .
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Generate impression based on findings.
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Male; 67 years old. Reason: large AA gradient, no anticoagulation, positive biomarkers; r/o PE History: chest pain, hypoxia PULMONARY ARTERIES: Single small partially occlusive pulmonary embolus a right lower lobe segmental artery extending into a subsegmental branch (series 4, images 217-227). This clot appears adherent to the anterior wall of the artery and is linear and web-like inferiorly, suggestive of chronic PE. The clinical significance of this finding is uncertain. Otherwise, no evidence of acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Mucus plugging causes complete atelectasis of the right lower lobe. Mild left basilar subsegmental atelectasis. Mild diffuse septal thickening, suggestive of pulmonary edema. Small pleural effusions.MEDIASTINUM AND HILA: Moderate cardiomegaly. No pericardial effusion. Moderate coronary artery atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Single right lower lobe segmental pulmonary embolus with appearance suggestive of chronic age. The clinical significance of this finding is uncertain. No evidence of right heart strain.2. Mucous plugging causes complete atelectasis of the right lower lobe.3. Findings suggestive of CHF with cardiomegaly, mild pulmonary edema, and small pleural effusions.PULMONARY EMBOLISM: PE: Positive.Chronicity: Indeterminate.Multiplicity: Single.Most Proximal: Segmental.RV Strain: Negative.
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Generate impression based on findings.
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79-year-old female with headaches after fall and loss of consciousness two weeks ago. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No extra-axial collections. There are nonspecific scattered areas of hypoattenuation in the periventricular and subcortical white matter, which were present on previous exam, and likely represent chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. Redemonstration of dehiscence of the left lamina papyracea, likely congenital or related to past trauma.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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Abdominal distentionVIEW: Abdomen AP 1/19/15 NG tube tip in the stomach. Disorganized nonobstructive bowel gas pattern. The previously noted dilated bowel loops have improved in the interval. No pneumatosis or pneumoperitoneum.
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Interval improvement in the bowel dilation with no pneumoperitoneum.
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Generate impression based on findings.
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78 years, Male. Reason: Check G tube placement s/p Foley insertion after original G tube fell out. Contrast injected through a Foley catheter opacifies the stomach with normal gastric fold pattern visualized. The tip of the tube projects over the gastric body on both AP and cross table lateral views, and no extraluminal contrast is seen. Nonobstructive bowel gas pattern. No free air seen on cross table view. Residual colonic contrast is noted, with round opacity in the right upper quadrant likely representing contrast within a high hepatic flexure; this correlates with colonic positioning seen on recent prior CT.
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Proper positioning of Foley catheter within the stomach as described above. No extraluminal contrast identified.
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Generate impression based on findings.
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72-year-old female with history of ESRD on hemodialysis, hypertension, CHF, cirrhosis, GI bleed (distal ileum/diverticular) presenting with hematochezia for two days. Evaluate. CT ANGIOGRAM: Diffuse severe atherosclerotic calcifications affect the abdominal aorta and its branches. Moderate atherosclerotic calcifications affect the origin of the celiac axis and superior mesenteric artery origins. The celiac axis (common hepatic artery, left gastric artery, and splenic artery) and SMA are patent. There is severe narrowing at the ostia of the renal arteries bilaterally. The IMA is patent. Again noted is partial to complete thrombosis extending from the right common iliac artery through the right external iliac artery. Femoral femoral bypass graft is present and patent. No evidence of dissection or thrombus in the abdominal aorta, aforementioned branches, left common iliac artery, or left external/internal iliac arteries.ABDOMEN:LUNG BASES: Interval increase in the size of the large pleural effusion with compressive atelectasis. New small left pleural effusion with mild associated atelectasis. Bilateral groundglass opacities likely edema. Lower lobe granuloma.Cardiomegaly with severe coronary artery atherosclerotic calcifications as well as calcifications affecting the aortic and mitral valves.LIVER, BILIARY TRACT: No significant change in hypodense hepatic lesions which are too small to characterize. No intra-or extrahepatic biliary ductal dilatation.Reflux of contrast into the IVC with mild heterogeneity of the hepatic parenchyma; findings suggestive of mild hepatic congestion.SPLEEN: No significant abnormality notedPANCREAS: Stable mild prominence of the pancreatic duct.ADRENAL GLANDS: Stable left adrenal gland thickening.KIDNEYS, URETERS: Kidneys are atrophic bilaterally.RETROPERITONEUM, LYMPH NODES: See above for CT angiogram findings.BOWEL, MESENTERY: Diffuse large ascites without evidence of small bowel obstruction. No specific findings to suggest colitis. No evidence of GI bleed in the arterial or portal venous phase. Metallic density in the terminal ileum likely an endoscopically placed clip.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse large ascites without evidence of small bowel obstruction. No specific findings to suggest colitis. High-density in the transverse colon may be related to prior contrast material administration. No evidence of GI bleed in the arterial or portal venous phase. Metallic density in the terminal ileum likely an endoscopically placed clip.Nonspecific calcified focus measuring 1.4 cm (series 3, image 397) in the right hemipelvis.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality noted
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1.No evidence of gastrointestinal bleed. 2.Unchanged large volume ascites and diffuse anasarca. Mild interval increase in the large right pleural effusion and interval development of trace left pleural effusion. Reflux of contrast into hepatic veins and suggestion of mild hepatic congestion. Overall, these findings could be related to some component of cardiac congestion.3.No interval change in complete thrombus extending from right common iliac artery through the right external iliac artery. Patent femoral-femoral bypass graft. Other CT angiogram findings as detailed above.
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Generate impression based on findings.
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Call back from screening mammogram for a new mass in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A circumscribed mass with thin halo is redemonstrated at 12 o'clock position in the right breast, suggesting benign etiology.Focused ultrasound was performed for the right breast. Detected is a circumscribed, anechoic mass measuring 22 x 17 mm at 12 o'clock position, consistent with a cyst.
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No mammographic evidence of malignancy. Benign cyst in the right breast. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations 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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CLINICAL DATA: Age: 59 years. Sex : Male. Indication: Reason: SBO History: Abdominal pain, emesis. LUNG BASES: Small left pleural effusion and associated atelectasis, and mild interlobular septal thickening in the right lower lobe.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys with cysts similar to prior.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several loops of mildly dilated small bowel in the lower abdomen and pelvis appear similar to prior, measuring up to approximately 2.8 cm. Transition point seems to be in the lower mid abdomen, and there is a short segment of bowel wall thickening at the suspected transition point (3/98, also coronal image 55). Small amount of adjacent abdominal and pelvic ascites again seen, nonspecific but may represent bowel wall injury. No pneumatosis, no free air.Small bilateral fat containing inguinal hernias, with a small amount of fluid in the right hernia sac. No bowel containing hernia.NGT is within the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerosis affects the visualized vasculature. A right iliac vein stent is noted, however given the arterial phase of contrast the venous vasculature cannot be adequately evaluated. A right femoral artery bypass graft is noted without internal contrast opacification, suggesting occlusion.
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Partial small bowel obstruction with transition point in the lower mid abdomen. At the transition point is a short segment of bowel wall thickening, so underlying neoplasm, infection or inflammation otherwise possible etiologies. There is adjacent small ascites, which may represent bowel injury in the setting of obstruction.
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Generate impression based on findings.
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Fall, rule out bleeding, bloody nose and face No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal volume loss commensurate with age. No extra-axial collections. No hydrocephalus.There is mild irregularity/buckling involving the left nasal bone anteriorly suspicious for fracture. There is overlying soft tissue swelling. No other fracture is seen. Orbits, paranasal sinuses, and zygomatic arches remain intact. Mandible including the temporomandibular joints are intact. Pterygoid plates are intact.Trace mucosal thickening in the ethmoid sinuses and small mucous retention cysts in the maxillary sinuses. Mastoid air cells are clear. Calvarium is intact. Degenerative changes are seen at the anterior atlantoaxial joint with retro-odontoid soft tissue with calcifications compatible with CPPD.
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1. No evidence of acute intracranial hemorrhage or mass effect. 2. Mild irregularity involving the left nasal bone anteriorly suspicious for fracture.Findings of nasal bone fracture were not reported in the initial preliminary wet read. Dr. Ali discussed the findings with Dr. Cheema at 1/20/2015.
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Generate impression based on findings.
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Male; 75 years old. Reason: r/p PE History: SOB, positive ddimer, CABG on 1/5/15 PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Large left pleural effusion with moderate left basilar compressive atelectasis.MEDIASTINUM AND HILA: Mild cardiomegaly with a small amount of pericardial fluid. Moderate coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No acute pulmonary embolus.2. Large left pleural effusion with adjacent compressive atelectasis. The effusion is nonspecific and may be related to recent cardiac surgery.3. Mild cardiomegaly.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Prematurity evaluate ET tubeVIEW: Chest AP and abdomen AP 1/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The umbilical venous catheter tip in the right atrium. The umbilical arterial catheter tip at T10. Cardiothymic silhouette normal. Minimal atelectasis in the right upper lobe and left lower lobe. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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ET tube tip below thoracic inlet and above the carina.
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Generate impression based on findings.
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Prematurity evaluate ET tubeVIEW: Chest AP and abdomen AP 1/20/15 ET tube tip in the right mainstem bronchus. The umbilical venous catheter tip in the right portal vein. The umbilical arterial catheter tip at T10. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Patchy atelectasis in the right lower lobe and left lower lobe. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Malpositioned ET tube.
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Generate impression based on findings.
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There is redemonstration of a relatively circumscribed homogeneously enhancing mass within predominantly the superficial lobe of the right parotid gland. It currently measures 3.3-cm transverse by 3.2-cm AP by 3.7 cm CC. This previously measured 2.7 x 2.8 x 3.6 cm. There are a few small areas of hypoenhancement specially along the inferior aspect of the mass. There are few coarse calcifications again scattered throughout the mass, increased in number since the prior exam especially within the center of the mass. The mass abuts the right retromandibular vein, predominantly remaining lateral, as well as minimally posterior to it along its medial aspect. The medial portion of the mass does extend between the mandible and the inferior right mastoid. There is no extension through the right stylomandibular canal. The anteromedial margin of the mass does abut the adjacent right posterior margin of the right mandibular ramus without osseous erosion. There again is a smaller soft tissue nodule superior anterior aspect of the gland which appears slightly increased in prominence since the previous exam although only measuring 8 x 6 mm, possible representing a small intraparotid lymph node. Fat remains within the mandibular foramen bilaterally.PHARYNX/LARYNX: There is a right-sided tonsillith. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the remaining salivary glands is unremarkable. The previously identified dominant hypodense lesion in the right lobe of the gland appears present but less distinct and smaller in size. There is suggestion of minimal linear hypodensity in the left lobe remaining.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is atherosclerotic calcification along the right carotid bifurcation. There is a tiny nonspecific ground glass opacity medial right lung apex, not included within the field of view on the prior exam. There is a small right apical bleb and mild apical pleural thickening bilaterally. There are scattered residual dental roots within the maxilla, one of which is associated with periapical lucency.
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1. Interval increased size of circumscribed right parotid mass predominantly in the superficial portion of the gland, remaining lateral to the right retromandibular vein, although a portion of the mass extends between the mandibular ramus and mastoid. No stylomandibular canal extension.2. No cervical lymphadenopathy. Small probable intraparotid lymph node along the superior aspect of the gland, with very minimal increased size, not pathologically enlarged.3. Slight interval decrease in prominence of dominant but small right thyroid lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.4. Nonspecific tiny ground glass opacity at the right lung apex which may be infectious/inflammatory etiology. Please see separate concurrent CT chest report for further details.
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Generate impression based on findings.
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IntubatedVIEW: Chest AP 1/20/15 ET tube tip below thoracic inlet and above the carina. Feeding tube in place. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe and left lower lobe increased in the interval. No pleural effusion or pneumothorax.
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Bilateral patchy atelectasis in the right upper lobe and left lower lobe increased in the interval.
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Generate impression based on findings.
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59-year-old male with headache, history of drug use. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. The ventricles and sulci are within normal limits for age. No extra-axial collections. Again noted are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes. Unchanged focus of encephalomalacia in the left frontal lobe likely chronic infarct.There has been interval increase in mucosal thickening of the bilateral maxillary and ethmoid sinuses. Evidence of chronic right mastoid disease. Old left zygomatic arch fracture. Calvarium is otherwise intact.
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1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Interval increase in paranasal sinus opacification.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable left intramammary and bilateral axillary lymph nodes. Stable left outer breast asymmetry.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Female; 49 years old. Reason: rule out PE in 49yo F patient with acute onset chest pain History: left-sided chest pain PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Mild bibasilar dependent atelectatic changes. 4 mm ovoid pulmonary nodule in the left lower lobe at the posterior costophrenic angle, which may be post infectious or inflammatory etiology (image 166, series 9). No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy. Residual thymic tissue.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No acute pulmonary embolus or other significant cardiopulmonary abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Respiratory distress intubationVIEW: Chest AP 1/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette at the upper limits of normal. Patchy atelectasis in the right upper lobe and left lower lobe in a background of chronic lung disease. No pleural effusion or pneumothorax.
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Patchy atelectasis bilaterally in a background of chronic lung disease.
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Generate impression based on findings.
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Male 55 years old; Reason: 55 y/o male with AML s/p 2 cycles of consolidation chemo. RLQ/Flank shooting pain worsening x 5 days. U/S completed with prelim indicating no major sources of pain History: pt RLQ/flank shooting pain x5 days, spreading across and behind abdomen at times. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Tubular, enhancing structure, presumably in the common, right lower quadrant, with periappendiceal inflammation. No evidence of extraluminal air to suggest rupture. No discrete fluid collection formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes of the spine.OTHER: No significant abnormality noted.
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1.Uncomplicated appendicitis, further described above.Findings discussed with Lauren Ziskind, NP at 8:40 a.m. on 1/20/2015.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable benign calcifications are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Seizures hypoxiaVIEW: Chest AP 1/20/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Gastrostomy tube in place. Epidural catheter in place. Bilateral lung opacities at the right lower lobe and left lower lobe likely atelectasis with small bilateral pleural effusions. No evidence of pneumothorax.
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Bilateral lung opacities likely atelectasis in the right lower lobe and left lower lobe.
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Generate impression based on findings.
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Ms. Serafin is a 39 year old female with a personal history of right breast mastectomy with reconstruction for metastatic IDC in January 2014. She has no current breast related complaints. Three standard views of the left breast with two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Focal asymmetries in the left inferior breast (best seen on the ML view) and the left retroareolar breast (best seen on the CC view) disperse into normal breast parenchyma on spot compression imaging. There are no new suspicious microcalcifications or areas of architectural distortion identified 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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3-year-old female with fever and hypoxiaVIEW: Chest AP (one view) 01/19/15 Mild peribronchial thickening suggestive of bronchiolitis/reactive airway disease. Patchy multifocal opacities in bilateral lower lobes likely reflects atelectasis. Small left pleural effusion.
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Bronchiolitis/reactive airway disease with bibasilar atelectasis and small left pleural effusion.
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Generate impression based on findings.
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39-year-old female status post knee manipulation. Hardware components of a right total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Alignment is anatomic. There are no acute fractures. There is perhaps a small joint effusion.
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Right total knee arthroplasty as above.
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Generate impression based on findings.
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53-year-old female with history of lower back pain. The bones are demineralized suggesting osteopenia. There is severe degenerative disc disease affecting of L4-5 and L5-S1. Moderate degenerative disc disease affects L3-4. Moderate facet joint osteoarthritis most notably in the lower lumbar spine. There is a grade 1 anterolisthesis of L4 on L5.
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Degenerative disc disease and other findings as above.
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Generate impression based on findings.
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35-year-old male with history of HIV, alcohol withdrawal, presenting with seizures. There is no evidence of intracranial hemorrhage. Mild global parenchymal volume loss is unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect 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 evidence of intracranial hemorrhage or mass effect. If there is continued suspicion for an underlying structural lesion, consider MRI for further evaluation.
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Generate impression based on findings.
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Female; 55 years old. Reason: r/o PE History: met breast CA with SOB PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Severe upper lobe predominant centrilobular emphysema.Again there is improved aeration with mildly decreased bilateral basilar atelectasis compared to the prior exam.Anterior subpleural post radiation and post surgical changes in the right upper and middle lobes.Reference right apical nodule (image 22, series 9) measures 10 mm x 6 mm, previously 10 x 6 mm.Stable small left apical scar-like opacity (image 29, series 9).No new pulmonary nodules identified.No pleural effusions.MEDIASTINUM AND HILA: Normal heart size. Interval resolution of pericardial effusion.Left chest Port-A-Cath catheter tip near the superior cavoatrial junction.Mixed osteolytic and sclerotic lesion in the sternum with presternal and retrosternal soft tissue extension and involvement of the pericardium, similar to prior study.Right low paratracheal enlarged lymph node (image 110, series 8) has mildly decreased measures 14 mm, previously 19 mm.CHEST WALL: Sternal mixed osteolytic/blastic sternal metastasis with retrosternal and presternal extension as noted above. Status post right mastectomy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.No acute pulmonary embolus.2.Interval resolution of pericardial effusion.3.Sternal osteolytic/blastic lesion with presternal and retrosternal soft tissue extension, similar to prior study.PULMONARY EMBOLISM: PE: Negative..Chronicity: Not applicable..Multiplicity: Not applicable..Most Proximal: Not applicable..RV Strain: Not applicable..
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Generate impression based on findings.
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11 year old male with sob, evaluate for consolidation. VIEWS: Chest PA/lateral (two views) 1/19/15 at 23:19. Mild peribronchial wall thickening and subtle right lower lobe airspace opacities. Cardiac silhouette normal in size. Metallic densities projecting over the abdomen are presumably external to the patient. Elevated BMI.
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Reactive airways disease/bronchiolitis pattern with new subtle right lower lobe airspace opacities suspicious for pneumonia.
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