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Generate impression based on findings.
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70 year old male s/p NG tube placement. Lateral right hemiabdomen is excluded from the field of view. Feeding tube tip in the gastric body. Mild diffuse bowel loop dilatation is compatible with generalized ileus pattern. Surgical clips project over the right hemipelvis.
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Feeding tube tip in gastric body. Mild ileus pattern.
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Generate impression based on findings.
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58-year-old male with shortness of breath, tachycardia, and hemoptysis. The study is suboptimal secondary to motion artifact.PULMONARY ARTERIES: No evidence of pulmonary embolism. Pulmonary artery size at the upper limits of normal. No evidence of right heart strain. There is decreased perfusion to the right upper lobe which is likely chronic in nature.LUNGS AND PLEURA: Lower lobe predominant mild mosaic attenuation with ground glass opacities and basilar septal thickening suggestive of mild pulmonary edema. Bronchial thickening which is consistent with the patient's known history of asthma. Small right pleural effusion. No focal air space opacity. Scattered pulmonary micronodules without significant change.MEDIASTINUM AND HILA: Cardiomegaly without pericardial effusion. Left ventricular wall thickening. Mild aortic atherosclerotic disease with moderate coronary calcifications. Stent in the circumflex artery. Mildly enlarged mediastinal lymph nodes which are similar in size to previous study. Additional calcified mediastinal hilar lymph nodes compatible with healed granulomatous disease. CHEST WALL: Mild degenerative changes of thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Thickened distal esophagus as seen in prior study.Punctate calcifications in the liver and spleen likely represent healed granulomatous disease.
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No evidence of pulmonary embolism. Findings suggestive of mild CHF and bronchial asthma.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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66 years, Female. Reason: Check NJ Feeding Tube Placement History: Check NJ Feeding Tube Placement Limited view of the abdomen. Nonspecific paucity of bowel gas. NJ tube tip overlies the 2nd segment of duodenum. Oral contrast material seen in the rectum. Biliary stent and drain partially seen.
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NJ tube tip overlies the 2nd segment of duodenum.
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Generate impression based on findings.
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13 year old female with trauma, lateral mid foot pain. VIEW: Left foot AP, oblique, lateral (3 views) 1/19/15 at 23:53. Normal alignment without fracture or dislocation. No soft tissue abnormalities.
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Normal examination.
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Generate impression based on findings.
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70 year old male s/p Dobbhoff placement. Pelvis excluded from field of view. Dobbhoff tube tip in gastric body. Nonobstructive bowel gas pattern with residual contrast material noted in the colon. Midline surgical staples and bilateral nephroureteral stents are present.
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Dobbhoff tube tip in gastric body.
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Generate impression based on findings.
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52-year-old male with hypotension, leukocytosis in setting of Clostridium difficile which is refractory to p.o. Flagyl. Evaluate for abdominal perforation. ABDOMEN:LUNG BASES: Interval increase in large left pleural effusion with associated basilar compressive atelectasis. Interval increase in right pleural effusion, now small to moderate sized with associated compressive atelectasis.Mild cardiomegaly. Large pericardial effusion which has increased in size compared to previous exam. Mitral and aortic valvular calcifications are noted.LIVER, BILIARY TRACT: Too small to characterize few scattered hepatic hypoattenuating foci. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant interval change in severe bilateral hydroureteronephrosis with bilaterally enhancing ureteral wall and bilateral extensive perinephric inflammatory changes. Interval lessening of gas in the collecting systems. Superimposed infection cannot be excluded. Nonobstructive left renal nephrolithiasis is unchanged.RETROPERITONEUM, LYMPH NODES: There is retroperitoneal lymphadenopathy. Index left para-aortic lymph node measures 2.5 x 1.9 cm (series 3, image 103), previously measuring 2.5 x 1.8 cm.BOWEL, MESENTERY: Stable large diffuse ascites.BONES, SOFT TISSUES: Sclerotic lesion in left lateral sixth rib.OTHER: No significant abnormality notedPELVIS: Streak artifact from bilateral femoral head/neck hardware limits evaluation.PROSTATE, SEMINAL VESICLES: Post operative changes of penectomy. There is an ill-defined 2.7 x 4.3 fluid and gas containing collection with rim enhancement at the base of the penis which is new compared to the previous examination and highly suspicious for infection (series 3, image 200).BLADDER: Postoperative changes of ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse large ascites without evidence of small bowel obstructionBONES, SOFT TISSUES: Bilateral femoral head and neck surgical hardware without evidence of complications.OTHER: No significant abnormality noted
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1.No significant change in bilateral severe hydroureteronephrosis with bilateral ureteral wall enhancement and perinephric fat stranding. Given stability, chronic infection suspected with acute component not excluded. 2.New fluid collection with rim enhancement and gas at the base of the penis. Differential considerations include early abscess versus postoperative fluid collection.3.Interval increase in size of large pericardial effusion.4.Interval increase in large left and small to moderate sized right pleural effusion with associated compressive atelectasis.5.Large volume ascites.6.Stable retroperitoneal lymphadenopathy.Findings relayed to Dr. Riedinger over the phone at approximately 10:35 a.m.
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Generate impression based on findings.
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14 year old male with stab to left chest. VIEW: Chest AP (one view) 1/20/15 at 5:08. The aortic arch, cardiac apex, and stomach are left sided. The cardiac silhouette is normal in size. No airspace opacities, pleural effusions or pneumothorax. Gaseous distension of the stomach. Irregular linear densities along the left abdominal wall may reflect soft tissue injury.
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Normal chest.
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Generate impression based on findings.
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76-year-old female with recent craniotomy and meningioma resection, now with headache. Redemonstration of postsurgical findings related to recent bicoronal craniotomy and resection of large right frontal meningioma, including air, blood products, and surgical packing material subjacent to the craniotomy site. There has been mild decrease in pneumocephalus. Persistent deformity of the right frontal lobe and right lateral ventricle, as well as interval worsening of bifrontal edema, which extends into the anterior parietal lobes, more extensive on the right. Multiple frontoparietal hyperdense foci, right greater than left, consistent with subarachnoid and intraparenchymal blood products have evolved. Small subdural along the falx. Trace residual midline shift to the left is similar to prior.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarial screws/fixation hardware, subgaleal drain, a small subgaleal hematoma, and scalp staples are unchanged.
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1. Evolving postsurgical changes related to recent craniotomy and resection of large right frontal meningioma, including blood products and surgical packing material. There is increase in bilateral frontoparietal edema, more extensive on the right with slight increase in downward mass effect. No significant effacement of the suprasellar cistern or uncal herniation. 2. Mild increase in density of frontoparietal subarachnoid and intraparenchymal blood products, right greater the left.
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Generate impression based on findings.
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7 month old female with cough, fever, tachypnea. VIEWS: Chest AP (one view) 1/20/15 at 5:54. There is mild peribronchial wall thickening and right upper lobe atelectasis with volume loss and mild rightward tracheal deviation. The right cardiac border is obscured by the right upper lobe opacity. Cardiac size is normal. Gaseous distension of bowel loops partially imaged.
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1. Bronchiolitis/reactive airways disease pattern with right upper lobe atelectasis. 2. Gaseous distension of bowel loops partially imaged.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Right maxillary mucus retention cyst/polyp, otherwise the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality. Please note that CT is not sensitive for the early detection of acute ischemic stroke and if there is strong clinical concern, an MRI may be considered.
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Generate impression based on findings.
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Male 52 years old; Reason: gastric mass on CT scan Oct 2014 History: gastric mass on CT scan Oct 2014 CHEST:LUNGS AND PLEURA: Interval improvement of basilar air space opacities. 6-mm nodule in the posterior right lung (3:69) could be postinfectious, but follow-up is recommended. Other micronodules at the same level in the left posterior lung also may be postinfectious in nature. 4mm nodule along minor fissure in RML. Mild bibasilar atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate, nonobstructing stone in the mid left kidney. Stable cyst in the upper pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Few prominent stable retroperitoneal nodes are not enlarged by size criteria.BOWEL, MESENTERY: Grossly stable calcified soft tissue mass along the lesser curvature of the stomach measuring approximately 2.6 x 2.7 cm (3:110).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable nonspecific lucency in the posterior left ilium.OTHER: No significant abnormality noted
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1.Grossly stable calcified soft tissue mass along the gastrohepatic ligament, of which the differential remains GIST tumor (favored), carcinoid or a calcified node.2.Bilateral pulmonary nodules as described above could be postinfectious, but follow-up is recommended to ensure stability.
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Generate impression based on findings.
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7 year old male with cough, fever. VIEWS: Chest AP/lateral (two views) 1/20/15 at 0601. The aortic arch, cardiac apex, and stomach are left sided. Normal heart size. Patchy opacity in the superior segment of the right lower lobe is suspicious for infection. Subsegmental retrocardiac atelectasis.
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Patchy opacity in the superior segment of the right lower lobe is suspicious for infection.
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Generate impression based on findings.
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29 year-old female status post colectomy with primary anastomosis. Patient now with bilious NG tube output, tachycardia. There is concern for leak or abscess. Evaluate. ABDOMEN:LUNG BASES: New small right pleural effusion with associated atelectasis. Mild left basilar atelectasis.LIVER, BILIARY TRACT: Post operative changes of right hepatectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nasogastric tube with tip in the antrum/first portion of the duodenum.Small pneumoperitoneum is presumably postoperative in etiology. Postoperative changes of colectomy with ileostomy takedown. No evidence of contrast extravasation at the anastomotic site to suggest a leak. Moderate dilation of proximal small bowel loops measuring up to 4 cm with a transition point in the left lower quadrant (series 3, image 107) compatible with small bowel obstruction. New small volume ascites. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Small focus of gas within the bladder is likely iatrogenic in etiology secondary to bladder Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Right lower quadrant anterior abdominal wall soft tissue stranding and gaseous foci is likely postoperative in etiology.OTHER: No significant abnormality noted
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1.Findings consistent with small bowel obstruction with transition point in the left lower quadrant. 2.Interval development of small volume ascites, which is nonspecific.3.Postoperative changes of colectomy including small pneumoperitoneum without evidence of anastomotic leak. 4.New small right pleural effusion with associated atelectasis.
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Generate impression based on findings.
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Female, 64 years old, with esophageal cancer, staging exam. Extensive treatment related findings are again seen including infiltration of the fascial planes, thickening of the platysma, supraglottic mucosal edema and a retropharyngeal effusion. These findings are not significantly changed. Note is made of mild asymmetric hyper enhancement of the left aryepiglottic fold and false vocal fold which may also be related to therapy.The appearance of an infiltrative lesion involving the right supraclavicular fossa and levels 4 and 5 remains much improved relative to the examination of 6/19/14. However, since the immediate prior examination, a small nodule of enhancement has returned at level 4, adjacent to a focus of calcification, and measuring 9 x 8 mm (image 53 series 6). No other new or discrete enhancing lesions are seen. The salivary glands are free of focal lesions. A punctate hypoattenuating focus is unchanged in the right thyroid lobe. The cervical vessels remain patent. Septal thickening and paraseptal cystic changes are demonstrated in the lung apices.
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1. Although the appearance of an infiltrative lesion involving the lower right neck remains much improved relative to the examination of 6/19/14, since the immediate prior study a subcentimeter nodule of enhancement has recurred at level 4.2. No definite evidence of additional lesions is seen. Extensive treatment related findings are redemonstrated. Asymmetric hyper enhancement of the left aryepiglottic fold and false vocal fold may also be related to treatment, but attention should be given to this area on subsequent studies.
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Generate impression based on findings.
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CHEST:LUNGS AND PLEURA: Minimal bibasilar atelectasis. No significant pleural effusion or consolidation. Left apical pulmonary nodule measuring approximately 8 mm (5/17), with an additional right lower lobe peripheral nodule, which should be followed on subsequent low dose CT lung without contrast according to Fleischner Society recommendations (3-6 mo follow up).MEDIASTINUM AND HILA: Heart size upper limits of normal, and there is minimal pericardial fluid. Mild coronary artery calcifications. Although this exam is not designed for evaluation of the aorta, the descending aorta measures approximately 3.5 cm, and the ascending aorta measures approximately 3 cm. Mild atherosclerotic calcifications affect the aorta and its branches.CHEST WALL: Degenerative changes affect the visualized spine. Enlarged, heterogeneous thyroid incompletely evaluated on this exam.ABDOMEN:LIVER, BILIARY TRACT: Small gallstones, without findings of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Mildly atrophic pancreas.ADRENAL GLANDS: Subtle nodularity of the left adrenal gland, nonspecific.KIDNEYS, URETERS: Bilateral hypoattenuating renal foci, likely cysts but incompletely evaluated on this limited study. Right renal parenchymal calcification, may be a nonobstructing stone a nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix is within normal limits.BONES, SOFT TISSUES: Nonspecific sclerotic focus in the right T5 vertebral body, may represent a benign bone island.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Coarse calcification in the uterus likely related to fibroid. Pessary is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Limited evaluation of the aorta, with subtle ascending arch ectasia as above.2.Pulmonary nodules, for which follow-up is recommended.
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Generate impression based on findings.
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38-year-old female with right lower quadrant and right upper quadrant pain. Evaluate for appendicitis versus kidney stones. ABDOMEN:LUNG BASES: Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: Numerous hypoattenuating foci in both lobes of the liver are too small to characterize. There is a hypoattenuating focus in segments 6 of the liver (series 3, image 48) consistent with a simple cyst. No CT evidence of radiopaque cholelithiasis or inflammatory changes to suggest cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No obstructing nephrolithiasis or ureteral calculus. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered mildly prominent pericecal lymph nodes are nonspecific. Nonspecific enlarged bilateral pelvic lymph nodes are identified.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis. The appendix is not identified; however, no secondary signs of appendicitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No evidence of appendicitis or nephrolithiasis as clinically questioned. 2.Nonspecific bilateral mildly enlarged pelvic and pericecal lymph nodes without associated inflammatory changes.3.Multiple diffuse hepatic hypoattenuating lesions are too small to characterize. Differential considerations include benign biliary duct hamartomatous process (von meyenburg complex) versus multiple cysts, favoring the former.
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Generate impression based on findings.
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There post-treatment findings in the neck, without definite evidence of tumor in the tongue base. PHARYNX/LARYNX: 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 salivary glands is unremarkable. The thyroid remains heterogeneous with a dominant stable 8 mm right-sided nodule. There is an adjacent persistent coarse calcification.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: Postoperative changes from right axillary lymph node dissection and right breast prosthesis placement are noted, which are partially imaged. There are minimal emphysematous changes and biapical pleuroparenchymal scarring. Very minimal cervical spondylotic changes are noted.
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1. No evidence of locoregional tumor recurrence of significant lymphadenopathy.2. Stable heterogeneous appearance of the thyroid gland.
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Generate impression based on findings.
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60 year-old female with altered mental status, evaluate for acute intracranial process. Mild motion artifact and patient positioning slightly limit evaluation. 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. Prominence of the extra-axial CSF spaces at the convexity also likely related to volume loss.There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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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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ConstipationVIEW: Abdomen AP 1/19/15 Moderate amount of fecal burden without obstruction. Disorganized nonobstructive bowel gas pattern. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum.
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Moderate amount of fecal burden.
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Generate impression based on findings.
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Increasing oxygen requirementVIEW: Chest AP and abdomen AP 1/19/15 NG tube tip in the stomach. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. Mildly distended bowel loops without obstruction. No pneumatosis or pneumoperitoneum.
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Minimal atelectasis in the left lower lobe.
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Generate impression based on findings.
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59-year-old female with history of bilateral breast cancers, now with right breast upper outer quadrant thickening. Ultrasound findings suggestive of mass versus necrosis/scarring. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 2.3 x 1.5 cm at the 10 o’clock position with increased vascularity, 4 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and an inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the anterior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Schacht and Vasnani. Dr. Schacht was present during the procedure at all times.
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Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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CVA, muscle weakness No intracranial hemorrhage is identified. There is extensive encephalomalacia involving the right frontal and to a lesser extent the right temporal and parietal lobes as well as the basal ganglia consistent with prior infarct. Hypoattenuation seen extending into the right centrum frontal centrum semi-ovale and volume loss along the right cerebral peduncles compatible with Wallerian degeneration. There is also evidence of chronic infarct involving the right posterior cerebellar hemisphere. There is ex vacuo dilatation of the right lateral ventricle. No hydrocephalus.Additional scattered areas of hypoattenuation in the bilateral periventricular and subcortical white matter are nonspecific but favored to represent chronic small vessel ischemic changes. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. Degenerative changes at the bilateral temporomandibular joints.
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1. No evidence of acute intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Chronic right frontotemporoparietal infarct including the right basal ganglia. Chronic right cerebellar infarct.
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Generate impression based on findings.
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Evaluate ET tubeVIEW: Chest AP 1/20/15 ET tube tip immediately above the carina. Esophageal temperature probe tip at the GE junction. The umbilical venous catheter tip in the umbilical vein. The umbilical arterial catheter tip at T4. Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax.
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Endotracheal tube immediately above the carina.
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Generate impression based on findings.
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Evaluate pneumothoraxVIEW: Chest AP and abdomen AP 1/20/15 ET tube tip immediately above the thoracic inlet. NG tube tip in the stomach. Umbilical lines unchanged. The two right chest tubes are unchanged. Cardiothymic silhouette normal. There is a small right subpulmonic pneumothorax unchanged. Diffuse atelectasis bilaterally not significantly changed. Probable bilateral small pleural effusions. Absent bowel gas without pneumatosis or pneumoperitoneum. There is surgical drain in the lower abdomen.
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Right small subpulmonic pneumothorax unchanged.
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Generate impression based on findings.
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15-year-old male with chest wall tenderness in patient with cerebral palsyVIEWS: Chest AP/lateral (two views) 01/19/15 Spinal fixation rods are again noted. Cardiothymic silhouette is normal. No pleural effusions or pneumothorax. Left retrocardiac atelectasis.
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Left retrocardiac atelectasis.
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Generate impression based on findings.
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TachypneaVIEW: Chest AP 1/20/15 NG tube tip in the stomach. Cardiothymic silhouette at the upper limits of normal. Increased atelectasis in the left lung new from prior study. No pleural effusion or pneumothorax.
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Interval increase in the atelectasis in the left lung.
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Generate impression based on findings.
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15-year-old female for evaluation of pelvic ring injuryVIEWS: Pelvis AP (4 views) 01/20/15 Minimally displaced oblique fracture through the left superior pubic ramus. Buckling of the left sacral arcuate lines is suggestive of a fracture through the left sacrum.
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Minimally displaced oblique fracture through the left superior pubic ramus. Buckling of the left sacral arcuate lines is suggestive of a fracture through the left sacrum.
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Generate impression based on findings.
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59 years, Male. Reason: 59M w pSBO by CT but no prior surgery, please evaluate for location and etiology of obstruction. History: abdominal pain Distended loops of small bowel are again seen centrally. There is oral contrast material in the decompressed small bowel in the left hemipelvis.Enteric tube tip overlies the gastric body. Right iliac stents noted.
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Distended loops of small bowel are again seen centrally. There is oral contrast material in the decompressed small bowel in the left hemipelvis.
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Generate impression based on findings.
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15-year-old female status post traumaVIEWS: Pelvis AP (one views) 01/19/15 There is a minimally displaced fracture of the superior left pubic ramus. Buckling of the left sacral arcuate lines is suggestive of a fracture through the left sacrum.
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Minimally displaced fracture of the superior left pubic ramus. Buckling of the left sacral arcuate lines is suggestive of a fracture through the left sacrum.
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Generate impression based on findings.
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Male; 45 years old. Reason: ILD History: Assess type and extent LUNGS AND PLEURA: Low lung volumes with severe lower lobe predominant interstitial lung disease. Moderate reticular opacities, architectural distortion, severe traction bronchiectasis and bronchiolectasis, and some honeycombing, in a pattern consistent with UIP. This is confluent in some regions resulting in consolidation.Small, scattered calcified granulomata.No pleural effusions.MEDIASTINUM AND HILA: Moderate cardiomegaly. Small likely physiologic pericardial effusion. No visible coronary artery calcifications. Dilated main pulmonary artery measuring up to 3.8-cm, suggestive of pulmonary arterial hypertension. No definite mediastinal or hilar lymphadenopathy, though evaluation is limited without IV contrast. Patulous esophagus, suggestive of dysmotility.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Severe interstitial lung disease in a pattern consistent with UIP. Patulous esophagus could indicate scleroderma.
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Generate impression based on findings.
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Ms. Boodro is a 61 year old female with a personal history of right breast mastectomy in 2009 with implant based reconstruction for IDC/DCIS followed by chemoradiation and hormonal therapy. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. Scattered benign calcifications are present.
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Scattered benign calcifications in the left breast. 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Female, 57 years old, status post basilar tip aneurysm coiling with elevated PTT, assess subarachnoid hemorrhage. A large basilar tip coil mass is redemonstrated obscuring visualization of the brain on several slices.A small amount of intraventricular blood product layering within the occipital horns demonstrates interval evolution appearing less dense than before and perhaps slightly reduced in quantity. Within the limits of this degraded exam, no enlarging or new extraventricular subarachnoid blood product is seen. At most there may be a small amount of residual subarachnoid blood product along the left cerebellar fissures which is unchanged.Patchy parenchymal hypoattenuation is redemonstrated involving the cerebral hemispheres and left greater than right cerebellum. No evidence of any new lesion is seen.The lateral ventricles remain mildly prominent but are stable relative to the immediate prior exam.Paranasal sinus opacification is similar to prior. The osseous structures are intact allowing for a small right frontal burr hole.
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1.Evolution of intraventricular blood product which appears less dense and perhaps slightly reduced in quantity.2.No significant enlarging or new areas of extraventricular subarachnoid blood.3.Redemonstrated are findings of basilar tip aneurysm coiling. Patchy parenchymal hypoattenuation is unchanged.
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Generate impression based on findings.
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PainVIEWS: Right hand AP, right middle finger oblique and lateral There is a cortical buckle fracture involving the base of the proximal phalanx of the middle finger. There is associated soft tissue swelling at this location. The remainder of the examination is normal. The alignment is normal.
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Cortical buckle fracture base of the proximal phalanx of the middle finger.
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Generate impression based on findings.
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14-year-old female for evaluation of fractureVIEWS: Right shoulder internal/external rotation, right humerus AP/lateral, right elbow AP/oblique/lateral (7 views) 01/19/15 No acute fracture or malalignment is evident. No elbow joint effusion.
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Normal examination.
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Generate impression based on findings.
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Female 58 years old; Reason: 58yo F w/ cirrhosis and rising TBili, evaluate for cholecystitis History: as above Angiographic images are unremarkable. There was persistence of radiotracer in the blood pool with eventual uniform accumulation in the liver. There was no gallbladder activity identified at one hour, with persistence of blood pool activity. Static and dynamic images obtained approximately 13-14 hours later reveal excretion of tracer into the intrahepatic ducts, common bile duct, gallbladder and duodenum, indicating patent common bile and cystic ducts.
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No obstruction of the cystic duct suggesting no scintigraphic evidence of acute cholecystitis. Delayed blood pool clearance of the activity suggesting hepatocellular dysfunction.
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Generate impression based on findings.
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11 month old male with fever.VIEWS: Chest AP (one view) 1/20/15 at 7:53. Right upper lobe atelectasis unchanged. Lingular airspace opacity may represent atelectasis or pneumonia with obscuration of the left heart border.Cardiomediastinal silhouette obscured by lingular and right upper lobe opacities. No pneumothorax.
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1.Lingular airspace opacities may represent atelectasis or pneumonia.2.Persistent right upper lobe atelectasis.
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Generate impression based on findings.
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Female; 67 years old. Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Scattered pulmonary micronodules are unchanged. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mild calcifications of the coronary arteries. Large hiatal hernia. Stable subcentimeter left supraclavicular lymph node. No mediastinal or hilar lymphadenopathy.CHEST WALL: Bilateral breast prostheses. Stable soft tissue thickening around the right breast prosthesis. Surgical clips in right axilla. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating focus near level of dome, too small to characterize (image 81, series 3).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable mild left adrenal thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix. Large stool throughout colon. Sigmoid and descending colon diverticulosis without evidence of acute diverticulitis. No bowel obstruction.BONES, SOFT TISSUES: Stable lucencies in the L1 and L4 vertebral bodies.
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No evidence of metastatic disease in the chest and abdomen.
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Generate impression based on findings.
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Tibia fractureVIEWS: Right tibia and fibula AP and lateral There is an oblique fracture involving the distal diaphysis of the right tibia. The distal fracture fragment is displaced laterally. The overlying cast obscures fine bony detail.
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Acute oblique fracture distal diaphysis of the right tibia.
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Generate impression based on findings.
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Fracture.VIEWS: Left ankle AP/lateral/oblique (3 views) 01/20/15 Three screws continue in place in the distal fibula. The fractures have healed. Alignment is anatomic.
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Healed ankle fractures.
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Generate impression based on findings.
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History of osteomyelitisVIEWS: Right tibia and fibula AP and lateral Again noted are multiple surgical clips along the medial distal aspect of the tibia. Bony deformity with sclerosis involving the mid diaphysis of the tibia again noted. Diffuse osteopenia noted. No acute fracture of the tibia and fibula.
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Bony deformity with sclerosis involving the mid diaphysis of the tibia in a patient with known history of osteomyelitis not significantly changed from prior study.
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Generate impression based on findings.
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Fracture.VIEWS: Left thumb PA/lateral (two views) 01/20/15 A buckling fracture of the posterior cortex of the distal phalanx metaphysis is noted. Minimal anterior subluxation of the proximal phalanx on the metacarpal is noted.
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Fracture of the distal phalanx. Abnormal alignment at the metacarpophalangeal joint.
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Generate impression based on findings.
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Male; 65 years old. Reason: Hx lung nodule 3 months History: cough LUNGS AND PLEURA: Interval resolution of nodular opacities including a 9-mm nodule in the right lobe, compatible with post infectious or inflammatory etiology. Stable bilobed nodule in the left upper lobe measuring 7 mm in the anterior lobe (image 159, series 4). No new suspicious nodules or masses. Severe emphysema. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Severe coronary artery calcifications. Stable mild dilation of the ascending aorta measuring up to 4.6-cm. Interval resolution of right hilar lymphadenopathy. No mediastinal or hilar lymphadenopathy.CHEST WALL: Stable small peripherally calcified nodule in the right thyroid lobe. Left shoulder arthroplasty hardware with streak artifact which limits evaluation of the surrounding area. Stable degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable appearance of the partially visualized kidneys with atrophy on the right and hypoattenuating lesion on the left likely due to a cyst.
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1. Interval resolution of multiple nodular opacities including a 9-mm right upper lobe nodule, compatible with post infectious or inflammatory etiology.2. Stable bilobed nodule in the left upper lobe, for which continued follow-up is recommended in another 9 and 21 months per Fleischner Society recommendations.3. Stable mild dilation of ascending aorta.
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Generate impression based on findings.
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Male; 61 years old. Reason: lung Ca. s/p chemo and RT and resection for left, and RT for right side cancer. Followup scan. History: cough CHEST:LUNGS AND PLEURA: Status post left upper lobectomy. Increased atelectasis/consolidation of the superior segment of the left lower lobe, likely secondary to radiation changes. Very small endobronchial right upper lobe lesion has slightly decreased in size and is not reliably measurable (image 37, series 4). Stable mild focal bronchiectasis just distal to this area. Stable scattered pulmonary micronodules. No new suspicious pulmonary nodule or mass.Stable trace left pleural effusion.MEDIASTINUM AND HILA: Referenced left lower paratracheal lymph node has decreased and now measures 5 mm (image 34, series 3), previously 7 mm. No significant mediastinal or hilar lymphadenopathy. Normal heart size. No visible coronary artery calcifications. Stable small pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Increased atelectasis/consolidation of the superior segment of the left upper lobe, likely secondary to radiation changes.2. Right upper lobe endobronchial lesion has again slightly decreased in size.3. No new sites of disease in the chest and abdomen.
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Generate impression based on findings.
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21-year-old male with osteosarcoma off therapy. Assess for metastatic disease. LUNGS AND PLEURA: Interval resolution of groundglass opacity in the left upper lobe seen on the prior study. Scattered new micronodules in the superior segment of the left upper lobe (series 4 image 45), in the lingula (series 4 image 68), and in the right middle lobe (series 4 image 76) are nonspecific. No pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes are unchanged in size. Normal heart size without pericardial effusion.CHEST WALL: Scattered axillary lymph nodes are unchanged in size. No suspicious osseous lesions are identified.UPPER ABDOMEN: High attenuation in the gastric antrum and duodenum may represent food material. The imaged portions of the liver, spleen, kidneys, and adrenal glands appear normal within the limitations of a noncontrast study.
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1.Interval resolution of left upper lobe opacity seen on the prior study.2.Scattered micronodules are new since the prior study and may be postinfectious/postinflammatory in etiology, but are nonspecific.
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Generate impression based on findings.
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Reason: evaluate sinuses History: chronic nasal congestion and sinus pain/pressure The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. There is only mild nasal septum deviation towards the left.The frontal sinuses are clear.Maxillary sinuses are clear. Ethmoid air cells are clear . Sphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits.
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1.There is no evidence for paranasal sinus obstruction.2.No evidence for active sinusitis at this time.
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Generate impression based on findings.
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Female 77 years old; Reason: Please evaluate for stones, upper urinary tract lesions History: microhematuria 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: Subcentimeter bilateral renal cysts. Adjacent punctate, nonobstructing stones in the mid right kidney. No mass lesions.RETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 6.0 x 2.7 cm mixed sclerotic and lucent lesion in the right femur is felt to be benign, may represent fibrous dysplasia versus a liposclerosing myxofibroma. OTHER: No significant abnormality noted.
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1.No CT findings to explain hematuria.2.6-cm mixed sclerotic and lucent lesion in the right femur is felt to be benign, and may represent a dysplasia versus a liposclerosing myxofibroma. If clinically indicated, MRI can be performed for further evaluation.
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Generate impression based on findings.
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CHEST:LUNGS AND PLEURA: Scattered bilateral nonspecific pulmonary micronodules.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no significant pericardial effusion. Moderate coronary artery calcifications. Scattered small lymph nodes are seen at the mediastinum. Atherosclerosis affects the aorta and its branches.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Marked splenomegaly, measuring up to 22 cm in the coronal plane.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating renal foci, incompletely evaluated on this exam but likely cysts.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes are seen, with one large left para-aortic lymph node measuring approximate 1.5 cm in the short axis (4/138).BOWEL, MESENTERY: Diverticulosis affects the colon..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: No significant abnormality noted.OTHER: No significant abnormality noted.
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Marked splenomegaly and scattered small lymph nodes as above, related to known history of NHL, without findings of infection to explain the patient's fever.
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Generate impression based on findings.
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Female 73 years old; Right breast mass seen on screening mammogram. Ultrasound findings suggestive of malignancy. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 12 x 12 x 12 mm at the 10 o’clock position with increased vascularity, 4 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Vasnani. Dr. Schacht was present during the procedure at all times.
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Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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toe walkerVIEWS: Pelvis AP No acute fracture or dislocation. Both the femoral heads are seated within the acetabula. Both the femoral epiphyses are symmetric in size.
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Both the femoral heads are seated within the acetabula.
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Generate impression based on findings.
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78 year old with history of right lumpectomy for IDC in January 2012. Patient received radiation therapy. No new breast complaints. Three standard views of both breasts and two spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable increased density, architectural distortion, and surgical clips are present within the right breast lumpectomy bed. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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FractureVIEWS: Left tibia and fibula AP and lateral Again noted a compression plate and multiple screws in the proximal tibia without evidence of hardware failure. There is interval healing of the comminuted fracture of the proximal tibia. There is periosteal reaction and sclerosis reflecting interval healing. Multiple metallic bullet fragments are present unchanged.
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Healing proximal tibial fracture as described above.
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Generate impression based on findings.
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Reason: lung cancer History: lung cancer CHEST:LUNGS AND PLEURA: Right upper lobe mass in the posterior segment of the right upper lobe is unchanged measuring 4.1 cm x 6.3 cm (image 27 series 5). This mass is abutting the medial pleural surface and mediastinum. No other suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: High right paratracheal lymph node (image 25 series 3) measures 10 mm previously measuring 11 mm.Low right paratracheal lymph node (image 34 series 3) is unchanged measuring 13 mm in its short axis.Enlarged right hilar lymph node better evaluated with IV contrast on the current exam (image 39 series 3) measures 16 mm.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Large subcapsular mass in the posterior right hepatic lobe with evidence of internal necrosis and focal area of contrast enhancement is unchanged in size measuring 6.6 cm x 7.8 cm (image 95 series 3) and compatible with large hepatic metastasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Large right posterior upper lobe necrotic mass abutting the pleura and mediastinum is unchanged in size. No additional pulmonary nodules or masses identified.2.Mediastinal lymphadenopathy and large hepatic metastasis unchanged in size.3.No new sites of disease identified.
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Generate impression based on findings.
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2-year-old female with altered mental status, seizure-like activity, after fall. Evaluate for hemorrhage. There is no evidence of intracranial hemorrhage. There is mild prominence of the ventricles and the anterior extra-axial space, presumably subarachnoid space. These findings were present on previous ultrasound of the head, however direct comparison is difficult due to difference in techniques and significant time interval between exams. There is questioned mild focal prominence of CSF spaces in the midline lateral ventricles which raises the possibility of small cavum septum pellucidum as well as a cavum velum interpositum. 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, without significant evidence of recent trauma.
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1. No evidence of intracranial hemorrhage or mass effect. If there is continued clinical concern for structural abnormality, consider MRI.2. Nonspecific prominence of the ventricles and extra-axial subarachnoid spaces likely relates to benign enlargement of the subarachnoid spaces of infancy. While this finding typically resolves by the two years of age, this may represent prolonged course. Follow-up imaging is recommended as clinically warranted.
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Generate impression based on findings.
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45 year old for annual mammogram. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications are unchanged in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and 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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FractureVIEWS: Right forearm AP and lateral Healing fractures involving the mid radius and ulna again noted. There has been interval healing as evidenced by bony remodeling. The alignment is near anatomic.
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Healing forearm fractures as described above.
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Generate impression based on findings.
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Male; 69 years old. Reason: AnCA positive LUL nodule? Surveillance History: none LUNGS AND PLEURA: Severe upper lobe predominant emphysema. Left apical scarring extending to a calcified nodular opacity in the left upper lobe, most likely due to prior granulomatous process. Additional scattered pulmonary micronodules, some of which are calcified. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size. Small amount of pericardial fluid. Moderate coronary artery calcifications. No mediastinal or hilar lymphadenopathy. Small calcified right hilar lymph node, most likely due to prior granulomatous process. Saber shaped trachea related to COPD.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy.
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Severe emphysema and findings suggestive of prior granulomatous process. No suspicious pulmonary nodules or masses.
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Generate impression based on findings.
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Reason: GERD Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated overall a normal primary peristaltic wave. There was trace proximal escape. During the exam, there gross reflux while table was being turned from supine to erect position. Patient vomited twice but denied nausea. Fluoroscopy afterwards showed rapid clearance. Repeat exam 5 minutes afterward showed no reflux on supine and erect position even with provoking maneuvers. Barium pill easily passed to stomach. TOTAL FLUOROSCOPY TIME: 6:48 minutes
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1.Normal esophageal and gastric mucosa.2.Minimal dysmotility with trace proximal escape.3.One episode of gross reflux in erect position. Patient vomited twice during exam but denied nausea.
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Generate impression based on findings.
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9-year-old male with abnormal gait.VIEWS: Pelvis AP and frog leg, left foot standing AP, oblique, lateral, and right foot standing AP, oblique and lateral (8 views). Pelvis: Alignment is within normal limits. The femoral heads are round and well-seated in the acetabula. There is no fracture.Left foot: Mild flattening of the dome of the talus and hypertrophy of the talar neck with mild dorsal subluxation of the navicular bone relative to the talus are consistent with a treated clubfoot deformity. There is no fracture. Right foot: Mild flattening of the dome of the talus and hypertrophy of the talar neck with mild flattening of the calcaneus are consistent with a treated clubfoot deformity. There is no fracture.
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1. Findings consistent with bilateral treated clubfoot deformities as described above. 2. Normal pelvis.
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Generate impression based on findings.
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81 year-old female with metastatic colon cancer who present for follow-up. Evaluate. Motion artifact limits evaluation.CHEST:LUNGS AND PLEURA: There is a new 2.2 x 1.9 cm (series 3, image 60) nodule at the right lung base highly suspicious for metastatic focus. There is a new micronodule in the right upper lobe (series 5, image 45). Other scattered micronodules are unchanged. Nonspecific areas of ground glass opacity may represent mosaic perfusion, not significantly changed. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart is normal in size without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Right-sided chest port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata noted. No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydroureteronephrosis. Subcentimeter bilateral hypoattenuating renal foci are too small to characterize.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: Moderate hiatal hernia. Postoperative changes with a ascending colonic resection and ileocolonic anastomosis. Diverticulosis without evidence of diverticulitis.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: As above.BONES, SOFT TISSUES: Unchanged severe compression deformity of the L1 vertebral body.OTHER: No significant abnormality noted.
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1.New right basilar pleural based mass highly suspicious for metastatic disease.2.New nonspecific right upper lobe micronodule.3.Stable abdominal and pelvic exam.
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Generate impression based on findings.
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Reason: pt w/ new onset facial/right hand numbess, c/f CVA History: see above The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter hypodensity is present.An asymmetrically hypodense focus is present at the right cerebellar medullary angle cistern measuring approximately 8 mm which is only seen on one slice and could represent volume averaging.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.There is a moderate to marked degree of periventricular and subcortical white matter lesions present which are rather unusual for the patient's stated age . These could be vascular in origin, related to a demyelinating process or vasculitis. Please correlate with clinical history.3.CT is insensitive for the early detection of nonhemorrhagic cerebral infarction.
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Generate impression based on findings.
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59 year-old female with swelling and decreased range of motion following injury There are two approximately 5 mm rounded foci of mineralization within the soft tissues just lateral to the lateral condyle of the distal humerus. While we suspect these represent small foci of calcification within the extensor tendon perhaps due to tendinosis, they also could represent avulsion fracture fragments. The anterior and posterior fat-pad are elevated, consistent with a joint effusion although no discrete intra-articular fracture is visualized. Diffuse reticulation of the subcutaneous fat suggests edema.
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1. Densities lateral to the distal humerus we suspect represent chronic mineralization within the extensor tendon, although we can cannot exclude avulsion fracture fragments.2. Joint effusion without discrete fracture visualized. Repeat radiographs are recommended to exclude occult fracture.Findings were discussed with Dr. Kiraly (pager 3655) at the time of dictation.
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Generate impression based on findings.
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Ms. Williams is a 35 year old female with a recent biopsy performed at an outside hospital for a palpable abnormality in the left upper outer breast. Pathology report from outside hospital: cystic apocrine metaplasia, intraductal papilloma, and columnar cell change. She presents today for confirmation of appropriate placement of biopsy clip within the palpable abnormality. A CC view and an ML view of the left breast 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. Biopsy marker clip is identified in the left upper outer breast, at site of previous palpable abnormality. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast.
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Biopsy marker clip is in the appropriate location at site of previous palpable abnormality. The overall imaging is concordant with the pathology. Patient is to follow-up with Dr. Jaskowiak later today for final results and recommendations.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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43 years, Female. Reason: hx c.diff. abdominal pain. ro toxic megacolon History: abd pain Cardiomediastinal silhouette is unremarkable. No significant pulmonary or pleural abnormality noted. Nonobstructive bowel gas pattern. No free air identified. Average stool burden.
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No acute cardiopulmonary process identified. Nonobstructive bowel gas pattern. No free air identified. Average stool burden.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are digital mammographic images with tomosynthesis images (12/11/14) performed at St. Mary Hospital. For comparison, digital mammographic images (5/17/13, 5/31/13, 12/26/13) are available. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is no significant change in the residual calcifications with X shaped clip at retroareolar region in the left breast. O shaped clip with a few calcifications are unchanged at upper inner quadrant in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. No significant interval changes st the benign biopsy sites in the left breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Reason: eval for ich, mass History: HA 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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Reason: restaging for head and neck cancer History: head and neck cancer CHEST:LUNGS AND PLEURA: Redemonstration of apical and paramediastinal postradiation fibrotic changes and accompanying bronchiectasis. Upper lobe subpleural microcystic changes are similar in appearance to the prior exam.Increasing ground glass opacities posteriorly at the lung bases compatible with aspiration.Right lower lobe subpleural nodule (image 54 series 4) is unchanged measuring 7 mm.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Left chest Port-A-Cath with its tip in the SVC.Subcarinal lymphadenopathy (image 45 series 3) is stable measuring 15 mm.Cardiac size is normal without evidence of a pericardial effusion.Minimal coronary calcification.CHEST WALL: Posttreatment changes are identified in the right supraclavicular fossa. Degenerative changes and scoliosis within the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodense lesion in the upper pole the right kidney is compatible a cyst. No evidence of an enhancing mass within the right kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Marked scoliosis of the thoracic lumbar spine with accompanying degenerative changes.OTHER: No significant abnormality noted.
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1.Increasing ground glass opacities of the lung bases compatible with aspiration.2.Stable post radiation fibrotic changes in the upper lobes.3.Stable right lower lobe subpleural nodule may be related to subpleural lymph node. Stable mediastinal lymphadenopathy No new suspicious pulmonary nodules or new sites of disease. 4.No suspicious renal masses.
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Generate impression based on findings.
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58-year-old male with pain Hardware components of a medial compartment arthroplasty device are again visualized without evidence of hardware complication. Severe osteoarthritis affects the lateral joint compartment. There is approximately 15 degrees valgus alignment of the knee relative to the neutral mechanical axis.
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Osteoarthritis and a valgus deformity of the knee.
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Generate impression based on findings.
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Male, 55 years old, status post posterior spinal fusion from C3 to T2. Posterior instrumented spinal fusion has been performed with bilateral lateral mass screws from C3 through C6, and bilateral pedicle screws at T1 and T2. The screws are affixed to bilateral stabilization rods. The screws are well seated. No instrument complications are suspected.In addition to the fusion, laminectomy has been performed from C4 through C6 with partial laminectomy at C3 and perhaps minimally at C7. Amorphous bone graft material has been placed along the stabilization rods. A surgical drain in place.Except where altered by surgery, vertebral body morphology and height are normal. No destructive osseous lesions are seen. Loss of disk height is present at C4-5, C5-6 and C6-7 with posterior disk osteophyte formation at these levels.Details of the spinal canal cannot be accurately assessed due to metallic streak artifact. However, any spinal canal stenosis which may have been caused by disk and/or osteophyte encroachment from C3-4 through C6-7 has probably been relieved by posterior decompression. Moderate bilateral foraminal narrowing is seen at C3-4 as well as C4-5, with severe narrowing at C5-6.
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Expected findings subsequent to instrumented posterior spinal fusion and posterior spinal canal decompression. No instrument complications are suspected.
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Generate impression based on findings.
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66-year-old male with right shoulder pain Moderate osteoarthritis affects the glenohumeral and acromioclavicular joints. A high riding humeral head with narrowing of the acromiohumeral interval to approximately 4 to 5 mm suggests a chronic rotator cuff tear. Cysts are noted within the humeral head
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Osteoarthritis with narrowing of the acromiohumeral interval suggestive of chronic rotator cuff tear. If further imaging evaluation is clinically warranted, MRI may be considered.
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Generate impression based on findings.
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20 year-old female, evaluate for fracture Again seen is a transverse fracture through the distal fibula with fracture fragments in near anatomic alignment. The lateral aspect of the fracture line remains visible, although the medial aspect appears indistinct, which may reflect some interval healing.
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Distal fibula fracture, as above.
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Generate impression based on findings.
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Ms. Perkovich is a 75 year old female with a personal history of right breast lumpectomy for IDC in 04/2013 followed by chemoradiation therapy. No current breast related complaints. Three standard views of both breasts with two right spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. Surgical clips are also present in the right axilla. Scattered calcifications, including coarse dystrophic and vascular calcifications, have developed in a benign fashion in the right breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is chronic compression fracture involving the L2 vertebral body with approximately 30% loss of height. No significant osseous retropulsion. Posterior elements are intact. Vacuum disk phenomena is noted at the adjacent L1-L2 level. Vertebral body heights are maintained in the remainder of the lumbar spine. Chronic pars defects are seen bilaterally at L5. Alignment is maintained. There is epidural lipomatosis involving the mid and lower lumbar spine. Multilevel degenerative changes are seen, as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is small right central protrusion without significant compromise to spinal canal or neural foramina.At L4-5 there is mild spinal canal stenosis related to epidural lipomatosis. No significant neural foraminal stenosis. At L5-S1 there is epidural lipomatosis and disk bulge with resulting severe spinal canal narrowing. There is mild bilateral neural foraminal narrowing. There is mild facet arthropathy throughout the lumbar spine, relatively worse at the L4-L5 and L5-S1 levels. Paraspinous soft tissues are within normal limits. Right femoral hardware is partially visualized.
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1. Chronic compression fracture at L2 with 30 percent loss of height is stable to minimally worse compared to CT abdomen from 7/11/2014. 2. No significant osseous spinal canal stenosis at any level in the lumbar spine. Please note MRI would be more sensitive to evaluate for stenosis related to soft tissues.3. Epidural lipomatosis in the lower lumbar spine with up to severe (chronic) spinal canal stenosis at the L5-S1 level. 4. Chronic pars defects bilaterally at L5 without spondylolisthesis.
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Generate impression based on findings.
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Male 65 years old; Reason: evaluate portal vein thrombosis History: cirrhosis with new finding of PVT with no portal vein flow ABDOMEN:LUNG BASES: New trace left pleural effusion with adjacent compressive atelectasis.LIVER, BILIARY TRACT: Morphologic changes compatible with cirrhosis. Thrombosis of the main portal vein and its branches. Other multifocal areas of thrombus of the PV system involving the SMV at the porta splenic confluence, and the confluence itself a. Stable ascites. Collateralization. Cholelithiasis.SPLEEN: Splenomegaly, measuring up to 14 cm. Nonspecific focus of arterial enhancement (11:45), stable, seen on MRI from 6/30/2014 (10:46)PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable portacaval and paracaval prominent lymph nodes (11:54, 11:62).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild calcification of the abdominal aorta and its branches.OTHER: No significant abnormality noted.
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1.Cirrhosis with multifocal thrombus involving the portal venous system, further detailed above. Ascites and sequela of portal hypertension, including splenomegaly. No suspicious hepatic lesion.2.New trace left pleural effusion.3.Cholelithiasis.
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Generate impression based on findings.
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37-year-old female with history of wrist pain after fall. There is equivocal widening of the scapholunate interval. There is mild osteoarthritis at the basilar joint. We see no fracture.
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No fracture evident and other findings as above.
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Generate impression based on findings.
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41-year-old male with history of trauma. Evaluate for neck stability. The cervicothoracic junction is obscured on the lateral projection by overlying anatomy. There is no acute fracture or subluxation. Alignment is anatomic. There is no evidence of cervical spine instability. Tiny posterior osteophytes are present at C3-4 and C4-5. The prevertebral soft tissues are within normal limits.
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Minimal degenerative changes, but otherwise no evidence of fracture or instability.
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Generate impression based on findings.
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Male, 57 years old, history of T4aN2c squamous cell carcinoma of the right tonsil/right base of tongue, status post induction chemotherapy and chemoradiation (completed July, 2014), status post bilateral neck dissection (October, 2014). Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Neck:Persistent treatment related findings are seen including infiltration of the fascial planes, thickening of the platysma, reticulation of the subcutaneous fat and supraglottic mucosal edema. Also seen is evidence of interval bilateral neck dissection.No discrete or measurable mass is evident at the right tongue base or tonsil. There aryepiglottic folds are thickened similar to prior.Multiple pathologically enlarged lymph nodes seen on the prior examination, some of which were partially calcified, have been resected. No pathologic adenopathy is detected on the current study by size criteria.The salivary glands and thyroid are unremarkable. The cervical vessels enhance normally with the exception of the right IJ vein which is probably present but of very small caliber. Lung apices are unremarkable. No concerning osseous lesions are demonstrated.
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1. Evidence of treatment related findings and interval bilateral neck dissection. Previously seen pathologic adenopathy is no longer apparent. No new pathologically enlarged lymph nodes are detected.2. No evidence of any discrete or measurable mass is seen at the right tongue base or tonsil.3. No evidence of intracranial metastatic disease.
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Generate impression based on findings.
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52-year-old male with history of pain. Left knee: Tricompartmental osteophytes and joint space narrowing worse in the medial tibiofemoral compartment compatible with moderate osteoarthritis. Bony excrescence on the medial aspect of the proximal tibial metadiaphysis is likely the site of tendon insertion. Moderate osteoarthritis affects the right knee as seen on the frontal views.Left hip: Severe osteoarthritis affects the left hip.Pelvis: Moderate to severe osteoarthritis affects the right hip. Severe osteoarthritis affects the left hip. Small ringlike sclerotic foci at the femoral neck and intertrochanteric region are nonspecific, but are presumably benign in etiology assuming that the patient does not have a known primary malignancy. Severe degenerative disc disease affects the visualized lower lumbar spine.
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Osteoarthritis at the hips and knee and other findings as above.
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Generate impression based on findings.
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54-year-old male with history of pancreatitis in 2012 and 2014. Endoscopic ultrasound with signs of chronic pancreatitis. No masses. Evidence of fullness in the head of the pancreas and adjacent lymph nodes. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal arterially enhancing hepatic lesions. No extra or intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is mild to moderate diffuse pancreatic ductal dilatation with no evidence of a mass in the pancreatic head. Mild pancreatic head fullness. Punctate calcifications of the pancreatic head consistent with sequela of chronic pancreatitis.ADRENAL GLANDS: Nonspecific thickening of the adrenal glands bilaterally.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes with index left para-aortic node measuring 1.2 x 1.0 cm (series 8, image 64). Additionally, there are mildly enlarged lymph nodes immediately inferior to the pancreatic head with index node measuring 1.0 x 0.8 cm (series 8, image 59).As noted on the arterial phase, no evidence of thrombus or dissection within the abdominal aorta. The celiac, SMA, IMA, bilateral renal arteries, and visualized common iliac arteries are patent without evidence of dissection or thrombus.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Nonspecific sclerotic focus in the right iliac wing measuring 1.1 x 0.8 cm (series 10, image 100), is likely a benign bone island.OTHER: No significant abnormality noted
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1.Mild to moderate diffuse pancreatic ductal dilatation without evidence of a mass in the pancreatic head. Further evaluation with MRCP is recommended.2.Two mildly enlarged peripancreatic lymph nodes.3.Mild nonspecific retroperitoneal lymphadenopathy.
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Generate impression based on findings.
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54-year-old female with history of right shoulder pain. Moderate osteoarthritis affects the acromioclavicular joint with prominent osteophyte production. Tiny glenohumeral osteophytes indicate mild osteoarthritis.
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Osteoarthritis is above.
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Generate impression based on findings.
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31-year-old female with chest pain. History of pulmonary emboli. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No acute pulmonary embolism. Pulmonary artery size is within normal limits.LUNGS AND PLEURA: Interval resolution of focal areas of increased density at the peripheral left lower lobe seen on previous exam. No pleural effusion. No suspicious nodule or mass.MEDIASTINUM AND HILA: Right ventricle enlargement is suggestive of right heart strain. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No acute pulmonary embolism. No significant pulmonary or pleural abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive.
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Generate impression based on findings.
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39-year-old female with history of foreign object in foot. There is a 4-mm triangular ossicle dorsal to the navicular compatible with a minimally displaced avulsion fracture appearing similar to the prior study when accounting for positional differences. We see no evidence of a foreign body.
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Tiny ossicle dorsal to the navicular compatible with avulsion fracture appearing similar to prior. We see no foreign body.
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Generate impression based on findings.
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66-year-old male with left hip pain Left hip: Severe osteoarthritis affects the left hip with near bone-on-bone apposition superiorly.Pelvis: Hardware components of a right total hip arthroplasty device are situated in near anatomic alignment, although the distal aspect of the prosthesis not visualized on this study. Severe osteoarthritis affecting the left hip is again visualized. The bones appear slightly demineralized. Mild osteoarthritis affects the SI joints. Severe osteoarthritis affects the visualized lower lumbar spine.
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Osteoarthritis, as described above.
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Generate impression based on findings.
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33-year-old female with neck pain post head injury The cervicothoracic junction is not well seen on the lateral view due to overlying anatomy. Given this limitation, no acute fracture is visualized. Small anterior osteophytes project from the vertebral bodies at C4/5 and C5/6. There is slight rightward curvature of the upper cervical spine and slight leftward curvature of the upper thoracic spine. There are non-segmentation anomalies of the upper cervical cervical spine, including fusion of the C2/3 vertebral bodies and possible fusion of the lateral masses of C1 to the skull base. The odontoid process is hypoplastic. The posterior arch of C1 also appears hypoplastic.Apparent narrowing of the neuroforamina may be artifactual. Note is made of impacted molars.
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No acute fracture is evident. Non-segmentation anomalies of the upper cervical spine and skull base as described above. If there is high clinical suspicion for fracture, CT may be considered for further evaluation.
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Generate impression based on findings.
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Reason: dysphagia Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Limited exam due to patient not tolerating the high density barium. No gross obstructive lesion of the esophagus was identified. No evidence of esophageal web or cricopharyngeal bar. Fluoroscopic evaluation of esophageal peristalsis showed moderate dysmotility with hold up of contrast in the mid esophagus with irregular tertiary waves. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Barium pill passed freely into stomach. TOTAL FLUOROSCOPY TIME: 8:06 minutes
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1.Fluoroscopic evaluation of esophageal peristalsis showed moderate dysmotility with hold up of contrast in the mid esophagus with irregular tertiary waves. 2.No evidence of reflux.3.Limited exam due to patient not tolerating high density barium.
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Generate impression based on findings.
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Interval postoperative changes are seen from left frontal craniotomy for hematoma evacuation from the left frontal lobe. There is a mixed density extra-axial collection underlying the craniotomy flap likely representing postoperative fluid and blood products. There are residual scattered areas of hyperdensity in the left frontal lobe, with the most confluent area measuring up to 5 cm in greatest axial dimensions, just deep to the posterior aspect of the craniotomy flap. There are scattered foci of pneumocephalus as well as more prominent extra-axial air overlying the anterior left frontal lobe with mild-moderate mass effect.In the area of rounded relative hypodensity on prior CT where there was a suspected nodule, a distinct area of soft tissue is no longer appreciated although evaluation is limited due to noncontrast CT technique. There remains abnormal low density within the left frontal white matter, consistent with vasogenic edema. There is slight decreased mass effect upon the left lateral ventricle. The degree of midline shift is similar, again measuring 5 mm. There remains diffuse left cerebral sulcal effacement, especially anteriorly. Partially visualized remote postoperative changes are seen along the posterior arch of C1. Mild disconjugate gaze is incidentally noted.
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1.Expected postoperative changes following evacuation of left frontal lobe parenchymal hematoma, with residual scattered areas of hemorrhage in the hematoma cavity. Similar degree of midline shift, with decreased mass effect on the left lateral ventricle.2.Incomplete assessment of suspected left frontal lobe nodule which has been reportedly resected, although no definite rounded soft tissue density is noted at the level of the prior finding, within limitations of noncontrast CT. Please correlate with postoperative MRI results.
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Generate impression based on findings.
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Ms. Buscar is a 62 year old female with a personal history of right breast lumpectomy for IDC/DCIS in August 2010 followed by radiation and Femara therapy. Family history of breast cancer in two sisters. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, skin retraction and surgical clips present within the right lumpectomy site. Scattered benign calcifications are present in both breasts. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Male 60 years old; Reason: kidney cancer History: kidney cancer There is focal uptake in the frontal bone on the right, lateral to the orbit.No uptake in the region of the right kidney compatible with patient's known history of right nephrectomy. Bilateral symmetric uptake in the metatarsophalangeal joints likely degenerative in nature.
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Uptake in the right frontal bone may be due to metastatic disease. Recommend continued follow-up.
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Generate impression based on findings.
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49-year-old female with pain, evaluate for bigger osteophyte Severe osteoarthritis affects the tibiotalar joint with prominent anterior osteophytes appearing similar to the prior exam. Moderate osteoarthritis affects the midfoot and talonavicular articulations. Posterior and plantar heel spurs are noted. There is medial soft tissue swelling.
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Osteoarthritis, appearing similar to the prior exam.
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Generate impression based on findings.
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Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Stable calcified and noncalcified micronodules. No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Right chest Port-A-Cath with its tip in the SVC.Mildly prominent right hilar lymph node stable.No definite hilar or mediastinal lymphadenopathy.Cardiac size is normal densely pericardial effusion.Moderate coronary artery calcification.Ectatic ascending aorta measuring 4 cm without interval change.CHEST WALL: Extensive blastic and osteolytic lesions within me vertebrae, sternum, and right scapula are redemonstrated. Several of the osteoblastic lesions have become osteolytic which may represent treatment response. No new sites identified.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Numerous sclerotic metastases some of which are becoming osteolytic and presumably represent treatment response.OTHER: No significant abnormality noted.
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1.No evidence of pulmonary or pleural metastatic disease.2.Extensive sclerotic osseous metastases with many of the sclerotic lesions becoming osteolytic compatible with treatment response.3.No new sites of disease identified.
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Generate impression based on findings.
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68-year-old female, follow up examination Again seen is a fracture of the proximal diaphysis of the fifth metatarsal with fracture fragments in near anatomic alignment. There has been progression of callus formation along the fracture indicating some interval healing.
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Healing fifth metatarsal stress fracture.
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Generate impression based on findings.
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55-year-old male with history of cervical spine fusion. There is an anterior plate device with screws entering the vertebral bodies of C3-4. A second anterior plate device is present with screws entering C5 and C7. The C6 vertebral body appears partially resected with spacer and bone graft material between C5 and C7. There is an additional spacer and bone graft material present at C3-4. There is no evidence of hardware complication. Mild degenerative disc disease affects C4-5. Alignment is slightly kyphotic. There is moderate neuroforaminal narrowing at C5-6 and C6-7 bilaterally.
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Postsurgical and degenerative changes as above.
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Generate impression based on findings.
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70 year-old male with neck pain, evaluate for osteoarthritis Severe degenerative disk disease affects C7/T1. Moderate degenerative disk disease affects C5/6 and C6/7. Mild degenerative disk disease affects C3/4 and C4/5. Moderate to severe multilevel facet joint osteoarthritis is noted with neuroforaminal narrowing bilaterally.
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Degenerative disk disease and osteoarthritis as described above.
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Generate impression based on findings.
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CLINICAL DATA: Age: 66 years. Sex : Male. Indication: Reason: Evaluate liver disease from metastatic colorectal cancer. Requesting triple phase CT scan. History: NA. LUNG BASES: Minimal subsegmental atelectasis at the lung bases. Left lower lobe pulmonary nodule (60/28) beasures 6mm, larger than the previously seen 4mm on 11/10/14 CT. Change in size could be accounted for with differences in technique, but recommend dedicated chest CT.LIVER, BILIARY TRACT: Right posterior hepatic dome heterogeneous hypoattenuating area (61/18) is not significantly changed from previous CT, and measures approximately 4.7 x 4.1 x 4 cm. A more anterior hypoattenuating focus in the right hepatic dome (61/15) measures 1.9 x 2 x 1.2 cm, not significantly changed. An additional area of heterogeneous hypoattenuation with associated coarse calcification/mineralization likely due to therapy (61/34) is difficult to actually measure given its ill-defined nature, but appears grossly unchanged.No significant biliary dilatation. Cholelithiasis, without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal hypoattenuating focus, nonspecific but likely a benign cyst, is unchanged.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix is within normal limits. Diverticulosis affects the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:PROSTATE: Mildly enlarged prostate, with several internal calcifications.BLADDER: Mild, uniform bladder wall thickening may be related to enlarged prostate and bladder outlet obstruction versus artifact from underdistention.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat-containing right inguinal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1) Foci of heterogeneous hypoattenuation of the liver, consistent with given history of metastatic colorectal cancer, unchanged compared to prior PET/CT.2) Left lower lobe pulmonary nodule, nonspecific, recommend dedicated CT Chest to ensure resolution/stability.
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Generate impression based on findings.
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68-year-old female with metastatic breast cancer and DJD, right shoulder pain The bones are demineralized with small foci of sclerosis seen in the humeral head and proximal diaphysis consistent with metastatic breast cancer. Additional metastatic foci are better seen on prior CT and bone scan examinations. Surgical clips project over the axilla. Mild osteoarthritis affects the glenohumeral joint. There is also mild spurring along the anterior aspect of the acromion process.
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Metastatic disease and mild osteoarthritis as described above.
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Generate impression based on findings.
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60 year-old male with history of ORIF. There is a plate and screw device affixing a comminuted interarticular fracture of the calcaneus in anatomic alignment. There is no evidence of hardware complication. The fracture lines remain partially visible appearing similar to the prior study when accounting for projectional differences. Mild osteoarthritis affects the first MTP joint.
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Orthopedic fixation of calcaneus fracture appearing similar to prior.
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Generate impression based on findings.
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57-year-old female with medial eminence pain at first metatarsal head Two orthopedic screws affix the first tarsometatarsal joint in near-anatomic alignment. The articulation appears at least partially fused. There is no evidence of hardware complication. Flattening of the medial aspect of the first metatarsal head is consistent with prior bunionectomy. Mild to moderate osteoarthritis affects the first MTP joint, appearing similar to the prior exam.
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Postoperative changes of Lapidus procedure and osteoarthritis affecting the first metatarsophalangeal joint, appearing similar to the prior exam.
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Generate impression based on findings.
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Male; 71 years old. Reason: 71 yo h/o indolent R pleural based adenocarcinoma with h/o pleurodesis for routine surveillance CHEST:LUNGS AND PLEURA: Stable nodular right pleural thickening. Post surgical scarring, atelectasis, and loculated effusion on the right is unchanged.MEDIASTINUM AND HILA: Redemonstration of mediastinal lymphadenopathy with reference right lower paratracheal lymph node measuring 18 mm (image 47, series 3), previously 18 mm. Stable enlarged right cardiophrenic angle lymph nodes. Heart size is normal without pericardial effusion. Mild to moderate coronary artery calcifications.CHEST WALL: Degenerative changes about the visualized spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy. Unchanged subcentimeter left hepatic lobe hypoattenuating lesion, likely a benign cyst. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable incompletely characterized hypoattenuating renal lesions, likely benign cysts. Stable right nonobstructing nephrolithiasis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable right pleural and mediastinal disease. No new sites of disease in the chest and abdomen.
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Generate impression based on findings.
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48-year-old female, evaluate for scoliosis There is approximately 35 degrees levoscoliosis of the upper thoracic spine measured from the superior endplate of T2 to the inferior endplate of T7. There is also approximately 55 degrees dextroscoliosis of the thoracolumbar spine, measured from the superior endplate of T7 to the inferior endplate of L3. The coronal balance is within normal limits. The sagittal balance is with normal limits. There is loss of the normal cervical lordosis. Mild degenerative disk disease affects the lower cervical spine. Degenerative arthritic changes affect the pubic symphysis. No focal vertebral body anomalies are visualized.
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Scoliosis, as described above.
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Generate impression based on findings.
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Male; 57 years old. Reason: HNSCC. 6mo post CRT FUP. Compare to previous. History: as above LUNGS AND PLEURA: New mild groundglass opacity in the right upper lobe (e.g. image 42, series 4), which may be due to aspiration. Otherwise, significant abnormality.MEDIASTINUM AND HILA: Interval removal of right chest Port-A-Cath. Scattered subcentimeter lymph nodes are unchanged. Normal heart size without pericardial effusion. Mild calcification of the coronary arteries.CHEST WALL: Focal sclerosis in L1 vertebral body is unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable punctate hepatic hypodensities are too small to characterize but likely due to benign cysts. Scattered small subcentimeter retroperitoneal lymph nodes nodes are unchanged. Partially visualized left renal cyst.
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1. No evidence of pulmonary metastases.2. New mild groundglass opacity in the right upper lobe, which may be due to aspiration.
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Generate impression based on findings.
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Confusion, heart failure, evaluate for CVA or other etiology No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. There are foci of hypattenuation in the basal ganglia which may represent lacunar infarcts or perivascular spaces. More prominent of these is in the right subinsular white matter.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is 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. Mild chronic small vessel ischemic changes with probable chronic lacunar infarct in the right subinsular white matter.
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