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Generate impression based on findings.
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41 years, Male. Reason: abdominal pain, evaluate for free air. Nonobstructive bowel gas pattern. No free air on decubitus view. Feeding tube tip in gastric antrum. Small bilateral pleural effusions, cardiomegaly, and streaky lung base opacities are noted.
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Nonobstructive bowel gas pattern. No free air.
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Generate impression based on findings.
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65 year old with history of right breast mastectomy 3/2012 after lumpectomy with positive margins for IDC. Status post radiation, chemotherapy and hormonal therapy. No current breast complaints. 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 elements, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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There are stable areas of abnormal low density somewhat symmetric in pattern in the posterior cerebellum bilaterally, slightly more extensive on the left side. There is associated volume loss. This finding was not evident on the more remote CT of 2003. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. There are scattered trace mucosal thickening in the maxillary sinuses. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality. Stable probable chronic bilateral cerebellar infarcts, not present on the 2003 exam. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended.
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Generate impression based on findings.
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88 years, Male. Reason: Check biliary stent placement. Lower pelvis excluded from field of view. Exam also limited by blurring from patient respiratory motion. Biliary stent, including pancreatic component, is in the expected position and not significantly changed when compared to recent ERCP images. Nonobstructive bowel gas pattern. Surgical clips project over the right upper quadrant and pelvis. Streaky lung base opacities and small left pleural effusion.
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1.Biliary stent in the expected position without significant interval change compared to recent ERCP images. 2.Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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PainVIEWS: Right ankle AP, oblique and lateral No acute fracture or dislocation. The ankle mortise joint is normal. There is soft tissue swelling about the ankle joint. No ankle joint effusion.
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No acute fracture or dislocation.
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Generate impression based on findings.
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Ms. Stockl is a 25 year old female presenting with unilateral right milky nipple discharge. A targeted right breast ultrasound was performed for the patient’s unilateral milky nipple discharge. Multiple ectatic ducts were identified in the right retroareolar region with no discrete intraductal mass identified. For comparison purposes, a limited left breast ultrasound was performed. Again, multiple ectatic ducts were identified without evidence of an intraductal mass. This appeared very similar to the right breast.
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Multiple ectatic ducts without evidence of intraductal mass in the right breast. No sonographic evidence for malignancy. All results were relayed to the patient and Dr. Jaskowiak.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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CVA. Altered mental status, difficulty speaking since 9 am. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. There is hypoattenuation involving the left frontal corona radiata extending into the anterior limb of the left internal capsule which may represent infarct. Additional scattered areas of hypoattenuation in the periventricular and subcortical white matter are nonspecific but compatible with age-indeterminant small vessel ischemic changes. There is encephalomalacia involving the right caudate head with ex vacuo dilatation of the right frontal horn. Apparent hypoattenuation in the pons is most likely artifactual.No midline shift or uncal herniation. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. Mild mucosal thickening in the paranasal sinuses. Mastoid air cells are clear. Calvarium is intact.
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1. No evidence of intracranial hemorrhage or mass effect. 2. Hypoattenuation in the left frontal corona radiata extending into the left internal capsule is age-indeterminant with subacute infarct not excluded. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI or follow-up CT should be considered if there is continued clinical suspicion3. Chronic infarct involving the right caudate head.
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Generate impression based on findings.
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Male, 63 years old, history of stage IVb, T4N2cM0 floor of the mouth squamous cell carcinoma s/p wide local excision, rim mandibulectomy, and bilateral selective neck dissection April 2010, followed by adjuvant CRT with TFHX completed in October 2010. Anatomic distortion and volume loss involving the right floor of mouth and submental space are unchanged. No evidence of locally recurrent tumor is seen.The oral tongue and base of tongue are unremarkable. Mild medialization of the right vocal cord with prominence of the sinus and vallecula are unchanged and may reflect vocal cord dysfunction. The remainder of the aerodigestive tract is within normal limits.Evidence of bilateral neck dissection is seen with scattered surgical clips and effacement of fascial planes. No pathologic adenopathy is detected by size criteria.The parotid glands are unremarkable. The submandibular glands are not well visualized and are likely absent. A punctate focus in the left thyroid lobe is unchanged. The cervical vessels enhance normally with the exception of the left IJ vein which does not opacify well in the neck. Emphysema is demonstrated in the lung apices. No concerning osseous lesions are detected. Deformity of the distal right clavicle is unchanged and may be posttraumatic. The patient is edentulous and there is a stable pattern of erosive change along the mandibular alveolar ridge which may reflect prior dental disease.Evidence of right temporal craniotomy is again seen. Areas of hypoattenuation within the left temporal lobe are unchanged. Evidence of scleral banding is seen on the left.
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Redemonstration of surgical and treatment related findings in the neck with no evidence suggest locally recurrent tumor or pathologic adenopathy.
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Generate impression based on findings.
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Male 53 years old; Reason: hep c cir tumor surveillance History: hep c cir ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular.Status post cholecystectomy. Features of portal hypertension: Splenomegaly and upper abdominal ascites. Portal vein: Portal vein is patent but small. There is a large varix that from the posterior aspect of portal vein connecting to extensive gastroesophageal varices.Hepatic veins: No significant abnormality notedHepatic artery: No significant abnormality notedHypodense subcentimeter lesion in segment 7 on the delayed phase of imaging is not seen on the arterial phase (image 32/series 12).No suspicious hepatic lesions.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny bilateral renal cortical cysts.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of upper abdominal ascites.
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1.Cirrhotic liver without suspicious hepatic lesion.
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Generate impression based on findings.
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Line placementVIEW: Chest AP 1/20/15 NG tube tip in the stomach. The endotracheal tube not visualized and likely to have been removed. Umbilical lines unchanged. Right upper extremity PICC with tip in the right axillary vein. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally increased in the interval. No pleural effusion or pneumothorax.
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Right upper extremity PICC with tip in the right axillary vein.
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Generate impression based on findings.
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Hip subluxation and.EXAMINATION: Pelvis AP/frog leg (two views) 01/20/15 The femoral head ossification centers are symmetric. Lateral uncovering of approximately 25% is present bilaterally. With frog leg positioning the femoral heads are well seated. The acetabula are mildly dysplastic. Bilateral coxa valga is noted.A moderate amount of feces is seen in the rectum.
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Mild lateral uncovering of both femoral heads.
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Generate impression based on findings.
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16 year old female with headache and occipital swelling. There is no evidence of acute intracranial hemorrhage. There is stable hypodense encephalomalacia with volume loss within the bilateral anteroinferior frontal lobes, left greater than right. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1.No evidence of acute intracranial hemorrhage.2.Encephalomalacia within the bilateral anteroinferior frontal lobes, left greater than right, likely related to prior contusions.
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Generate impression based on findings.
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Reason: evaluate for disease progression. History: synovial sarcoma. LUNGS AND PLEURA: Multiple pulmonary nodules demonstrating mild interval increase in size since the prior exam.Reference nodules as follows:Reference right middle lobe nodule (image 36 series 5) now measures 15 mm x 15 mm , previously measuring 13 mm x 15 mm.Left lower lobe superior segment subpleural nodule (image 29 series 5) now measures 23 mm x 44 mm previously measuring 23 mm by 39 mm.Several additional nodules demonstrate mild interval increased in size.No new nodules identified.No pleural effusion.Surgical sutures identified at the left upper and lower lobes, right middle lobe, and right upper lobe.MEDIASTINUM AND HILA: Right chest Port-A-Cath with its tip in the SVC.No hilar or mediastinal lymphadenopathy identified.Cardiac size is normal without evidence of a pericardial effusion.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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Multiple pulmonary metastases demonstrating mild interval increase in size. No new sites of disease identified.
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Generate impression based on findings.
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Follow-up There is a side plate and screws affixing a fracture of the distal fibula in near-anatomic alignment. Much of the fracture is indistinct suggesting some healing. There are also minimally displaced fractures of the posterior and medial malleoli appearing similar to the prior study. Mild osteoarthritis of the tibiotalar joint.
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Orthopedic fixation of distal fibular fracture and other findings as above.
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Generate impression based on findings.
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Hip subluxation.EXAMINATION: Pelvis AP/frog leg (two views) 01/20/15 Femoral head ossification centers are symmetric. Bilateral coxa valga is present. The femoral heads are well seated within the acetabula. A moderate amount of feces is present in the rectosigmoid.
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Bilateral coxa valga.
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Generate impression based on findings.
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Hip subluxation.EXAMINATION: Pelvis AP/frog leg (two views) 01/20/15 Femoral head ossification centers are symmetric. They are well directed into normally formed acetabula. Bilateral coxa valga is noted.
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Bilateral coxa valga.
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Generate impression based on findings.
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There is extensive susceptibility artifact again noted from the patient's indwelling bilateral shunt catheters, which limits evaluation of surrounding structures. The ventricles are stable in size. Right frontal approach and left temporal approach ventriculostomy catheters are grossly stable. There remains diffuse bilateral cerebral white matter T2/FLAIR hyperintensity which is nonspecific but is likely related to post treatment changes. This has progressed since the more remote exam from June 2014. Other scattered distinct foci of T2/FLAIR hyperintensity are noted in the right greater than left upper lobe subcortical and deep white matter, nonspecific but possibly representing mild chronic small vessel ischemic changes.There is a small area of persistent marginal diffusion hyperintensity with ADC isointensity without T2 shine through along the lateral margin of the left occipital horn, in the area of previously identified nodular enhancing lesion in this location. There remains patchy mild diffusion restriction within the left parietal periventricular white matter along the posterior body of the left ventricle. There remains susceptibility along the margin of the left occipital horn and atrium, as well as within the ventricle, consistent with chronic hemosiderin deposition.A previously described enhancing lesion along the left ventricular atrium now only demonstrates minimal punctate along its posterior margin and therefore is difficult to completely delineate on postcontrast images. Comparing prior T2 weighted images to current comparable imaging, the lobulated lesion is not significantly changed in size, measuring 18 x 13 mm on 601/13 compared to previous 19 x 30 mm. Likewise, the ependymal area of enhancement along the left occipital horn now only demonstrates punctate enhancement as seen on 1301/40. There has been slight further interval increased size of a small peripherally enhancing lesion in the deep white matter of the right parietal lobe, now measuring 10 x 8 mm on 1301/55, compared to previous 9 x 7 mmThere is redemonstration of a right frontal developmental venous anomaly. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Perfusion imaging demonstrates no significant hyperperfusion along the areas of residual enhancement in the left occipital and parietal lobes, along the left lateral ventricle. However, the left lateral occipital periventricular white matter lesion is very small in size. There is relative hypoperfusion along the cord plexus in the atrium the left lateral ventricle, and the configuration of the pubis the noted enhancing mass. The additional subtle peripherally enhancing lesion in the right parietal white matter is obscured by artifact on the perfusion imaging, and can therefore not be assessed.
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1. Decreased enhancement associated with posterior left lateral atrial mass and left lateral occipital periventricular lesion. Similar T2 appearance and size of left atrial lesion. No convincing hyperperfusion these areas, with relative hypoperfusion along the left atrial choroid plexus in the configuration of the tumor, suggestive of further interval treatment response.2. Slight further increased size of ring enhancing lesion in the right parietal lobe, which cannot be assessed by perfusion imaging due to susceptibility artifact. Continued follow-up is recommended to exclude the possibility of tumor progression.
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Generate impression based on findings.
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Left knee pain Four views of the left knee are provided. There is severe narrowing of the medial tibiofemoral compartment with bone-on-bone apposition noted on the skiers view. There are also tricompartmental osteophytes as well as a mild varus deformity of the knee. These findings indicate severe osteoarthritis of the knee that has progressed slightly when compared with the prior study.Similar osteoarthritic changes affect the right knee as seen on the frontal views.
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Osteoarthritis.
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Generate impression based on findings.
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Female 61 years old; Reason: hx resected renal cancer, on surveillance History: hx resected renal cancer, on surveillance ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy. Scattered hepatic hypodensities, the largest 3 stable hypodensities near the dome of the liver, likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructing stone in the lower left kidney. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Mild calcification abdominal aorta and its branches. A few stable prominent retroperitoneal lymph nodes.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: Colonic diverticulosis, without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of recurrence on this noncontrast CT scan.
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Generate impression based on findings.
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Pain at first metatarsophalangeal joints. Evaluate bunion and hammertoe deformities. Three views of the right foot are provided. There is a mild hallux valgus deformity. Mild osteoarthritis affects the first metatarsophalangeal joint. There is slight flattening of the medial aspect of the first metatarsal head that could conceivably represent prior surgery, but this is equivocal. I see no frank hammertoe deformity. The bones appear slightly demineralized. Two orthopedic screws affix a calcaneal osteotomy in near-anatomic alignment. Mild osteoarthritic changes affect the hindfoot and midfoot.Three views of the left foot are provided. There is a moderate hallux valgus deformity and mild osteoarthritis at the first metatarsophalangeal joint. I see no frank hammertoe deformities.
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Hallux valgus deformities and other findings as described above.
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Generate impression based on findings.
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Female 85 years old; Reason: patient with a history of neuroendocrine tumor, please assess for disease progression History: neuroendocrine tumor CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Esophagus is moderate to severely dilated.Heart size is normal. No pericardial effusion. Calcified right posterior mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal hepatic masses. Gallbladder contains layering calculi.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic focus in the pancreatic tail (image 101/series 7) may represent a small IPMN. No pancreatic ductal dilatation or atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left renal cyst. No hydronephrosis in either kidney.BOWEL, MESENTERY: Post surgical changes in the ileum. The resected segment is mildly patulous.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine. Mixed sclerotic lucent lesion in the left femur represents fibrous dysplasia versus liposclerosing myxofibrous tumor.OTHER: No significant abnormality noted.
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1.Postsurgical changes in the ileum without evidence for recurrent disease.2.Dilated esophagus of unclear etiology.
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Generate impression based on findings.
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Previous left total hip Three views of the left hip are provided. Severe osteoarthritis affects the hip. There is deformity of the proximal femur affixed via two orthopedic screws, perhaps reflecting prior SCFE surgery, with nearly 90 degrees of varus alignment of the femoral head/neck relative to the diaphysis.The AP view of the pelvis show severe osteoarthritis of the right hip, with deformity suggesting prior slipped capital femoral epiphysis and resultant varus alignment.
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Severe osteoarthritis and other findings as described above.
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Generate impression based on findings.
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Pain Three views of the left shoulder are provided. Tiny glenohumeral joint osteophytes suggest minimal osteoarthritis, essentially within normal limits for age. There is a slight lateral downsloping of the acromion process which may not be of any significance. Mild enthesopathic changes are noted along the greater tuberosity at the expected site of insertion of the rotator cuff.Three views of the right shoulder are provided. Tiny glenoid osteophytes suggest minimal osteoarthritis, essentially normal for age. There is surgical suture material overlying the right hilar region and mediastinum as well as the right upper lung.
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Minimal degenerative arthritic changes as described above.
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Generate impression based on findings.
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Male, 72 years old, history of T2N2b p16+ right base of tongue squamous cell carcinoma. Mild asymmetric thickening of the right tongue base is unchanged and likely reflect sequela of treated tumor. No evidence of local tumor recurrence is seen.Treatment related findings are seen in the neck including thickening of the platysma and infiltration along the carotid spaces. No pathologic adenopathy is detected by size criteria on the present examination.The salivary glands demonstrate a normal posttreatment appearance. No concerning thyroid lesions are identified. The lung apices are unremarkable. The cervical vessels enhance normally. A right IJ central venous catheter is partially visualized.No concerning osseous lesions are seen. Multilevel cervical spondylosis is redemonstrated. Mucosal thickening and debris within the right maxillary sinus have improved from prior. Right scleral banding is noted incidentally.
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Treatment related findings with no evidence of locally recurrent tumor or pathologic adenopathy.
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Generate impression based on findings.
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T3/4 N2b right submandibular gland ductal carcinoma s/p resection 2/28/14 with positive margins. TFHx completed 7/18/2014. Again seen are postoperative findings related to right submandibular gland resection and neck dissection. There is increased enhancement and nodularity at the base of tongue which likely represents hyperplasia of the lingual tonsils. There are edematous changes involving the oropharynx, right submandibular region, and supraglottic larynx. There is associated partial effacement of the vallecula and pyriform sinuses. No discrete mass lesions is seen. Again seen is fatty atrophy of the right tongue and volume loss of the muscles of mastication on the right compatible with denervation atrophy. Again seen is enlargement of the right foramen ovale with enhancement compatible with known perineural tumor spread.The remainder of the salivary glands are unremarkable. The thyroid gland is heterogeneous in appearance. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. Extra-axial enhancing lesion along the left frontal convexity is partially visualized. Limited evaluation of the visualized brain demonstrates no other mass or mass effect. There is some improvement in opacification of the right mastoid air cells and middle ear. The left mastoid air cells are clear. Again seen are numerous sclerotic lesions affecting almost every vertebral level including one that occupies the entire T1 vertebral body. Other bony structures are also affected such as a sternum and ribs. The visualized lung apices are unremarkable. The carotid arteries and jugular veins are patent. Right chest wall port.
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1.Post-treatment changes in the neck without discrete mass lesion. No findings to suggest tumor progression. No significant cervical lymphadenopathy.2.Redemonstration of perineural tumor spread along V3 through the foramen ovale. Denervation atrophy of the right muscles of mastication as well as of the right hemitongue again seen.3.Widespread osseous metastatic disease appears similar to 9/19/2014.4.Partially visualized extra-axial lesion along the left frontal convexity, possibly meningioma and better seen on prior MRI.
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Generate impression based on findings.
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There has been interval development of mucosal thickening within the bilateral maxillary sinuses as well as complete opacification of the rudimentary sphenoid sinuses and near complete opacification of the posterior ethmoid sinuses. There is near complete opacification of the right maxillary ostium and infundibulum and complete opacification of the left maxillary ostium and infundibulum. There is a patent but narrowed left accessory ostium and an obstructed right accessory ostium. There has been interval development of fluid opacifying the bilateral mastoid air cells and middle ear cavities. There is a nasogastric and an endotracheal tube. The nasal cavity is clearThe lamina papyracea and ethmoid roofs are intact. The carotid groove and optic canals are covered by bone. The facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There are partially imaged slightly prominent upper cervical lymph nodes bilaterally.
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Interval development of paranasal sinus opacification and mastoid air cell / middle ear cavity fluid. These findings may be related to intubation or represent sinusitis and mastoiditis. Please correlate clinically.
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Generate impression based on findings.
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Trouble swallowing. Evaluate fusion and hardware. Again seen is an anterior plate with screws entering C4 and C5. There is an intervertebral spacer device at C4/5. Also again seen are posterior rods with screws entering C3, C4, C5, C6, and T1. I see no hardware complications. Severe degenerative disk disease affects C5/6, C6/7 and C7/T1, with minimal retrolisthesis of C5 and C6. There is also minimal retrolisthesis of C3 and minimal anterolisthesis of C2. Calcifications lateral to the cervical spine likely reside in the carotid vasculature. I see no specific findings to account for the patient's swallowing difficulties. The previously seen skin staples and surgical drain have been removed.
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Postoperative changes of cervical spine fusion and degenerative disk disease as described above.
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Generate impression based on findings.
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Status post left total hip arthroplasty The AP view of the left hip reveals components of a total hip arthroplasty device situated in near anatomic alignment without radiologic evidence of hardware complication. A drain and foci of gas density in the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Components of a right total hip arthroplasty device are situated in near anatomic alignment, although the distal extent of the prosthesis is not included on the field-of-view of this study.
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Total hip arthroplasty as above.
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Generate impression based on findings.
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Adjacent segment disease. Progression? Again seen is a posterior stabilization device with screws entering L2, L4, L5, and S1. I see no hardware complications. Spacer devices/bone graft are again noted at L2/3, L4/5, and L5/S1 appearing similar to the prior study accounting for technical differences. Severe degenerative disk disease affects L1/2 and L3/4. There is a grade 1 retrolisthesis of L1, and a grade 1 anterolisthesis of L3. Severe degenerative disk disease also affects T12/L1. Degenerative disk disease affects the remainder of the thoracic spine, most severely from T5 through T9. Severe degenerative disk disease affects the mid and lower cervical spine. There is a grade 1 anterolisthesis of C5. There is mild anterior wedging of the T8 vertebral body that I suspect is chronic in etiology. Again seen is approximately 30 degrees of dextroscoliosis of the thoracic spine as measured from the superior endplate of T2 to the inferior endplate of T11. Also again seen is approximately 22 degrees of levoscoliosis of the thoracolumbar spine as measured from the superior endplate of T11 to the inferior endplate of L3. Coronal balance is within normal limits. There is approximately 5 cm of positive sagittal balance. Overall, these findings are similar to those seen on the prior study.
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Postoperative changes of lumbosacral fusion, scoliosis, and degenerative disk disease appearing similar to the prior study.
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Generate impression based on findings.
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Congenital anomaly.VIEWS: Pelvis AP/frog leg (two views), left femur AP/lateral (two views), left knee AP/lateral (two views), left tibia-fibula AP/lateral (two views), left foot AP/lateral (two views) 01/20/15 The proximal femurs are symmetric and normal in appearance. Acetabular configurations are normal.The distal left femur is abnormal in appearance. It is duplicated the medially and posteriorly. A distal femoral ossification center is associated with lateral aspect. A single bone is present in the lower leg. This bone has the appearance of the fibula. A clubfoot deformity is present.
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Femoral bifurcation/duplication with tibial aplasia and clubfoot.
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Generate impression based on findings.
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Extensive postoperative changes are again seen relating to previous right hemimandibulectomy and superficial parotidectomy. The surgical constructs appear stable in position, without fracture of any instrumentation. Streak artifact from the instrumentation slightly limits evaluation of surrounding structures.The vertical component of the right hemimandible reconstruction is essentially in stable position with minimal bony bridging centrally, although there are areas of new cortical lucency at the level of the previous surgical margin. For example in the medial cortex there is a focal oval area of lucency at 80221/100 on the lateral and posterior aspect, there is focal lucency on 80221/104. Sagittal images also demonstrate the same findings more thickness involvement of the posterior aspect of this surgical margin, near the neo-angle of the mandible. The cranial aspect of this graft remains anteriorly positioned with respect to the articular fossa, with the posterior margin of the osseous grafts again in line with the articular eminence. There has been interval development of irregular lucencies along the superior cortical margin of the vertical graft component. There has been interval healing across the juncture of the horizontal component of the graft and the native mandible.The fat planes of the right parapharyngeal space remain effaced. The right retromaxillary fat has cleared. Surgical clips are again seen along the parotidectomy bed. There is persistent severe thinning of the posterior and lateral wall of the right maxillary sinus. This likely relates to chronic remodeling by the mass. There is a small left maxillary sinus mucosal retention cyst.
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1. Areas of new cortical bone loss along the surgical margin between the vertebral and horizontal components of the right hemimandibular bone graft perhaps relating to incomplete healing, as well as along the superior aspect of the vertical component, of uncertain clinical significance. No definite evidence of recurrent mass. Please correlate with any history of infection.2. Interval healing on the inferior aspect of the horizontal component with respect to the native mandible.
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Generate impression based on findings.
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Evaluate left total knee arthroplasty Components of a total knee arthroscopy are situated in near anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery.
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Total knee arthroplasty as above.
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Generate impression based on findings.
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Pelvic and hip pain. Knee osteoarthritis and pain. Rheumatoid arthritis? Osteoarthritis? Crystal arthritis? The AP view of the pelvis reveals mild osteoarthritic changes affecting both hip joints. Degenerative arthritis also affects the right sacroiliac joint. Overall, the bones appear demineralized. I see no erosions or specific radiographic features of rheumatoid arthritis. I see no chondrocalcinosis.Five views of the left knee are provided. There is mild-moderate medial compartment narrowing as well as small medial and patellofemoral compartment osteophytes indicating mild-moderate osteoarthritis. I see no joint effusion or erosions. There is thickening of the cortex along the anterolateral aspect of the distal femoral diaphysis which is nonspecific but may reflect old traumaFive views of the right knee reveal narrowing of the medial tibiofemoral compartment and small tricompartmental osteophytes indicating moderate osteoarthritis. I see no large joint effusion, nor do I see any erosions.
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Osteoarthritis of the hips and knees as described above.
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Generate impression based on findings.
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Reason: Hx Malignant Neoplasm base of tongue compare with previous scans, measurements please History: none CHEST:LUNGS AND PLEURA: Small stable calcified granuloma, but no other significant pulmonary abnormality and no sign of metastases. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No coronary calcifications present, the heart and pericardium appear normal.Right jugular catheter terminates in the SVC.Large hiatal hernia, the stomach completely intrathoracic.CHEST WALL: No significant abnormality noted.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: Renal cysts unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No sign of metastases, or other significant abnormality.
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Generate impression based on findings.
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17-year-old male with abdominal painVIEWS: Abdomen AP supine, AP upright (two views) 01/20/15 There is mild leftward curvature of the lumbar spine. Lumbarization of the S1 vertebral body is noted. Moderate amount of stool is seen within the rectum and descending colon. Small air-fluid levels are also noted in the right hemiabdomen. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Right patella fracture Again seen is a comminuted intra-articular fracture of the patella with fracture fragments in near anatomic alignment. There is a small joint effusion/hemarthrosis. There is mild diffuse soft tissue swelling.
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Patellar fracture as above.
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Generate impression based on findings.
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Reason: eval for cva History: transient loss of vision The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a mild degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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42 year-old male with pain, redness, and swelling status post I&D 2 days ago, currently with no drainage. Evaluate.Per additional history obtained from the emergency department, patient with left anterior abdominal wall I&D at the level of the umbilicus. ABDOMEN:LUNG BASES: Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is nonspecific soft tissue nodule measuring 2.6 x 1.6 cm (series 3, image 33) at splenic hilum and abutting the tail of the pancreas. It is difficult to determine whether this arises from the pancreatic tail.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left upper pole hypoattenuating lesion is too small to characterize. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: Approximately 8mm defect in the left anterior abdominal wall at the level of the umbilicus with mild underlying fat infiltration consistent with inflammatory changes. No fluid collections to suggest abscess.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly prominent bilateral inguinal lymph nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Approximately 8mm defect in the left anterior abdominal wall at the level of the umbilicus with mild underlying fat infiltration consistent with inflammatory changes. No fluid collections to suggest abscess.OTHER: No significant abnormality noted
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1.Subcentimeter defect in left anterior abdominal wall with mild underlying fat infiltration consistent with mild inflammatory changes. No fluid collections to suggest abscess as clinically questioned.2.Incidentally noted low attenuation lesion in the left upper quadrant may arise from the pancreatic tail versus splenic hilum. MRI/MRCP may be helpful in differentiating the origin. Differential includes a pancreatic cystic lesion or small lymphangioma.
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Generate impression based on findings.
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Reason: 88yo female with new AMS and supratherapeutic anticoagulation. History: altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a moderate degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.Punctate sulcal calcifications are present in the right parietal lobe and right frontal lobe which are stable since the prior examThe 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. The eyeball lenses are thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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13 year old female with fracture. VIEW: Right knee AP, lateral 1/20/15 at 10:01. Two surgical screws affix a distal femoral fracture in anatomic alignment. There is callus formation and the fracture line appears slightly less distinct suggesting some interval healing. There is a probable small joint effusion. The bones appear demineralized.
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Healing distal femoral fracture.
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Generate impression based on findings.
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55 year old female with history of carcinoid, pancreatic primary, who presents for re-evaluation of disease. CHEST:LUNGS AND PLEURA: Stable subcentimeter right middle lobe nodule, best visualized on MIP images. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Left axillary clips noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic lesions which demonstrate central necrosis and the thick rind of arterial enhancement with interval increase in size of many of the lesions.Reference left hepatic lobe lesion measures 5.0 x 4.0 cm (series 9, image 39), previously measuring 2.7 x 5.0 cm. Reference right hepatic lobe lesion measures 2.9 x 3.3 cm (series 9, image 74), previously measuring 2.1 x 2.7 cm.SPLEEN: Accessory splenule again noted.PANCREAS: Pancreatic body mass measures 4.4 x 2.3 cm (series 12, image 106), previously measuring 2.8 x 2.3 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic lymph node measures 1.9 X 1.0 cm (series 80697, image 57), previously measuring 1.5 x 2.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic foci through the vertebral bodies as well as the iliac lungs are nonspecific and unchanged.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: Scattered sclerotic foci through the vertebral bodies as well as the iliac lungs are nonspecific and unchanged.OTHER: No significant abnormality noted.
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Interval increase in size of the arterially rim enhancing hepatic lesions as detailed above.Interval increase in size of the pancreatic mass, which is patient's known primary neuroendocrine tumor according to given history.Interval increase in size of the gastrohepatic lymph node.
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Generate impression based on findings.
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2 year old male with neuroblastoma, suspicion of fungal infection. CHEST:LUNGS AND PLEURA: Interval development of patchy airspace opacities throughout both lungs, most prominent in the lung bases but throughout both upper lobes as well. No pleural effusions. MEDIASTINUM AND HILA: Bilateral central venous catheters. The right internal jugular catheter terminates in the SVC. The left subclavian catheter terminates in the right atrium. Endotracheal tube with tip above the carina. NG tube with tip in the stomach. No lymphadenopathy or pericardial effusion. CHEST WALL: No axillary adenopathy. Line placements as above. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly without focal lesion. SPLEEN: Normal in size and attenuation. PANCREAS: Normal in size and attenuation. ADRENAL GLANDS: Partially calcified left adrenal mass measures 3.7 x 2.2 cm in axial dimension (series 3 image 67), previously 4.0 x 2.9 cm but these differences most likely represent differences in technique as opposed to a true change in size. The mass continues to displace the left kidney laterally and left renal artery anteriorly. The right adrenal gland appears normal. KIDNEYS, URETERS: Lobulated small left kidney with mild hydronephrosis appearing similar to the prior study. Normal right kidney. RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: Mildly dilated fluid filled loops of bowel throughout the abdomen without evidence of obstruction. BONES, SOFT TISSUES: Increased edema of the subcutaneous soft tissues. No suspicious osseous lesions. OTHER: Abdominal and pelvic free fluid appears unchanged. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place. The bladder is distended and air in the bladder lumen likely from the catheter. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above. BONES, SOFT TISSUES: As above. OTHER: Abdominal and pelvic free fluid appears mildly unchanged.
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1. New patchy bilateral airspace opacities are consistent with infection, with atypical etiologies including fungal infection differential considerations. 2. Left adrenal mass is not significantly changed compared with recent prior studies from 1/7/15 and 1/2/15 allowing for differences in technique. 3. Other findings as described above.
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Generate impression based on findings.
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Male, 61 years old, with history of T1N0 SCC of the left retromolar trigone s/p excision in 8/2012, subsequently presenting with T4N2b SCC of the left upper gingiva s/p surgery and induction chemotherapy with carboplatin/paclitaxel, s/p TFHX 5/5 completed 5/21/2014, status post repair of oroantral fistula and resection of necrotic bone on 9/25/14. Again seen are findings related to partial left maxillectomy with resection of the left hard palate and much of the left maxillary sinus. There remains a wide fistulous communication between the residual maxillary antrum, the nasal cavity and the oral cavity.Since the prior examination, a small amount of bone has been removed adjacent to the residual left maxillary premolar compatible with the history of resected osteonecrotic bone. However, the left mandibular coronoid process is also newly absent with a relatively sharp margin along its junction with the mandible proper.Ill-defined soft tissue thickening persists in the left masticator space continuing anteriorly along the left buccal space. The appearance of this tissue is largely unchanged and probably represents the placement of soft tissue flaps or other surgical alteration. Ill-defined enhancement within the center of this masticator space soft tissue, approximately along the expected position of the missing coronoid process, has increased.Hypoattenuating material continues to fill the nasal cavity. Peripheral hypoattenuating material within the right maxillary sinus has increased from the prior exam. Similar peripheral thickening along the margins of the left maxillary sinus has improved from prior.No pathologically enlarged or growing nodes are detected within the neck. The parotid glands are free of suspicious lesions as is the right submandibular gland. The left submandibular gland is not clearly seen and has probably been resected. The thyroid is unremarkable.The cervical vessels enhance normally. Peripheral cystic changes are demonstrated in the lung apices. Except as discussed above, no new or concerning bony abnormalities are identified.
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1.Demonstration of extensive surgical findings including partial left maxillectomy and soft tissue grafting. There remains a wide fistulous communication between the left maxillary antrum, nasal cavity and oral cavity.2.The left mandibular coronoid process is newly absent relative to the prior study. The sharp margin at its junction to the mandible proper suggests interval surgery, though no record of such a procedure is found in our EMR. Correlation with history of outside surgery is suggested. If indeed this is a surgical change, then ill defined enhancement within the masticator space soft tissues is also likely postoperative.3.No definite evidence of progressive disease is seen elsewhere in the neck including no pathologically enlarged or growing lymph nodes. The remainder of the exam is unchanged.
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Generate impression based on findings.
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71 year old female with history of bladder cancer status post radical cystectomy and ileal conduit diversion, please evaluate for metastatic disease with delayed imaging. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small gallstones, without additional significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no hydronephrosis or hydroureter. The ureters attach to the previously seen ileal conduit without filling defects.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterior right lower quadrant ileal conduit is seen, unchanged from prior and appears intact.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Status post cystectomy with ileal conduit. Surgical clips are again seen in the abdomen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Postoperative findings of cystectomy with ileal conduit, without evidence of recurrent metastatic disease.
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Generate impression based on findings.
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Male 49 years old; Reason: R/O HCC History: HCV, cirrhosis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Morphologic changes of the liver, suggestive of cirrhosis. A couple subcentimeter hypodensity in the the right lobe are too small to accurately characterize, but likely cysts. No suspicious hepatic lesions. Patent hepatic vasculature.SPLEEN: Splenomegaly, measuring up to 17.3 cmPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Gastroesophageal varices, and collateralization.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Cirrhosis with sequela of portal hypertension as described above. No suspicious hepatic lesions.
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Generate impression based on findings.
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Reason: hemorrhagic conversion History: ams, on AC The CSF spaces are appropriate for the patient's stated age with no midline shift. There is encephalomalacia involving the inferior and medial aspect of the right cerebellar hemisphere. In general the brainstem is small. Focus of encephalomalacia is also present in the right precentral gyrus. A hypodense focus is present in the right basal ganglia which is associated with mild mass effect. A hypodense focus in the left basal ganglia is present which is associated with volume loss.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate small opacities in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
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1.Subacute infarction along the right basal ganglia with no evidence for hemorrhagic conversion.2.Right cerebellar encephalomalacia is suspected to be due to old infarction.3.Older lacunar infarction along the left basal ganglia.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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11 year old female with right knee circumferential tenderness, unable to bear weightVIEWS: Right knee AP, oblique, lateral (3 views) 01/20/15 No acute fracture malalignment is evident. Large joint effusion. Lucent lesion with mild sclerotic border measuring 9 mm without correlate on the lateral view may represent a nonossifying fibroma.
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Large joint effusion without evidence of acute fracture or malalignment.
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Generate impression based on findings.
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51-year-old male with back pain and history of L5-S1 fusion, evaluate hardware and fusion Postsurgical changes of posterior spinal fusion at L5-S1 with posterior stabilization rods and screws entering the pedicles of L5 and S1 as well as interbody spacer device at L5-S1. No evidence of hardware displacement, hardware fracture or peri-hardware lucency. Alignment at this level is anatomic. Prominent endplate degenerative changes are seen at L2-3 with vacuum disc phenomenon and sclerosis at the inferior endplate of L2 possibly related to old Schmorl node. Vertebral body heights are intact. Individual levels as below:T12-L1: No spinal canal or foraminal stenosis.L1-L2: No spinal canal or neuroforaminal stenosis.L2-L3: Broad based disk bulge without significant spinal canal or neuroforaminal stenosis. L3-L4: Broad-based disk bulge with ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis. L4-L5: Streak artifact obscures visualization, however there appears to be a broad-based disk bulge with a superimposed small central protrusion and ligamentum flavum thickening producing mild spinal canal narrowing. Mild bilateral neural foraminal narrowing.L5-S1: Streak artifact limits evaluation. Surgical decompression dorsally. No spinal canal or neuroforaminal stenosis.Atherosclerotic calcifications of the aorta and its branches.
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1.Postsurgical changes of posterior spinal fusion at L5-S1 without evidence of hardware complication. There is some bony interbody bridging at L5-S1 without solid fusion and can be correlated with prior imaging and timing of surgery.2.Mild degenerative changes as detailed above, relatively prominent at the L2-3 intervertebral disc space. Mild L4-5 spinal canal and neural foraminal stenosis.
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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 (10/11/14, 12/13/14), ultrasound images of left breast (12/13/14) and images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (12/17/14) performed at Advocate Trinity Hospital. DIGITAL MAMMOGRAPHIC IMAGES (10/11/14, 12/13/14):The breast parenchyma is composed of scattered fibroglandular elements. There is a focal asymmetry with architectural distortion, measuring approximately 4 x 3 cm, at upper outer quadrant in the left breast. Pleomorphic calcifications, spanning approximately 4 x 4 x 4.5 cm (AP x LR x CC), are associated with this focal asymmetry. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (12/13/14):An irregularly-shaped hypoechoic mass measuring 12 x 8 x 10 mm is visualized at one o'clock position in the left breast, corresponding to the focal asymmetry with distortion seen on the mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (12/17/14):Ultrasound guided needle biopsy was performed for the hypoechoic mass at one o'clock position in the left breast with an appropriate needle placement. A normal-appearing lymph node is visualized in the left axilla.Postprocedural left mammographic images show a marker clip within the focal asymmetry in the left breast.Per outside pathology report, the results were invasive and in situ ductal carcinoma grade 1.
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Biopsy proven invasive and in situ carcinoma in the left breast. Mammographic measurement of the lesion with calcifications is 4 x 4 x 4.5 cm, but that of ultrasound lesion is 12 x 8 x 10 mm. The discrepancy in measurement is probably because the lesion seen on ultrasound is the invasive component only, and the distribution of the calcifications on mammogram might suggest in situ component. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Reason: HRCT of the chest for a history of nocardia and pneumonia History: Cough LUNGS AND PLEURA: Moderate to severe centrilobular emphysema is present.Nodular right upper lobe scarring is present, but no other significant abnormality.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.The heart and pericardium appear normal.CHEST WALL: Mild thoracic endplate compression.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Upper abdominal surgical clips are present.
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Moderate to severe centrilobular emphysema. No other significant abnormality, and no sign of infection.
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Generate impression based on findings.
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Female 41 years old; Reason: 41 yo F with wegeners and renal mass (s/p biopsy c/w wegeners). Please evaluate for change in size of mass History: back pain ABDOMEN:LUNG BASES: Interval resolution of previously seen centimeter pulmonary nodule in the right lobe. Bilateral breast implants.LIVER, BILIARY TRACT: Stable segment 8 hypodensity, indeterminate, likely hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in size, complex, enhancing heterogenous left renal mass with perinephric stranding, now measuring 7.7 x 4.9 cm (coronal image 30), previously 9.7 x 5.4 cm (arterial coronal image 76). Mild proximal ureteral wall nodular thickening likely related to this process.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval reduction in size of left renal mass and interval resolution of right lower lobe pulmonary nodule. In conjunction with history of positive renal mass biopsy of Wegener's, these findings likely represent interval improvement in Wegener's granulomatosis.
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Generate impression based on findings.
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61 years old male with a history of esophageal cancer. This study was performed for initial staging. RADIOPHARMACEUTICAL: 15.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 108 mg/dL. Today's CT portion grossly demonstrates distal esophageal thickening. There is a low-attenuation lesion in the right kidney. Linear density is seen in the left lung base. A sclerotic focus is seen in the right femoral intertrochanteric region.Today's PET examination demonstrates intense FDG uptake in the distal esophageal wall thickening with maximal SUV of 19.2, which is consistent with patient's diagnosis of esophageal cancer. There is a focus of increased activity in the right paratracheal region, corresponding to a small lymph node seen on recent diagnostic chest CT. The maximal SUV in the lymph node is 6.4.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.There is decreased metabolic activity in the low-attenuation lesion of the right kidney, which is most likely due to renal cyst. There is no abnormal FDG uptake in the sclerotic focus seen on CT in the right proximal femur.
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1.Intense FDG uptake in the distal esophageal wall thickening, which is consistent with the patient's diagnosis of esophageal cancer.2.Hypermetabolic lymph node in the mediastinal right paratracheal region, suspicious for nodal metastasis.3.No other evidence of FDG avid tumor.
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Generate impression based on findings.
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Left hip pain Three views of the left hip are provided. Severe osteoarthritis affects the hip. This appears similar to the prior study accounting for slight positional differences.The AP view of the pelvis reveals the aforementioned severe osteoarthritis of the left hip. Components of a right total hip arthroplasty device are situated in near anatomic alignment although the distal extent of the prosthesis is not included on the field of view of this study. Degenerative arthritic changes also affect the visualized lower lumbar spine.
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Osteoarthritis.
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Generate impression based on findings.
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Tight hips.VIEW: Pelvis AP (one view) 01/20/15 Femoral head ossification centers are symmetric. They are well directed into normally formed acetabula. No fracture is present.
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Normal examination.
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Generate impression based on findings.
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Reason: eval shunt History: HA, abd pain The patient is status post ventriculostomy tube placement coursing through the right parietal lobe with the the tip of the ventriculostomy tube in the anterior aspect of the body of the right lateral ventricle. It is in stable position. In the lateral ventricles are stable in size compared to the prior exam.There is redemonstration of low lying cerebellar tonsils small fourth ventricle small posterior fossa and interdigitation across the falx cerebri.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.The ventricular system is stable in size and in nondilated3.Redemonstration of stigmata of Chiari two malformation.
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Generate impression based on findings.
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Ms. Bonini is a 71 year old female with a personal history of bilateral lumpectomies in February 2014 (left breast - DCIS, right breast - microinvasive IDC), complicated by multiple seromas status post aspiration. She has a family history of breast cancer in a maternal aunt. Three standard views of both breasts along with two spot compression views of each 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. Linear markers were placed on scars overlying the right breast and axilla. There are expected 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. A linear marker was placed on the scar overlying the left breast. There are expected postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Scattered benign calcifications, including vascular calcifications, are present. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Expected postsurgical changes in both breasts. 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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38-year-old female with history of metastatic pancreatic cancer. Evaluate. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Scattered pulmonary micronodules are unchanged. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Chest port with catheter tip in the SVC/right atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Numerous hypodense hepatic lesions consistent metastatic disease with some of the lesions which are more conspicuous on the current examination.Reference right hepatic lobe lesion measures 1.0 x 0.8 cm (series 3, image 87), previously measuring 0.8 x 0.8 cm.Reference inferior left hepatic lobe lesion measures 1.0 x 0.9 cm (series 3, image 97), previously measuring 0.9 x 0.8 cmPatent metallic common bile duct stent with persistent associated pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: No significant interval change in the large pancreatic head mass encasing the distal common bile duct and measuring 4.1 x 3.4 cm (series 3, image 99), previously measuring 4.2 x 3.4 cm. Severe diffuse proximal pancreatic ductal dilatation with pancreatic atrophy, unchanged.The superior mesenteric artery is again noted to be encased by the tumor. The superior mesenteric vein is occluded at the inferior aspect of the mass. Mesenteric haziness surrounding the celiac axis and SMA is again noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 1.4 x 0.8 cm (series 3, image 92), unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple abdominal venous collaterals are noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple abdominal venous collaterals are noted.
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1.No significant interval change in the pancreatic head mass which encases the superior mesenteric artery and with occlusion of the superior mesenteric vein.2.Mild interval increase in hepatic metastatic disease.3.Stable portacaval lymph node.
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Generate impression based on findings.
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Femoral osteotomy.VIEW: Pelvis AP (one view) 01/20/15 A cast obscures bone detail. Plate and screws devices are present in the proximal femurs. In this single plane, the femoral heads are well directed into the acetabula. Proximal femoral osteotomies are well visualized.A moderate amount of feces is present in rectosigmoid.
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Femoral heads remain directed into acetabula.
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Generate impression based on findings.
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Line placementVIEW: Chest AP and abdomen AP 1/20/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal patchy atelectasis right lower lobe and left lower lobe. No pleural effusion or pneumothorax. The umbilical venous catheter tip is coiled within the umbilical vein. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Malpositioned umbilical venous catheter.
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Generate impression based on findings.
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Reason: Eval for resolution of ground glass opacities of Lower lung fields History: Lung opacifications after heart transplant, complicated by ARDS and bacteremia LUNGS AND PLEURA: Previously seen groundglass opacities have now nearly resolved, except for some residua in the left lower lobe. MEDIASTINUM AND HILA: Median sternotomy status post heart transplant, with a large left atrium. CHEST WALL: IABP catheter introducer unchanged in the left chest wall.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Near complete resolution of pulmonary opacities, with no new findings.
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Generate impression based on findings.
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Fracture Again seen is a short oblique fracture of the distal fibula. There is minimal posterolateral displacement of the distal fracture fragment. There is also a minimally displaced fracture of the medial malleolus. There is soft tissue swelling about the ankle.
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Distal fibular and medial malleolar fractures appearing similar to those seen on the prior study.
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Generate impression based on findings.
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Increasing pain in left ankle and foot. History of foot injury as child, has needed ankle brace since then. Three views of the left ankle show severe osteoarthritis of the tibiotalar joint that has perhaps progressed slightly when compared with the prior study. Slight anterior subluxation and inversion of the talus relative to the long axis of the tibia is again noted. Mild deformity of the tibial plafond appears similar that seen on the prior study and may reflect a combination of prior trauma and chronic erosive remodeling.Three views of the left foot are provided. Again seen is severe osteoarthritis of the ankle joint. Mild osteoarthritis affects the first metatarsophalangeal joint. The bones appear demineralized, suggesting osteopenia. Chronic deformity of the fifth metatarsal may reflect old trauma.
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Severe osteoarthritis of the ankle joint and other findings as described above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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55-year-old male with lymphoma and mediastinal lymphadenopathy, concern for SVC syndrome. Please evaluate tumor burden.RADIOPHARMACEUTICAL: 14.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 84 mg/dL. Today's CT portion grossly demonstrates large conglomerate mediastinal lymphadenopathy, centered in the anterior mediastinum extending to the right paratracheal, right hilar and precarinal regions, and with possible necrotic components. Moderate bilateral pleural effusions, relatively unchanged, with associated compressive atelectasis. Nodular opacities in the right upper lobe appear stable to slightly decreased from the previous exam. Few prominent right axillary lymph nodes are also noted. There is trace pericardial effusion. Additional note is made of prostatic enlargement.Today's PET examination demonstrates markedly hypermetabolic activity associated with the large anterior mediastinal conglomerate adenopathy (SUV max 32.2), compatible with known lymphoma. Small additional lymph nodes associated with foci of mild hypermetabolic activity are seen in the anterior pericardium and left low cervical region anterior to the second left costovertebral junction, compatible with additional sites of disease.Nodular opacities described above in the right upper lobe also demonstrate mild hypermetabolic activity, though much less intense than mediastinal FDG uptake. The most intense activity associated with a nodular opacity is located in the right upper lobe along the minor fissure (SUV max 3.1).
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1.Markedly intense hypermetabolic activity associated with large mediastinal conglomerate lymphadenopathy, compatible with known lymphoma. Additional pericardial and low left neck lymph nodes demonstrate mild hypermetabolic activity and may represent additional sites of disease.2.Mild FDG activity associated with nodular lung opacities in the right upper lobe, which are mildly decreased on CT from the previous exam, may represent inflammation/infection, and less likely tumor activity.
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Generate impression based on findings.
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51-year-old male with history of end-stage renal disease. Pre-kidney transplant evaluation. Evaluate aorta and iliac vessels. Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.ABDOMEN:LUNG BASES: Minimal dependent right lung base opacities, likely atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality noted, with presumed vascular calcifications in the hepatic hilum.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate atherosclerosis affects the aorta and its branches. Moderate atherosclerosis of the proximal common iliac arteriesthe aorta and common iliac arteries are normal in caliber. ~50% circumferential calcification of the proximal common iliac arteries.PELVIS:.PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: Bladder is relatively decompressed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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The aorta and common iliac arteries are normal in caliber, with moderate atherosclerosis as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Unchanged scattered benign calcifications bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Male 55 years old; Reason: History metastatic renal cancer; assess for progression on pazopanib History: cough CHEST:LUNGS AND PLEURA: There are multiple bilateral pulmonary lesions. Reference left upper lobe lesion measures 1.3 x 1.1 cm (image 34/series 4) previously, 1.3 x 1.1 cm.Reference right lower lobe pulmonary lesion measures 6 mm (image 47/series 4)MEDIASTINUM AND HILA: Reference mediastinal lymph node has decreased in size. It measures 1.9 x 1.2 cm (image 32/series 3) previously, 2.5 x 1.4 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuation of the hepatic parenchyma suggests fatty infiltration. No solid hepatic lesions. Hepatic vasculature are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland nodule is unchanged. Left adrenal gland lesion measures 2.5 x 1.6 cm (image 104/series 3) previously, 2.5 x 1.7 cm.KIDNEYS, URETERS: Partially necrotic right adrenal mass measures 10.6 x 9.5 cm (image 108/series 3) previously, 10.9 x 9.0 cm.RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node has increased in size now measuring 1.8 x 1.8 cm (image 133/series 3) previously, 1.3 x 1.0 cm.Mild calcific arteriosclerotic disease affects the aorta.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: Small enhancing nodules in the left flank and left upper back.OTHER: No significant abnormality noted
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1.Decrease in size of some of the lesions. 2.Increase in the size of the aortocaval node.
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Generate impression based on findings.
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72 years, Female. Reason: Kidney stone? History: Flank pain No radiopaque renal calculi are identified. Nonobstructive bowel gas pattern. Above average stool burden.
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1.No radiopaque renal calculi seen.2.Nonobstructive bowel gas pattern with above average stool burden.
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Generate impression based on findings.
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20 year-old male with pain in right upper extremity, deformity of clavicle Clavicle and ribs: There is a comminuted but predominately transverse fracture of the mid to distal clavicular diaphysis with approximately 1 shaft width inferior displacement of the distal fracture fragment. The acromioclavicular joint alignment is within normal limits. A transverse fracture extends through the anterolateral aspect of the right first rib with approximately 8 mm anterolateral displacement of the anterior fracture fragment. There is a minimally displaced fracture of the anterolateral right second rib as well as a nondisplaced fracture of the posterior aspect of the right third rib. There may also be a nondisplaced fracture through the posterior right fifth rib.
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Right clavicle and multiple right rib fractures as described above.
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Generate impression based on findings.
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Need left hand for comparison to right hand syndactylyVIEWS: Left hand AP, oblique and lateral The metacarpals and phalanges of the digits are normal. No acute fracture or dislocation.
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Normal examination of the left hand.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with an additional right MLO view and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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67 years old male presents for the evaluation of left upper lobe nodular density. RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates interval increase in size of the nodular and streaky opacities in the left upper lobe. Stable nodular densities in the right upper lobe. Diffuse emphysematous changes are noted in the stable. Extensive calcifications are seen in the coronary arteries. Postsurgical changes with a vascular graft seen in the right side of the neck.Today's PET examination demonstrates interval increase in size, number and metabolic activity in the nodular and streaky opacities left upper lobe with maximal SUV of 8.3 (it was 4.7 on the prior study). There is an interval decrease in metabolic activity in the nodular densities in the right upper lobe with SUVmax of 2.1 (it was 3.2 on prior study).A focus of increased activity is seen at the root of the left common carotid artery, which is most likely due to atherosclerotic disease. Foci of increased activity in are seen in the upper endplate of the L3 vertebral body, which is most likely due to degenerative changes. Increased activity is also seen in the posterior element of C2/3 vertebrae, which is most likely due to degenerative change.There is a focus of cutaneous FDG uptake in the midline of the back of the chest. Suggest clinical correlation.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1.Interval increased in size, number, and metabolic activity in the nodular and streaky opacities in the left upper lobe, suspicious for tumor. However, this finding is not specific for tumor and differential diagnosis including infection and inflammatory change.2.Stable nodular densities in the right upper lobe, which is indeterminate. Suggest follow-up.3.Degenerative changes in the cervical spine and lumbar spine with increased activity.
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Generate impression based on findings.
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50 years, Male. Reason: abd distension History: abd distension with decreased po intake There is prominent loops of jejunum with differential air fluid level on the RUQ. Paucity of bowel gas elsewhere. Early obstruction cannot be excluded. No definite free air.
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Prominent loops of jejunum with differential air fluid level on the RUQ. Early obstruction cannot be excluded. No definite free air. Follow up as clinically indicated.
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Generate impression based on findings.
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PICC placementVIEW: Chest AP 1/20/15 ET tube tip at the level of the carina. NG tube tip in the stomach. Right upper extremity PICC with tip at the right subclavian vein. The umbilical venous catheter has been removed in the interval. The umbilical arterial catheter tip at T8. Cardiothymic silhouette normal. Minimal atelectasis right lower lobe. No pleural effusion or pneumothorax.
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Right upper extremity PICC with tip in the right subclavian vein.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign left breast excisional biopsy and benign right breast core biopsy. History of breast cancer in two paternal cousins. Left breast cyst seen on prior ultrasound at the 9:00 position. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The biopsy clip is again seen in the right lower inner quadrant. Benign appearing scattered calcifications are present, unchanged. The subcentimeter circumscribed mass in the medial left breast corresponding to a cyst is again noted. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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54 year-old female with right knee pain Hip: Severe osteoarthritis affects the right hip.Pelvis: Severe osteoarthritis is again visualized affecting the right hip. Relatively mild osteoarthritis affects the left hip. Degenerative arthritic changes also affect the visualized lower lumbar spine.Knee: Small osteophytes indicate mild osteoarthritis affecting the knee. No joint effusion is noted. Mild osteoarthritis also affects the left knee as seen on the frontal views.
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Hip and knee osteoarthritis as described above.
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Generate impression based on findings.
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81-year-old male with history of bladder cancer. Status post ileal diversion. Creatinine greater than 2.5. P.O. contrast on the IV. Please note lack of IV contrast limits evaluation of solid organ pathology.CHEST:LUNGS AND PLEURA: Small, right greater than left pleural effusions. Patchy foci of nodular opacities, particularly in the right apex and right upper lobe. A reference nodule (5/40) measures approximately 1 x 1.7 cm, and has adjacent ground glass opacities, nonspecific and could represent metastases, particularly in the setting of right renal abnormalities further described in the abdomen section of this report, though less likely could be infectious/inflammatory.MEDIASTINUM AND HILA: Multiple enlarged mediastinal and hilar lymph nodes are seen, with a reference right precarinal/R4 lymph node (3/40) measuring approximately 1.2 cm in the short axis. Additional scattered calcified and noncalcified lymph nodes are seen. No significant pericardial effusion. Left chest subclavian cardiac assist device.CHEST WALL: Degenerative disease affects the spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clips are seen.SPLEEN: Scattered splenic calcified granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild bilateral, right greater than left, perinephric stranding. The right kidney has contour irregularity and multiple exophytic projections, as well as nodularity in the perirenal fat. No significant hydronephrosis or hydroureter. Findings suggestive of neoplastic involvement.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes, with a reference right para-aortic lymph node (3/108) measuring approximately 1.1 cm in the short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: History of cystectomy and ileal diversion.LYMPH NODES: Scattered bilateral inguinal lymph nodes are seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right femoral artery dense calcific atherosclerosis approaching 50%.OTHER: No significant abnormality noted
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1.Right perinephric stranding and contour abnormality with exophytic projections and nodules in the perirenal fat, in the setting of retroperitoneal adenopathy is suspicious for neoplastic involvement.2.No significant hydronephrosis or hydroureter.3.Small pleural effusions, with patchy focal nodular opacities that are nonspecific but could be related to metastatic disease, although infection and inflammation are lower on the differential.
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Generate impression based on findings.
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74-year-old female, evaluate for scoliosis There is levoscoliosis of the thoracolumbar spine, measuring approximately 48 degrees from the superior endplate of T11 to the inferior endplate of L3. Severe multilevel degenerative disk disease and facet joint osteoarthritis also affects the lumbar spine and the lower thoracic spine. Moderate degenerative disk disease affects the upper thoracic spine. Moderate to severe degenerative disease affects the cervical spine, worst at C6/7. There is also grade 1 anterolisthesis of the C3, C4, and C5 vertebral bodies.The coronal balance is with normal limits. The sagittal balance measures approximately +2 cm.
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Degenerative disk disease and scoliosis as described above.
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Generate impression based on findings.
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Female 71 years old; Reason: reassess mass/ lymph nodes. malignancy of unknown primary History: compare to last scan CHEST:LUNGS AND PLEURA: No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There is left chest wall port terminates at the cavoatrial junction.CHEST WALL: Right axillary enhancing soft tissue nodule along the body wall measures 1.0 x 1.0 cm (image 22/series 3) previously, 0.9 x 0.6 cm.There are sclerotic changes in the T1 vertebral body compatible with metastatic disease extending into the left pedicle.ABDOMEN:LIVER, BILIARY TRACT: Liver is hypoattenuating compatible with fatty infiltration. No solid hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Cystic pancreatic lesion in the tail of the pancreas measures 1.2 x 0.8 cm (image 108/series 3) previously, 1.1 x 0.8 cm.No pancreatic atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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: Right ischium sclerotic lesion compatible with metastatic disease.OTHER: No significant abnormality noted.
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1.Slight increase in the size of the reference right axillary soft tissue.2.Findings highly suspicious for metastatic disease to the T1 vertebral body and right ischium (unchanged).
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Generate impression based on findings.
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57-year-old male with restaging scan status post left nephrectomy 1.5 years ago. Evaluate. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart is normal in size without pericardial effusion. Mild to moderate coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post left adrenalectomy. Nodular thickening of the right adrenal gland is unchanged.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence in the left renal fossa. No evidence of a renal mass. The right kidney enhances and excretes contrast promptly. Mild right perinephric fat stranding is unchanged.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: Moderate L1 compression deformity is unchanged. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Nonspecific bladder wall thickening which may be secondary to underdistention.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate L1 compression deformity is unchanged.OTHER: No significant abnormality noted
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1.Postoperative changes of left nephrectomy without evidence of tumor recurrence.2.Stable nodularity of the right adrenal gland.
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Generate impression based on findings.
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19 year-old female with pain and swelling, inability to bear weight Ankle: There is soft tissue swelling about the ankle. We see no fracture.Foot: No fracture or malalignment.
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Soft tissue swelling without fracture evident.
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Generate impression based on findings.
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52-year-old female with history of surgery Evaluation of the cervicothoracic junction is limited due overlying anatomy. Small osteophytes are noted along the anterior aspect of the cervical vertebrae. No large osteophytes are present. There are also small posterior vertebral body osteophytes at C5/6. The disk spaces and vertebral body heights are preserved.
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Small vertebral body osteophytes.
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Generate impression based on findings.
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Extensive postoperative findings related to left facial tumor resection, left inferior parotidectomy, left anteromedial maxillectomy, left neck dissection, and flap reconstruction. There is a mild amount of left periorbital edema as well as nonspecific soft tissue along the inferior aspect of the left orbit extending along the left nose, slightly decreased in thickness from the prior exam. There are surgical clips within the subcutaneous tissues overlying the left maxilla extending inferiorly along the left neck with fascial thickening appearing similar to the prior exam. No significant cervical lymphadenopathy.The thyroid and major salivary glands are unremarkable. Mild degenerative changes of the visualized spine. The airways are patent. For findings in the lungs, please see dedicated chest CT performed on the same day. Large CSF collection is seen in the right middle cranial fossa, similar to the prior exam, likely an arachnoid cyst. Prior right lateral occipital craniotomy and partial mastoidectomy.
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1.Lack of intravenous contrast slightly limits evaluation. No significant interval change in extensive postoperative findings related to left facial tumor resection and flap reconstruction. No new mass to suggest tumor progression.2.No significant cervical lymphadenopathy.
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Generate impression based on findings.
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Reason: h/o maxilla/alveolus ca and CRT, liver hemangioma, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Paraseptal and centrilobular upper lobe predominant emphysema unchanged.Stable calcified and noncalcified micronodules, without evidence of metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted, although there are calcified nodes from healed granulomatous disease.Mild coronary artery calcifications are present.The heart and pericardium are otherwise unremarkable. CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged benign-appearing hepatic cystlike hypodensities. The previously described hypodensity in hepatic segment VI is not as well seen, and was shown by MRI to be a hemangioma. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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62-year-old male with shortness of breath. Pulmonary embolism. History of lung cancer. PULMONARY ARTERIES: No evidence of pulmonary embolism. Pulmonary artery size is within normal limits.LUNGS AND PLEURA: Increase in size of the large left pleural effusion with pleural nodularity. Linear mass is obscured secondary to overlying pleural effusion.Pleural-based left upper lobe nodule is stable measuring 6 x 5 mm (series 13, image 23)Right apex nodule stable in 10 x 9 mm (series 13, image 23) Severe centrilobular paraseptal emphysema.Postsurgical changes of right upper lobe which are section.MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes are stable in size. Atherosclerotic calcifications of the aorta and its branches. CHEST WALL: Multiple sclerotic skeletal lesions in the spine and sternum consistent with metastasis. Compression fracture of T11 again seen.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense liver lesion, right adrenal module, and hypodense left kidney lesion are not well visualized.
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No acute pulmonary embolism. Interval increase in left pleural effusion.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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Testicular carcinoma CHEST:LUNGS AND PLEURA: No significant difference in numerous bilateral pulmonary metastatic nodules. Reference right apical nodule best seen on image 10 of series 5 now measures 0.7 x 0.8 cm. Reference lingular nodule best seen on image 34 series 5 measures 1.6 x 1.6 cm.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No significant change in numerous bilateral metastatic pulmonary nodules. No new metastatic focus.
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Generate impression based on findings.
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Female 40 years old; Reason: concern for RSD History: pain Angiographic phase images are unremarkable.No evidence of abnormal blood pooling on the blood pool images. On delayed osseous phase imaging there is increased uptake at approximately the region of the left third metacarpophalangeal joint or base of the proximal phalanx.
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Uptake at approximately the region of the left third metacarpophalangeal joint or base of the proximal phalanx seen only on delayed osseous phase images. Findings not consistent with reflex sympathetic dystrophy and more likely related to previous trauma or arthritis.
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Generate impression based on findings.
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Again seen is is evidence of a left temporomandibular joint arthroplasty, with vertically oriented implant affixed to the lateral aspect of the lower left hemimandible with multiple screws. No evidence of hardware displacement. The right hemimandible is again noted to be dysplastic with interval progression of healing at the right mandibular vertically oriented osteotomy. Multiple screws are seen along the anterior maxillary walls, consistent with the maxillary osteotomy. On the sagittal reformatted images, there is 6-mm over jet and 3-mm overbite. There is again hypoplasia of the left hard palate with cleft palate identified.Again seen asymmetric enlargement of the left bony orbit is compared to the right. There is a thin semilunar hyperdensity along the anterior aspect of the right globe, with slight disconjugate gaze. There is a small rounded ossific density in the right ethmoid sinus, likely an osteoma. There is mild rightward nasal septal deviation inferiorly.Other previously described asymmetric bony structures of the face and at the skull base are unchanged, as are the abnormalities involving the left external and internal ear structures. This is stable appearance of congenital fusion of the cervical vertebrae as previously detailed, as well as other developmental anomalies. Marked interval improvement in diffuse paranasal sinus opacification with mild residual mucosal thickening in the maxillary sinus and minimal opacification in the frontal and ethmoid sinuses. The mastoid air cells are clear.
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Postsurgical changes of extensive orthognathic surgery including LeFort 1 osteotomy, right hemimandible sagittal split osteotomy, and left temporomandibular joint arthroplasty. Left temporomandibular prosthesis remains unchanged in position and without evidence of hardware complication. Right mandibular osteotomy also demonstrates interval progression of healing.
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Generate impression based on findings.
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45-year-old male with history traumatic amputation of the ring finger. There has been amputation of the ring finger through the distal interphalangeal joint. A couple small densities distal to the head of the middle phalanx are present, perhaps representing fracture fragments from the amputated distal phalanx; however we see no fracture/donor sites from the middle phalanx.
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Traumatic amputation through the DIP joint of the ring finger as above.
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Generate impression based on findings.
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7-year-old male with distal radius and supracondylar fractures. VIEW: Left elbow (AP, lateral), left wrist (PA, lateral) four views 01/20/15 Left elbow: Alignment is near-anatomic, with mild residual mottling of the distal humerus. Periosteal reaction along the posterior distal humerus appears similar to the prior study, without discrete fracture line evident. Left wrist: There is mild unchanged lateral and dorsal angulation of the distal radius. Periosteal reaction and sclerosis of the distal radial metaphysis appears similar to the prior study.
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Healing supracondylar and distal radial fractures as described above.
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Generate impression based on findings.
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69 year old female with history of recurrent metastatic ovarian cancer with abdominal and sacral metastases. Back pain. Evaluate extent of disease.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 122 mg/dL. Today's CT portion grossly demonstrates right chest wall port catheter with tip at the SVC/RA junction. 6-mm right upper lobe nodule in the posterior segment is noted. Other new micronodules are present in the lingula and left base. Micronodules along the major fissures bilaterally likely represent intrapulmonary lymph nodes. Dense coronary and moderate aortic atherosclerotic vascular calcifications are present. Bilateral total shoulder arthroplasty devices are noted. In the abdomen, surgical mesh along the anterior abdominal wall and postsurgical findings in the pelvis related to hysterectomy/bilateral salpingo-oophorectomy are redemonstrated. Midline sacral bone lesion demonstrates increased sclerosis.Right pelvic mass seen on prior PET/CT was resected without evidence of recurrence on subsequent exams, however there is presently a 2-cm round soft tissue mass in the cul-de-sac, suspicious for tumor recurrence. Today's PET examination demonstrates intense hypermetabolic activity associated with a 2-cm cul-de-sac lesion (SUV max 8.2). Previously demonstrated peripherally FDG avid right pelvic mass is no longer evident. Sacral bone lesion demonstrates moderate hypermetabolic activity (SUV max 8.8, previously 7.0). New hypermetabolic activity associated with a right axillary lymph node is noted (SUV max 3.8). Finally, a new 6-mm right upper lobe, posterior segment lung nodule also demonstrates mild hypermetabolic activity.Mild hypermetabolic activity cysts associated with bilateral shoulder arthroplasty devices likely represent postsurgical/arthritic changes.
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1.New moderately FDG avid 2 cm soft tissue cul-de-sac lesion, suspicious for tumor recurrence.2.New hypermetabolic activity associated with a right axillary lymph node and a new right upper lobe lung nodule may represent additional sites of disease versus inflammatory changes.
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Generate impression based on findings.
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Female; 61 years old. Reason: hx resected renal cancer, on surveillance History: hx resected renal cancer, on surveillance LUNGS AND PLEURA: Mild upper lobe predominant centrilobular and paraseptal emphysema. Stable biapical scarring. No significant interval change scattered pulmonary micronodules. Reference right upper lobe nodule measures 6 mm, previously 6 mm (image 19, series 7). No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Please see report from dedicated CT abdomen and pelvis performed concomitantly.
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Stable pulmonary micronodules. No new suspicious pulmonary nodules or masses. Please see report from dedicated CT abdomen and pelvis performed concomitantly.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Arterial calcifications are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy with unchanged mild intrahepatic and extra hepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left nephrectomy site clear.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in mixed sclerotic lytic bone lesions with compression fractures involving multiple vertebral bodies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable examination
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Generate impression based on findings.
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72-year-old male with bilateral hip pain Right hip: Severe osteoarthritis affects the hip.Left hip: Severe osteoarthritis affects the hip.Pelvis: Severe osteoarthritis is again noted affecting both hips. Moderate osteoarthritis affects the pubic symphysis. Degenerative arthritic changes affect the visualized lower lumbar spine. Vascular calcifications are noted in the soft tissues.
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Severe osteoarthritis affecting both hips.
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Generate impression based on findings.
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Male, 65 years old.RFO trigger: Unexpected change in procedure. Counts correct. No unexpected radiopaque foreign body identified. Two surgical drains in the left hemiabdomen. IVC filter in expected location. Nonobstructive bowel gas pattern.
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No unexpected radiopaque foreign body. Findings were discussed with the attending physician, Dr. Millis, via telephone on 1/20/2015 at 14:14.
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Generate impression based on findings.
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Ms. Hunt is a 49 year old female with a personal history of left breast mastectomy in 2013 for DCIS followed by radiation and tamoxifen therapy. Family history of breast cancer in mother. Three standard views of the right 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. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Focal asymmetry in the right upper outer breast corresponds to a cyst that was previously identified on prior ultrasound exams.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Arterial calcifications are again seen in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of breast cancer in sister. Personal history of rectal cancer. Two standard digital views of both breasts with additional MLO view were performed and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Dual lumen right chest port noted. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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11-year-old male postop SCFEVIEWS: Pelvis AP/frog leg (two views) 01/20/15 Orthopedic screws traverse the femoral necks with tips in the epiphyses bilaterally. The femoral heads are well seated into the acetabula. No evidence of hardware complication. No acute fractures.
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No evidence of hardware complication after affixation of bilateral SCFE.
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