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Generate impression based on findings.
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Female 37 years old; Reason: 37 y/o woman receiving adjuvant therapy for breast cancer with new cervical spine pain. Evaluate for bony metastases. History: Cervical spine pain (C6-7) Diffuse increased uptake in the frontal bone likely related to hyperostosis frontalis. No abnormal osseous foci are identified to indicate metastatic disease.
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No evidence of bone metastases.
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Generate impression based on findings.
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58-year-old female with history of supraglottic head and neck cancer, status post CRT; compare to previous. Since the prior exam, there has been removal of the right retropharyngeal drain. No evidence of current pneumomediastinum. Interval resolution of the fluid/edema in the retropharyngeal space.Diffuse supraglottic mucosal edema appears similar to prior exam except for slight increased thickening of the epiglottis. Mild irregularity of the glottic mucosal contour is also unchanged.No significant cervical lymphadenopathy. The salivary glands and thyroid are unremarkable. The cervical vessels appear patent. A right chest port terminates out of field-of-view. There is redemonstration of extensive ground glass and reticulonodular opacities, traction bronchiectasis, and peripheral honeycombing, consistent with interstitial lung disease. Degenerative disease, including moderate central spinal canal stenosis at the C4/C5 and C5/C6 levels.
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1. Interval removal of right retropharyngeal drain and resolution of retropharyngeal edema.2. Stable appearance of supraglottic mucosal edema and mild glottic mucosal irregularity, likely post-treatment related.3. No evidence of significant lymphadenopathy in the neck or evidence to suggest progression/recurrence of disease.
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Generate impression based on findings.
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Extra-axial lesion with enhancement along the right posterior frontal convexity measures 0.9 x 0.6 cm (coronal 1100/62), unchanged. Nonenhancing lesion in the left high convexity with associated susceptibility is unchanged measuring 9 mm (11/146). Right frontal high convexity lesion with associated susceptibility and no enhancement is unchanged measuring 5 mm (11/146). Additional nonenhancing lesions in a right temporal lobe, left cerebellum and left occipital lobe with associated susceptibility are unchanged. No new enhancing parenchymal lesions are evident. There is no associated edema with these lesions.There is a new enhancing lesion involving the left frontal calvarium which is suspicious for an osseous metastasis.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1.New enhancing lesion along the left frontal calvarium is suspicious for an osseous metastases.2.Multiple foci of susceptibility in the brain consistent with treated hemorrhagic metastases. No new or enlarging parenchymal or extra-axial lesions.
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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 additional views in all projections bilaterally (9 total images) and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple benign appearing masses are present in both breasts, unchanged in morphology and size. 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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Female 75 years old; Reason: hydronephrosis History: hydronephrosis The posterior abdominal radionuclide angiogram demonstrates no perfusion in the right kidney with delayed parenchymal uptake noted in the periphery. There is no excretion noted with delayed washout. The posterior abdominal radionuclide angiogram demonstrates normal perfusion and uptake in the left kidney. Sequential renal images show the left kidney to be of normal size and morphology. There is normal excretion and washout.The estimated contribution of the right kidney to total renal function is 20.6% and that of the left kidney is 79.4%. There are no abnormalities of the ureters or bladder.Following administration of the diuretic, there was improvement in washout of collecting system radiotracer into the bladder from the right kidney; the T1/2 washout from the right collecting system was not reached during this exam. The T1/2 washout from the left collecting system was 13.5 minutes.
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There is evidence of obstruction of the right kidney. There is normal left kidney function.
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Generate impression based on findings.
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Reason: h/o squamous cell carcinoma of the left face History: r/o lung mets LUNGS AND PLEURA: No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderate coronary artery calcifications. No pericardial effusion.CHEST WALL: Compression deformity of the T12 vertebral body, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Nonspecific hypodense lesion with focal calcifications in the anterior aspect of the spleen, unchanged and likely benign.
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No evidence of metastatic disease.
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Generate impression based on findings.
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46 years old male with history of head and neck cancer, status-post chemotherapy and radiation therapy. This study was performed for restaging. RADIOPHARMACEUTICAL: 15.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates linear and nodular densities in the posterior right lower lung with surgical sutures. The prostate is prominent.Today's PET examination demonstrates interval increase in metabolic activity of the multiple foci of increased activity in right hilum and infrahilar region. The maximal SUV in right hilum is 4.6 (it was 3.2 on prior study). Minimal FDG uptake is seen in the linear and nodular densities in the posterior right lower lung. There is a new focus of increased activity in the right paratracheal region, corresponding to a small lymph node seen on CT. The SUVmax in the lymph node is 2.5.Several new foci of increased activity are seen in the mesentery, which may correlate with the normal-sized lymph nodes seen on CT.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.No evidence of FDG avid tumor in the neck.
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1.Interval increased metabolic activity in the several hypermetabolic small lymph nodes in the right hilum and infrahilar regions, which may represent inflammatory change or tumor. Please note that the comparison the two studies is limited due to different techniques of the studies.2.New hypermetabolic normal-sized lymph nodes in the mediastinal right paratracheal region and mesentery, which are nonspecific.3.Postsurgical/inflammatory change in the right lower lung.
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Generate impression based on findings.
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Female 39 years old; Reason: evaluation for other metastases. History: metastatic breast CA to bone, on endocrine therapy. Restaging, response to therapy.RADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion grossly demonstrates a patchy opacity in the left upper lobe with pleural thickening not significantly changed. The patient is status post bilateral breast augmentation. There is thickening of the posterior nasopharyngeal wall. There is increased density in the left sixth and seventh ribs, with thickening of the cortex of the left seventh rib consistent with healing rib fractures. There is symmetric increased density in the ischia not significantly changed. Focal hyper density in the right hemipelvis likely a colonic diverticulum.Today's PET examination demonstrates interval resolution of the two foci of increased activity in the left sixth and seventh ribs previously related to the fractures noted on CT. There is a focus of activity within the thickened posterior nasopharyngeal wall, which is retrospectively seen on prior exam, slightly increased in intensity with an SUV value of 5.8, previously 4.6. There is mild activity in the left upper lobe corresponding to the pleural thickening seen on CT, likely inflammatory in nature. Nonspecific focus of activity in the left lower quadrant correlates with the junction of the descending colon with the sigmoid colon. There is persistent activity in the left infraspinatus muscle, slightly increased however likely benign. There is mild increased activity involving several bilateral normal sized inguinal lymph nodes which is stable in appearance, likely inflammatory in nature. The FDG uptake in the remaining portion of the body is physiological. Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1. No definite evidence of FDG avid tumor.2. Nonspecific focus of activity in the left lower quadrant correlates with the junction of the descending and sigmoid colon. 3. There is a focus of activity within the thickened posterior nasopharyngeal wall, which is retrospectively seen on prior exam with slight interval increase in activity, likely inflammatory in nature.
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Generate impression based on findings.
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69-year-old female with history of pain. There is severe degenerative disk disease present at C4-5, C5-6, C6-7 and C7-T1. Alignment is kyphotic. There is moderate neuroforaminal narrowing on the right at C4-5, C5-6, C6-7 and on the left at C6-7. We see no fracture. A tracheostomy tube and surgical clips are present. There is thickening the prevertebral soft tissues especially at the level of C3-4, nonspecific.
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Severe degenerative disc disease, mild cervical kyphosis, and nonspecific prevertebral soft tissue swelling. We see no fracture.
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Generate impression based on findings.
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Female; 76 years old. Reason: Patient is participating in research study. Evaluate for lung disease History: History of rheumatoid arthritis LUNGS AND PLEURA: 16 mm solitary part solid nodule in the superior segment of the left lower lobe (image 34, series 5). Scattered pulmonary micronodules. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Small calcified right hilar lymph nodes, likely due to prior granulomatous process. Normal heart size without pericardial effusion. Severe calcifications of the coronary arteries. Moderate mitral annular calcifications.CHEST WALL: Degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis, partially visualized.
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16 mm solitary part solid nodule in the left lower lobe, which may be post infectious or inflammatory in etiology and for which 3 month follow up is recommended.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications are unchanged in both breasts. A benign intramammary lymph node is present within the left upper outer quadrant. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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23 year old female with history of running injury. There is no fracture or other findings to account for the patient's symptoms. The left knee likewise appears normal as seen on the frontal views.
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No fracture or other findings to account for the patient's symptoms.
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Generate impression based on findings.
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Reason: 76 yo M with h/o NSCLC. Please assess for recurrence History: none CHEST:LUNGS AND PLEURA: New right -sided pleural effusion.Bilateral perihilar and paramediastinal fibrosis and atelectasis consistent with post radiation changes.Anterior subpleural fibrotic changes stable. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiomegaly without evidence the pericardial effusion.Marked coronary artery calcification.CHEST WALL: Degenerative changes of the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Right hepatic lobe calcification unchanged.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: Marked atherosclerotic changes of the aorta.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 recurrent or metastatic disease. New moderate-sized right-sided pleural effusion.
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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. Benign appearing mass is again noted in the left upper outer breast, likely an intramammary lymph node. 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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5-year-old female status post surgeryVIEWS: Left elbow AP/lateral (two views) date Overlying cast material obscures fine bone detail. There are 4 K wires affixing a supracondylar fracture in near-anatomic alignment without evidence of hardware complication. Periosteal reaction is seen along the distal humerus.
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Fixation of supracondylar fracture as described above.
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Generate impression based on findings.
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49-year-old female with history of pain. Evaluate for inflammatory arthropathy. Left hand: Minimal osteoarthritis at the interphalangeal joint of the thumb. There is no evidence of osseous erosions or specific radiographic findings of inflammatory arthritis.Right hand: Mild osteoarthritis at the distal interphalangeal joints. There is no evidence of osseous erosions or specific radiographic findings of inflammatory arthritis. Tiny ossific density in the soft tissues dorsal to the carpus may reflect old trauma.SI joints: The SI joints are unremarkable with no specific radiographic evidence of sacroiliitis.Left foot: There are moderate hallux valgus and mild pes planovalgus deformities. There is no evidence of osseous erosions or specific radiographic findings of inflammatory arthritis. Right foot: There are moderate hallux valgus and mild pes planovalgus deformities. There is no evidence of osseous erosions or specific radiographic findings of inflammatory arthritis.
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No specific radiographic findings of inflammatory arthritis. Bilateral hallux valgus and pes planovalgus deformities as well as minimal osteoarthritis of the hands.
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Generate impression based on findings.
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The frontal sinus and frontoethmoidal recesses are clear. The anterior ethmoid air cells are clear. The posterior ethmoid air cells are clear. The maxillary sinuses are clear. The ostiomeatal units are clear. The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. Tiny hyperdensity in the posterior left ethmoid sinus again seen and may represent a small osteoma. The nasal cavity is clear. Again seen are postsurgical changes of left lateral occipital craniotomy and hyperdense material at the left cerebellopontine angle related to history of decompressive surgery for hemifacial spasm. Evidence of bilateral lens replacement and bilateral staphylomas.
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Paranasal sinuses are clear.
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Generate impression based on findings.
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62-year-old female with history of pancreatic cancer who presents for restaging. CHEST:LUNGS AND PLEURA: Few scattered micronodules are again noted. Nonspecific minimal interval increase in left lower lobe micronodule which measures 3 mm (series 4, image 66), previously measuring 2 mm. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: Right-sided chest port with catheter tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Common bile duct stent is patent with mild pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Mass in the pancreatic head measures 2.3 x 2.4 cm (series 3, image 88), previously measuring 2.4 x 2.5 cm. This mass encases the common hepatic artery and proximal splenic artery. Additionally, it encases a large portion of the main portal vein.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild decrease in perfusion of the upper poles of the kidneys again noted.RETROPERITONEUM, LYMPH NODES: Nondistended IVC may be secondary to hypovolemia.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific small to medium volume free pelvic fluid. There is slight nodular haziness of the omentum (series 3, image 148) which is nonspecific but attention on subsequent examinations is recommended.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality noted.
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1.Stable size of pancreatic head mass with encasement of the main portal vein, common hepatic artery, and proximal splenic artery.2.Mild decreased perfusion of the apices of the kidneys is again noted.3.Nonspecific new slight nodular haziness of the pelvic omentum. Attention on subsequent imaging is recommended.4.Nonspecific minimal interval increase in right lower lobe pulmonary nodule. Attention on subsequent imaging is recommended.5.Nondistended IVC may be secondary to hypovolemia.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Prior mammogram at Advocate in 2013. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. Scattered calcifications are noted bilaterally. Fibroadenomatous benign calcifications noted in the left upper inner quadrant. No suspicious masses or areas of architectural distortion are present.
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Scattered calcifications are noted bilaterally. Comparison to prior studies is needed to assess for stability.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.
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Generate impression based on findings.
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90 year-old female with headache after recent fall. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate to severe age-related volume loss. No extra-axial collections. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes, not significantly changed when compared to prior MRI.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. No significant soft tissue abnormality to suggest recent trauma.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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Reason: h/o HNC/CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema.No new suspicious nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Status post laminectomy posterior fusion at the L5-S1 level.OTHER: Atherosclerotic changes of the aorta and iliac arteries.
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No evidence metastatic disease. Severe emphysema.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy in 1997. 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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Asymptomatic female presents for routine screening mammography. History of bilateral mastopexy in 2009. History of breast carcinoma in maternal aunt diagnosed in her 60s. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Stable focal asymmetry in the right central breast since 2010. 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. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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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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63-year-old male with history of prostate cancer, rising PSA. Evaluate for recurrence. Radiotracer activity likely related to degenerative changes is noted in the shoulders, knees, right foot, lumbar spine, and posterior elements of the cervical spine. Focal left L2 vertebral body lesion correlates with sclerotic lesion on CT, compatible with metastasis.
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Suspicious abnormal focus of radiotracer uptake in the L2 vertebral body, compatible with metastasis.
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Generate impression based on findings.
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Male 63 years old; Reason: biochemical prostate cancer recurrence History: rising PSA ABDOMEN:LUNG BASES: Scattered micronodules at the lung bases. There is mild fatty pleural thickening at the left lung base.LIVER, BILIARY TRACT: The liver is normal in morphology. No suspicious hepatic lesions and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aorta. Few scattered lymph nodes in the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion in the left L2 vertebral body.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy. Subtle hyperenhancement near the expected location of the bladder to urethra anastomosis suggestive of disease.BLADDER: No significant abnormality noted.LYMPH NODES: Near fluid attenuating structure on the left pelvic side wall favored to be a seroma or lymphocele. There are small pelvic lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Soft tissue in the left inguinal canal may represent a hernia plug.OTHER: No significant abnormality noted.
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1.Findings suspicious for bony metastases to the L2 vertebral body on the left.2.Findings suspicious for soft tissue in the prostatic bed which may a site of disease recurrence.3.Nonspecific pulmonary nodules in the lower lobes.
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Generate impression based on findings.
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49-year-old male with pain and soft tissue infection, evaluate for osteomyelitis Osteoarthritic changes affecting the first metatarsophalangeal joint appear similar to the prior exam. Overall the bones are demineralized, but there is no focal osteolysis to indicate osteomyelitis. Extensive arterial calcifications are noted in the soft tissues. Talonavicular osteophytes are again noted.
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Osteoarthritis and other findings as described above with no specific radiographic features of osteomyelitis. If further evaluation is clinically warranted, MRI may be considered.
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Generate impression based on findings.
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69-year-old female with history of right total knee arthroplasty. Hardware components of a right total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. Skin staples, surgical drain, and foci of gas density within the soft tissues reflect recent surgery.
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Right total knee arthroplasty as above.
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Generate impression based on findings.
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Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Numerous bilateral metastatic nodules. A representative right lower lobe nodule best seen on image 75 series 5 measures 1.3 x 1.2 cm. A representative left lower lobe nodule best seen on image 65 of series 5 measures 0.9 x 1 cm.Likely metastatic left pleural based mass best seen on image 38 series 3 measuring 3.4 x 8.6 cmMEDIASTINUM AND HILA: Metastatic mediastinal adenopathy. Right paratracheal node is seen on image 37 series 3 measures 3.3 x 3.5 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy site clear.RETROPERITONEUM, 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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Intrathoracic metastasis manifest by numerous bilateral pulmonary nodules, left pleural-based metastatic mass, and mediastinal metastatic adenopathy.
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Generate impression based on findings.
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51 years old, Male, Reason: RCC History: RCC CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary micronodules are again noted. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Severe coronary artery calcifications are noted. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index left hepatic segment 4 hypodense lesion is not significant changed in size measuring 3 . 0 x 2.6 cm (series 3, image 101), previously measuring 2.1 x 2.6 centimeters. Another hypodense lesion in the caudate is not significant changed in size. Reference perihepatic lesion is unchanged in size measuring 2.7 x 1.7 cm (series 3, image 89), previously measuring 1.7 x 2.9 cm. Another right perihepatic hypodense lesion appears slightly larger in size.SPLEEN: Multiple parasplenic metastatic lesions appear larger in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously measured mass anterolateral to the left kidney is not significant changed in size measuring 5.5 x 3.8 cm (series 3, image 113), previously measuring 5.4 x 3.7 cm. multiple other metastatic deposits between left kidney, spleen, and descending colon appear minimally larger in size.RETROPERITONEUM, LYMPH NODES: Postsurgical changes in the retroperitoneum.BOWEL, MESENTERY: Multiple peritoneal metastatic lesions appear larger in size. For reference left anterior peritoneal lesion measures 1.4 x 1.6 cm (series 3, image 125), previously measuring 0.8 x 0.8 cm. No evidence of bowel obstruction, pneumatosis, or free air.BONES, SOFT TISSUES: Left lateral anterior subcutaneous tissue mass is unchanged in size measuring 2.8 x 2.5 cm (series 3, image 146), previously measuring 2.8 x 2.5 cm.OTHER: 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 ascites.
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1.Significant progression of peritoneal metastatic disease.2.Hepatic parenchymal metastases are not significantly changed in size.3.Retroperitoneal mass abutting the left kidney not significantly changed in size.
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Generate impression based on findings.
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FractureVIEWS: Right tibia and fibula AP and lateral There is a healing fracture involving the distal diaphysis of the tibia in near anatomic alignment. There is sclerosis and periosteal reaction reflecting interval healing.
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Healing fracture of the distal tibia in near anatomic alignment.
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Generate impression based on findings.
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Hypoxia. Bone marrow transplant. Fanconi anemia. Astrocytoma.VIEW: Chest AP (one view) 01/20/15, 1444 Endotracheal tube tip is above carina. Left upper extremity PICC tip is at junction of superior vena cava and right atrium. Right-sided central line tip is in superior vena cava.Left lower lobe opacity has worsened in the interval. Minimal patchy opacity is seen in both lungs. Cardiothymic silhouette is normal.
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Worsening left lower lobe opacity may be pneumonia or atelectasis.
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Generate impression based on findings.
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72-year-old female with pain, evaluate for osteoarthritis Mild osteoarthritis affects the left hip, left SI joint and pubic symphysis.
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Mild osteoarthritis.
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Generate impression based on findings.
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39-year-old female with shoulder pain Mild osteoarthritis affects the glenohumeral joint. A radiolucent lesion with sclerotic margins within the glenoid probably represents a degenerative cyst.
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Glenohumeral osteoarthritis.
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Generate impression based on findings.
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Increased oxygen requirementVIEW: Chest AP and abdomen AP 1/20/15 Nasogastric tube tip in the stomach. Cardiothymic silhouette at the upper limits of normal. Cardiac apex and stomach left-sided. No focal lung opacity. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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No focal lung opacity.
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Generate impression based on findings.
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3-year-old male with history of fracture.VIEWS: Right elbow AP/lateral (two views) 01/20/15 Interval removal of 3 K wires. Indistinctness of the fracture line suggest a healed supracondylar fracture. There is mild periosteal reaction along the distal humerus. Elevation of the posterior fat pad is suggestive of an effusion.
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Healing/healed supracondylar fracture.
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Generate impression based on findings.
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Scoliosis.VIEW: Spine AP supine in brace (one view) 01/20/15 Right curve between T4 and T9 measures 24 degrees. Left curve between T10 and L3 measures 24 degrees. A small to moderate amount of feces is present in the rectosigmoid.
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Decrease in left thoracolumbar curve in brace.
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Generate impression based on findings.
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FractureVIEWS: Right forearm AP and lateral There are healing fractures involving the mid diaphysis of the radius and ulna in near anatomic alignment. There is periosteal reaction and sclerosis reflecting interval healing. The overlying cast has been removed in the interval. Mild osteopenia noted.
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Healing forearm fractures as described above.
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Generate impression based on findings.
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Altered mental status, evaluate for acute process No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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No acute intracranial findings.
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Generate impression based on findings.
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Epiphysiodesis.VIEW: Right knee AP (one view) 01/20/15 One staple is present in the the lateral aspect of the proximal tibia. Two staples are present in the lateral aspect of the distal femur and two staples are present in the medial aspect. One of the medial staple's prongs are diverging. The rest of the staples have parallel prongs. The physis is of the distal femur is narrow. The physis of the proximal lateral tibia is narrowed. A staple has been removed from the proximal tibia between 11/19/13 and 05/06/14 and lucent and sclerotic areas are seen from it.
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Postoperative change.
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Generate impression based on findings.
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Female, 8 years old, with profound SN deafness bilaterally. Right temporal bone:Debris is present along the tympanic membrane, though the tympanic membrane itself is not well visualized. The posterior wall of the external auditory canal is sclerotic and thickened, particularly inferiorly. The mastoid air cells and middle ear cavity are normally aerated. The sinus tympani and facial recess are present and of normal caliber. The malleus and incus demonstrate normal morphology and articulation. The stapes head is visualized, but the crura and footplate are not well seen. The oval window and round window are both patent and unremarkable. The middle and apical turns of the cochlea are not well separated which may reflect a real finding or an imaging artifact. The cochlear aperture is patent. The semi-circular canals are normally formed without evidence of dehiscence. The vestibule may be slightly small but is otherwise unremarkable. The vestibular aqueduct is enlarged measuring up to 2.3 mm at its aperture and up to 1.8 mm at its mid point. The internal auditory canal is unremarkable. The labyrinthine, tympanic and mastoid segments of the facial nerve canal are visualized demonstrating normal course and caliber. The bony wall surrounding the tympanic segment of the facial nerve is not well seen which again could be a real finding or an imaging artifact. The carotid canal, jugular bulb and sinus angle are unremarkable.Left temporal bone:Minimal debris is present along the tympanic membrane, though the tympanic membrane itself is not well visualized. The posterior wall of the external auditory canal is sclerotic and thickened. The mastoid air cells and middle ear cavity are normally aerated. The sinus tympani and facial recess are present and of normal caliber. The malleus and incus demonstrate normal morphology and articulation. The stapes head is visualized, but the crura and footplate are not well seen. The round window is patent and unremarkable. The oval window is also probably patent, however there is a small focus of possible otospongiotic bone at the fissula ante fenestram.The middle and apical turns of the cochlea are not well separated which may reflect a real finding or an imaging artifact. The cochlear aperture is patent. The semi-circular canals are normally formed without evidence of dehiscence. The vestibule may be slightly small but is otherwise unremarkable. The vestibular aqueduct is enlarged measuring up to 2.3 mm at its aperture and up to 1.3 mm at its mid point. The internal auditory canal is unremarkable. The labyrinthine, tympanic and mastoid segments of the facial nerve canal are visualized demonstrating normal course and caliber. The bony wall surrounding the tympanic segment of the facial nerve is not consistently seen throughout which again could be a real finding or an imaging artifact. The carotid canal, jugular bulb and sinus angle are unremarkable.
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1. Enlarged vestibular aqueducts are seen bilaterally. There may also be some associated incomplete partition of the middle and apical cochlear turns, but poor image quality prevents definitive diagnosis in this regard.2. A small focus of otospongiotic bone is suspected at the fissula ante fenestram on the left. 3. Questionable dehiscence of the tympanic segments of the facial nerve canals is seen. Again, however, image artifact may be contributing to this appearance.4. The round windows are patent and the facial recesses are present and of fairly normal caliber. Note is made of some thickening and sclerosis of the posterior wall of the external canal which does involve the region of the facial nerve recesses, left side more so than right.
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Generate impression based on findings.
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22 year old male with history of mixed connective tissue disease and severe primary tricuspid regurgitation and right heart enlargement presents for cardiac CT prior to possible tricuspid valve replacement.CPT: 75574 Left Ventricle: The left ventricular end-diastolic volume is within normal limits There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Mass: There are several large masses present adjacent to the heart:1. Very large calcified mass extending from mid-ventricle to apical ventricle along the interventricular groove in the pericardial space. At the apex, the mass extends into the myocardium.2. Large calcified mass in pericardial space along the basal to mid posterior wall of the left ventricle. The mass is extrinsically compressing/ distorting the shape of the left ventricle. Small amounts of the mass extends into the adjacent myocardium. 3. Large calcified mass along RVOT which is causing extrinsic compression of the RVOT.4. Large calcified mass extending along the basal to mid RV free wall. The mass is causing extrinsic compression of the RV.5. Large calcified mass along inferior wall of the RV.Right Ventricle: The right ventricle is severely dilated.Left Atrium: The left atrium is normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is severely dilated. The superior and inferior vena cavae are dilated. The coronary sinus is normal in size. Aortic Valve: The aortic valve is trileaflet. There is no significant aortic valve calcification. Mitral Valve: No mitral annular calcification is noted.Tricuspid Valve: There is mild calcification of the tricuspid valve leaflets. The leaflets are thickened and demonstrate malcoaptation.Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. There is no significant atherosclerosis of the proximal brachiocephalic vessels. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has minimal tortuosity. No protruding aortic atheroma, calcification, or thrombus is noted in the thoracic aorta. No aortic coarctation is noted. Pulmonary Artery: Mildly dilated. Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Coronary imaging was performed without beta-blockers and nitrates because of relative hypotension. LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant calcification of the left main coronary artery. There are no significant obstructions noted. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is no significant calcification of the LAD. There are no significant stenoses noted in the proximal or mid LAD. The distal LAD is poorly visualized due to the adjacent large calcified mass. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches. There is no significant calcification of the LCx. There are no significant stenoses noted in the proximal and mid LCx and also in the obtuse marginal branch. The distal LCx is not well seen RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the RCA.Coronary Bypass Grafts:None present.
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1. Multiple large calcified masses noted around the heart as described above.2. Severe right ventricular and right atrial enlargement3. Tricuspid valve thickening with malcoaptation and mild leaflet calcification.4. No thoracic aortic aneurysm or dissection noted.5. No obstructive coronary artery disease noted. Of note, the distal LAD and distal LCx are poorly visualized due to inability to give nitrates.6. Mild dilation of the main pulmonary artery.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvic CTA will be reported separately.
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Generate impression based on findings.
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16-year-old male status post fibular free flap to left lower extremity.VIEWS: Left tibia-fibula AP/lateral (two views) 01/20/15 There is been interval removal of the antibiotic spacer in the proximal tibia with placement of a fibular bone graft. Hardware components of a plate and screw device affixing the tibial epiphysis and mid tibial diaphysis are in near anatomic alignment without evidence of hardware complication. Multiple surgical staples, vascular clips, and a drain with tip in the region of the proximal tibial metaphysis reflect recent surgery.
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Postoperative changes of a fibula bone graft to the proximal tibia as described above.
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Generate impression based on findings.
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32-year-old male with HIV/AIDS and new diagnosis of Burkitt lymphoma; initial staging of disease.RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates anterior mediastinal lymphadenopathy, right internal mamillary chain adenopathy and prominent bilateral axillary lymph nodes. Additional masslike conglomerate lymphadenopathy seen in the retroperitoneum extending to the pelvis, particularly the presacral space and right pelvic wall. Bilateral inguinal lymphadenopathy is also noted. Mucus retention cysts are seen in the maxillary sinuses. Right medial basilar lung opacity may represent atelectasis or infection. There is also a new 5.2-cm right inguinal soft tissue mass.Today's PET examination demonstrates extensive abnormal increased FDG uptake including the abdomen, thorax, and bones as follows:In the neck, there are left level 2 cervical lymph nodes demonstrating moderate hypermetabolic activity. Additional linear focus in the right neck without definite CT correlation may represent additional pathologic lymph nodes versus physiologic muscle activity.Markedly hypermetabolic activity in the anterior mediastinum and moderate activity in the bilateral internal mammary chains, right pericardium, and bilateral axillae are present.In the abdomen, there is anterior diaphragmatic lymph node hypermetabolic activity, extensive masslike retroperitoneal lymphadenopathy extending to the pelvis and pelvic sidewalls, right greater than left. Right pelvic sidewall maximum SUV is 18.3. There is also diffuse FDG uptake in the right kidney with a surrounding curvilinear area of increased activity in the perinephric space. These findings are concerning for lymphomatous involvement of the right kidney. Hypermetabolic soft tissue in the left retroperitoneal space abutting/inseparable from the left kidney likely represents retroperitoneal lymphadenopathy and less likely left renal extension. The right inguinal mass seen on CT does not demonstrate FDG avidity, and while necrotic tumor is a consideration, correlation with procedural history for hematoma or clinical signs of abscess is recommended.Abnormal osseous FDG uptake includes the C3 vertebral body, C4 spinous process, bilateral proximal humeri, bilateral scapulae, T11, T12, L5 vertebral bodies, bilateral iliac wings, left ischial tuberosity, and bilateral proximal femora.
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1.Extensive FDG avid tumor activity in the anterior mediastinum and retroperitoneum, with additional sites of disease as detailed above.2.Findings suspicious for right renal lymphomatous involvement. Left renal involvement is possible though less likely.3.Multifocal osseous extension as detailed above.4.New non-FDG avid right inguinal soft tissue mass; correlation with procedural history for hematoma or clinical signs of abscess is recommended. Necrotic lymphadenopathy is also a diagnostic consideration.
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Generate impression based on findings.
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CLINICAL DATA: Age: 88 years. Sex : Male. Indication: Reason: 88M s/p ampullectomy with abdominal pain, fever, sepsis History: abdominal pain. LUNG BASES: Large right and small left pleural effusions with associated atelectasis. Cardiomegaly with cardiac assist leads partially visualized. Nasogastric tube within the stomach.LIVER, BILIARY TRACT: Pneumobilia, consistent with recent papillectomy. Common bile duct and pancreatic duct stents are noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific bilateral renal cysts, some of which are complex,incompletely evaluated on this noncontrast study, recommend renal ultrasound.RETROPERITONEUM/LYMPH NODES: No retroperitoneal air, fluid collections or significant lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis. No small bowel destruction or free air. Rectum is distended with stool, but there is no bowel wall thickening or adjacent stranding.BONES, SOFT TISSUES: No significant abnormality noted.Marked atherosclerotic calcifications of the aorta and its branches.PELVIS:PROSTATE: Radiation brachytherapy seeds are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No retroperitoneal air or fluid collections.2.Large right and small left pleural effusions, and associated atelectasis.3.Pneumobilia, consistent with recent papillectomy.4.Renal cysts, some of which are complex, should be further evaluated with ultrasound.
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Generate impression based on findings.
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Reason: COPD, Lung Transplant Evaluation History: SOB LUNGS AND PLEURA: Lobulated and mildly spiculated noncalcified nodule in the right upper lobe (series 4/29) measuring 8 x 13 mm, highly suspicious for primary lung carcinoma.Diffuse severe centrilobular emphysema.Bronchial thickening compatible with bronchitis and very mild bronchiectasis in the right lower lobe.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple sharply defined hepatic hypodensities most consistent with cysts.
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1.8 x 13 mm lobulated and spiculated right upper lobe nodule suspicious for primary lung carcinoma.2. Severe predominantly upper zone centrilobular emphysema.3. Severe coronary artery calcifications.A text page was sent to Dr. Nacpil at the time of reporting.
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Generate impression based on findings.
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51-year-old female status post spinal cord stimulator placement A spinal cord stimulator device overlies the right iliac crest with wires coursing superiorly beyond the field-of-view. Mild osteoarthritis affects both hips. Degenerative arthritic changes also affect the visualized lower lumbar spine.
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Partially visualized spinal cord stimulator device and degenerative arthritic changes as described above.
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Generate impression based on findings.
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71-year-old female with bilateral knee pain Right knee: Moderate osteoarthritis affects particularly the patellofemoral joint.Left knee: Mild osteoarthritis affects the knee.
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Osteoarthritis, as described above.
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Generate impression based on findings.
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4-year-old female with cough, hypoxia, dehydration.VIEWS: Chest AP/lateral (two views) 1/20/2015, 15:15. The aortic arch, cardiac apex, and stomach are left-sided. The cardiac silhouette is normal in size.Increased lung volumes and peribronchial thickening with lingular and right middle lobe atelectasis.
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Reactive airways disease/bronchiolitis pattern with lingular and right middle lobe atelectasis.
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Generate impression based on findings.
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50 year-old female with history of fall. Right wrist: Thin lucency along the distal ulna extending into the ulnar styloid is likely artifactual. We see no acute fracture.Right elbow: There is a nondisplaced intraarticular fracture of the radial head. There is elevation of the distal humeral fat pads indicating a hemarthrosis. There is diffuse subcutaneous edema about the elbow.
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Radial head fracture as above.
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Generate impression based on findings.
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32-year-old male with history of ankylosing spondylitis. Cervical spine: There is straightening of the normal cervical lordosis. There are tiny posterior vertebral body osteophytes at C3-4. There is equivocal ankylosis of the facet joints at C2-3. There is mild neuroforaminal narrowing at C4-5 bilaterally. Thoracic spine: There is a mild dextroscoliosis of the upper thoracic spine. Mild multilevel degenerative disease affects the thoracic spine. There are no specific radiographic features of ankylosing spondylitis.Right hip: There is mild prominence of the lateral femoral head/neck junction. We see no erosions.Left hip: Hardware components of a left hip resurfacing device are in anatomic alignment without radiographic evidence of hardware complication. There is a small focus of heterotopic bone adjacent to the hip joint.
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1.Equivocal ankylosis of the facet joints at C2-3.2.Small thoracic vertebral osteophytes but no specific radiographic features of ankylosing spondylitis in the thoracic spine.3.Prominence of the right femoral head/neck junction is noted and can be associated with femoroacetabular impingement in the correct clinical context.4.Left hip resurfacing device appearing similar to prior.
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Generate impression based on findings.
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Urinary bladder carcinoma ABDOMEN:LUNG BASES: Stable chronic lung findings, including pleural plaquesLIVER, BILIARY TRACT: Stable bilobar hepatic cysts.SPLEEN: Stable benign hilar enhancing focusPANCREAS: 0.9 x 0.6 cm cystic focus arising from the uncinate process of the pancreas best seen on image 61 of series 7. In retrospect, this lesion was present on the prior study and has remained stable.ADRENAL 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: Stable mildly enlarged prostateBLADDER: Continued interval decrease in size of left trigonal asymmetrical wall thickening best seen on image 117 of series 7 now measuring 2.7 x 1 cm.LYMPH NODES: Stable mildly enlarged pelvic lymph nodes. Reference right femoral lymph node best seen on image 117 of series 7 it measures 1.7 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Continued interval decrease in size of left trigonal asymmetrical wall thickening. No evidence of metastatic focus.Subcentimeter pancreatic uncinate process cystic focus unchanged from prior study. Recommend continued surveillance monitoring.
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Generate impression based on findings.
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66-year-old female with history of end to end colonic anastomosis. Evaluate for small bowel obstruction. Evaluation of solid organs is limited given lack of intravenous contrast.ABDOMEN:LUNG BASES: Mild bilateral basilar atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without evidence of inflammatory changes to suggest cholecystitis. Small amount of nonspecific perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Too small to characterize right renal hypoattenuating lesion. Mild to moderate left renal cortical scarring is not significantly changed. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There has been interval takedown of the right lower quadrant ileostomy. Oral contrast maternal is noted to traverse into the ascending colon. However, there mildly dilated loops of proximal small bowel measuring up to 2.4 cm; additionally, there is mesenteric haziness in the left lower quadrant suggestive of edema. Small amount of nonspecific fluid adjacent to the left colon. Findings suspicious for mild multifocal partial small bowel obstruction secondary to multiple adhesions.There are at least two small sized small bowel-containing and one small fat containing anterior abdominal wall hernia.Small hiatal hernia.BONES, SOFT TISSUES: Multilevel degenerative changes about the visualized spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Multifocal degenerative changes.OTHER: No significant abnormality noted
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1.Findings suggestive of mild multifocal early partial small bowel obstruction secondary to multiple adhesions.2.Interval take down of right lower quadrant ostomy.
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Generate impression based on findings.
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Reason: HIV not on HAART with odynophagia, has gastric lap band placed, would like to investigate possible migration as etiology of swallowing pain History: Severe odynophagia; EGD 1/19/2015 with esophageal mucosal irregularity noted, path not up yet Frontal scout view shows partial "open" configuration of the lap band. This was not seen on prior CT and may be projectional. Phi angle measures 43 degrees. There is no measurable gastric pouch proximal to the lap band, suggesting location at cardia. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave with rapid transit past the lap band.There is movie of lap band on inspiration and expiration. TOTAL FLUOROSCOPY TIME: 5:21 minutes
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Phi angle of 43 with partial "open" configuration that may be projectional. If there is slippage it is minimal without functional obstruction to liquid contrast. If worsening symptoms, may reevaluate as clinically indicated.
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Generate impression based on findings.
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7-year-old female with right internal jugular port placementVIEW: Chest AP (one view) 01/20/15 Right internal jugular chest port with tip at the superior cavoatrial junction. Cholecystectomy clips are noted. Interval removal of left upper extremity PICC.Mild cardiomegaly. Low lung volumes. No pleural effusion or pneumothorax. No focal pulmonary opacities.
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Right IJ chest port with tip at the superior cavoatrial junction.
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Generate impression based on findings.
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Reason: eval for Crohn's disease History: hx of abscess and fistulas and partial response to Remicade Scout radiograph showed a nonobstructive bowel gas pattern. Spinal fixation device noted. Incomplete exam due to limited patient cooperation. Normal appearing proximal jejunum, unable to evaluate ileum. Transit time to ostomy was about 1 hour 10 minutes. No evidence of obstruction.TOTAL FLUOROSCOPY TIME: 8 seconds
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Incomplete exam due to limited patient cooperation. Normal appearing proximal jejunum, unable to evaluate ileum.
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Generate impression based on findings.
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CLINICAL DATA: Age: 62 years. Sex : Female. Indication: Reason: Triphasic CT to better dilineate large hepatic mass seen on CT History: Hepatitis C cirrhosis with new mass. LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Large right hepatic mass (9/32) measuring approximately 8.5 x 8.5 x 6.4 cm. This mass demonstrates early arterial enhancement and washout consistent with hepatocellular carcinoma, particularly given this patient's history of cirrhosis. This mass invades and narrows the portal vein, as well as the intrahepatic branches.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM/LYMPH NODES: Marked retroperitoneal lymphadenopathy, with a conglomerate lymph node mass at the hepatic hilum (11/48) measuring approximately 6.8 x 5.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:UTERUS: The uterus is enlarged and distorted by fibroids, some of which are calcified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Large right hepatic mass, consistent with hepatocellular carcinoma, which invades the portal vein. Associated partially necrotic lymph node mass at the hepatic hilum as above.
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Generate impression based on findings.
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Male 79 years old; Reason: r/o mass History: Hx CLL and Hx of NHL of ileum, s/p resection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Aberrant right subclavian artery posterior to the esophagus. Significant interval decrease in mediastinal lymph nodes. A reference AP window lymph node measured 2.5 x 1.8 cm, and now measures 1.8 x 0.9 cm (3:45). Coronary artery calcifications.CHEST WALL: Right chest wall port with tip in the superior vena cava. Interval reduction in right axillary lymphadenopathy, now measuring 1.3 x 1.0 cm (3:30), previously 2.0 x 1.3 cm. Significant interval decrease in paraspinal lymphadenopathy. For example, at the level of the gastroesophageal junction, right paraspinal lymphadenopathy previously measured 1.6 cm in thickness, now not measurable (3:98 vs 3:99).OTHER: ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Significant interval decrease in mesenteric lymphadenopathy and retroperitoneal lymphadenopathy, with mild residual soft tissue opacities, not distinctly measurable, with most nodes now subcentimeter in size and not conglomerate.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: Previously seen left pelvic lymph node measuring 1.5 x 1.2 cm now measures 5 mm (3:199)BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multilevel degenerative changes of the spine. Degeneration is noted at the junction between the anterior first rib and sternum, which may be related to old trauma.OTHER: No significant abnormality noted
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1.Significant interval improvement in lymphadenopathy of the chest, abdomen, and pelvis as described above.
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Generate impression based on findings.
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5-year-old female status post cochlear implantsVIEWS: Skull AP/lateral (2 views) 01/20/15 Again seen is a right cochlear implant unchanged in position from the prior exam. Interval placement of a left cochlear implant with lead loop in the expected location of the cochlea. The paranasal sinuses are clear.
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Bilateral cochlear implants without complications.
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Generate impression based on findings.
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Female 89 years old; Reason: 89 y/o with pancreatic ca. On chemo. Compare CT scan to prior History: Pancreatic Ca CHEST:LUNGS AND PLEURA: Right upper lobe subpleural thickening measures 1.7 x 0.4 cm (image 15 is series 5) unchanged.Multiple other pulmonary nodules at the lung bases are also unchanged.MEDIASTINUM AND HILA: Heart size is mildly enlarged. No pericardial effusion. No new mediastinal lymphadenopathy.CHEST WALL: Post surgical changes in the left breast.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. The reference left hepatic lobe lesion now measures 0.4 x 0.6 cm (image 84/series 3) previously, 0.8 x 0.8 cm.Reference right hepatic lobe mass with area of capsular retraction measures 0.7 x 0.7 cm (image 110/series 3) previously, 0.9 x 0.7 cm.No new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic uncinate process mass with extension to the mesenteric vasculature measures 1.9 x 1.5 cm (image 119/series 3) previously, 1.7 x 1.7 cm. The superior mesenteric vein is thrombosed with venous collaterals.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Slight decrease in size of the reference hepatic lesions.2.Near stable size measurement of the uncinate process mass.
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Generate impression based on findings.
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44-year-old female with right breast cancer.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.957 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker.
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Sentinel node identified in the right axilla.
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Generate impression based on findings.
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50-year-old female status post lumbar fusion. Posterior rods with screws are seen entering L4-5. There is no evidence of hardware complication. Spacer device with bone graft material is present between L4-5 appearing similar to prior when accounting for positional and technical differences. There is a grade 1 anterolisthesis of L4 on L5. Severe degenerative disc disease affects L3-4. Mild degenerative disc disease affects the remaining lumbar spine. There is a mild levoscoliosis of the lumbar spine.
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Postoperative changes of lower lumbar fusion and degenerative disc disease as above.
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Generate impression based on findings.
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62-year-old female with history of pain. Right ankle: There is moderate soft tissue swelling about the lateral aspect of the ankle. There is no acute fracture. There is mild osteoarthritis of the midfoot.Right wrist: Mild osteoarthritis affects the basilar and triscaphe joints. We see no acute fracture.
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Soft tissue swelling and osteoarthritis without acute fracture.
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Generate impression based on findings.
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61 year-old female with history of metastatic uterine cancer status post 3 cycles of chemotherapy with rise in CA 125 and abdominal pain. Evaluate disease status. CHEST:LUNGS AND PLEURA: Innumerable nodules consistent with metastatic disease. Reference right lower lobe nodule measures 0.8 x 0.8 cm (series 5, image 37), previously measuring 0.9 x 0.8 cm. Reference left lower lobe nodule measures 0.8 x 0.7 cm (series 5, image 26), previously measuring 0.9 x 2.9 cm. While the reference nodules are smaller in size compared to previous examination, there are multiple other nodules which are mildly increased in size compared to prior examination; findings suggestive of worsening thoracic metastatic disease.MEDIASTINUM AND HILA: Partially visualized left supraclavicular soft tissue mass/adenopathy appears increased in size compared to previous exam. This mass displaces the left carotid artery and the left subclavian artery. Additionally, there is splaying of the left brachiocephalic vein as noted on the coronal series, image 43. No mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval worsening of innumerable hepatic metastatic lesions. Reference right hepatic lobe lesion measures 1.1 x 1.3 cm (series 3, image 76), previously measuring 1.0 x 0.8 cm. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bulky retrocrural and retroperitoneal lymphadenopathy with interval worsening. Reference left para-aortic conglomerate lymph node measures 5.6 x 4.1 cm (series 3, image 118), previously measuring 4.7 x 4.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of sclerotic lesions within it the vertebral bodies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large thick walled multiseptated left adnexal cystic lesion most likely patient's primary tumor. The cystic component measures 8.0 X 4.8 cm (series 3, image 141), previously measuring 7.9 x 4.7 cm. Numerous small high attenuation lesions within the uterus are presumably fibroids but incompletely characterized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of sclerotic lesions within it the vertebral bodies.OTHER: No significant abnormality noted.
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1.Interval worsening of thoracic, hepatic and retroperitoneal lymphadenopathy.2.Left adnexal thick walled and multiseptated cystic mass most likely patient's primary tumor.3.Interval increase in size of left supraclavicular lymphadenopathy with mass effect on the great vessels as detailed above.4.Interval development of sclerotic osseous lesions which are most likely metastatic. Further evaluation with nuclear medicine examination may be considered for more sensitive evaluation of the bones.
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Generate impression based on findings.
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Reason: eval for bleed History: headache on xarelto There is an intraparenchymal hematoma centered in the tail of the right caudate nucleus adjacent to the body and trigone of the right lateral ventricle measuring 41 x 16 mm axial dimensions.There is intraventricular blood involving the right lateral ventricle more than the left. There is also a third and fourth ventricular blood present.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.There is a hematoma centered in the right caudate tail adjacent to the body and trigone of the right lateral ventricle associated with intraventricular blood .
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Generate impression based on findings.
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Female 57 years old Reason: 57yo F with upper extremity DVTs and concern for new PE given bradycardia/tachycardia. History: chest pain, sob. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Interval increase in right pleural effusion.MEDIASTINUM AND HILA: Unchanged mild aneurysmal dilatation of the ascending aorta. Severe atherosclerotic disease of the aorta and its branches with mild coronary artery calcifications.CHEST WALL: Extensive anasarca. Mild degenerative changes thoracic spineUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous cystic hepatic lesions are too small to characterize. Calcified lesion in the dome liver likely represents a large granuloma. Extensive vascular calcifications.
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No evidence of pulmonary embolism. Right greater than left left pleural effusion slightly increased compared to prior exam.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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15-year-old male with fracture.VIEWS: Right ankle AP, lateral, and oblique (3 views) 1/20/15 at 15:57. Two orthopedic screws affix a fracture of the distal tibial epiphysis in anatomic alignment without evidence of complication. Periosteal reaction along the lateral distal tibia appears similar to the prior study.
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Orthopedic fixation of healing distal tibial fracture.
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Generate impression based on findings.
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Male; 66 years old. Reason: 66M with Head & Neck cancer on CRT, now with neutropenic fever, SIRS, and persistent tachycardia, new oxygen requirement History: 66M with Head & Neck cancer on CRT, now with neutropenic fever, SIRS, and persistent tachycardia, new oxygen requirement PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Stable appearance of right middle lobe flat opacity near the diaphragm, most compatible with atelectasis/scarring. Additional right basilar subsegmental atelectasis and/or scarring is similar to prior study. Mild left basilar nonspecific atelectasis/consolidation has slightly increased. Stable scattered pulmonary micronodules, some which are calcified. No pleural effusions.MEDIASTINUM AND HILA: Stable nodular enlargement of the right lobe of the thyroid gland. Stable prominent mediastinal lymph nodes. Reference subcarinal lymph node measures 13 mm, previously 13 mm (image 138, series 12). Normal heart size without pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Right chest wall Port-A-Cath with catheter tip in the right atrium. Degenerative arthritic changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No acute pulmonary embolus.2. Mild nonspecific left basilar atelectasis/consolidation has slightly increased and may be due to aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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56-year-old male with history of lateral foot pain. The bones are demineralized. There is a small ossicle adjacent to the base of the fifth metatarsal likely representing old trauma. There is an additional ossicle adjacent to the third MTP joint which likewise appears chronic. We see no acute fractures. There is chronic-appearing periosteal reaction along the fourth metatarsal which is unchanged. There are scattered arterial calcifications.
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Findings suggestive of old trauma, but we see no acute fracture.
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Generate impression based on findings.
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16-year-old male self extubated, reinstatedVIEW: Chest AP (one view) 01/20/15, 1553 ET tube tip is below thoracic inlet and above the carina. NG tube is coiled in the stomach with tip in the gastric fundus. Swan-Ganz catheter tip is in the main pulmonary artery. Left upper extremity PICC tip is at the superior cavoatrial junction.Unchanged right upper lobe and bibasilar opacities. No pleural effusion. No pneumothorax. Cardiothymic silhouette is normal.
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ET tube tip is below the thoracic inlet and above the carina.
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Generate impression based on findings.
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Postoperative changes are seen from previous injury fusion of C5-C6 and C6-C7, with presence of interbody spacers. There is evidence of osseous fusion across the C5-C6 this is. There are areas of linear lucency along the edges of the bone graft at C6-C7, although a portion of the inferior aspect of the bone graft does appear confluent with the C7 superior endplate.The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with straightening of the normal cervical lordosis. There is a wedged appearance of the C6 vertebral body anteriorly. The remaining vertebral body and disk space heights are well-maintained.There is no acute fracture.At C1-C2, there is a normal relationship of the dens with the arch of C1.At C2-C3, there is mild left facet arthropathy.At C3-C4, there is minimal bilateral facet arthropathy.At C4-C5, there is minimal bilateral facet arthropathy and left-sided uncovertebral hypertrophy. There is a trace posterior osteophyte disk complex.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with right paracentral/proximal foraminal prominence. There is right greater than left uncovertebral hypertrophy. There is at most minimal central spinal canal stenosis. Moderate right and mild left foraminal narrowing.At C6-C7, there is a mild diffuse posterior osteophyte disk complex with minimal bilateral facet arthropathy. There is bilateral uncovertebral hypertrophy contributing to overall moderate right and moderate to severe left foraminal narrowing. There is mild to moderate central spinal canal stenosis.At C7-T1, there is no significant disk pathology or stenosis.The axial images do not demonstrate any significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.The visualized intracranial structures and lung apices appear normal.
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1. Expected postoperative changes from C5-C6 and C6-C7 anterior fusion, with confluent ossific density across the C5-C6 disk space and minimal bony bridging from the C6-C7 interbody graft along the C7 superior endplate. No acute fracture or subluxation.2. Scattered spondylotic changes most prominent at C5-C6 and C6-C7, where there is up to moderate central spinal canal stenosis at C6-C7 as well as moderate to severe left foraminal narrowing.
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Generate impression based on findings.
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57-year-old female with history of right foot pain and swelling. The bones are demineralized. There is a transverse fracture through the base of the proximal phalanx of the fourth toe. The fracture fragments are in near anatomic alignment.
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Fourth toe fracture as above.Findings discussed with pager 3498 on 1/20/15 at 1605.
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Generate impression based on findings.
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42-year-old female with history of pain to midfoot. There is no acute fracture or malalignment. No specific radiographic evidence to account for the patient's pain.
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No fracture evident or other findings to account for the patient's pain.
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Generate impression based on findings.
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Female; 58 years old. Reason: h/o hnc and crt, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Severe interstitial lung disease, peripheral and basilar predominant, with reticulation, honeycombing and traction bronchiectasis, similar to prior. No evidence of metastatic disease.MEDIASTINUM AND HILA: Interval removal of surgical drain in the prevertebral soft tissues in the upper chest. Right chest Port-A-Cath with catheter tip at the superior cavoatrial junction. Prominent mediastinal lymph nodes consistent with inflammatory lung disease, grossly similar compared to prior. Severe coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly 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: Severe right-sided hydronephrosis, possibly from UPJ obstruction, with a markedly thinned cortex and dilated central collecting system, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease affects the aorta and iliac vessels.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Severe interstitial lung disease in a pattern consistent with UIP, similar to prior study.2. No evidence of metastases in the chest and upper abdomen.
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Generate impression based on findings.
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76-year-old female with pain, evaluate for fracture Lumbar spine: Severe degenerative disk disease affects the lower lumbar spine. There is also posterior bulging of a partially calcified disk at L2/3. Moderate facet joint osteoarthritis affects the lower lumbar spine. Moderate to severe degenerative disk disease affects the lower thoracic spine.Hip: Small osteophytes indicate minimal osteoarthritis affecting the hip. No fracture is evident.Femur: Minimal osteoarthritis affects the knee. No fracture is evident.
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Degenerative disk disease and osteoarthritis without fracture evident.
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Generate impression based on findings.
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Metastatic lung carcinoma with right lower quadrant fullness and edema with shortness of breath ABDOMEN:LUNG BASES: Slight increase in size of loculated pleural effusions. Interval increase in size pericardial effusion.LIVER, BILIARY TRACT: Largely unchanged bilobar hepatic metastases. Reference segment 4 left lobe lesion best seen on image 23 of series 7 measures 4.8 x 2.2 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Stable reference portacaval lymph node seen on image 40 of series 7 measures 1.5 x 2.3 cm.BOWEL, MESENTERY: Slight interval increase in mild ascites.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: Slight increase in mild ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Slight interval increase in bilateral pleural effusions and pericardial effusion as well as mild ascites. Stable bilobar hepatic metastases. Evaluation of chest CT on separate report.
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Generate impression based on findings.
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The right rena artery branch supplying the AML was embolized using 500-700 micron Embospheres until near stasis was achieved. The main feeding artery branch was then embolized using two 3 mm push-able coils. POST EMBOLIZATION ANGIOGRAM: No flow beyond the coil pack with sparing of the remaining renal vessels.The catheters were removed. Right common femoral artery was performed through the sheath demonstrating patent right common femoral artery. Angio-seal closure devise was used to achieve hemostasis. The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 15.8 MinutesAIR KERMA: 355 mGyESTIMATED BLOOD LOSS: Less than 5cc.
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Successful particle and coil embolization of right renal angiomyolipoma.
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Generate impression based on findings.
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71 year-old female with hypercalcemia, hyperparathyroidism. Evaluate for adenoma. There are two foci of symmetric, bilateral uptake at the level of the vocal cords on delayed SPECT/CT imaging, compatible with muscle activity. However, there is also a questionable focus of increased radiotracer activity posterolateral to the right thyroid lobe. This may represent a parathyroid adenoma.
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Questionable focus of increased activity posterolateral to the right thyroid lobe may represent a parathyroid adenoma.
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Generate impression based on findings.
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61-year-old male with knee pain, assess for osteoarthritis Right knee: Examination of the right knee is limited due to inability to optimally position the patient. Components of a total knee arthroplasty device are identified with lateral dislocation of the patella. Tibiofemoral alignment is within normal limits. The bones are demineralized. Foci of heterotopic ossification are seen along the knee joint.Left knee: Severe tricompartmental osteoarthritis affects the knee. The bones are demineralized.
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1. Right TKA with lateral dislocation of the patella.2. Severe osteoarthritis affecting the left knee.
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Generate impression based on findings.
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52-year-old male with pain, evaluate for osteoarthritis or fracture Mild osteoarthritis affects the hip appearing similar to the prior exam. No fracture is visualized.
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Mild osteoarthritis without fracture evident.
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Generate impression based on findings.
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16-year-old male with history of renal stones. BLADDER Wall Thickness: Normal Contents: Echogenic focus demonstrating twinkle artifact measuring 8 mm in diameter. No additional debris is present. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 10.6 cm Left: 10.5 cm Mean for age: 10 cm Range for age: 9 - 12 cmADDITIONAL OBSERVATIONS: No renal stones.
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Echogenic focus demonstrating twinkle artifact measuring 8 mm in diameter most consistent with a bladder calculus. *SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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Again seen are postsurgical changes of posterior spinal fusion and interbody fusion at L4-5 and L5-S1 with left S2 screw. Left S2 screw tip is just beyond the anterior aspect of the left sacroiliac joint. Vertebral body heights are maintained. There is grade 1 anterolisthesis of L5 on S1 which remains unchanged. Right-sided laminotomy defects are again present at L5 and L4, with evidence of right facetectomy. Mild dysplastic appearance of the posterior elements is again seen with developmental nonunion of the left paramedian posterior elements of S1.There are persistent lucencies surrounding the L4-L5 and L5-S1 interbody grafts with mild subsidence which remain unchanged. There is some increase in density at the superior margin of the L5-S1 interbody graft. There is some bony bridging at the level of the right L4-L5 facet joint which appears similar to prior. There is also mild bony bridging involving the left L4-L5 facet joint, similar to prior. There is mild progression of fusion at the level of the left L5-S1 facet joint.No evidence of hardware displacement or new perihardware lucency. No significant spinal canal or neural foraminal stenosis is evident.
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1. Again seen postsurgical changes of posterior spinal fusion and interbody fusion from L4 to S1 and placement of left S2 screw. L4-L5 interbody graft is not clearly incorporated. L5-S1 interbody graft demonstrates mild interval increase in density along the superior margin suggestive of some incorporation. 2. There is suggestion of some bony bridging at the level of the facet joints on the right at L4-5 and on the left at L4-5 and L5-S1 without solid osseous fusion.3. Mild L5-S1 anterolisthesis is unchanged.4. No hardware fracture, displacement, or perihardware lucency.
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Generate impression based on findings.
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Eight year-old female with PICCVIEW: Chest AP (one view) 01/20/15 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Right upper extremity PICC tip is at the superior cavoatrial junction.
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Right upper extremity PICC tip is at the superior cavoatrial junction
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Generate impression based on findings.
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Female 79 years old; Reason: atypical parkinson's History: tremor, sleep d/o and memory issue Normal symmetric activity is seen in the basal ganglia.
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Normal examination. No evidence of nigrostriatal dopaminergic dysfunction. Given the history, these findings are suggestive of essential tremor.
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Generate impression based on findings.
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57-year-old male with history of metastatic prostate cancer. Abnormal foci of radiotracer activity in the thoracic and lumbar spine and bilateral proximal femora appear increased in intensity and size from the previous exam. Right parietal bone and right scapula metastases appear stable. New lesion in the left occipital bone is noted.Three right rib foci of radiotracer activity are decreased from the prior exam, and likely represent healing rib fractures.
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Increased activity and size of spinal and femoral metastases with new right occipital bone metastasis.
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Generate impression based on findings.
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There is a large aneurysm of the outflow vein just central to the AV anastomosis, however, there remains a small neck of the anastomosis itself. The artery distal to the AV anastomosis is patent.Findings were discussed with Dr. Thistlethwaite. ANGIOPLASTY: A 7 mm angioplasty balloon catheter was advanced to the narrowing and angioplasty was performed in standard fashion.POST-ANGIOPLASTY SHUNTOGRAM: There is improved patency with minimal residual narrowing. The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 9.9 MinutesAIR KERMA: 72.17 mGyESTIMATED BLOOD LOSS: Less than 5cc.
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Juxtaanastomotic aneurysm, likely enlarged secondary to high grade stenosis central to the aneurysm. Successful angioplasty of stenosis with 7 mm angioplasty balloon.PLAN: Patient will follow-up with nephrology and at dialysis.
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Generate impression based on findings.
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Pain. Rule-out fracture. The bones appear slightly demineralized. I see no fracture or malalignment. I see no joint effusion. Arterial calcifications are noted.
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Demineralized bones and arterial calcifications; I see no fracture.
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Generate impression based on findings.
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Assess for causes of left lateral foot pain. Tender to palpation, difficult to walk on it. The bones appear slightly demineralized. I see no fracture. I see no specific findings to account for the patient's lateral foot pain. There are scattered arterial calcifications in the soft tissues.
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No specific findings to account for the patient's left lateral foot pain. If there is clinical concern for stress fracture, repeat radiographs may be considered in 7 to 14 days.
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Generate impression based on findings.
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Diabetic wound status post partial amputation. The patient has undergone amputation of the forefoot and midfoot. There is a large wound extending from the amputation margin to the anterior margin of the calcaneus and possibly the anterior margin of the talus. Mottled density within the wound presumably represent packing material. The anterior margin of the calcaneus is poorly defined on the lateral view and hence I cannot exclude the possibility of osteomyelitis. The head and neck of the talus are absent, presumably due to surgical resection. The anterior margin of the remaining talus appears relatively well-defined. Additional foci of gas density are seen within the plantar soft tissues of the foot beneath the aforementioned wound. Surgical clips are noted anterior to the distal tibia and ankle joint. There is diffuse soft tissue swelling. The Achilles' tendon silhouette is indistinct which may simply be due to surrounding edema, although I cannot exclude a tear.
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Forefoot/midfoot amputation with large surgical wound extending to the calcaneus, the anterior margin of which is indistinct; I cannot exclude the possibility of osteomyelitis of the calcaneus, and if further imaging evaluation is clinically warranted, MRI may be considered.
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Generate impression based on findings.
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Status post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density within the soft tissues reflect recent surgery.
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Postoperative changes of total knee arthroplasty.
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Generate impression based on findings.
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Sickle cell with history of avascular necrosis, active effusion. Compare to 2011 x-ray. Four views of the right knee are provided. Bony sclerosis is compatible with the stated history of sickle cell disease and osteonecrosis. I see no subchondral fracture, articular surface collapse, or other findings to suggest disease progression. Poorly marginated opacification anterior to the distal femur may represent a joint effusion, but this is equivocal.Bony stigmata of sickle cell disease also affect the left knee as seen on the frontal view.
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Bony stigmata of sickle cell disease and possible knee joint effusion appearing similar to the prior study.
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Generate impression based on findings.
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Bilateral hip pain. Osteoarthritis? Two views of the left hip are provided. Tiny osteophytes indicate very mild osteoarthritis. A small focus of ossification superior to the greater trochanter may represent chronic enthesopathic changes, not necessarily of any current clinical significance.Two views of the right hip are provided. There is minimal if any osteoarthritic disease of the hip. Mild chronic enthesopathic changes are noted along the greater trochanter but are not necessarily of any current clinical significance. Mild osteoarthritis affects the visualized right sacroiliac joint.
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Mild osteoarthritis and other findings as above.
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Generate impression based on findings.
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Increasing oxygen requirementVIEW: Chest AP and abdomen AP 1/20/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. No focal lung opacity. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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No focal lung opacity.
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Generate impression based on findings.
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Abdominal painVIEW: Abdomen AP 1/20/15 Moderate amount of fecal burden. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum.
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Moderate amount of fecal burden.
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Generate impression based on findings.
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60-year-old female with chest pain. Evaluate for dissection. CT ANGIOGRAM: No evidence of hematoma or dissection in the thoracic or abdominal aorta. Left common carotid artery originates from the innominate artery. Visualized innominate, left common carotid, and subclavian arteries are patent. Mild atherosclerotic calcifications at the origin of the celiac axis, which is patent. SMA, IMA, renal arteries, common iliac arteries, internal and external iliac arteries are patent without evidence of thrombus or dissection.CHEST:LUNGS AND PLEURA: Multifocal air space opacities in the left lung highly suspicious for infectious etiology. Bilateral basilar atelectasis. No pleural effusions or pneumothorax.Left apical pulmonary nodule measures 8 mm (series 9, image 18). Previously noted right lower lobe 8mm nodule is no longer identified.MEDIASTINUM AND HILA: Moderate cardiomegaly with small pericardial effusion.CHEST WALL: Degenerative changes affect the visualized spine. ABDOMEN:LIVER, BILIARY TRACT: No arterially enhancing hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating foci consistent with cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Vaginal pessary is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of aortic dissection as clinically questioned.2.Left pulmonary airspace opacities highly suspicious for infection.3.Stable left apical pulmonary nodule. Follow-up in 3 to 6 months with chest CT to document stability is recommended.4.Moderate cardiomegaly with small pericardial effusion.
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Generate impression based on findings.
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History of fractureVIEWS: Left elbow AP, oblique and lateral There has been interval placement of a cast which obscures fine bony detail. The alignment of the osseous structures are normal.
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Interval placement of cast with anatomic alignment of the bony structures as described above.
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Generate impression based on findings.
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Surgery for transposition of the great vessels. History of rhinovirus.VIEW: Chest AP (one view) 01/20/15, 2112 Epicardial pacer leads are again seen. Mild enlargement of the cardiac silhouette persists. Subsegmental atelectasis is seen in the medial bases.
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No evidence of postoperative complication.
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Generate impression based on findings.
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17-year-old male with abdominal pain feverVIEWS: Chest PA, abdomen supine/upright (3 views) 01/21/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Stool is noted within the rectum and descending colon. Air-fluid levels are seen. Air distended loops of small bowel are more prominent compared to the prior exam. Nonobstructive bowel gas pattern. 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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4-month-old male with bradycardia, ET tube placementVIEW: Chest AP (one view) 01/21/15, 0141 ET tube tip is at the thoracic inlet. NG tube side-port is at the GE junction with tip in the proximal stomach.Cardiothymic silhouette is top normal. Large lung volumes. Persistent bibasilar and right upper lobe atelectasis on background of chronic interstitial changes. No pleural effusion or pneumothorax.
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ET tube tip is at the thoracic inlet. Persistent patchy atelectasis bilaterally on background of chronic lung disease.
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Generate impression based on findings.
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Male, 25 years old.Elevated BMI and longer than 8 hours surgery No RFO identified. Nonobstructive bowel gas pattern. Free air noted likely postsurgical. Triangular lucency overlying sacrum and pelvis which may represent free air or unusual fat plane. NGT side port above the GE junction. Multiple surgical clips noted. Linear opacity overlying right hemipelvis is external to patient per clinical team.
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No RFO identified. NGT side port above the GE junction, recommend advancement. Nonobstructive bowel gas pattern. Free air likely related to surgery. Findings discussed with Dr. Eggener by on call radiologist via telephone on 1/20/2015 at 18:35.
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