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Generate impression based on findings.
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82 years, Female. Reason: r/o obstruction History: pain and distention No definite evidence of free air. There is differential air-fluid level in the stomach on upright view. There is distended mid-abdomen small bowel loop on supine view with paucity of gas distally. There is small amount of gas in the proximal colon. Findings are consistent with early partial small bowel obstruction.Cholecystectomy clips and scattered pelvic surgical clips are noted. Please see same day chest radiograph report for additional findings.
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No definite free air. Findings consistent with early partial small bowel obstruction.
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Generate impression based on findings.
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Male; 35 years old. Reason: evaluation preoperatively, ribs 1-4 LUL synovial sarcoma History: sob LUNGS AND PLEURA: Left superior sulcus tumor located posteriorly has significantly decreased in size since prior study and currently measures approximately 1.7 x 3.2 x 1.6 cm (AP by transverse by craniocaudal) (series 4/13, series 80376/28). Stable scattered pulmonary micronodules, some which are calcified. Mild left lower lobe opacities suggestive of aspiration have resolved. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size. No pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest Port-A-Cath with catheter tip near the superior cavoatrial junction. Mild rightward curvature of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Left superior sulcus tumor has significantly decreased in size as above.
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Generate impression based on findings.
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Lumbar pain There are 5 lumbar vertebral bodies. The bones are demineralized. There is a slight leftward curvature of the lumbar spine. Mild facet arthropathy affects the lower lumbar spine. Hypertrophy of the lower lumbar spinous processes and associated degenerative changes are noted.
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Degenerative disk disease and other findings as described above.
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Generate impression based on findings.
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64-year-old female status post ORIF A volar plate with screws affixes a distal radius fracture in near-anatomic alignment without evidence of hardware complication. Slight progression of callus formation along the radial aspect of the fracture indicates some interval healing. The bones are demineralized. There is slight widening of the scapholunate interval. Severe osteoarthritis affects the basilar joint.
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Orthopedic fixation of distal radius fracture as described above.
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Generate impression based on findings.
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70 year-old female with pain, evaluate left shoulder Right shoulder: Hardware components of a reverse total shoulder arthroplasty device are situated in near-anatomic alignment without evidence of complication.Left shoulder: Streaky calcifications along the superolateral aspect of the greater tuberosity suggest calcific tendinosis that we suspect involves the infraspinatus tendon. The shoulder otherwise appears normal.
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Right reverse total shoulder arthroplasty and left calcific rotator cuff tendinosis as described above.
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Generate impression based on findings.
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18 year-old male with lbp for a year with arching; wrestling. Evaluate for spondylolysis. No abnormal osseous foci are identified.
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Normal examination with no evidence of spondylolysis.
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Generate impression based on findings.
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Postoperative changes are seen from posterior surgical fusion of L4 and L5 with bilateral pedicle screws at these levels and intervening interbody spacer. There is suggestion of bilateral laminectomies and a left facetectomy.The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild disk narrowing at L3-L4 and L4-L5, as well as mild-moderate disk narrowing at L5-S1. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the upper L2 level.The left L4-L5 foramen is not well assessed secondary to the artifact however there appears to be a abnormal T1 hypointense signal within the foramen partially obscuring the exiting left L4 nerve root which may relate to postoperative changes.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. Prominent STIR hyperintensity is seen within the lumbosacral paraspinal soft tissues bilaterally, consistent with edema.
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Postoperative changes at L4-L5 without significant central spinal canal stenosis at any level. Nonspecific abnormal signal in the left L4-L5 foramen which may relate to post operative changes. Postcontrast images of the lumbar spine may be helpful to evaluate for granulation tissue versus recurrent disk, if clinically indicated.
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Generate impression based on findings.
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CLL on clinical trial. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable. There is an unchanged appearance of the thyroid gland with multiple nodules. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are postoperative findings related to endoscopic sinus surgery with mild scattered mucosal thickening. There are bilateral lens implants and scleral plaques. There is mild nonspecific diffuse interstitial thickening in the lung apices. There is a partially-imaged right axillary lipoma.
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1. No evidence of significant lymphadenopathy in the neck to suggest recurrent lymphoma.2. Unchanged appearance of thyroid gland with multiple nodules.
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Generate impression based on findings.
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29-year-old female with SOB. Evaluate for PE. The comparison chest radiograph performed on the same day demonstrates no focal pulmonary opacities or pleural fluid. Again seen is pulmonary artery enlargement compatible with pulmonary arterial hypertension.The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is slight retention in the left lung base during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion. The hila are prominent which corresponds with enlarged pulmonary arteries seen on chest radiograph. Activity is seen in the kidneys and brain suggestive of a right to left shunt.
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1.Very low probability for pulmonary embolism.2.Scintigraphic findings in conjunction with chest radiograph findings compatible with pulmonary arterial hypertension.3.Findings suggestive of a right to left shunt with differential including Eisenmenger syndrome.
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Generate impression based on findings.
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Esophageal cancer. CHEST:LUNGS AND PLEURA: Bronchiolitis pattern in the posterior right upper lobe, most likely related to aspiration.Scattered ground glass opacities in the right lung, some of which are new and may be the result of radiation therapy warmer post inflammatory. Peripheral opacity in the anterior right lower lobe (5/87) now has surrounding linear and ground glass opacity; the central solid component remains 6-mm (5/87).Groundglass opacity abutting be left diaphragmatic hernia is consistent with atelectasis. Scarring adjacent to the neoesophagus.MEDIASTINUM AND HILA: 9-mm high right tracheoesophageal lymph node (3/19), previously 8-mm.Other subcentimeter lymph nodes are unchanged. Mild cardiomegaly. Posterior mediastinal nodal dissection clips.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The liver margin extends into the pelvis and was not included in this scanning range in its entirety. Visualized hepatic parenchyma is unremarkable in appearance.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: Dissection clips in the gastrohepatic ligament. Eccentric mural thrombus in the superior mesenteric artery just past its origin (3/116). Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.The appearance of thickening of the distal pull-up (3/99) is new from the previous study with single wall thickness measuring up to 14-mm and slight shouldering distally (3/101, coronal image 51) of unclear etiology given under distention/ lack of oral contrast.Left posterior diaphragmatic hernia containing unobstructed large bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Stable mildly enlarged high right tracheoesophageal lymph node.2. Nodular density in the right lower lobe and is now associated with some surrounding linear densities. Although this is of unclear etiology the appearance is atypical for a metastasis and a post inflammatory lesion, possibly related to radiotherapy, is favored.3. Mild apparent circumferential thickening of the distal pull-up just above the level above the retroperitoneal dissection clips in the upper abdomen, incompletely assessed without oral contrast. This may be further evaluated by endoscopy or an upper GI fluoroscopic study to confirm or exclude fold redundancy if required.
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Generate impression based on findings.
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Hodgkin's disease. Follow-up. CHEST:LUNGS AND PLEURA: Scattered micronodules as noted previously.MEDIASTINUM AND HILA: Unchanged reference left supraclavicular lymph node, measuring 2.2 x 0.9 cm (image 12; series 3). Anterior mediastinal soft tissue attenuation measures 3.9 x 2.0 cm (image 35; series 3), equivocally smaller compared to prior but not substantially changed compared to 3/5/2014 study. No new mediastinal adenopathy seen. No enlarged axillary adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver unchanged in appearance. Patent portal veins, patent splenic vein and SMV. The reference portacaval lymph node measures 9 x 7 mm (image 100; series 3), unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. PELVIS:UTERUS, ADNEXA: Small bilateral ovarian follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Stable appearance of decreased osseous mineralization and mild multilevel degenerative changes of spine.
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1.Equivocal interval decrease in size of mediastinal mass; the mass appears unchanged compared to 3/5/2014 study.2.Stable decreased osseous mineralization.
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Generate impression based on findings.
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53 year-old female with lung cancer. The comparison chest radiograph performed on 1/21/2015 demonstrates known right upper lobe mass. The ventilation images show no uptake in the right upper lobe that correlates with the patient's known mass. Otherwise, there is uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion with exception of no activity in the right upper lobe, correlating with the patient's known mass.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 48.1% (upper lung 11.9%; middle lung 24.0%; lower lung 12.2%)Right lung: 51.9% (upper lung 5.7%; middle lung 28.7%; lower lung 17.5%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 46.1% (upper lung 13.2%; middle lung 23.0%; lower lung 10.0%)Right lung: 53.9% (upper lung 7.5%; middle lung 31.5%; lower lung 14.9%)
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Triple matched perfusion and ventilation defect involving the patient's known right upper lobe mass. Otherwise, normal symmetric ventilation and perfusion images as quantified above.
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Generate impression based on findings.
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Female; 63 years old. Reason: ILD protocol, SLE with possible parenchymal disease History: DOE, hypoxemia LUNGS AND PLEURA: Respiratory motion limits evaluation of fine parenchymal detail. Within this limitation, no definite interstitial abnormalities are evident. Mild hazy opacity posteriorly in both lungs, most suggestive of dependent subsegmental atelectasis. Scattered pulmonary micronodules. Mild upper lobe predominant paraseptal and centrilobular emphysema. No air trapping. No honeycombing.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. Severe calcifications of the coronary arteries.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Limited evaluation of parenchymal detail due to respiratory motion. Within this limitation, no definite interstitial abnormality.2. Severe calcifications of the coronary arteries.
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Generate impression based on findings.
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Female 79 years old; Reason: evaluate for cause of abd pain in 79yo female w PMH of enlarging AAA, recurrent c diff, multiple abd surgeries History: elevated WBC but no fevers, diarrhea ABDOMEN:LUNG BASES: Atelectasis/scarring is noted in the lung bases.LIVER, BILIARY TRACT: Moderate to severe intrahepatic and extrahepatic biliary duct dilation is seen with debris within the common duct. Status post cholecystectomy. Hypodense liver lesions are unchanged and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule is unchanged.KIDNEYS, URETERS: Hypodense renal lesions are unchanged and likely represent cysts. The hypodense renal lesion in the upper pole the right kidney is again higher density than expected for simple cysts, however this is unchanged and favored to represent a hemorrhagic cyst. RETROPERITONEUM, LYMPH NODES: Aneurysmal dilation of aorta is again seen at multiple levels. This again measures 4.4 cm in diameter at the level of the ventricles (image 4, series 4). The infrarenal abdominal aorta measures 4.4 x 4.7 cm (image 41, series 4) in transverse dimension, previously 4.3 x 4.6 cm. BOWEL, MESENTERY: Focal dilation of a central small bowel loop is present at the site of anastomosis, however oral contrast passes into the colon and there is no evidence of obstruction.BONES, SOFT TISSUES: Vertebroplasty material is seen in multiple vertebral bodies. Wedge deformity of multiple vertebral bodies is unchanged.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel wall thickening of the sigmoid colon and rectum is present with surrounding fat stranding likely representing colitis.BONES, SOFT TISSUES: Aneurysm of the right common iliac artery is present measuring up to 6.4 cm (image 74, series 4), previously 6.3 cm. Ectasia of the left common iliac artery is also noted again measuring 1.8 cm (image 66, series 4).
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1.New moderate to severe biliary duct dilation. A distal obstructing lesion cannot be excluded and correlation with ERCP should be considered. Ascending cholangitis should also be considered.2.Bowel wall thickening of the sigmoid colon and rectum likely represents colitis.3.No significant change in aneurysmal dilation of the aorta and right common iliac artery.
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Generate impression based on findings.
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75 years old male presents with a lung nodule. This study was performed to evaluate for mediastinal and extrathoracic involvement.RADIOPHARMACEUTICAL: 15.2 MCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion grossly demonstrates a mass in the right upper lobe. Diffuse emphysematous changes are noted in both lungs. Scattered micronodules are seen in both lungs. Significant arterial calcifications are noted in the aorta and its branches including coronary arteries.Today's PET examination demonstrates intense FDG uptake in the mass in the right upper lobe at perihilar region with SUV Max of 17.4, which is consistent with a diagnosis of lung cancer.Minimal FDG uptake is seen in both lung hila and in the mediastinal precarinal and subcarinal regions, which is nonspecific.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1.Hypermetabolic tumor in the right upper lobe at perihilar region, consistent with a diagnosis of lung cancer.2.No definite evidence of regional nodal metastasis or distant metastasis.3.Symmetrical in the multifocal mild FDG uptake in both lung hila and mediastinal subcarinal and precarinal regions, which are nonspecific.4.Scattered micronodules in both lungs without increased metabolic activity.
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Generate impression based on findings.
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CLINICAL DATA: Age: 77 years. Sex : Male. Indication: Reason: Pancreatic pseudocyst s/p drainage History: Pancreatic pseduocyst. LUNG BASES: Interval decreased pleural effusions, with a small amount of right basilar dependent atelectasis remaining.LIVER, BILIARY TRACT: Cholecystectomy clips. No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Previously seen large pancreatic pseudocyst/peripancreatic fluid collection has been drained over the interval with an Amplatzer cystgastrostomy, and only a small amount of fluid remains. The largest remaining fluid collection (10/31) measures approximately 21 x 9 millimeters. Subtle haziness in the area of the previously seen pseudocyst, consistent with mild scarring. The adjacent vessels are patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM/LYMPH NODES: IVC filter in the expected location.BOWEL, MESENTERY: No small bowel obstruction or free air, no bowel wall thickening. Cyst gastrostomy, as above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:Moderate atherosclerosis affects the visualized aorta and its branches. The celiac trunk is narrowed to approximately 50%. Mild thickening of the superior mesenteric artery origin. Greater than 50% narrowing of the inferior mesenteric artery origin.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Interval decreased size, and near complete resolution, of the previously seen pancreatic pseudocyst.2.Interval decreased pleural effusions.3.Significant atherosclerosis as above.
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Generate impression based on findings.
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Pain and swelling to proximal elbow, abrasion posteriorly, evaluate for fracture Right elbow:There is an oblique fracture through the proximal ulna and olecranon extending to the articular surface. There is elevation of the distal humeral fat pads compatible with a lipohemarthrosis.Right wrist: Three views of the right wrist show no fracture. Mild osteoarthritis affects the basilar joint and trapezioscaphoid articulation. Deformities of the first and fifth metacarpals likely reflect old trauma.
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Proximal ulna/olecranon fracture as above.
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Generate impression based on findings.
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CLINICAL DATA: Age: 61 years. Sex : Male. Indication: Reason: History of bladder cancer and renal lesion, monitor for stability or disease spread/recurrence History: Bladder cancer on surveillance and renal lesion. LUNG BASES: Scattered small calcified hilar lymph nodes, unchanged. Heart size within normal limits, no pericardial effusion. No pleural effusion or consolidation.LIVER, BILIARY TRACT: Unchanged hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right kidney middle pole lesion (5/82) measures approximately 2.1 x 1.6 cm, compared with previous 2.0 x 1.6 cm. Mild bilateral pelvic stranding again noted.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small anterior abdominal wall/ventral hernia containing loops of small bowel, similar to prior. No free fluid or bowel wall thickening, no obstruction. Suture line at the known ileocolic anastomosis site.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Unchanged right renal lesion, and although stable is worrisome for renal cell carcinoma.
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Generate impression based on findings.
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40-day-old male with with abdominal distention. Is there dilation or pneumatosis?VIEW: Abdomen AP (one view) 1/21/2015, 1312 NG tube tip in the stomach. Bowel gas pattern is disorganized. Long segment of dilated bowel loop may represent colon in the left hemiabdomen. Bubbly appearance to the bowel contents in the pelvis and right lower quadrant likely represents pneumatosis, however could also reflect formed stool if this is present. No portal venous gas or intraperitoneal free air is evident.
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Probable pneumatosis and less likely formed stool in the pelvis and right lower quadrant.
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Generate impression based on findings.
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Female; 79 years old. Reason: Pleural mesothelioma. Please compare to prior exam per recist criteria. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Left nodular pleural thickening is compatible with given diagnosis of mesothelioma is unchanged. Reference measurements are asfollows:1. At the level of aortic arch (series 5/37), 27 mm at 10 o'clock and 52 mm at 7 o'clock, both unchanged.2. At the level of the pulmonary artery (series 5/55), 30 mm at 9 o'clock 11 mm at 4 o'clock, both unchanged.3. At the level of the left ventricle (series 5/69), 20 mm at 2 o'clock and 25 mm at 8 o'clock, both unchanged.Stable small left pleural effusion with tumor extending into the costophrenic angle and abutting the left hemidiaphragm, again with diaphragmatic deformity/distortion and with involvement focally of the perisplenic fat as best seen on sagittal image 84, series 80417; this is not significantly changed since prior study on 7/7/14. No suspicious pulmonary nodule or mass in the right lung. Mild to moderate centrilobular emphysema. No consolidation is present. Minimal right basilar subsegmental atelectasis.MEDIASTINUM AND HILA: Reference AP window lymph node measures 9 mm (series 5/41), unchanged. Extension of previously described left pleural tumor into the mediastinum and left pericardium, similar to prior study.CHEST WALL: Stable left pacemaker leads. No axillary lymphadenopathy. Stable degenerative arthritic changes of the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominalpathology. LIVER, BILIARY TRACT: Cholelithiasis.ADRENAL GLANDS: Stable mild left adrenal thickening.KIDNEYS, URETERS: Stable bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branchesis noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GIpathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable degenerative arthritic changes of the spine.
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Stable mesothelioma with reference measurements as detailed above.
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Generate impression based on findings.
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Ms. Williams is a 62 year old female recalled from screening mammogram for an asymmetry in the right breast. She has a personal history of multiple bilateral breast biopsies and aspirations. Family history breast cancer in maternal aunt. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Previously identified focal asymmetry in the central right breast disperses on spot compression imaging. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Acute appendicitis, taken to the OR on 12/16/14. Case aborted because of a large phlegmon. Treated conservatively with antibiotics. Right lower quadrant abdominal pain. ABDOMEN:LUNG BASES: Mild left basilar atelectasis or scarring. Calcified right infrahilar lymph nodes.LIVER, BILIARY TRACT: Status post cholecystectomy. SPLEEN: Unchanged splenic calcifications consistent with prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Previously described findings compatible appendicitis have regressed. The appendix remains enlarged measuring 1.6 cm in diameter but surrounding inflammatory changes have decreased. There is no evidence of abscess. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval regression of findings which previously demonstrated acute appendicitis. The appendix remains dilated with surrounding inflammation. However, degree of distention and inflammatory change has lessened. No evidence of abscess.
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Generate impression based on findings.
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55-year-old female with history of urine leak and fluid collections who presents for evaluation. ABDOMEN:LUNG BASES: Bilateral basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant interval change in the atrophic bilateral native kidneys with right-sided hydronephrosis.Right iliac fossa transplant kidney is again noted with a nephroureteral stent in place and a percutaneous nephrostomy tube with no evidence of hydronephrosis.Fluid collection seen anterior and inferior to the transplant kidney has resolved compared to the prior examination (series 5, image 101); there is a residual soft tissue component at this location. No significant interval change in position of the pigtail catheter which courses anterior to this fluid collection.Mild interval decrease in the fluid component of the fluid collection anterior to the psoas muscle without significant change in the peripheral soft tissue component.RETROPERITONEUM, LYMPH NODES: There are bilateral common iliac artery and external iliac artery stents. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Near complete resolution of fluid collection anterior and inferior to the transplanted kidney with residual soft tissue component. No significant interval change in pigtail catheter position.2.Mild interval decrease in the fluid collection seen anterior to the right psoas muscle as above.
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Generate impression based on findings.
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Follow-up Side plate and screw device affixes a distal fibular fracture in near-anatomic alignment. The fracture line remains visible. A screw and pin affix a medial malleolar fracture in near-anatomic alignment. The fracture line remains visible. Additionally, there is a fracture of the "posterior malleolus" situated in near anatomic alignment. No evidence of hardware complications. Soft tissue swelling about the ankle.
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Orthopedic fixation of distal tibial and fibular fractures as above.
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Generate impression based on findings.
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Female 52 years old; Reason: rule out intraabdominal abscess History: fever leukocytosis, s/p tumor debulking omentectomy, HIPEC ABDOMEN:LUNG BASES: Centrilobular emphysema is seen in the lung bases. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense right renal lesions are unchanged and presumably benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post sigmoid colon resection.BONES, SOFT TISSUES: Anterior abdominal wall laxity with mesh material in place. Two subcutaneous drains are seen in the anterior abdominal fat with their tips care in a vein near the level of the diaphragm. Subcutaneous gas near the tips of these drains is likely echogenic. A midline abdominal skin staples are noted. Skin thickening and underlying fat stranding is seen over the right anterior abdomen. While this may be related to the recent procedure, cellulitis cannot be excluded. Mild diffuse body wall edema is noted.No loculated fluid collection is identified.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Small amount of air within the bladder is likely iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No loculated fluid collection is seen to suggest abscess formation.
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1.Right anterior abdominal wall skin thickening and underlying edema is present which may represent cellulitis. 2.No loculated fluid collection is seen to suggest abscess formation.
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Generate impression based on findings.
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72-year-old male with prostate cancer. Again seen are increased activity in within the right lateral 10th rib, L5 for tubal body, and left scapula, unchanged compared to prior. No new foci of increased activity.Scattered degenerative again noted.
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Stable osseous metastases. No new foci of disease.
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Generate impression based on findings.
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Mesothelioma status post-pleurectomy and decortication on observation. CHEST:LUNGS AND PLEURA: Post surgical changes right hemithorax. Minimal lateral pleural thickening near the costophrenic angle measures 5-mm, previously 6 mm at the 9 o'clock position (3/60). Minimal nodularity along the right major fissure appears similar to prior exam.Left apical ground glass nodule measures 11 mm, unchanged (series 5 image 17). Clustered nodular densities at the left apex are not conclusively changed dating back to 9/2012. Postsurgical changes from wedge resection in the right middle lobe with associated traction bronchiectasis. No contralateral pleural thickening.MEDIASTINUM AND HILA: Cardiac size is within normal limits without pericardial effusion. Mild coronary artery calcifications noted.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative changes affect the thoracic spine. Stable sclerotic focus in the right lateral fourth rib. Surgical resection of the right lateral 7th rib.Previously described soft tissue thickening along the lateral aspect of the right eighth rib measures 9-mm, previously 7-mm. The degree of enhancement of this area is decreased compared to the prior study although there is now an associated small fluid collection extending between the fascial planes of the external musculature (3/82).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating lesion in the posterior right lobe of the liver (3/70) measures 11 mm, previously 7-mm. Additional hyperattenuating lesions are unchanged and most consistent with hemangiomas.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Mild asymmetric wall thickening at the GE junction incompletely evaluated but has been present in varying degrees on the prior examinations. Please note that this is a nonspecific finding and underlying pathology cannot be reliably excluded by CT, though chronicity favors a benign cause.BONES, SOFT TISSUES: Superior endplate depression of the L2 vertebral body appear some are compared to prior examination and is new compared to examination dated 8/28/2013.Mild focal thickening of the anterior right hemidiaphragm (3/71, coronal image 88), unchanged over multiple prior studies.OTHER: No significant abnormality noted.
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1.No significant change in right lateral chest wall measurement and minimal residual pleural scarring.2.Left upper lobe ground glass nodules are stable and continued annual follow-up is recommended.3. Indeterminate hypoattenuating lesion in the liver is incompletely characterized and continues to slightly enlarge; consider dedicated hepatic CT or MRI for characterization.
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Generate impression based on findings.
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Left lower chest wall pain Three views of the ribs show no fracture or other findings to account for the patient's left lower rib pain. Mild osteoarthritis affects the acromioclavicular joint bilaterally.
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No findings to account for the patient's pain.
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Generate impression based on findings.
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Reason: lung cancer History: 11 years after RUL lobectomy for NSCLC. Found to have FDG avid right lung nodule suspicious for cancer CHEST:LUNGS AND PLEURA: Right upper lobe nodule (image 54 series 5) slightly increased in size now measuring 17 mm x 19 mm previously measuring 17 mm x 17 mm.Left upper lobe poorly marginated nodule image 20 series 5) now measuring 9 mm previously measuring 7 mm. Stable postsurgical changes related to prior right lower lobectomy. MEDIASTINUM AND HILA: Stable multinodular goiter.Necrotic right hilar lymph node (image 52 series 3) measuring 10 mm.CHEST WALL: Prior thoracotomy on the right.Subchondral sclerosis of multiple thoracic vertebrae compatible with prior inflammatory/degenerative changes.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Mild interval increase in size of right and left upper lobe nodules. 2.Minimally enlarged necrotic right hilar lymph node.3.Severe subchondral sclerosis involving multiple thoracic vertebrae may be degenerative or post-inflammatory in origin.
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Generate impression based on findings.
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Check for lung nodules, adrenal mass and known primary adrenal neoplasm LUNGS AND PLEURA: Mild to moderate scattered emphysematous changes with calcified granulomata bilaterally no suspicious nodules or masses. No effusions.MEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardial appearance is unremarkableCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Particular attention is made of bilateral adrenal mass and nodule greater on the left. The left mass measures 4.0 x 3.7 cm and is grossly homogeneous and right adrenal demonstrates a 1.9 x 1.2 cm mass (image 88 series 3). The remainder of the visualized upper abdomen is unremarkable other than dependent high density material in the gallbladder with a possible small gallstone.
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1. Bilateral adrenal masses without evidence of pulmonary involvement.2. Cholelithiasis
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Generate impression based on findings.
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Pain, evaluate for fracture Evaluation of fine bone detail is limited by overlying cast material. There is an oblique distal fibular fracture extending to the tibiotalar joint with 4 mm of lateral displacement of distal fracture fragment. There is medial translation of the talus with widening of the medial gutter compatible with deltoid ligament injury. A fracture of the "posterior malleolus" is present. Soft tissue swelling is noted about the ankle.
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Fractures of the distal fibula, posterior malleolus, and deltoid ligament injury as described above.
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Generate impression based on findings.
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4-year-old male with Dravet syndrome and intractable seizures. Rule out intracranial hemorrhage. There is no evidence of acute intracranial hemorrhage. The ventricles, basal cisterns, and sulci are diffusely prominent, suggestive of global atrophy. There is no mass effect or herniation. There is mucosal thickening in the bilateral maxillary and posterior ethmoid sinuses. Fluid is present within the left mastoid air cells. There appears to be diffuse thickening of the skull base and maxillofacial skeleton.
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1. No evidence of acute intracranial hemorrhage. 2. Diffuse global atrophy is likely related to Dravet syndrome. A brain MRI may be useful for further evaluation of potential seizure foci.3. Apparent diffuse thickening of the skull base and maxillofacial skeleton of uncertain significance.
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Generate impression based on findings.
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Back pain Again seen is a wedge compression fracture of the L1 vertebral body similar in appearance to the prior exam accounting for technical differences. There is no scoliosis. There is a negative sagittal balance measuring 2.5 cm. The remainder of the spine is unremarkable.
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L1 compression fracture as described above.
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Generate impression based on findings.
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Metastatic lung cancer check, compare to prior. Lung cancer CHEST:LUNGS AND PLEURA: Stable unchanged appearance including diffuse moderate emphysematous changes. The focal opacity observed in the right major fissure thought to represent scarring remains unchanged and again difficult to measure.Scattered traction bronchiectasis is again observed in overall distribution and appearance remains consistent with radiation reaction. The reference focal pulmonary opacity in the left upper lobe when measured similarly again measures 9 x 30 mm (image 29 series 6). Right pleural calcifications and unchanged thickening. No effusionsMEDIASTINUM AND HILA: No lymphadenopathy. Mild distortion again left to right shift unchanged and postsurgicalPersistent mural thrombus observed in the right main pulmonary artery unchanged.The cardiac and paracardiac again significant for severe coronary calcifications without additional new superimposed acute abnormalitySmall hiatal herniaCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without additional hepatic abnormalitySPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous scattered bilateral renal cysts unchanged and benign-appearingPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered unchanged and non-pathologically appearing gastrohepatic lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate scattered osteoarthritic changes without suspicious lytic or blastic lesionsOTHER: No significant abnormality noted.
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1. Unchanged appearance without suspicious new abnormalities port or suggest recurrent or metastatic disease2. Chronic thrombus in the right main pulmonary artery
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Generate impression based on findings.
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Ms. Davis is a 40 year old female recalled from screening mammogram for a focal asymmetry in the right upper inner breast. An ML view and three spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Previously identified focal asymmetry in the upper inner right breast disperses into normal breast parenchyma on spot compression imaging. A biopsy marker clip is identified in the right lateral breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Subject in the EMPROVE clinical research trial 6 month follow-up for COPD. LUNGS AND PLEURA: No pneumothorax. Severe centrilobular emphysema unchanged. The left upper lobe remains collapsed and its airways contain endobronchial valves. Lung volumes appear unchanged.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Leftward mediastinal shift. Mild to moderate coronary artery calcifications. Normal heart size. Small volume of pericardial fluid.CHEST WALL: Bilateral breast prostheses. Severe compression deformities of the lower thoracic spine with collapse of the T6, T11 and T12 vertebral bodies, unchanged. Osteopenia.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Vascular calcifications. Granuloma in the spleen.
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Severe centrilobular emphysema without acute change. The left upper lobe remains collapsed, with endobronchial valves in place. Coronary artery calcifications.
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Generate impression based on findings.
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79-year-old female with shoulder swelling, rule out fracture The bones are demineralized. Moderate osteoarthritis affects the glenohumeral joint and mild osteoarthritis affects the acromioclavicular joint. A high riding humeral head suggests chronic rotator cuff tear. Multiple ossicles overlie the glenohumeral joint, likely secondary to osteoarthritis. There may also be a subdeltoid bursal fluid collection/bursitis as well containing a loose body. Severe degenerative disease affects the visualized cervical spine.
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Osteoarthritis, with findings suggestive of chronic rotator cuff tear and possible subdeltoid bursitis.
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Generate impression based on findings.
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85 year-old female with left knee pain Large joint effusion. Osteoarthritis most severely affects the patellofemoral joint. There is chondrocalcinosis of the menisci. No erosions are noted.
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1. Degenerative arthritic changes and chondrocalcinosis, which may represent a combination of osteoarthritis and CPPD arthropathy.2. Large joint effusion.Findings text paged to Mark Myren (pager 1949).
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Generate impression based on findings.
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46-year-old male with right hand pain after injury There is a small step-off along the articular surface of the base of the distal phalanx of the fifth finger suggesting a nondisplaced subchondral fracture. No additional fracture is evident.
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Findings suggestive of a nondisplaced fracture of the articular surface of the base of the distal phalanx of the fifth finger. The metacarpal is unremarkable. Findings discussed with David Landy (pager 3669) at the time of dictation.
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Generate impression based on findings.
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59 year-old female, assess fracture Again seen is an ununited fracture through the distal phalanx of the third toe appearing similar to the exam dated 1/14/15. Severe osteoarthritis affects the first MTP joint.
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Third toe fracture appearing similar to the prior exam.
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Generate impression based on findings.
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Thymoma. Benign neoplasm of the thymus. LUNGS AND PLEURA: New multi-focal clustered tree in bud opacities, peribronchial nodular opacities and groundglass opacities, mainly in the posterior and dependent lung fields, left greater than right. Confluent nodules measuring up to 18-mm with irregular borders in the left costophrenic angle (4/76) surrounded by ground glass opacity and intralobular septal thickening as well as tree-in-bud opacities. Right middle lobe predominantly groundglass opacity with associated bronchiolectasis (4/60), also new.No pleural fluid or pneumothorax. Calcified nodule in the anterior right lung is likely a granuloma.MEDIASTINUM AND HILA: Eccentric right sided anterior mediastinal mass extends to the midline there may level of the azygos arch to the level of the right atrial appendage. Maximal transaxial dimensions are 6.7 x 4.1-cm (3/40) and craniocaudal extent of the mass is 5.6cm. The mass contains a posterior septation, is homogeneously solid and does not contain calcifications, internal fat or fluid. There is an adjacent nodule anterior to the ascending aorta (3/33) measuring 17-mm which appears to extend through the posteromedial border of the mass.10-mm right right tracheoesophageal lymph node has enlarged from the prior study, previously 6-7 mm.Right hilar lymph node measures just above the upper limits of normal at 11-mm (3/41).Enlarged low left paraesophageal lymph node (3/46), not normally visible, and a prominent adjacent left subcarinal lymph node are noted.Severe coronary artery calcifications. Mild cardiomegaly. Large hiatal hernia. Endobronchial debris noted on the right.CHEST WALL: Severe scoliosis.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Atherosclerotic calcification of the aorta and its branches.
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1. Solid homogeneous 6.7 x 4.1 x 5.6 cm right anterior mediastinal mass consistent with provided diagnosis of thymoma. Extracapsular extension cannot be excluded.2. Enlarged high right tracheoesophageal lymph node, mildly enlarged right hilar lymph node and an enlarged low left paraesophageal lymph node are noted. Correlate with PET scan.3. Interval development of multifocal air space opacities, some of which have an appearance suggestive of pneumonia while others in the left lower lobe are more solid and nodular in appearance. If the patient is neutropenic, opportunistic infection such as fungal pneumonia may be considered. Development over a one month time interval would be unusual for metastatic lesions however follow-up to complete radiographic resolution is recommended for exclusion. Amy Durkin-Celauro verbally notified at 3:09 p.m. on 1/21/2015.4. No pleural fluid or pleural metastases.
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Generate impression based on findings.
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70 year-old female with neck pain after fall Cervical spine: The C5 and C6 vertebral bodies appear fused. Severe degenerative disk disease affects C3/C4 and C5/C6. Moderate degenerative disk disease affects C4/5. There is straightening of the cervical spine and a grade 1 retrolisthesis of C3. There is narrowing of bilateral C6/7 neuroforamina. Surgical clips project over the neck. No fracture is evident.Right shoulder: No fracture or dislocation. Minimal osteoarthritis affects the acromioclavicular joint. An ovoid calcific density overlying the greater tuberosity likely represents calcium hydroxyapatite deposition within the rotator cuff insertion. Degenerative arthritic changes effect the visualized spine.
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1. Mild osteoarthritis and findings suggesting calcific tendinosis of the rotator cuff. No fracture evident.2. Severe degenerative disk disease without cervical spine fracture evident. If there is strong clinical concern for fracture, CT may be considered.
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Generate impression based on findings.
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Male; 90 years old. Reason: suspected mesothelioma, on observation, eval EOD, compare to previous History: none CHEST:LUNGS AND PLEURA: Pleural calcifications and subpleural scarring bilaterally.Left hemithorax pleural thickening with reference measurements as follows (prior measurements from 8/27/14):Level of the aortic arch (5/28): 10:30 position 8-mm, unchanged. 6 o'clock position 3 mm, unchanged.Level of the AP window (5/34): 9 o'clock position 7 mm, unchanged. 10:30 position 13 mm, previously 12 mm.Level of the left atrium (5/55): 11 o'clock position 20 mm, previously 19 mm. 6 o'clock position 14 mm, unchanged.Overall, there is slight interval increase in pleural thickening since 8/27/14 and 10/26/14. Scarring and volume loss in the left lung, similar to prior studies. Small left pleural effusion, similar to prior studies. Stable scattered pulmonary micronodules, many of which are calcified.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Moderate coronary artery calcification. Moderate hiatal hernia.Tumor extends into the pericardial fat pad and thickens the pericardium, similar to prior studies. Mild mediastinal lymphadenopathy is new since 8/27/14. For future reference, a prevascular lymph node measures 10 mm in short axis, previously 5 mm (series 3/38).CHEST WALL: Reference enlarged left internal mammary chain lymph node has mildly increased in size and measures 10 mm, previously 6 mm (series 3/54) on 8/27/14. Previously described mildly enlarged intercostal lymph lymph nodes posteromedial lung base are grossly similar to prior study.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic lesions incompletely characterized but most likely represent cysts. Stable focal fat deposition along the falciform ligament.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right superior pole renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches; the aorta appears mildly ectatic in some areas, similar to prior study.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Colonic diverticuli.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Slightly increased left pleural thickening since 8/27/14 with reference measurements as above.2. Increasing mediastinal lymphadenopathy since 8/27/14.
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Generate impression based on findings.
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10-week-old female with left PICCVIEW: Chest AP (one view) 01/21/15 Left upper extremity PICC with tip in the right atrium. ET tube is below the thoracic inlet and above the carina. NG tube tip is in the stomach.Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Bilateral patchy atelectasis is unchanged.
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Left upper extremity PICC tip is in the right atrium.
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Generate impression based on findings.
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The ventricles and sulci are prominent, consistent with mild global volume loss slightly greater expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is an incidental partially empty sella. The remainder of the midline structures and craniocervical junction are within normal limits.
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Essentially unremarkable contrast enhanced MRI brain.
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Generate impression based on findings.
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58-year-old female with metastatic melanoma. Patient is status post 4 cycles Ipilimumab. Please assess disease status and compared to previous imaging.RADIOPHARMACEUTICAL: 15.1 mCi F-18 fluorodeoxyglucose (FDG). BLOOD GLUCOSE (FASTING): 171 mg/dL. Today's CT portion grossly demonstrates multiple pulmonary nodules, which have significantly decreased in size. Postsurgical changes of a cholecystectomy. New asymmetric right rectal wall thickening. Right inguinal lymph node has slightly increased in size.Today's PET examination demonstrates progression of disease. Previously seen hypermetabolic tumors in the lungs, spleen, right inguinal region, and right perineal region have increased in size compared to prior. For reference, right middle lobe lateral nodule measures a maximum SUV of 17.5, previously 12.1. Also for reference, right inguinal lymph node measures a maximum SUV of 38.3, previously 7.1.Additionally, there are new foci of hypermetabolic tumor in the right lobe of the liver, left inguinal region, right pelvic floor, and two foci within the rectosigmoid, one of which corresponds with asymmetric wall thickening on CT. Additional nonspecific focal activity is seen in the intestines.Mild hypermetabolic focus adjacent to the left greater trochanter, likely related to trochanteric bursitis.
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Interval progression with increase in size and number of FDG-avid tumor in the chest, abdomen and pelvis as described above. Additional findings as above.
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Generate impression based on findings.
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Multiple sclerosis and recent altered mental status and seizures. Evaluate for intracranial hemorrhage. No intracranial hemorrhage is identified. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter. There is no intracranial mass or evidence of mass-effect. There is no mass, midline shift or uncal herniation. The ventricles and sulci are enlarged, consistent with severe diffuse volume loss. There is mucosal thickening and air-fluid levels within the posterior ethmoid sinuses. Otherwise, the paranasal sinuses and mastoid air cells are clear. The calvarium is intact.
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1. Scattered areas of hypoattenuation in the white matter are likely related to multiple sclerosis. 2. Severe diffuse global atrophy with resultant prominence of the ventricular system, which is likely related to known history of multiple sclerosis.3. No evidence of intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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17 year-old female with ankle pain status post sprain with swelling and painVIEWS: Right ankle AP, oblique, lateral (3 views) 01/21/15 at 1420 No acute fracture or malalignment is evident. Mild soft tissue swelling over the lateral malleolus.
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Soft tissue swelling without evidence of acute fracture or malalignment.
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Generate impression based on findings.
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Ms. TorresLopez is a 46 year old female recalled from screening mammogram for calcifications in the right lower inner breast. Family history of breast cancer in two maternal aunts and one maternal aunt. An ML view and three spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Spot magnification views were performed of the right lower inner breast, confirming a loose cluster of likely benign calcifications. These appear similar to calcifications seen elsewhere in the right breast and in the left breast, favoring a benign etiology. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.
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High probability benign calcifications in the right lower inner breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).
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Generate impression based on findings.
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Pain, evaluate alignment Four views of the shoulder show slight inferior subluxation of the humeral head with respect to the glenoid. There is no fracture or dislocation.
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Slight inferior subluxation of the humeral head.
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Generate impression based on findings.
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50 year-old female with history of cervical cancer. Patient with previous liver lesions who presents for characterization of these lesions. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are multiple hypoattenuating foci throughout the liver without enhancement which are not changed compared to the 2011 examination and consistent with cysts.SPLEEN: No significant abnormality notedPANCREAS: Nonspecific subcentimeter hypoattenuating focus in the body of the pancreas may be partial volume averaging.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Surgical clips within the retroperitoneum consistent with previous dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical clips within the pelvis consistent with prior dissection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Numerous hepatic hypoattenuating lesions consistent with cysts.2.No evidence of local tumor recurrence or metastatic disease.
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Generate impression based on findings.
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Right cheek squamous cell carcinoma status post resection and chemoradiation. There are post-treatment findings with right lateral cheek skin thickening and mild subcutaneous fat volume loss. There is no otherwise evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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Post-treatment findings with right lateral cheek skin thickening and mild subcutaneous fat volume loss. Otherwise, evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy.
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Generate impression based on findings.
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Esophageal atresia repair. Postoperative day 7. Extubated.VIEW: Chest AP (one view) 01/21/15, 1425 Endotracheal tube has been removed. Feeding tube tip is at level of gastric fundus and side port is at GE junction. Left-sided central line has its tip in left brachiocephalic vein. A right chest tube is present with sidehole in subcutaneous tissues.. There is a gastrostomy tube.Mediastinum is slightly shifted to the right. Hyperlucency is noted in the right upper thorax periphery. Left lung is normal in appearance. Cardiothymic silhouette is normal.
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Persistent small right pneumothorax.
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Generate impression based on findings.
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Ms. Carter is a 61 year old female with a recent benign right breast biopsy in December 2013. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy mark clip is identified in the right superior breast, at site of prior benign biopsy. Left ductal ectasia is stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Stage IV Hodgkin lymphoma. There is no significant interval change in the cervical lymph nodes. For example, a right level 2A lymph node measures 8 mm in shift axis, previously 8 mm and a left level 2A lymph node measures 7 mm in short axis, previously 8 mm. There are unchanged left palatine tonsilloliths. The Waldeyer ring structures are otherwise not significantly enlarged. The airways are patent. The thyroid and salivary glands are unremarkable. The imaged paranasal sinuses are clear. The osseous structures are unremarkable. The major cervical vessels are patent. The partially imaged intracranial structures are unremarkable.
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No significant interval change in the cervical lymph nodes.
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Generate impression based on findings.
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31-year-old female with daily headaches. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. 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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MVA, pain, swelling, recently diagnosed leg fracture Left tibia-fibula:There is a mildly comminuted but predominantly transverse fracture of the proximal fibular diaphysis in near anatomic alignment with overlying soft tissue swelling. No additional fractures are evident.Left elbow:No fracture, malalignment, or joint effusion. Mild soft tissue swelling about the elbow.
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1. Fibular fracture as described above.2. Mild soft tissue swelling of the elbow without fracture.
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Generate impression based on findings.
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Pain, status post fall onto shoulder Four views of the left shoulder show no acute fracture or malalignment. The glenohumeral joint alignment is preserved.
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No fracture, malalignment, or other findings to account for the patient's pain.
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Generate impression based on findings.
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79-year-old male with adenocarcinoma right lung with concern for bone mets.RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 117 mg/dL. Today's CT portion grossly demonstrates innumerable bilateral pulmonary nodules compatible with metastases. Right lower lobe mass and consolidation with surrounding ground glass opacity and interstitial thickening. Right chest port with catheter tip in the cavoatrial junction. Coronary calcifications/stents. Right paratracheal, precarinal, subcarinal enlarged lymph nodes. Scattered lytic osseous lesions including the thoracic spine and pelvis. Prostate radiotherapy seeds. Bilateral scrotal calcifications.Today's PET examination demonstrates multiple foci of FDG activity within the thoracic spine vertebrae, bilateral ribs and bilateral pelvic bones. Diffuse mild hypermetabolic activity within the right lower lobe with focal areas of more intense activity likely represent tumor with associated atelectasis/pneumonia. For reference, the more intense focal area measures a maximum SUV of 6.3. Increased FDG activity is also seen in a few pulmonary nodules, right paratracheal, AP window, precarinal, subcarinal and bilateral hilar lymph nodes.Focus of increased FDG activity seen in the left lobe of the thyroid gland.
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1.Focus of moderate hypermetabolic tumor in the right lower lobe with surrounding mild diffuse FDG activity likely representing primary malignancy with associated atelectasis/consolidation. Innumerable bilateral pulmonary metastases, a few of which demonstrate increased FDG activity.2.Hypermetabolic mediastinal and bilateral hilar lymphadenopathy as described above.3.Multiple osseous metastases in the thoracic spine, bilateral ribs and bilateral pelvic bones.4.Nonspecific focal FDG activity in the left lobe of the thyroid gland, which may represent carcinoma or an adenoma.
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Generate impression based on findings.
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Numbness in the upper extremities Two views of the cervical spine are provided. Again noted are morphologic abnormalities of C1 and C2. The C2 vertebral body is block shaped with a flat superior surface. The os odontoideum seen on CT is not evident on these radiographs. The anterior arch of C1 is unusually large and situated superior to the C2 vertebral body. There is incomplete fusion of the posterior arch of C1. The C2-3 facet joints appear fused. There is moderate degenerative disk disease at C5-6 with minimal retrolisthesis of C5. Mild degenerative disk disease affects the C6-7.
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Morphologic abnormalities of the upper cervical spine and degenerative disk disease of the lower cervical spine appearing similar to the prior exam.
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Generate impression based on findings.
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Cough S.O.B. and process. Unspecified allergic alveolitis and pneumonitis. LUNGS AND PLEURA: Mosaic attenuation of the lung parenchyma, most pronounced at the bases, persists on the expiration sequence. No pleural fluid or pneumothorax. Subpleural reticulation and honeycombing is mild. Mild patchy groundglass opacity is seen in association with traction bronchiectasis and bronchiolectasis bilaterally. Localized emphysema or a small pneumatocele adjacent to a wedge biopsy suture line in the lingula.MEDIASTINUM AND HILA: Main pulmonary artery mildly enlarged at 3.6-cm in transverse dimension (3/52). Moderate coronary artery calcifications. Mild aortic valve calcifications. Mild cardiomegaly with left ventricular enlargement. No pericardial fluid. Numerous subcentimeter mediastinal lymph nodes, which may be seen in association with ILD but are nonspecific.CHEST WALL: Degenerative change of the spine with osteophyte formation.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. The visualized portion of the left kidney appears atrophic.
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Pulmonary fibrosis in a pattern most compatible with chronic hypersensitivity pneumonitis. Signs of pulmonary hypertension. Moderate coronary artery calcifications.
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Generate impression based on findings.
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The right internal auditory canal is diminutive in size, although demonstrates normal signal intensity. There is lack of delineation of a right lateral semicircular canal, which appears as a common cavity with possibly mildly enlarged vestibule on the right. The inner ears are otherwise normal on MR, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. The seventh and eighth cranial nerves are unremarkable on the left. On the right, these cannot be assessed secondary to the diminutive caliber of the canal.The ventricles are prominent, with additional prominence of the anterior subarachnoid spaces along the frontal and temporal lobes. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. 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. There are enlarged bilateral upper cervical lymph nodes which are partially visualized along the jugular chains, which are nonspecific but most likely reactive in a patient of this age.
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1. Semicircular canal-vestibule globular anomaly involving the right lateral semicircular canal. Significantly hypoplastic right internal auditory canal with inability to assess right seventh and eighth cranial nerves.2. Semicircular canal-vestibule globular anomaly involving the left lateral semicircular canal with less severe involvement is there appears to only be increased caliber of the canal lumen. 3. Nonspecific prominence of the ventricles on anterior subarachnoid spaces which may relate to benign enlargement of subarachnoid spaces of infancy, which should resolve by two years of age. Imaging follow-up may be obtained as clinically indicated. Otherwise, unremarkable contrast enhanced MRI of the brain.
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Generate impression based on findings.
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66-year-old female with chronic calcific pancreatitis with recent onset of vomiting. Evaluate for duodenal obstruction. ABDOMEN:LUNG BASES: Severe cardiomegaly with moderate pericardial effusion.LIVER, BILIARY TRACT: Heterogenous appearance of the liver with dilated hepatic veins compatible with passive hepatic congestion. Small polyp on the nondependent wall of the gallbladder (series 3, image 70), unchanged.SPLEEN: Nonspecific hypoattenuating lesion within the spleen.PANCREAS: Calcifications throughout the pancreas have increased compared to the prior examination and most likely sequela of chronic pancreatitis. No discrete pancreatic mass identified.ADRENAL GLANDS: Partially calcified right adrenal mass is unchanged in size and likely benign.KIDNEYS, URETERS: Right 2-mm non-obstructing nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of duodenal obstruction as clinically questioned. No evidence of small bowel obstruction. Small fat containing hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of duodenal obstruction as clinically questioned. No evidence of small bowel obstruction. No findings to suggest colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No evidence of duodenal obstruction as clinically questioned. 2.Findings consistent with sequela of chronic pancreatitis.3.Severe cardiomegaly with moderate sized pericardial effusion, unchanged.4.Findings consistent with passive hepatic congestion.
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Generate impression based on findings.
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Male, 59 years old.RFO NG tube tip overlies gastric antrum. IVC filter projects over the L2/3 vertebral bodies. Right upper quadrant postsurgical material was also expected. Surgical drains were expected. There is right sacral sponge, which was sutured to the ostomy site.No unexpected radiopaque foreign body.
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No unexpected radiopaque foreign body.
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Generate impression based on findings.
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Male 62 years old; newly diagnosed ampullary/pancreatic malignancy ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Accounting for differences in technique, stable 2.2 x 1.4 cm hepatic lesion located in segment 7 (timing of IV contrast bolus not optimal for assessment of hepatic lesions). Cholelithiasis. Interval placement of biliary stent with interval improvement in intrahepatic biliary duct dilatation. Small pneumobilia. Some intraluminal heterogeneity seen at level of portosplenic confluence, image 56 series 8, without definite thrombus.SPLEEN: No significant abnormality noted.PANCREAS: Minimal stranding around level of pancreatic head. Decreased size of reference portacaval lymph node measuring 2.5 x 1.2 cm, image 54 series 2, previously measured 2.8 x 1.4 cm. Additional subcentimeter periportal and peripancreatic lymph nodes. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypoattenuating renal lesions, stable, most likely cysts but too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of submucosal fat deposition in rectosigmoid colon, compatible with sequela of prior inflammation.PELVIS:PROSTATE/SEMINAL VESICLES: Prostatic calcifications. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Small bilateral fat containing inguinal hernias. Visualized osseous structures stable in appearance with multilevel degenerative disease and age indeterminate compression deformities of L1 and L3 vertebral bodies.
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Outside exam read:1. Interval placement of biliary stent with improved biliary ductal dilatation. 2. Mild interval decrease in size of reference lymph node, remainder of exam without significant change including stable indeterminate hepatic segment 7 lesion as above.
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Generate impression based on findings.
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85 years, Male. Reason: check for ileus History: check for ileus Enteric tube tip overlies the gastric antrum. Partially visualized nonobstructive bowel gas pattern. Aortoiliac graft and brachytherapy seeds are noted.
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Enteric tube tip overlies the gastric antrum. Partially visualized nonobstructive bowel gas pattern.
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Generate impression based on findings.
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57 year old female with history of recent partial small bowel obstruction in January. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple bilateral hypoattenuating hepatic lesions, some of which are consistent with simple cysts and some of which are too small to characterize. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypoattenuating focus consistent with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is abnormal dilation of the proximal jejunal loops just distal to the ligament of Treitz with swirling of the mesentery and apparent small bowel projecting in the inferior lesser sac. Finding suggestive of a lesser sac internal hernia versus. left paraduodenal internal hernia. No findings to suggest bowel wall ischemia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Findings consistent with mild partial small bowel obstruction, possibly due to lesser sac internal hernia versus left paraduodenal internal hernia as detailed above. Finding relayed to Dr. Schwartz nurse, Mirthala Benavida, RN over the phone at approximately 4:27 p.m.
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Generate impression based on findings.
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85 years, Male. Reason: abdominal pain s/p AAA repair, check for free air History: abdominal pain Exam is limited by motion artifact. No definite evidence of free air. Enteric tube side port remains above the GE junction.
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Exam is limited by motion artifact. No definite evidence of free air. Enteric tube side port remains above the GE junction. Partially visualized aortoiliac graft.
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Generate impression based on findings.
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50 years, Female. Reason: perforation? History: cardiac arrest Decubitus image is nondiagnostic due to artifact. Semierect view is also limited by motion artifact. NG tube tip overlies the gastric antrum.
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NG tube tip overlies the gastric antrum. Exam limited by motion artifact.
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Generate impression based on findings.
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Weakness and weight loss and former smoker, asbestos. Motion artifact limits exam quality, especially at the lung bases.LUNGS AND PLEURA: At the right lung base, there is a irregularly thin-walled cystic lesion measuring 13-mm near the right hemidiaphragm (4/90), indeterminate in appearance. On a prior abdominal CT dated 1/16/2013 the lesion measured 11-mm and had a more scar-like appearance. The increase in size may be due to enlargement of the cystic component has the wall thickness appears unchanged, previously 4-mm. Scattered noncalcified pulmonary micronodules statistically most likely representing benign granulomas however in the context of smoking history should be followed in one year to exclude growth of any of the lesions.No radiographic findings to suggest asbestosis or radiographic signs of asbestos exposure.Scattered calcified pulmonary nodules and micronodules, statistically most likely representing a benign granulomas.No pleural fluid or pneumothorax.Mild traction bronchiolectasis in the costophrenic angles.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta and its branches. Normal heart size. Normal caliber of the main pulmonary artery. Calcified lower right paratracheal lymph node, statistically most likely due to old, healed granulomatous infection.CORONARY ARTERIES: Mild to moderate triple-vessel calcification, poorly assessed but he technique and lack of cardiac gating.CHEST WALL: Spinal osteophyte formation.UPPER ABDOMEN: Low dose technique markedly limits sensitivity for abdominal pathology. Left kidney incompletely included in this scanning range however there appears to be left hydronephrosis and hydroureter in the upper pole. There is a subcortical calcification in the upper pole left kidney as well.
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1. Indeterminate 13-mm cystic lesion in the right lower lobe with irregular walls measuring up to 4 mm in thickness, slightly larger, although increase in size may be due to enlargement of the central cystic component. Three-month CT follow-up recommended. 2. Additional subcentimeter noncalcified pulmonary nodules appear benign and statistically most likely represent granulomas and may be conservatively followed in one year by CT given the clinical history.Lung-RADS: Category: 4A (Suspicious: Findings for which additional diagnostic testing and/or tissue sampling is recommended)RECOMMENDATION: 3 month LDCT; PET/CT may be used when there is a = 8 mm solid component.
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Generate impression based on findings.
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Fractures of the third and fourth metatarsals Three views of the left foot show fractures through the necks of the third and fourth metatarsals in near anatomic alignment. There is early callus formation suggestive of attempted early healing. There is a hallux valgus deformity with additional deformities of the proximal first metatarsal and proximal phalanx suggestive of healing osteotomies.
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Third and fourth metatarsal fractures with early callus formation.
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Generate impression based on findings.
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The paranasal sinuses and nasal cavity are clear. Unchanged mild nasal septal deviation and spur directed to the right. The lamina papyracea and ethmoid roofs are intact. The nasopharynx, orbits, and imaged intracranial structures appear to be unremarkable.
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No evidence of sinusitis.
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Generate impression based on findings.
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65 years, Female. Reason: 65F s/p lung transplant with abdominal distention, epigastric pain History: abdominal distention/pain Nonobstructive bowel gas pattern. Vascular calcification noted. Overlying heart monitor limits exam.
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Nonobstructive bowel gas pattern. Overlying heart monitor limits exam.
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Generate impression based on findings.
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Pain There appears to be partial sacralization of the L5 vertebra, which likely accounts for apparent narrowing of the L5/S1 intervertebral disk space. Moderate degenerative disk disease affects L3/4, with a minimal anterolisthesis of L3. Mild facet joint osteoarthritis affects the lower lumbar levels. There is perhaps a minimal rightward curvature of the thoracolumbar spine. Vertebral body heights are preserved. Surgical clips are noted in the upper abdomen.
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Degenerative disk disease and other findings as above.
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Generate impression based on findings.
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Male; 67 years old. Reason: history of renal cancer, liver lesions. Evaluate for change History: renal cancer and sarcoid, sarcoidosis CHEST:LUNGS AND PLEURA: Scattered micronodules. Reference lesion in the right lung base measures 0.8 x 0.5 cm (series 5, image 67), stable. Stable thyroid nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference hypodense nodule in the inferior right lobe of the liver (segment 6) measures 0.5 x 0.7 cm (series 3, image 100), smaller compared to previous exam. Hypodensity in the dome of the liver is unchanged from prior exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule stable since 2011.KIDNEYS, URETERS: Postsurgical changes consistent with left partial nephrectomy. The residual complex cystic lesion in the area of the resection is unchanged measuring 2.0 x 1.8 cm (image 105; series 3). The 1.1 x 1.0 cm soft tissue nodule (image 101; series 3) lateral to the upper pole of the kidney is stable to slightly smaller compared to prior. 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: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Multiple, bilateral enlarged pelvic lymph nodes which appear stable. The reference left common femoral lymph node is stable in size at 1.9 x 1.3 cm (series 3, image 185).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Overall stable examination. Reference measurements are given above.
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Generate impression based on findings.
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72-year-old male with small cell cancer; please two scan and evaluate for abnormalities.RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 90 mg/dL. Today's CT portion grossly demonstrates scattered nonspecific bilateral pulmonary micronodules. Coronary artery and abdominal aortic atherosclerotic calcifications. Again seen are conglomerate right inguinal lymph nodes and mildly enlarged right external iliac lymph node.Today's PET examination demonstrates markedly hypermetabolic activity involving the conglomerate right inguinal lymph nodes. For reference, maximum SUV measures 12.3. Mildly enlarged right external iliac lymph node also demonstrates increased FDG activity.Normal size left inguinal lymph nodes demonstrate mild hypermetabolic activity, nonspecific.Questionable increased FDG activity in the right temporal frontal lobe.
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1.Markedly hypermetabolic conglomerate right inguinal lymph nodes and hypermetabolic right external iliac lymph node suspicious for malignancy.2.Mildly hypermetabolic normal sized left inguinal lymph nodes, nonspecific.3.Questionable increased FDG activity in the right temporal lobe, which could be further evaluated with pre and postcontrast MRI brain if clinically indicated.
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Generate impression based on findings.
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Reason: evaluation of lung / mediastinal mass History: evaluation of lung / mediastinal mass LUNGS AND PLEURA: Right upper lobe compressive atelectasis secondary to large anterior mediastinal mass.No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Large anterior mediastinal mass demonstrates mild interval increase in size (image 49 series 4) now measuring 13.1 cm x 8.9 cm. On the corresponding images from outside exam this mass measured 11.9 cm x 8.8 cm.Enlarged anterior mediastinal lymph node (image 37 series 4) measuring 16 mm. This measured 13 mm on the prior outside exam.No hilar lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Large right anterior mediastinal mass demonstrating mild interval increase in size from the prior outside exam dated 10/22/14.2.Enlarged anterior mediastinal lymph nodes demonstrating interval increase in size.
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Generate impression based on findings.
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4-year-old male with pneumonia. Question of aspiration.EXAMINATION: Oropharyngeal motility study 1/21/2015, 1330 hrs. Julie Ecclestone, speech and language therapist, supervised the examination.62 seconds of fluoroscopy was used.Thin liquids were administered via open cup and with a straw. Nectar fluid was administered via a straw. Table purée consistency and solids were also administered.No oral deficits were observed. There was shallow penetration with cup sip and straw sip of thin liquids, which cleared completely with swallow. No aspiration was observed.
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Shallow penetration without aspiration.Please see the speech and language therapist's report for feeding recommendations.
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Generate impression based on findings.
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70 years, Male. Reason: eval Dobbhoff placement History: feeding tube DHT tip overlies gastric fundus. Partially visualized central lines overlies cavoatrial junction. Limited bowel gas evaluation.
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DHT tip overlies gastric fundus.
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Generate impression based on findings.
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Ms. Streeter is a 77 year old female with a personal history of left breast mastectomy in 1988 for cancer. Family history of breast cancer in sister and maternal aunt. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Laceration, evaluate for foreign body Three views of the right foot show a large laceration along the plantar and lateral aspect of the mid/hindfoot. There are several shard-like radiopaque foreign bodies within this laceration measuring up to 2 cm in length. At least three smaller fragments are seen in the deeper soft tissues with the deepest situated along the inferolateral margin of the calcaneus.Three views of the left foot show no radiopaque foreign bodies. There is a tibiotalar joint effusion without evidence of fracture.
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1.Right mid/hindfoot soft tissue laceration with multiple foreign bodies as described above.2.Left tibiotalar joint effusion.
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Generate impression based on findings.
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49 years old Female with malignant neoplasm of the Breast - unspecified site. This study was performed for staging. RADIOPHARMACEUTICAL: Please see report from outside hospital.BLOOD GLUCOSE (FASTING): Please see report from outside hospital. Today's CT portion grossly demonstrates a surgical clip is seen in the lateral aspect of the left breast. There is a sclerotic focus in the right femoral head.Today's PET examination demonstrates multiple conglomerate foci of increased activity in the left breast involving majority of the left breast with maximal SUV of 8.2. There are several hypermetabolic lymph nodes in the left axilla with maximal SUV of 5.7. A focus of increased activity is seen in the left mediastinal internal mammary region.There is a focus of increased activity in the right lung hilum with maximal SUV of 1.9.FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.
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1. Multiple conglomerate foci of increased activity in the left breast, consistent with the breast cancer.2.Hypermetabolic lymph nodes in the left axilla and left mediastinal internal mammary region as well as in the right lung hilum, suspicious for nodal metastases.3.No evidence of distant metastasis.
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Generate impression based on findings.
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Eight year-old female with constipationVIEW: Abdomen AP (one view) 01/21/15 Amorphous stool is noted within the rectum and ascending colon.
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Below-average stool burden.
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Generate impression based on findings.
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53-year-old male with history of end-stage renal disease. Pre-kidney transplant workup. ABDOMEN:LUNG BASES: Moderate pericardial effusion and cardiomegaly. No pleural effusions or focal areas of consolidation. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic and cystic kidneys, with some cysts showing calcification, consistent with polycystic kidney disease.RETROPERITONEUM, LYMPH NODES: Mild ectasia of the abdominal aorta. Mild atherosclerotic calcifications affect the aorta and proximal common iliac arteries.BOWEL, MESENTERY: Mildly indurated mesentery, similar to prior. No small bowel obstruction or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild diffuse skeletal sclerosis, consistent with renal osteodystrophy.PELVIS: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: Moderate atherosclerosis of the aorta and common iliac arteries, with mild atherosclerotic calcifications of the external iliac arteries.
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1.Unchanged bilateral atrophic cystic kidneys, as above.2.Moderate atherosclerosis of the aorta and common iliac arteries, with mild atherosclerotic calcifications of the external iliac arteries.
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Generate impression based on findings.
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Female, 74 years old.Multiple surgical teams, accounts are correct NG tube side-port just distal to GE junction. ET tube tip is at the carina. Circular sutures around the gastric cardia are expected. Bilateral abdominal drains are noted. Multiple surgical clips and skin staples are expected. Bilateral femoral fixation devices are expected.No unexpected radiopaque foreign body.
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No unexpected radiopaque foreign body. Findings discussed with Dr. Raphael Lee at 3:42 PM 1/21/2015.
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Generate impression based on findings.
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A patient submitted outside study for review for a recent pea-sized palpable abnormality along the lateral margin of the scar along the inferior aspect of the left breast reported by the patient. Submitted for review are left breast mammograms and left breast ultrasound performed at South Bend Clinic. For comparison, mammograms are available from UCM 5/14/2014 and priors dating back to 11/20/2009. LEFT MAMMOGRAM Three standard views of the left breast were obtained with a lateral exaggerated left CC view. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Postoperative changes from lumpectomy in the left breast, 6 o'clock position with surgical clips and architectural distortion in the surgical bed. A BB was placed at the site of the palpable abnormality. No discrete abnormality is seen in the breast in this region.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. LEFT BREAST ULTRASOUND
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Findings compatible with scar tissue. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Presyncope, gait instability No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal volume loss. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. Mega cisterna magna incidentally noted. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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No evidence of acute intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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Generate impression based on findings.
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Mesothelioma, chemotherapy follow-up. "Mesothelioma compare to last CT & measure 1) aortic arch 7 o'clock, 2) AP window 2 o'clock, 3) AP window 7 o'clock, 4) left atrium 4 o'clock, 5) left atrium 9 o'clock,, 6) left costophrenic angle mass." CHEST:LUNGS AND PLEURA: Interval removal of right-sided Pleurx catheter. Severe emphysema. Left upper lobe paramediastinal fibrosis. Contralateral pleural tumor slightly worse at the lung base. Measurements on the left as follows:1. At the level of the aortic arch (image 31 series 3), 4 o'clock position measures 8 mm, previously 9-mm. 7 o'clock position measures 18 mm, unchanged. 2. At the level of the AP window (image 33 series 3), 2 o'clock position decreased, 4-mm compared to 9-mm previously. 7 o'clock position 9 mm, previously 11 mm. 3. At the level of the left superior pulmonary vein (image 53 series 3), the 4 o'clock position measurement is 7 mm, previously 9 mm. The 9 o'clock position measurement is 6 mm, previously 7 mm. Confluent pleural tumor deep in the left costophrenic angle is again observed with extension to the diaphragm and chest wall. Reference measurement is 3.3 x 4.1 cm, previously 3.7 x 3.9 cm, (3/83) . Tumor is also identified extending into the major fissures bilaterally, with enlargement of an intrafissural nodule on the left (4/59).MEDIASTINUM AND HILA: Transverse dimension of the mediastinum is slightly narrowed by mediastinal pleural tumor increase on the right. The SVC remains patent. Severe coronary calcification. Scattered small nodules invading the pericardium. Small pericardial effusion, slightly increased in volume. Unable to exclude myocardial invasion along the lateral wall of the right atrium and right atrial appendage.Enlarged left inferior pulmonary ligament lymph node and small lymph nodes elsewhere not significantly changed.Moderate hiatal herniaCHEST WALL: Left lower chest wall tumor, intercostal lymphadenopathy and left paraspinal invasion not significantly changed. Cortical thickening and sclerosis involving left posterior ribs 4-7 about the same, with cortical irregularity and extension of the soft tissue into the rib interspaces and eroding rib 5.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Unchanged appearance with involvement of adjacent fascial planes but no specific findings of organ invasionADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left lateral distal abdominal aortic saccular aneurysm, probably due to a penetrating atherosclerotic ulcer. The aneurysm is partially thrombosed and unchanged compared to recent previous studies but has enlarged when comparing back to remote earlier exams. No significant change in lymphadenopathy..BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Mesenteric and retroperitoneal fat stranding and nodularity minimally more prominent in the left upper quadrant and left posterior paracolic gutter.BONES, SOFT TISSUES: Invasion of the hemidiaphragm which extension into the peri-splenic fat of the left upper quadrant.OTHER: No significant abnormality noted.
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Thoracic and abdominal mesothelioma with reference measurements provided in the body of the report.
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Generate impression based on findings.
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Postoperative changes are again seen from prior right suboccipital cranioplasty. Compared to 7/15/2014, interval decrease in size of heterogeneously enhancing lesion within the right cerebellopontine angle cistern is seen, measuring 8x12x10, previously 15x11x16 mm. Linear intracanalicular enhancement, which in part is postsurgical, extending to the modiolus appears slightly decreased, previously 4 millimeters, now 3 mm in thickness. The left internal auditory canal is unremarkable. Again seen is FLAIR hyperintensity compatible with gliosis along the right lateral pons, middle cerebellar peduncle, and cerebellum.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift. Minimal scattered foci of FLAIR hyperintensity are again seen within the subcortical and deep white matter, likely relating to mild chronic small vessel ischemic changes. There are no areas of pathological enhancement. There is no diffusion abnormality. Incidental note is again made of slight focal prominence of CSF space just lateral to the sylvian fissure with slight scalloping of the inner table of the adjacent calvarium. A small arachnoid cyst in this location cannot be entirely excluded. Right eyelid weight.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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Compared to 7/15/2014, there is interval decrease in size of the vestibular schwannoma involving the right cerebellopontine angle and internal auditory canal.
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Generate impression based on findings.
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52-year-old female with inability to ambulate, rule out intracranial hemorrhage. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. Patchy bilateral opacification of the ethmoid air cells. Mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. 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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Cerebral palsy and hip surgery.EXAMINATION: Pelvis AP/frog leg (two views) 01/21/15 Left femoral blade plate and screws device is in place. A healed left proximal femoral osteotomy is seen. The left femoral head is directed into the dysplastic acetabulum. The right femoral head is directed into the dysplastic acetabulum. Postoperative changes from a femoral varus derotational osteotomy are seen on the right.A moderate to large amount of feces is noted in the rectosigmoid.
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Bilateral femoral varus derotational osteotomy with femoral heads well directed into acetabula.
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Generate impression based on findings.
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24-year-old female with nausea, vomiting, and visual changes after recent head trauma. Redemonstration of a right frontal subgaleal hematoma that measures up to 8 mm in thickness, which appears more focal when compared to prior. There is beam hardening artifact in the frontal region. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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Evolving right frontal subgaleal hematoma, but no evidence of skull fracture or acute intracranial hematoma.
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Generate impression based on findings.
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Renal mass CHEST:LUNGS AND PLEURA: 4-mm right upper lobe micronodule as seen on image 28 of series 3.MEDIASTINUM AND HILA: Bilateral thoracic inlet adenopathy. Representative left thoracic inlet mass best seen on image 5 series 2 measures 3.5 x 2.9 cm.Mildly enlarged mediastinal lymph nodes. Representative left paratracheal lymph node best seen on image 25 series 2 measures 1.1 x 1.5 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 3.4 x 5.3 cm mass arising from the upper mid pole right kidney best seen on image 41 of series 6. This mass abuts against the renal sinus and also extends into the perinephric space.Bilateral subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Extensive bulky retrocrural and retroperitoneal adenopathy. A representative left para-aortic lymph node best seen on image 49 of series 6 measures 2.6 by 1.6 cm.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: Bilateral common and external iliac adenopathy. A representative left external iliac lymph node best seen on image 76 of series 6 measures 1.7 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Right renal mass as described. Associated with extensive bulky retrocrural, retroperitoneal, and proximal pelvic adenopathy. Bilateral thoracic inlet adenopathy suggestive for metastatic involvement. While the findings support the suspected diagnosis of metastatic renal cell carcinoma, other etiologies including lymphoma cannot be completely excluded. The right renal mass will be biopsied today.
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Generate impression based on findings.
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Pain, bunion There is a mild hallux valgus deformity with mild soft tissue prominence along the medial aspect of the first metatarsal head, similar to the prior exam.
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Mild hallux valgus deformity appears similar to the prior exam.
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Generate impression based on findings.
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Right shoulder pain with decreased range of motion; bilateral knee pain; ankle pain Right shoulder:Tiny glenohumeral osteophytes indicate mild osteoarthritis. The shoulder is otherwise within normal limits.Right knee:Severe osteoarthritis affects the medial compartment with near bone-on-bone apposition. There are small tricompartmental osteophytes. These findings have progressed from the prior exam. A mild varus deformity of the knee is noted.Left knee:Moderate to severe osteoarthritis affects the medial compartment. There are small tricompartmental osteophytes. These findings have progressed from the prior exam.Right ankle:Three views of the right ankle show diffuse soft tissue swelling. Ossicles distal to the fibular tip are compatible with old trauma. There is no acute fracture. Plantar and posterior calcaneal spurs are noted. Mild degenerative arthritic changes affect the ankle.
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Osteoarthritis of the right shoulder, knees, and right ankle as described above.
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Generate impression based on findings.
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Status post reduction of ankle fracture Evaluation of fine detail is limited by overlying cast material. Again noted is an oblique distal fibular fracture with 4 mm lateral displacement of the distal fracture fragment. There is persistent widening of the medial tibiotalar gutter measuring 8 mm, previously 10 mm. The previously described posterior malleolus fracture is not seen on the current exam.
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Distal fibular fracture and medial gutter widening as described above.
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Generate impression based on findings.
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85 years, Male. Reason: NGT placement History: NGT placement Aortoiliac graft is noted. Side-port of the enteric tube is above the GE junction.
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Aortoiliac graft is noted. Side-port of the enteric tube is above the GE junction
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Generate impression based on findings.
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72-year-old male with history of prostate cancer. Evaluate. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is a bulky mediastinal lymphadenopathy which is stable. Reference subcarinal lymph node measures 3.1 cm in diameter (series 3, image 48), unchanged.Heart is normal in size with small pericardial effusion, unchanged.CHEST WALL Left axillary lymphadenopathy with the reference lymph node measuring 1.7 centimeters (series 3, image 17), previously measuring 1.7 cm when remeasured.Retrocrural lymphadenopathy measures 1.4 cm (series 3, image 80), unchanged.Stable supraclavicular lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Collapsed gallbladder with cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky retroperitoneal lymphadenopathy with the reference left para-aortic lymph node measuring 3.7 cm (series 3, image 111), unchanged.BOWEL, MESENTERY: Small fat containing ventral hernia.BONES, SOFT TISSUES: No significant abnormality.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: Unchanged sclerosis and compression deformity of L5 vertebral body.OTHER: No significant abnormality noted
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Stable lymphadenopathy in chest and abdomen.
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Generate impression based on findings.
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RIGHT TEMPORAL BONE: The external auditory canal contains scattered opacifications likely representing debris/cerumen. The tympanic membrane is faintly visualized. The scutum remains sharp.The tympanic cavity and mastoid air cells are clear. The ossicular chain and tegmen tympani are intact, although the stapes is diminutive in size with an abnormally narrow footplate as well which suggests that the oval window may be stenotic.There is an absent bone island of the lateral semicircular canal, with globular appearance of the possibly mildly enlarged vestibule with the lateral semicircular canal. In addition, the modiolus is enlarged and the cochlear aperture is narrowed, with perhaps mild dysplasia of the cochlea in its basal to middle turn. The inner ear structures otherwise have a normal morphology. The bony coverings of the cochlea, vestibule, semicircular canals, and facial nerve canal are intact. The vestibular aqueduct is within normal limits in size. The osseous and auditory canal is hypoplastic.LEFT TEMPORAL BONE: The external auditory canal contain scattered opacifications, likely debris/cerumen. The tympanic membrane is faintly visualized. The scutum remains sharp.The tympanic cavity and mastoid air cells are clear. The ossicular chain and tegmen tympani are intact.The bone island associated with the lateral semicircular canal is diminutive in size, with diffuse enlarged caliber of the lateral semicircular canal lumen. The inner ear structures otherwise have a normal morphology. The bony coverings of the cochlea, vestibule, semicircular canals, and facial nerve canal are intact. The vestibular aqueduct is within normal limits in size. No abnormalities of the osseous internal auditory canal are demonstrated.
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1. Hypoplasia of the bony right internal auditory canal. Mildly dysplastic right cochlea with enlarged modiolus and cochlear aperture stenosis. Findings consistent with right lateral semicircular canal-vestibule globular anomaly. Probable associated right oval window stenosis with diminutive appearing stapes.2. Diminished bone island associated with the widened left lateral semicircular canal, also along the spectrum of the same above anomaly.
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Generate impression based on findings.
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Infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Right tube opacified with contrast and had free spillage. There is a left hydrosalpinx with no spillage.TOTAL FLUOROSCOPY TIME: 2:22 minutes
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Normal uterine cavity and patent right fallopian tube. Left hydrosalpinx and blocked tube.
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