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Generate impression based on findings.
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Reason: esophageal cancer History: regionally advanced cancer s/p neoadjuvant chemotherapy/radiation CHEST:LUNGS AND PLEURA: Centrilobular emphysema with with scattered micronodules some other calcified compatible prior granulomatous disease.No suspicious nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Calcified hilar and mediastinal lymph nodes compatible to prior granulomatous disease.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.Esophageal thickening in the mid to distal esophagus again noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable extensive multicystic disease throughout the liver with areas of marked calcification. Status post cholecystectomy.SPLEEN: Calcifications compatible with prior granulomatous disease.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts with focal areas of cortical atrophy consistent with prior infarcts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Marked atherosclerotic changes of the aorta and its branches.
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No interval change without evidence of metastatic disease.
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Generate impression based on findings.
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93 year old female with history of aortic valve disorder. Preoperative TAVR CT protocol. Limited field of view for evaluation of central vasculature, so evaluation of soft tissues is limited. Moderate atherosclerosis affects the visualized aorta, with mild atherosclerosis of the common iliac arteries. The celiac trunk, superior mesenteric, renal arteries and inferior mesenteric artery are widely patent.ABDOMEN:LUNG BASES: Lung bases are clear, however refer to CT chest portion for additional diagnostic details.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating renal cysts are incompletely evaluated on this exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix is within normal limits. Diverticulosis affects the colon.BONES, SOFT TISSUES: Degenerative changes affect visualized spine, with grade 1/mild retrolisthesis of L5 on S1.OTHER: 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: The right common iliac artery is markedly kinked at the level of the common iliac artery bifurcation. The left common iliac artery is mildly tortuous.
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1. Moderate atherosclerosis of the distal aorta, and mild atherosclerosis of the common iliac arteries.2. The right common iliac artery is markedly kinked at the level of the common iliac artery bifurcation. The left common iliac artery is mildly tortuous.
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Generate impression based on findings.
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Concern for worsening MAI. Solitary pulmonary nodule LUNGS AND PLEURA: Persistent and mildly shifting areas of bronchiectasis with clustered nodules which many are calcified. Both tree in bud opacities in the right upper and right lung base are again observed scattered micronodules. The left upper lobe specific nodule appears similar in size, however a new adjacent focal area is observed and likely post obstructive. Overall involvement similar with moderate shifting. Again no effusions and largely involving the right lungMEDIASTINUM AND HILA: No lymphadenopathyModerate coronary calcifications unchanged. Cardiac and pericardium are otherwise within limitsCHEST WALL: Right mastectomy. No definite left breast lesion, however the majority of the breasts is otherwise outside the field-of-viewUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Extensive surgical clips, largely with an area the GE junction
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Persistent bronchiectasis with reimposed opacities again representing suspected chronic infection such as MAI. Overall appearance and disease burden is similar yet shifting in location
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Generate impression based on findings.
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Male; 61 years old. Reason: S/P LVAD. S/P chest wound debridement; Eval for fluid collection at chest and VAD drive line site History: Leukocytosis CHEST:LUNGS AND PLEURA: Calcified granulomas. Lungs hypoinflated. Mild streaky bibasilar subsegmental atelectasis, similar to prior study. No pleural effusions.MEDIASTINUM AND HILA: Few nonspecific punctate foci of mediastinal air adjacent to the aortic limb of the LVAD are stable to slightly decreased. Stable cardiomegaly.CHEST WALL: Left chest wall ICD.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Small hemangioma at the inferior tip of the right lobe of the liver.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical scarring on the left.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: Small soft tissue wound midline anterior superior abdomen.OTHER: LVAD drive line in expected location with no evidence of fluid collection. Stable minimal skin thickening around the drive line.
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Few nonspecific punctate foci of mediastinal air adjacent to the aortic limb of the LVAD are stable to slightly decreased. No evidence of fluid collection or abscess.
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Generate impression based on findings.
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Right cheek squamous cell carcinoma. Check for lung metastatic disease LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No lymphadenopathy.Severe coronary calcifications without additional cardiac or pericardial abnormality.Small hiatal herniaCHEST WALL: Mild gynecomastiaUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Incomplete visualization of the kidneys, the right kidney appears mildly atrophic without visualization of the left, presumably below the inferior margin of the imaging otherwise no additional focal abnormality within this limited view of the upper abdomen.
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No evidence of metastatic disease
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Generate impression based on findings.
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40 year-old male with new lung cancer, evaluate for sites of metastasis.RADIOPHARMACEUTICAL: 15.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 90 mg/dL. Today's CT portion grossly demonstrates left upper lobe mass. With hilar lymphadenopathy. Paraseptal emphysema. Basilar atelectasis. Enlarged left adrenal gland.Today's PET examination demonstrates hypermetabolic tumor involving the left upper lobe mass with a maximum SUV of 10.0. Left hilar lymph nodes and two small foci in the right hilum also demonstrate hypermetabolic activity. Small focus of increased FDG activity in the right upper lobe appears to correlate with a nodule between two bullae.Left adrenal gland demonstrates hypermetabolic activity compatible with metastasis.Diffuse pancreatic parenchymal hypermetabolic activity. Additional hypermetabolic foci involving the omentum, left upper quadrant, mesenteric lymph node, retroperitoneal lymph node, presacral lymph node, left pelvic sidewall lymph node, and ascending colon also suspicious for tumor involvement.
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1.Markedly hypermetabolic left upper lobe mass compatible with patient's known history of lung cancer. Additional hypermetabolic right upper lobe probable nodule. 2.Bilateral hypermetabolic lymphadenopathy.3.Hypermetabolic probable left adrenal metastasis.4.Diffusely hypermetabolic pancreas, which can represent malignancy or pancreatitis.5.Scattered hypermetabolic implants and lymph nodes in the abdomen and pelvis compatible with metastases.
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Generate impression based on findings.
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72-year-old male with pain and swelling over medial malleolus Ankle: There is diffuse soft tissue swelling without fracture evident.Foot: No fracture is evident. Soft tissue swelling is again seen. A round, lucent lesion with sclerotic margins in the navicular likely represents a small cyst or ganglion, unchanged. Mild hallux valgus deformity.
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Soft tissue swelling and other findings as described above appearing similar to the prior exam. We see no fracture.
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Generate impression based on findings.
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28-year-old female with pain, reduced range of motion, evaluate elbow fracture There is a comminuted fracture of the coronoid process of the ulna with mild volar displacement of the fracture fragments. No fragments have migrated posteriorly within the joint. The remainder of the proximal ulna is intact. The proximal radius and distal humerus are intact. Evaluation of the supporting structures of the elbow is limited as the elbow is held in flexion. The biceps and triceps tendons appear intact. The medial and lateral supporting structures are not well visualized. There is edema within the soft tissues dorsal to the proximal ulna.
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Coronoid process fracture as described above.
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Generate impression based on findings.
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Pre-stem cell transplant evaluation. Patient with history of myelodysplastic syndrome LUNGS AND PLEURA: Scattered subcentimeter nonspecific subcentimeter nodules with apical chronic scarring bilaterally. Mild septal distribution cannot be excluded and associated mild bronchial wall thickening is also observed. Though not specific, in the appropriate clinical setting a superimposed process, such as sarcoidosis can present in this pattern. The chest plain appears similar from Oct. 2014. Distribution changes essentially only involve the upper lobes. Lower lungs are clear. No effusionsMEDIASTINUM AND HILA: No lymphadenopathyQuestionable small pericardial effusion with minimal underlying coronary calcifications largely left descending coronary.Small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Multiple hepatic cysts similar to the prior exam. Cholecystectomy clips. No suspicious additional focal lesions in this limited view of the upper abdomen
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Mild chronic appearing change in the upper lungs without evidence of superimposed acute disease. See detail provided.
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Generate impression based on findings.
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64-year-old female with history of diplopia. Evaluate for intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No mass, midline shift or uncal herniation. Gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent mild chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Scattered nonspecific lucencies in the calvarium.
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No evidence of intracranial hemorrhage or mass effect. If there is continued suspicion for structural abnormality, consider MRI for further evaluation.
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Generate impression based on findings.
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Female; 30 years old. Reason: 30yo F with HIV and AIDS presenting with odynophagia, upper abd, and back pain worsened by swallowing. History: abd pain, odynophagia, back pain CHEST:LUNGS AND PLEURA: Interval resolution of scattered ground glass nodular opacities in both lungs, most likely post infectious or inflammatory etiology. No abnormal pulmonary opacities or pleural effusions.MEDIASTINUM AND HILA: Borderline heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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.Status post lap band. Residual barium opacifies the colon and causes streak artifact, which mildly limits examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No acute abnormality or findings to explain the patient's symptoms. Interval resolution of bilateral groundglass nodular opacities, most likely post infectious or inflammatory in etiology.
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Generate impression based on findings.
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Dyspnea, persistent shortness of breath, IBD on immunosuppression. Further characterize changes on CXR. LUNGS AND PLEURA: Mild centrilobular and paraseptal emphysema. Interval worsening of multifocal segmental/subsegmental scarring and atelectasis. No pleural fluid or pneumothorax. Motion artifact at the lung bases limits assessment of these areas. Mild localized cylindrical bronchiectasis in the right middle lobe and lingula. Assessment of the collapsed airways is limited by motion artifact however on the high resolution sequence (series 4, image 144) focal circumferential wall thickening can be identified within a branch of the apical posterior segment. Small mucous plug subsegmental right upper lobe airway (4/133).MEDIASTINUM AND HILA: Calcification with a lymph node at the left hilum may be secondary to healed granulomatous process. Severe coronary artery and aortic valve calcifications. Calcified mitral annulus. Normal heart size.The distal trachea is focally narrowed at the level of the aortic arch in the transverse dimension measuring 12-mm (5/32), unchanged. Visualized portion of the cervical trachea is patent.CHEST WALL: T12 compression fracture post vertebroplasty.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcification aorta and its branches.
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Small airways abnormalities likely related to IBD include very mild bronchiectasis, probable segmental/subsegmental airway narrowing and stenosis resulting in atelectasis and scarring and minimal mucous plugging. Stable mild focal tracheal narrowing. Moderate to severe centrilobular and paraseptal emphysema. No signs of organizing or infectious pneumonia.
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Generate impression based on findings.
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Postcontrast images demonstrate enhancing tissue along the site of laminectomy/left facetectomy at L4-L5. Additional enhancing tissue extends along the left lateral epidural space at this level without mass effect upon the sac. Although evaluation remains limited secondary to susceptibility artifact, there appears to be predominantly enhancing tissue within the left L4-5 foramen likely representing granulation tissue rather than recurrent disk. The interbody spacer does not extend beyond the margin of the vertebral bodies. There is no abnormal intrathecal enhancement.
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Redemonstration of postoperative changes with probable granulation tissue along the left L4-L5 foramen, although evaluation remains limited secondary to susceptibility artifact.
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Generate impression based on findings.
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18 year-old male with pain and swelling after injury, evaluate for fifth finger fracture There is a transverse fracture of the mid diaphysis of the fifth metacarpal with approximately 30-40 degrees volar angulation of the distal fracture fragment.
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5th metacarpal fracture as described above. Findings discussed with Dr. Martin by phone at the time of dictation.
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Generate impression based on findings.
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Female; 68 years old. Reason: 68 y/o woman with metastatic breast cancer with new SOB. Evaluate for PE. History: SOB PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. Evidence of right heart strain.LUNGS AND PLEURA: Large left pleural effusion with underlying mild compressive atelectasis, either recurrent or persistent since 10/14/13. Numerous pulmonary metastases seen on prior study on 10/14/13 have largely resolved with few scattered subcentimeter pulmonary nodules remaining.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy. Numerous sclerotic foci in the visualized bones, the majority of which are punctate, have increased in size and number since prior study on 10/14/13, consistent with treated metastases. No discretely measurable right breast mass; correlate with prior dedicated breast imaging.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Stable prominence of the common bile duct.
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1. No acute pulmonary embolus.2. Large left pleural effusion.3. Significant interval decrease in pulmonary metastases with few scattered subcentimeter pulmonary nodules remaining.4. Increased increased sclerotic foci in the visualized bones, which are predominantly punctate and consistent with treated metastases.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Not moving arm much.VIEWS: Left clavicle AP/axial (two views), left humerus AP/lateral (two views) 01/21/15 A transverse fracture of the proximal humeral metadiaphysis has posterior angulation. Soft tissue swelling surrounds the fractures.
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Fracture of the proximal humerus.
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Generate impression based on findings.
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Female, 34 years old.Multiple surgical teams involved in retroperitoneal operation, evaluate for RFO. Right upper quadrant surgical clips are seen. IUD is in expected location. Pelvic catheter, likely a temperature probe, is also noted. No unexpected radiopaque foreign objects.
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No unexpected radiopaque foreign objects, with other findings as above. Dr. Eggener notified of findings 1/21/2015; 4pm
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Generate impression based on findings.
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93 year old female with severe aortic valve stenosis who is being considered for TAVR and referred for evaluation of her cardiovascular anatomy to help plan the procedure. The patient has significant renal disease, after discussion regarding the risk/ benefit profile with the referring physician and with the patient, the decision was made to proceed with this contrast-enhanced study.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm is noted. The descending thoracic aorta is mildly dilated. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is mild calcification of the aortic root. There is severe calcification of the aortic arch. There is mild to moderate calcification/ atherosclerosis of the descending aorta. No aortic coarctation is noted. There is no significant atherosclerosis the proximal brachiocephalic vessels. Aortic Annulus: Dimension: 20 mm x 24 mm Perimeter: 6.9 cm Area: 3.6 cm2Sinus of Valsalva: Width: 28 mm x 28 mm x 27 mm Height: 17 mmSinotubular Junction: 25 mm x 26 mmAscending Aorta (4cm from annulus): 28 x 29 mmMid Aortic Arch: 24 x 23 mmDescending Aorta: 27 x 25 mmAnnulus to LM Height: 13 mmAnnulus to RCA Height: 15 mmAortic Leaflet Length: 14 mmFluoroscopic Angle: LAO18 CRA9Aortic Valve: The aortic valve is trileaflet. There is severe aortic valve calcification, which involves all of the cusps. Mitral Valve: No mitral annular calcification is noted. There is mild calcification of the anterior leaflet extending from the aortic valve calcium.Left Ventricle: The left ventricular end-diastolic volume is normal. The ventricle has mild circumferential hypertrophy. There is evidence of a resting apical subendocardial perfusion defect. There is no thrombus noted in the left ventricle. There is a prominent sigmoid septum noted. Right Ventricle: Visually the right ventricular end-diastolic volume is within normal limits.Left Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. The interatrial septum bows to the right, consistent with increased left atrial pressure. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is mildly dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Moderately dilated (35mm).Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is mild calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obuse marginal branches and a small AV circumflex branch. There is no calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Coronary Bypass Grafts:None present.
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1. Severe aortic valve calcification 2. Thoracic aortic anatomy as above; of note, the leaflet length is slightly greater than the left main height. 3. Mild left ventricular hypertrophy with prominent sigmoid septum and evidence of a resting apical perfusion defect. 4. Severe left atrial dilation. 5. Moderate dilation of the main pulmonary artery. 6. Mild coronary calcification. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvis CTA is reported separately.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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Not moving arm much.VIEWS: Left forearm AP/lateral (two views) 01/21/15 The bones are normal in appearance. No fracture is present.
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Normal examination.
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Generate impression based on findings.
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Postoperative changes are again seen from left frontal craniotomy for resection of a previous large left frontal lobe mass. There has been interval decrease in size of the fluid filled resection cavity which continues to demonstrate FLAIR hyperintensity, with decreased amount of layering irregular heterogeneous signal. There is also been interval decrease in thickness of the overlying extra-axial collection, which now only measures 3 mm with a rind of enhancing tissue. There is marginal susceptibility along the dependent aspect of the cavity as well as along the residual anterior left frontal lobe parenchyma, consistent with chronic hemosiderin deposition likely from the prior surgery.Following contrast, there is smooth dural enhancement in the left frontal region with mild thickening, likely postoperative in etiology. There is minimal ill-defined irregular enhancement along the surgical margin of the left frontal lobe although this has decreased in thickness and conspicuity over the course of the last two outside exams.FLAIR hyperintensity which remains in the frontal lobe white matter, left than right side, is similar in distribution but decrease in confluence. There is also decreased decreased delineation of the posterior margin on the left side at the level of the mid body of the lateral ventricle. The abnormal signal does cross the genu of the corpus callosum which appears somewhat thickened in the sagittal plane. There has been slight interval increased thickness of FLAIR hyperintensity along the lateral aspect of the anterior body of the right lateral ventricle. There is decreased mass effect upon the left lateral ventricle.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are other minimally scattered punctate foci of T2/FLAIR hyperintensity within the periventricular and subcortical white matter which are nonspecific. There is no significant 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.Perfusion imaging cannot be postprocessed at this time due to a technical error. If upon investigation this can be remedied, an addendum will be issued.
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1. Expected evolution of postoperative changes from bifrontal craniotomy for resection of a large left frontal lobe mass. No definite evidence of tumor recurrence at this time. Please note that perfusion imaging could not be processed due to technical errors.2. Decreased confluence of the left moderate and right frontal FLAIR hyperintensity which crosses the genu of the corpus callosum with decreased mass effect upon the left lateral ventricle which likely represents a combination of nonenhancing tumor, vasogenic edema, and posttreatment effects.3. Slight increased thickness of abnormal signal along the lateral aspect of the anterior body of the right lateral ventricle. Continued attention to this area is recommended on follow-up exams, to about the possible extension of tumor.
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Generate impression based on findings.
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28-year-old female with history of urinary tract infections. Evaluate kidneys and bladder. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis, no hydroureter and no calculi. No structural abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: IUD in the expected location.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No hydronephrosis or other structural renal abnormality.
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Generate impression based on findings.
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There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size for age. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute infarct. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild bilateral maxillary mucosal thickening and small right maxillary retention cyst.
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No intracranial mass or mass effect. MRI of the brain appears within normal limits for age.
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Generate impression based on findings.
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17 year-old female with Crohn's disease, evaluate extentEXAMINATION: MR enterography without and with IV contrast 01/21/15 ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hypointense lesion in the inferior pole the left kidney is unchanged, perhaps reflecting a proteinaceous cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval improvement of the terminal ileal wall thickening and mucosal hyperenhancement is noted, with only mild residual wall thickening evident in the distal terminal ileum, just proximal to the cecum. The small bowel demonstrates appropriate peristalsis to the level of the distal terminal ileum, where there is mild prestenotic dilatation and hyperperistalsis, just proximal to the the area of mild wall thickening, with associated mild fixed luminal narrowing. There is mild nonspecific dilatation of the right colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right ovarian cyst and fluid within the endometrial cavity, presumably physiologic in etiology.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval improvement of the terminal ileal wall thickening and mucosal hyperenhancement is noted, with only mild residual wall thickening evident in the distal terminal ileum, just proximal to the cecum. The small bowel demonstrates appropriate peristalsis to the level of the distal terminal ileum, where there is mild prestenotic dilatation and hyperperistalsis, just proximal to the the area of mild wall thickening, with associated mild fixed luminal narrowing. There is mild nonspecific dilatation of the right colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Mild fixed luminal narrowing of the distal terminal ileum consistent with chronic sequelae of Crohn's disease, without additional areas of active inflammation identified.
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Generate impression based on findings.
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Right shoulder pain. Evaluate for fracture. I see no fracture or malalignment. I see no specific findings to account for the patient's shoulder pain.
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No fracture or other findings to account for the patient's shoulder pain.
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Generate impression based on findings.
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Right groin pain, evaluate for osteoarthritis Two views of the right hip show tiny osteophytes indicating mild osteoarthritis. There is no fracture. Arterial calcifications are noted.
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Mild osteoarthritis.
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Generate impression based on findings.
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Cough for 4 months, weight loss of 30 pounds. LUNGS AND PLEURA: No pleural fluid or pneumothorax. Mild centrilobular emphysema. Upper lobe predominant subpleural reticulation and honeycombing consistent with mild pulmonary fibrosis, most pronounced in the lingula.13-mm right lower lobe nodule is of mixed density, predominantly groundglass though it does it contain punctate internal solid foci. Scattered peripheral 3-5 mm groundglass to sub-solid density pulmonary nodules.MEDIASTINUM AND HILA: Upper normal heart size. No pericardial fluid. Severe coronary artery calcification. Main pulmonary artery is enlarged measuring 33-mm in transverse dimension, consistent with pulmonary hypertension.Mild diffuse lymph node enlargement in the mediastinum and hila bilaterally. For reference a lower right paratracheal lymph node measures 12-mm in short axis (3/31). Multiple small to mildly enlarged lymph nodes were present previously and these lymph nodes appear slightly larger.No anterior mediastinal mass.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. No mediastinal mass.2. 13-mm indeterminant pulmonary nodule; a minimally invasive or invasive adenocarcinoma cannot be excluded. Three-month CT follow-up recommended. If the solid component increases at that time, then PET/CT may be warranted.3. Mild pulmonary fibrosis, new from 2002, atypical in distribution for UIP though the pattern of subpleural reticulation and honeycombing is suggestive of the diagnosis. Consider ILD related to collagen vascular disease or less likely appropriate clinical context chronic hypersensitivity pneumonitis. The latter could be confirmed within the expiration sequence if required.4. Mild mediastinal and hilar lymphadenopathy nonspecific but may be related to underlying ILD.5. Scattered subcentimeter pulmonary nodules nonspecific but based on distribution are mildly suspicious for follicular bronchiolitis related to underlying ILD.
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Generate impression based on findings.
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There is diffuse increased gyral diffusion restriction within the cerebrum and cerebellar grey matter, as well as bilaterally within the caudate, putamen and thalamus suggestive of global hypoxic ischemic injury. Associated increased T2/FLAIR signal is noted in the same distribution. The brainstem is intact without evidence of diffusion restriction or abnormal signal.The ventricles are small, likely from diffuse edema. The basal cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. There is moderate mucosal thickening of the left frontal, bilateral ethmoids and sphenoid sinuses. There is mild mucosal thickening of the bilateral maxillary sinuses. A small amount of fluid is seen within the mastoid air cells bilaterally. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. An orogastric tube is partially visualized. A disconjugate gaze is noted.
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1.Findings suggestive of global hypoxic ischemic injury with decreased ventricular size likely relating to cerebral edema.2.Moderate mucosal thickening of the paranasal sinuses. Small amount of fluid in the mastoid air cells bilaterally. Please correlate clinically.
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Generate impression based on findings.
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Female 31 years old Reason: r/o acute appy History: RLQ abdominal pain, iv contrast dye allergy The exam is not sensitive for detecting lesions in the solid organs of vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Profound, diffuse fatty liver. No intrahepatic or extrahepatic biliary dilatation or definite focal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate focus of nephrolithiasis in the left lower pole, and another small focus in the right upper pole unchanged. No hydronephrosis or hydroureter. No calcifications along the course of the ureters. No perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: 4 x 5.1 cm left adnexal near fluid density collection. Likely ovarian cyst. May be functional. This is not seen on prior exams. Correlate clinically.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Appendix is not visualized. Possible sutures in the area correlate for surgical history. No evidence of fat stranding, bowel wall thickening or dilatation. No free or loculated intraperitoneal fluid.Few foci of diverticulosis with no evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Left adnexal cyst (5.1cm largest dimension). Correlate clinically as to the need for further evaluation with pelvic ultrasound.Diffuse fatty liver.No evidence of bowel abnormality to explain right lower quadrant pain. No evidence of appendicitis. Possible sutures suggesting prior appendectomy correlate with surgical history.
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Generate impression based on findings.
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Male 46 years old; Reason: r/o diverticulitis History: no h/o diverticulosis and LLQ pain. ABDOMEN:LUNG BASES: Focal small right lower lobe opacity unchanged from prior exam correlate for infection.Left lower lobe bronchiectasis, unchangedLIVER, BILIARY TRACT: Soft tissue density material layering in the gallbladder likely represents cholelithiasis, unchanged. No biliary dilatation. No focal liver lesions.SPLEEN: 1.9 x 1.3 cm hypodense non-fluid lesion in the spleen series 2 image 30, not significantly changed. Likely benign hemangioma or other benign lesion given lack of other findings are history.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously seen focal dilatation of lower pole calix right kidney versus cyst, is unchanged. Cortical loss and scarring adjacent to aforementioned is unchanged. Few scattered small lesions are seen elsewhere to characterize likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall. Previously seen fluid and gas are resolved.Mild fat stranding in the subcutaneous fat low is size, unchanged.OTHER: No significant abnormality noted
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Right and left lower lobe lung findings as above, unchanged.No evidence of acute process to explain lower abdominal pain.Numerous other findings as above chronic in nature.
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Generate impression based on findings.
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85 years old, Male, Reason: pt w/ feculent emesis and abd distention. c/f obstruction and need to visualize source Respiratory motion limits fine detail.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Adjacent to the duodenal diverticulum there is a focally dilated pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypoechoic foci in the kidneys bilaterally which are too small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Multiple fluid-filled loops of small bowel measuring up to 2.7 cm in diameter. Mild small bowel distention without evidence of transition point likely represents ileus. No discrete lesion is seen at the ileocecal valve. No evidence of bowel wall thickening, pneumatosis, or free air. No hypo-or hyper enhancing bowel wall to suggest ischemia. No loculated fluid collection. Small hiatal hernia is present. There is a small soft tissue nodule in the first portion of the duodenum (series 8022, image 71) which may represent a submucosal mass. If clinically warranted further evaluation with endoscopy could be considered.There is a duodenal diverticulum.BONES, SOFT TISSUES: Surgical hardware is seen involving L3 through S1. Degenerative changes are seen in the lumbar spine.OTHER: No significant abnormality notedPELVIS: Streak artifact from surgical hardware limits fine detail.PROSTATE, SEMINAL VESICLES: Surgical clips are noted in the area of the seminal vesicles and prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Multiple fluid-filled loops of small bowel measuring up to 2.7 cm in diameter. Mild small bowel distention without evidence of transition point likely represents ileus. No discrete lesion is seen at the ileocecal valve. No evidence of bowel wall thickening, pneumatosis, or free air. No hypo-or hyper enhancing bowel wall to suggest ischemia. No loculated fluid collection. Small hiatal hernia is present. There is a small soft tissue nodule in the first portion of the duodenum (series 8022, image 71) which may represent a submucosal mass. If clinically warranted further evaluation with endoscopy could be considered.There is a duodenal diverticulum.BONES, SOFT TISSUES: Surgical hardware is seen involving L3 through S1. Degenerative changes are seen in the lumbar spine.OTHER: No significant abnormality noted
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1.Diffuse mild small bowel dilatation without evidence of transition point likely representing an ileus.2.Small soft tissue nodule in the first portion of the duodenum may represent a a submucosal mass. If clinically warranted further evaluation with endoscopy may be helpful for further evaluation.3.Focal dilatation of the pancreatic duct adjacent to a duodenal diverticulum.
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Generate impression based on findings.
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14-year-old male with right foot/ankle pain after being run over by CTA busVIEWS: Right tibia-fibula AP/lateral, right foot AP/oblique/lateral, right ankle AP/oblique/lateral (8 views) 01/21/15 Soft tissue swelling is identified about the ankle. There is mild cortical irregularity along the medial aspect of the right distal tibial metaphysis. No definite fracture line is seen. Also seen is a well corticated bone fragment along the dorsal aspect of the midfoot on the lateral view without significant soft tissue swelling.
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1.Soft tissue swelling about the ankle without evidence of acute fracture.2.Mild cortical flaring/irregularity of the distal tibial metaphysis likely represents a prominent physis.3.Dorsal aspect of the midfoot bone fragment without significant soft tissue swelling is equivocal for fracture. Follow-up may be considered if clinically warranted.
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Generate impression based on findings.
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63-year-old male with pain, no trauma, metastatic prostate cancer. Evaluate for fracture. Left hip:Two views of the left are provided. No acute fracture or dislocation is evident. Diffuse mottled appearance of the bones compatible with diffuse osseous metastases. Moderate osteoarthritis affects the left hip.Lumbar spine:Four views of the lumbar are provided. Alignment is anatomic. Minimal vertebral body height loss at L4 and L5. Mild degenerate disk disease affects L4-5 and L5-S1. No acute fracture or malalignment is evident. Mottled appearance of the lower lumbar spine and pelvis compatible with diffuse osseous metastases.
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No acute fracture or malalignment of the left hip or lumbar spine. Findings compatible with diffuse osseous metastases.
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Generate impression based on findings.
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1-day-old female with RDS, increasing O2 requirement.VIEW: Abdomen and chest AP (two view) 1/21/2015, 10:49 Streaky bibasilar and right upper lobe opacities are evident, consistent with subsegmental atelectasis. No pleural effusion or pneumothorax is seen. The lung volumes are small. The aortic arch, cardiac apex and stomach are left sided. The cardiothymic silhouette is normal.The bowel gas pattern is disorganized and nonobstructive. No pneumoperitoneum, pneumatosis intestinalis or portal venous gas is seen.
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Multifocal subsegmental atelectasis and low lung volumes.
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Generate impression based on findings.
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Female 37 years old Reason: perirectal abscess s/p I\T\D r/o worsening Dz History: increased pain and drainage. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential wall thickening (about 4 mm thick wall) involving distal transverse colon and proximal descending colon for about 10 cm in length, with some adjacent mesenteric adenopathy, but no significant fat stranding or fluid. The remainder of the colon is normal. Scattered nodes in the mesenteric root. The stomach and jejunum are normal unopacified with oral contrast.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mature fluid collections consistent with Crohn's disease and possible infected fluid collections. There are two measurable lesions.The lesion on the left is in the lower aspect of the ischio rectal fossa, abutting the anorectal junction, measured on series 3 image 108, 2.2 x 1.6 cm. Minuscule amount of fluid was there previously.The right-sided collection is in the perirectal fat at the 11 o'clock position abutting cervicovaginal area, measured on series 2 image 120, 1.6 x 0.7 cm. There is no fluid there previously but a small ringlike structure was present in that location suggesting that this area was abnormal previously.Percutaneous catheter remains in place in the right perianal region. Fat stranding to the perianal skin. Fistulous communications cannot be excluded.Intraperitoneal bowel in the pelvis demonstrates no significant wall thickening and there are no loculated fluid collections. There are likely nonobstructive adhesions causing some distortion of bowel. There is an ileocolic anastomosis.BONES, SOFT TISSUES: Distortion of the left anterior abdominal wall fat presumably from prior surgery or catheter placement. Specifically there is some bulging fat in the anterior abdominal wall along the left rectus muscle, series 2 image 73, where there is a small ventral hernia with soft tissue tracking to the skin which may represent a prior catheter or fistula site. Correlate clinically. This was not seen previously on the 2011 CT.OTHER: No significant abnormality noted
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Two discrete mature perirectal/perianal fluid collections as detailed above. Fat stranding to the perianal skin.Changes left intra-abdominal wall may be related to prior surgery or cancer there is correlate for fistulous communications.Postsurgical changes consistent with ileocolic anastomosis.
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Generate impression based on findings.
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Fall one month ago, altered mental status, evaluate for delayed hemorrhage 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 mild global parenchymal volume loss. No hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but likely 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.
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Generate impression based on findings.
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64-year-old female with right wrist pain and inflammation. Evaluate for wrist fracture. Three views of the right wrist are provided. Mild soft tissue swelling about the wrist. No acute fracture or malalignment. Degenerative changes affect the radiocarpal and distal radioulnar joint. Ossific density adjacent to the ulnar styloid likely is related to prior trauma.
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Soft tissue swelling with no acute fracture or malalignment. Additional chronic findings as above.
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Generate impression based on findings.
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17-year-old male with right upper quadrant abdominal pain, fever ABDOMEN:LUNG BASES: No pleural effusion. Bibasilar dependent groundglass opacities bilaterally likely represents atelectasis.LIVER, BILIARY TRACT: No hepatic lesions. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is incomplete rotation of the kidneys bilaterally with the pelvis facing anteriorly.RETROPERITONEUM, LYMPH NODES: Enlarged left para-aortic lymph node measuring 11 mm (series 4, image 63).BOWEL, MESENTERY: There is marked thickening of the cecal wall. In the right upper quadrant there is a 4.1 x 2.5 cm walled off fluid collection adjacent base of the cecum. Prominent mesenteric lymph nodes are present, likely reactive. There is no evidence of obstruction. The proximal portion of the appendix is only visualized.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: Small amount of free fluid is noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is marked thickening of the cecal wall. In the right lower quadrant a 4.1 x 2.5 cm walled off fluid collection is adjacent to base of the cecum. Prominent mesenteric lymph nodes are present, likely reactive. No dilated bowel loops are present. The proximal portion of the appendix is only visualized.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: Small amount of free fluid in the pelvis.
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Marked cecal wall thickening with adjacent encapsulated fluid collection. The proximal appendix is only visualized. These findings likely represent complicated appendicitis. Other considerations may include colitis complicated by abscess or typhlitis in the correct clinical context. Small amount of free fluid and reactive mesenteric lymph nodes are present.
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Generate impression based on findings.
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53-year-old male with severe PVD, down to have right lower extremity calf wound, concern for osteomyelitis. Soft tissue defect along the lateral aspect of the mid to distal fibular diaphysis compatible with history of ulceration. Small amount of underlying cortical irregularity may represent acute osteomyelitis.
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Soft tissue ulceration with questionable underlying cortical irregularity, which may represent acute osteomyelitis. These findings could be further evaluated with MRI if clinically indicated.
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Generate impression based on findings.
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Eight year old female with cough, fever and recent pneumonia status post course of antibiotics. Evaluate for pneumonia.VIEWS: Chest AP/lateral (two views) 1/22/2015 The lung volumes are large and there is peribronchial wall thickening. Streaky left basilar opacity most consistent with atelectasis. The aortic arch, cardiac apex and stomach are left-sided. The cardiothymic silhouette is normal.
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Bronchiolitis/reactive airways disease pattern without evidence of superimposed pneumonia.
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Generate impression based on findings.
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Altered mental status. There is a hyperdense mass along the left parietal convexity at the midline measuring 19 x 35 x 21 mm and better seen on prior postcontrast CT and MRI. There is mild local mass effect which appears similar to prior. No intracranial hemorrhage is identified. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Minimal fluid in the mastoid air cells. Calvarium is intact.
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1. No evidence of intracranial hemorrhage or new mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Left parietal extra-axial mass likely representing a meningioma is grossly stable and better assessed on prior postcontrast CT and MRI.
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Generate impression based on findings.
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72 years, Male. Reason: assess OG placement History: as above OG tube side port is at the level of GE junction. Recommend advancement by 12 cm. Incompletely visualized distended loops of colon with paucity of gas beyond the splenic flexure. This may represent colonic ileus, correlate with patient history and symptoms. Follow-up is suggested.Cardiac wires partially visualized. Please see same day chest radiography report for additional findings.
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1.OG tube side port is at the level of GE junction. Recommend advancement by 12 cm. 2.Incompletely visualized distended loops of colon with paucity of gas beyond the splenic flexure. This may represent colonic ileus. Correlate with patient history and symptoms. Follow-up is suggested to exclude underlying obstruction.Findings discussed with Dr. Steiman on 1/22/2015 at 9:04 AM.
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Generate impression based on findings.
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43-year-old female with ulcer medial aspect of left lower leg down to the bone. Evaluate for osteomyelitis, necrotizing fasciitis. Two views of the left tibia/fibula are provided. Moderate soft tissue defect is again seen along the soft tissues overlying the medial aspect of the distal tibial metaphysis. Associated periosteal reaction along the medial aspect of the distal tibial metaphysis is compatible with acute osteomyelitis and has slightly increased compared to prior. Chronic deformity and punctate metallic foci are again noted involving the distal lower leg. Serpentine sclerosis involving the distal femoral metaphysis compatible with bone infarct.
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Distal medial soft tissue ulceration with findings suggestive of acute osteomyelitis, increased compared to prior, in a background of chronic deformity.
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Generate impression based on findings.
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82 year old female with abdominal pain. Evaluate for diverticulitis versus small bowel obstruction. ABDOMEN: Lack of intravenous contrast enhancement limits evaluation of solid organs.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas, not significantly changed.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypoattenuating lesions compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant interval change in retroperitoneal lymphadenopathy. Reference left para-aortic lymph node measures 1.2 x 0.9 cm (series 3, image 42), previously measuring 1.2 x 0.9 cm when remeasured on series 3, image 50. Mild atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: Small hiatal hernia is unchanged. Colonic diverticulosis with mild fascial thickening along the descending colon suspicious for early diverticulitis. Left inguinal hernia containing loop of small bowel measuring up to 2.8 cm in diameter; given that there is fluid within the hernia sac, incarcerated/strangulated hernia cannot be excluded. No proximally dilated loops of small bowel to suggest small bowel obstruction.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above. Nonspecific small amount of free pelvic fluid again noted.BONES, SOFT TISSUES: There is pelvic laxity.OTHER: No significant abnormality noted
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1.Early descending colonic diverticulitis. 2.Bowel-containing left inguinal hernia with fluid in the hernia sac. Incarcerated/strangulated hernia cannot be excluded and clinical correlation is advised. 3.No findings to suggest small bowel obstruction as clinically questioned. 4.Nonspecific small volume free pelvic fluid.5.Cholelithiasis.
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Generate impression based on findings.
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33-year-old male with history of end-stage renal disease and renal transplant. Also with open wound. Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.ABDOMEN:LUNG BASES: Mild patchy bilateral lower lung ground glass opacities, nonspecific. No pericardial effusion or pleural effusion. Mild coronary artery calcifications.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right kidney with cortical calcifications again seen, unchanged. No native left kidney visualized.Transplant kidney in the right iliac fossa is again noted, with resolution of previously seen collecting system gas. Interval near complete resolution of previously seen hematoma.RETROPERITONEUM, LYMPH NODES: Lack of contrast limits evaluation of the retroperitoneum. Multiple surgical clips and vascular calcifications are seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osseous sclerosis, consistent with renal osteodystrophy. Extensive anterior abdominal wall collaterals, better visualized on the prior exam with IV contrast.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Interval removal of Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Findings of renal osteodystrophy, similar to prior. Previously described anterior abdominal wound is no longer well visualized. Left pelvis atrophic, failed transplant kidney is again seen.OTHER: Left lower extremity graft material is partially visualized.
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1. Interval near complete resolution of the previously described right lower quadrant hematoma. Additionally, the previously described right lower quadrant wound is not well visualized.2. Bibasilar ground glass opacities, likely related to infection/aspiration.
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Generate impression based on findings.
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Female; 84 years old. Reason: eval for pe History: sob, active ca PULMONARY ARTERIES: No evidence of pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Mild central bronchial wall thickening and diffuse interlobular septal thickening, most suggestive of pulmonary edema. Moderate streaky bibasilar subsegmental atelectasis and/or scarring. No suspicious pulmonary nodules. Trace right pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild cardiomegaly without pericardial effusion. Mild calcifications of the coronary arteries. Normal variant aberrant right subclavian artery.CHEST WALL: Numerous lytic lesions effect the visualized bones, compatible with the patient's known history of multiple myeloma. Multiple compression deformities of the spine are similar to prior MRI spine from 11/20/14.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No acute pulmonary embolus.2. Findings suggestive of mild CHF with cardiomegaly, pulmonary edema, and right pleural effusion.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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15-year-old male with hypoxia after seizure.VIEW: Chest AP (one view) 1/22/2015 The left chest wall neurostimulator position is unchanged. A new left retrocardiac opacity is present, likely reflecting atelectasis, perhaps related to aspiration, although superimposed infection is not excluded. The cardiothymic silhouette is normal.
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New retrocardiac opacity likely reflecting atelectasis, perhaps related to aspiration, although superimposed infection not excluded.
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Generate impression based on findings.
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21 years, Male. Reason: abdominal pain, evaluate for obstruction History: LLQ pain Nonobstructive bowel gas pattern.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Respiratory problems after birth, evaluate endotracheal tube placement.VIEW: Chest AP (one view) 1/22/2015, 06:13 The endotracheal tube has been retracted with the tip now terminating below the thoracic inlet and above the carina. Interval placement of an enteric feeding tube is noted, with the tip terminating out of the field of view inferiorly. Right upper extremity PICC terminates in the right brachiocephalic vein.Improved focal right upper lobe opacity consistent with improved atelectasis. Diffuse hazy pulmonary opacity without significant change when accounting for differences in technique. No pneumothorax or pleural effusion is evident. The cardiothymic silhouette is normal.
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Endotracheal tube in appropriate position with resolution of the right upper lobe atelectasis. Persistent diffuse hazy opacity.
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Generate impression based on findings.
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55 years, Male. Reason: DHT placement Limited view of the abdomen due to motion artifact. Pelvis is excluded from the field-of-view. Dobbhoff tube tip overlies the gastric fundus. Incompletely imaged prominent gas containing small and large bowel, without significant change from prior study.
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1.Dobbhoff tube tip overlies the gastric fundus.2.Incompletely imaged prominent gas containing small and large bowel, without significant change from prior study.
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Generate impression based on findings.
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90 year-old female with bone pain, rule out lytic lesion Thoracic spine There is an age indeterminate compression fracture of the T7 vertebral body which is new from the prior exam dated 1/1/13. Moderate multilevel degenerative disk disease.Lumbar spine: Vertebral body heights are maintained. There is severe degenerative disk disease worst at L5-S1, progressed from the prior exam, as well as moderate facet joint hypertrophy.
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New age indeterminate T7 vertebral body compression fracture and degenerative arthritic changes as described above.
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Generate impression based on findings.
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56 show female with foot pain Moderate osteoarthritis affects the first MTP joint. There is flattening along the medial surface of the distal first metatarsal. No fracture is visualized.
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Osteoarthritis and additional findings as described above.
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Generate impression based on findings.
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59-year-old female status post left TKA Hardware components of a left total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Foci of gas, staples and drain in the soft tissues reflect recent surgery.
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TKA in near anatomic alignment.
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Generate impression based on findings.
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59-year-old female with back pain Mild to moderate degenerative disk disease affects L5/1. There is mild anterolisthesis of L5 on S1. Small anterior vertebral body osteophytes are noted along the lumbar spine. Mild to moderate facet joint hypertrophy affects the lower lumbar spine.
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Grade 1 anterolisthesis of L5 on S1 and degenerative arthritic changes as described above.
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Generate impression based on findings.
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Fall, head laceration, alcohol intoxication Small left parietal subgaleal hematoma. 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 mild global parenchymal volume loss including the cerebellum. No hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes.Mild opacification of the left ethmoid air cells. Mastoid air cells are clear. Calvarium is intact.
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1. No evidence of intracranial hemorrhage or mass effect. 2. Small left parietal subgaleal hematoma with intact calvarium.
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Generate impression based on findings.
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85 years, Male. Reason: Abdominal fullness, emesis. Evaluate for obstruction. Evaluation is somewhat limited by motion artifact. Nonobstructive bowel gas pattern. Surgical clips scattered throughout the pelvis. Spinal degenerative changes and scoliosis are noted, with orthopedic fixation hardware in the lower lumbar spine and presumed laminectomies seen.
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Nonobstructive bowel gas pattern. Please see report from subsequent CT exam for further details.
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Generate impression based on findings.
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Headache, vomiting, evaluate for subarachnoid hemorrhage No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific and present on prior MRI.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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No evidence of intracranial hemorrhage or mass effect. If there is continued suspicion for intracranial mass, consider MR for further evaluation.
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Generate impression based on findings.
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70 year old female with history of neutropenia and abdominal pain. Assess for infection/bowel wall thickening. ABDOMEN:Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholecystectomy clips. No additional significant abnormality.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. No bowel wall thickening. The appendix is within normal limits.BONES, SOFT TISSUES: Degenerative changes affect the spine, with vertebroplasty cement within an old compression fracture of L2 extending into the adjacent paraspinal musculature. Mild/grade 1 retrolisthesis of L5 on S1.OTHER: 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: Small amount of gas in the anterior subcutaneous fat of the superior pelvis, likely from recent injection.OTHER: No significant abnormality noted
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No small bowel obstruction or bowel wall thickening, given the limitations of this exam. No significant ascites, or other findings to explain the patient's abdominal pain.
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Generate impression based on findings.
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35-year-old male with history of Crohn's disease. Evaluate for bowel perforation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered hypoattenuating lesions throughout both kidneys with some of which are compatible with simple cysts and some which are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse colonic wall thickening is again noted consistent with colitis, acute on chronic. There are regions of fibrostenotic disease, for example (series 3, image 44), consistent with patient's known Crohn's disease.There is increased dilatation of the colon at the anastomotic site with the cecum which measures up to 6 cm in diameter and with increased fecalization. There is associated pericecal fluid. No evidence of small bowel obstruction. No pneumatosis intestinalis, pneumoperitoneum, or portal venous gas. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Findings consistent with acute on chronic colitis, which may be infectious or inflammatory in etiology. Given the presence of pericecal fluid, ischemic etiology cannot be excluded.2.Other chronic colonic findings of Crohn's disease as above.
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Generate impression based on findings.
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26 years, Female. Reason: Abdominal pain. Nonobstructive bowel gas pattern. Moderate to large stool burden. There is an incompletely imaged nonspecific radiodensity in the left lung base.
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1.Nonobstructive bowel gas pattern. 2.Incompletely imaged left lung base radiodensity, presumably representing overlying structures. If there is clinical concern, further evaluation with dedicated chest radiography is recommended.
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Generate impression based on findings.
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70 years, Male. Reason: Patient s/p ex-lap with abdominal pain. Evaluate for obstruction. Nonobstructive bowel gas pattern, with residual contrast material identified in the colon. Dobbhoff tube tip in gastric body. Bilateral nephroureteral stents. Abdominopelvic surgical clips and staples.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Female 60 years old; Reason: hx of chronic left upper quadrant abdominal pain, worse this past week with nausea and vomitting history gastric bypass in 2002, hysterectomy, and ventral hernia repair History: same ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuation of the liver, compatible with fatty infiltration. 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: Status post gastric bypass. Oral contrast does not enter the excluded stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic/not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No CT findings to explain patient's history of left upper quadrant pain. Status post gastric bypass.2.Fatty liver.
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Generate impression based on findings.
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Infant born prematurely with acute respiratory distress. Evaluate endotracheal tube placement.VIEW: Chest AP (one view) 1/22/2015, 02:58 The endotracheal tube has been advanced with the tip in the right mainstem bronchus. Right upper extremity PICC terminates in the right brachiocephalic vein.New focal right upper lobe opacity consistent with atelectasis. Diffuse hazy pulmonary opacity without significant change when accounting for differences in technique. No pneumothorax or pleural effusion is evident. The cardiothymic silhouette is normal.
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Right mainstem bronchus intubation, with new right upper lobe atelectasis. Diffuse hazy pulmonary opacity persists.
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Generate impression based on findings.
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Images are slightly limited by patient motion. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality, although with mild motion limitation.
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Generate impression based on findings.
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Female; 47 years old. Reason: eval for retrocardiac opacity c/f for PNA History: see above LUNGS AND PLEURA: Moderate nonspecific left basilar atelectasis/consolidation, not significantly changed since 1/16/15. Minimal right basilar dependent subsegmental atelectasis. No suspicious pulmonary nodules or masses. Trace left pleural effusion.MEDIASTINUM AND HILA: Mild cardiomegaly. Small pericardial effusion grossly stable since 1/16/15. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy, though evaluation is limited without IV contrast.CHEST WALL: Marked bilateral reactive axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Moderate nonspecific left basilar atelectasis/consolidation is not significantly changed since 1/16/15. This may be due to aspiration or pneumonia.2. Small pericardial effusion.3. Marked bilateral reactive axillary lymphadenopathy, with biopsy performed on 11/5/14 demonstrating benign etiology.
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Generate impression based on findings.
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64 year old male s/p OG tube placement. Orogastric tube sidehole in the gastric fundus. Nonobstructive bowel gas pattern.
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Orogastric tube as above.
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Generate impression based on findings.
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Female 58 years old Reason: patient with pancreatic cancer s/p Whipple now with weight loss. Needs restaging History: pancreatic cancer, weight loss. CHEST:LUNGS AND PLEURA: Moderate-sized left pleural effusion and underlying atelectasis. No lung nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty liver with some areas of focal sparing in the left and along the inferior subcapsular portions of the right lobe. No focal liver lesions. Hepatic vasculature enhances normally with no evidence of thrombus. Cholecystectomy. No biliary dilatation.SPLEEN: Spleen is normal. There is some attenuation of the splenic vein near the confluence. Soft tissue in the pancreatic bed abuts and partially encases the splenic artery and vein.PANCREAS: Postsurgical changes consistent with Whipple procedure. There is soft tissue density encasing the celiac artery, trifurcation and superior mesenteric artery as well and the splenic artery and vein. Soft tissue density distorts and partially encases the left renal vein. There findings are probably similar in extent to limited upper abdominal images on the 10/14/14/ chest CT.For baseline purposes soft tissue density thickness between the origin of the supra-mesenteric artery and the dorsal wall of the splenic vein is 1.5-cm as measured on series 2 image 91.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nephrolithiasis left lower pole without hydronephrosis. No focal lesions in either kidney.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes. Atherosclerotic changes there is no evidence of aneurysm. Some distortion is seen at the junction of the left renal vein and inferior vena cava with soft tissue density extending from the pancreatic surgical bed. Postsurgical fibrotic change versus neoplasm.BOWEL, MESENTERY: There is submucosal edema in a collapsed stomach with suture line seen along the greater and lesser curvature. Correlate with surgical history. Correlate for gastritis.Loculated fluid dorsal to the gastric fundus extending to about the anterior margin of the pancreatic body. A mature wall is probably present. For baseline purposes collection is measured on series 2 image 75/210, 3.3 x 2.8 cm. Air seen in this collection on the 10/14 CT is no longer present.There is diffuse colonic wall thickening low density consistent with submucosal edema suggestive of a colitis. In the clinical context correlate infectious colitis.Small amount of generalized ascites from loculation of fluid possibly in the left paracolic gutter and along the left subphrenic space. See coronal image 35. No visible lateral to these fluid collections.Some distortion of small bowel suggestive of adhesions without evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of free fluid in the pelvis, unchanged. Diffuse colonic wall thickening with sparing of the rectum and sigmoid colon. Correlate for infectious colitis. No intramural air or free air.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall. Mild anasarca diffusely. Multifocal presumed injection sites left abdominal wall.OTHER: No significant abnormality noted.
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New finding of a diffuse submucosal edema involving most of the colon consistent with colitis. Correlate for infectious colitis.Submucosal edema stomach for gastritis.Postsurgical changes of the with soft tissue encasing all the adjacent vasculature as detailed above. Soft tissue may represent a combination of neoplasm and postsurgical change.Moderate free, and some loculated fluid collections.Diffuse fatty liver.Left pleural effusion.Nephrolithiasis right kidney.
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Generate impression based on findings.
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51 year old female with known cyst in the right breast presents for annual exam. Family history breast cancer in her paternal aunt. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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74 years, Female. Reason: Dobbhoff tube moved History: Dobbhoff tube Motion artifact significantly limits evaluation. DHT tip suggested in gastric body. Possible IABP marker at approximately L2 level. Please see same day chest radiograph report for additional findings.
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Enteric tube tip as above.
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Generate impression based on findings.
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Increased abdominal girth, fullness and dark brown residuals.VIEW: Abdomen AP (one view) 1/22/2015, 06:21 The enteric feeding tube tip terminates in the body of the stomach. The UAC tip projects out of the field of view superiorly. The UVC tip is in the ductus venosus/hepatic vein.Mild interval increased diffuse gaseous distention of the bowel, with a disorganized, nonobstructive pattern. No portal venous gas, pneumatosis intestinalis or pneumoperitoneum is seen. Incompletely imaged bibasilar hazy opacities.
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Mild gaseous distention in a disorganized, nonobstructive pattern.
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Generate impression based on findings.
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75-year-old female with history of left breast lumpectomy and sentinel lymph node biopsy in July 2013 for IDC, presents for routine follow-up. No current breast complaints. Three standard views of both breasts and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Postsurgical scar with multiple surgical clips is identified at upper outer quadrant in the left breast. Scattered benign calcifications are unchanged in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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64-year-old female with toe pain. Evaluate for fracture, dislocation, patient with history of fifth toe surgery, stubbed yesterday, here with pain. Postsurgical changes of resection of the middle phalanx and distal aspect of the proximal phalanx of the little toe. Moderate soft tissue swelling about the little toe. No underlying acute fracture or malalignment is evident.
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Postsurgical changes and soft tissue swelling without acute fracture or malalignment evident.
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Generate impression based on findings.
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History of acute myeloid leukemia, known sinusitis. Evaluate for interval change. Sinuses: There is unchanged complete opacification of the right maxillary sinus. There is persistent involvement of several adjacent ethmoid air cells, as well as a rudimentary right frontal sinus. There is mild interval increased mucosal thickening in the sphenoid sinuses. Otherwise, there is unchanged mild scattered paranasal sinus mucosal thickening elsewhere, including the left maxillary sinus. The left ostiomeatal unit, bilateral sphenoethmoidal recesses, and left frontoethmoidal recess are clear. There is mild nasal septal deviation to the right with associated spur that contacts the right inferior turbinate. There is a left mesiodens. Tooth # 3 is carious.Head: There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is an unchanged nonspecific lucent lesion in the right parietal bone. The orbits are unremarkable.
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1. Persistent pansinus opacification that is most pronounced in the right osteomeatal unit, but otherwise has a sporadic distribution. The degree of opacification in the sphenoid sinuses has increased slightly, but remains relatively mild.2. Tooth # 3 is carious.3. No evidence of acute intracranial hemorrhage or mass.
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Generate impression based on findings.
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4-month-old male with left humerus fractureEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, right forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (19 views) 01/21/15 Mineralization and modeling are within normal limits. A minimally displaced transverse fracture through the left proximal humeral metadiaphysis is again seen. No additional fractures are noted.Pseudosubluxation of C2 on C3, a normal variant. Pseudo-thickening of the prevertebral soft tissue likely due to expiration and kyphotic positioning.Moderate gaseous distention of the stomach likely due to air swallowing secondary to crying.
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Minimally displaced fracture through the left proximal humerus without additional fractures.
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Generate impression based on findings.
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77-year-old female with history of Crohn's and intestinal fistulas. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable mild intrahepatic biliary ductal dilatation. Perfusion defect versus focal fat sparing noted along the falciform ligament.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypoattenuating lesion compatible with simple cyst. Additional subcentimeter hypoattenuating foci are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is suboptimal fluid distention of the small bowel. Postsurgical changes about the proximal colon with configuration of the colon and the surgical findings of end to side ileocolonic anastomosis similar to the small bowel follow through examination.There is conglomerate of multiple matted and distorted cluster of small bowel loops including the neoterminal ileum with appearance of a cloverleaf with multiple sinus tracts and at least two enterocutaneous fistulous connections (series 4, image 71 and 77). The neoterminal ileum demonstrates wall thickening and hyperemia extending approximately 10 cm proximal from the neoterminal ileum consistent with acute disease. Additionally, there is fat stranding and soft tissue thickening in the region of the right rectus abdominis muscle which is decreased compared to previous examination.No proximal small bowel dilatation to suggest small bowel obstruction.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 acute Crohn's disease involving the small bowel and neoterminal ileum. There are multiple sinus tracts and at least two enterocutaneous fistula as detailed above. CT is insensitive for evaluation of fistulous disease and further evaluation with fluoroscopy versus MRI may be considered if clinically indicated.2.No evidence of small bowel obstruction.
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Generate impression based on findings.
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82 year old female with history of abdominal pain, nausea vomiting, sickle cell, uterine cancer. Evaluate for small bowel obstruction. Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.ABDOMEN:LUNG BASES: Bibasilar scarring, similar to prior. Cardiomegaly, without significant pericardial effusion. Coronary artery calcifications.LIVER, BILIARY TRACT: Cholecystectomy clips, with mild intrahepatic biliary dilatation.SPLEEN: Spleen is atrophic and calcified, consistent with splenic infarction not uncommon in patients with sickle cell.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys are atrophic bilaterally, with multiple small cysts incompletely evaluated on this exam.RETROPERITONEUM, LYMPH NODES: Previously described right cardiophrenic lymph node (3/22) measures 12 x 9 mm, not significantly changed from the previous 12 x 8 mm.Descending aortic ectasia, similar to prior.BOWEL, MESENTERY: Multiple loops of dilated small bowel are seen, some measuring up to 4.5 cm (3/71). Likely transition point in the left lower quadrant (coronal image number 62). Small amount of abdominal ascites, in the setting of obstruction, may represent bowel injury.BONES, SOFT TISSUES: Diffuse mixed sclerosis of the visualized axial and appendicular skeleton consistent with history of sickle cell disease. OTHER: Nasogastric tube tip is in the stomach.PELVIS:UTERUS, ADNEXA: The uterus is surgically absent.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel obstruction as above.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine, with mild/grade 1 anterolisthesis of L4 on L5. Stigmata of sickle cell disease about the skeleton.OTHER: No significant abnormality noted
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1.Small bowel obstruction, with likely transition point in the left lower quadrant. Small amount of free fluid in the abdomen comment a setting of small bowel obstruction is nonspecific, but the possibility of ischemia is raised.2.Stigmata of sickle cell disease, and other findings as above without significant interval change.
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Generate impression based on findings.
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Reason: evaluate for sarcoidosis History: as above LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No lymphadenopathy. No coronary calcifications. 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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Normal examination. No evidence of sarcoidosis as clinically questioned.
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Generate impression based on findings.
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Female 68 years old; Reason: 68F with breast cancer and DDD/OA, p/w worsening back pain, please eval for bony mets/disease progression Exam is limited given patient's body habitus.Again seen are widespread osseous metastases involving the thoracolumbar spine, sternum, bilateral humeri and ribs, skull and right anterior ilium with interval decrease in activity involving multiple skull and bilateral rib lesions. However there is a new punctate focus in the right pedicle of the L2 vertebral body pedicle as well as several new foci involving the bilateral distal femuri suspicious for progression of disease. Focus in the right mid femur as well as foci in the bilateral humeri and thoracic spine appear stable.
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Widespread osseous metastatic disease with apparent mixed interval response. There has been decrease in activity of multiple skull and bilateral rib lesions, however foci involving the right L2 pedicle and bilateral femuri appear to be new. Other lesions involving the bilateral humeri and thoracic spine are stable.
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Generate impression based on findings.
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Male 50 years old; Reason: evaluate for abscess or hematoma History: prolonged neutropenia, recurrent fevers, abd distension, c diff and fungemia ABDOMEN:LUNG BASES: New small bilateral pleural effusions. At least two groundglass nodules measuring up to 6 mm are seen in the right lung (3:5 and 3:9), and are nonspecific.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter seen in the decompressed urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated colonic wall thickening and pericolonic induration. No free intraperitoneal air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. At least two new ground glass nodules are seen in the right lung, which are nonspecific, but likely infectious. Dedicated CT chest is recommended to further evaluate extent.2. Again seen is colonic wall thickening and pericolonic induration extending from the cecum to at least the sigmoid colon, compatible with nonspecific colitis.3. Compared to study from January 5th 2015, there is significant interval increase in anasarca and ascites, and new bilateral pleural effusions.
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Generate impression based on findings.
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Reason: eval for worsening ILD, UIP or infection History: SOB LUNGS AND PLEURA: Continued mild progression in basilar predominant subpleural retraction, bronchiectasis, and groundglass opacity with honeycombing since the prior study. Diffuse centrilobular nodularity has also mildly increased. No new suspicious masses or nodules. No pleural effusions. MEDIASTINUM AND HILA: Scattered small lymph nodes unchanged. Moderate coronary calcifications. Mildly patulous esophagus. 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. Continued mild progression of interstitial lung disease as described above. 2. No evidence of superimposed infection or other acute process.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality.
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Generate impression based on findings.
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74 years old, Female, Reason: eval for porgression History: met urothelial cancer CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema appearing similar to prior exam. Reference left upper lobe pulmonary nodule is not significantly changed in size now measuring 0.4 x 0.5 cm (series 6, image 20), previously measuring 0.4 x 0.6 cm.Additional calcified and noncalcified micronodules are again seen.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the coronary arteries. Scattered dense calcification of the aortic arch and thoracic aorta. Small pericardial effusion appears minimally smaller than prior exam. Multiple thyroid nodules bilaterally unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Left lateral segment lesion now measures 0.9 x 1.0 cm (series 4, image 84), previously measuring 0.9 x 1.0 cm.SPLEEN: Splenic granuloma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic partially calcified superior pole lesion of the right kidney now measures 0.7 x 1.2 cm (series 4, image 95), previously measuring 1.0 x 0.7 cm. additional exophytic lesion arising off the inferior pole of the left kidney now measures 1.6 x 1.2 cm (series 4 image 110), previously measuring 1.8 x 1.8 cm. Hypoattenuating lesion in the left renal parenchyma likely represents a renal cyst and is unchanged. Nonobstructing left renal stones are again identified.RETROPERITONEUM, LYMPH NODES: There are severe atherosclerotic calcifications of the abdominal aorta and many of its branches. There is persistent retroperitoneal lymphadenopathy appearing similar to the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destructive lesions in the pelvis compatible with metastatic disease are not significantly changed compared to most recent exam. Sacral mass with associated obstructive changes measures approximately 8.2 by 5.9 cm (series 4, image 160), previously measuring 10.0 x 5.8 cm.New compression fracture of the T11 vertebral body, which previously had a lytic lesion. No definite new vertebral body metastases. Nuclear medicine bone scan is better evaluation for bone metastases.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Markedly enlarged uterus with partially calcified lesions compatible with fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destructive lesions in the pelvis compatible with metastatic disease are not significantly changed compared to most recent exam. Sacral mass with associated obstructive changes measures approximately 8.2 by 5.9 cm (series 4, image 160), previously measuring 10.0 x 5.8 cm.New compression fracture of the T11 vertebral body, which previously had a lytic lesion. No definite new vertebral body metastases. Nuclear medicine bone scan is better evaluation for bone metastases.OTHER: No significant abnormality noted.
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1. New compression fracture of the T11 vertebral body, which previously had a lytic lesion. 2. Osseous metastatic disease not significantly changed compared to prior exam.
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Generate impression based on findings.
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52-year-old female with right knee pain and anterior tenderness. Evaluate for fracture or signs of arthritis. Four nonweight bearing views of the right knee are provided. Small osteophytes along the medial tibiofemoral joint are compatible with minimal osteoarthritis. No joint effusion or soft tissue swelling. No acute fracture or malalignment is evident.
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Minimal osteoarthritis with no acute fracture or malalignment.
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Generate impression based on findings.
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Image quality is degraded by motion artifact. There are post-operative findings related to right retrosigmoid craniotomy for tumor resection. The right cerebellopontine angle component appears completely resected. There is a small enhancing lesion involving the right internal auditory canal measuring 6x6x6 mm compatible with residual tumor.There is an extra-axial collection in the right cerebellopontine angle and along the right lateral cerebellar hemisphere. There is pneumocephalus which is decreased since prior CT. There is susceptibility artifact in the right cerebellopontine angle, consistent with blood degradation products. Trace layering blood products is noted in the bilateral occipital horns. There is minimal curvilinear dural enhancement, likely post-surgical. Redemonstrated is diffuse prominence of the ventricular system, which is not significantly changed. There is no midline shift. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with minimal chronic small vessel ischemic changes. There is no diffusion abnormality. Again noted is a right MCA bifurcation aneurysm and a left M1 segment aneurysm as seen on recent CTA. The midline structures and craniocervical junction are within normal limits.
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1. Post-operative findings related to right retrosigmoid craniotomy for tumor resection. No evidence of residual tumor in the cerebellopontine angle. There is a 6x6x6 mm enhancing component in the right internal auditory canal consistent with small residual tumor.2. Communicating hydrocephalus again seen, similar to prior. 3. Interval improvement in mass-effect on the right pons, middle cerebellar peduncle, cerebellum, as well as the cisternal segment of the right trigeminal nerve. Small intraventricular hemorrhage.4. Middle cerebral artery aneurysms better demonstrated on recent CT angiogram.
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Generate impression based on findings.
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Please note that postcontrast images were not obtained as patient was agitated and IV access was not able to be obtainedThere is relatively symmetric increased T2 signal within the mesial temporal lobes bilaterally, along the parahippocampal gyri, extending through both hippocampal tails without associated susceptibility or diffusion restriction. The mesial right temporal lobe demonstrates gyral expansion as compared to the left, however there is no significant mass effect or midline shift. The left hippocampal tail is somewhat thicker than the right. A minimal amount of T2 hyperintensity within the periventricular and subcortical white matter are nonspecific but may suggest chronic small vessel ischemic disease.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. 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 is mild mucosal thickening in the sphenoid sinuses.
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1.Increased T2 signal within bilateral mesial temporal lobes extending through the hippocampal tails, with near symmetry except for greater anterior gyral expansion. Differential includes encephalitis, including herpes and limbic encephalitis, and status epilepticus, with neoplasm considered much less likely. Correlation with outside hospital imaging may be helpful to evaluate for progression of findings. Postcontrast images were unable to be obtained due to inability to obtain intravenous access and follow-up postcontrast images may also be helpful.2.Minimal chronic small vessel ischemic disease.
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Generate impression based on findings.
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20 year-old male with pain/swelling. Evaluate for fracture. Elevation of the anterior distal humeral fat pad compatible with a joint effusion. No definite underlying acute fracture is evident. Well corticated ossific density along the lateral aspect of the elbow joint may be related to prior trauma.
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Joint effusion with no definite underlying acute fracture. Patient may return in 7-10 days for followup imaging if clinically indicated to exclude occult fracture.
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Generate impression based on findings.
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45-year-old male with right ankle pain. Three non-weight-bearing views of the right foot are provided. Extensive vascular calcifications. Bones are demineralized.Hallux valgus deformity. Large accessory navicular bone. No acute fracture or malalignment is evident.
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No acute fracture or malalignment. Additional findings as above.
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Generate impression based on findings.
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68 year-old female with breast cancer, DJD, and chronic shoulder pain. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: No significant interval change in multiple pulmonary nodules. Stable post radiation changes in the right upper lobe.Reference right upper lobe nodule measures 0.6 x 0.6 cm (series 5, image 31), previously measuring 0.7 x 0.8 cm.Reference right lower lobe nodule measures 1.6 x 1.2 cm (series 5, image 48), previously measuring 1.5 x 1.2 cm.Reference left lower lobe nodule measures 0.6 x 0.7 cm (series 5, image 58), previously measuring 0.7 x 0.7 cm. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Soft tissue thickening at the prior surgical excision site on the right, which is not significantly changed and may be postsurgical in etiology. Correlation with mammography is recommended. No axillary lymphadenopathy.Innumerable osseous sclerotic lesions are noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. No focal hepatic lesions are identified. Status post cholecystectomy.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.BONES, SOFT TISSUES: Innumerable osseous sclerotic lesions are noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable osseous sclerotic lesions are noted.OTHER: No significant abnormality noted.
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1.Stable pulmonary metastatic disease. 2.Extensive sclerotic osseous lesions consistent metastatic disease. Correlation with nuclear medicine bone scan for more sensitive evaluation of osseous metastatic disease is recommended.3.Right breast soft tissue thickening is stable and may be postsurgical in etiology. Correlation with mammography is recommended.
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Generate impression based on findings.
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27-year-old male with history of abdominal pain, epigastric pain and lupus. Evaluate for pathology of abdominal pain. ABDOMEN:LUNG BASES: Minimal basilar scarring, similar to prior.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. The appendix is within normal limits. No convincing evidence of bowel wall thickening, and there is no pneumatosis or appreciable free fluid.BONES, SOFT TISSUES: Small benign bone island in the left ilium.OTHER: IVC filter in place.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: No significant abnormality noted
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No small bowel obstruction or free air. No acute abnormality to explain the patient's abdominal pain.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. Small foci of abnormal low density are seen in the right basal ganglia as well as possibly just cranial to the right external capsule. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Numerous calcifications are seen within the scalp vessels.
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No acute intracranial hemorrhage. Foci of abnormal density in the right basal ganglia and possibly just cranial to the right external capsule which could represent age indeterminate small vessel ischemic changes/lacunar infarcts. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended for further evaluation.
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Generate impression based on findings.
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Hip dysplasia.VIEW: Pelvis AP (one view) 01/22/15 Femoral head ossification centers are symmetric. They are well directed into normally formed acetabula. No fracture is identified.
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Normal examination.
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Generate impression based on findings.
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45-year-old female with recurrent abscess on hand and forearm. Evaluate how deep abscess tracks. Again seen is a peripherally enhancing multiloculated intramuscular fluid collection anterior to the distal humerus in the flexor compartment compatible with an abscess, which has decreased compared to prior, measuring 3.4 x 2 .4 cm, previously 2.8 x 2.5 cm. Associated fat stranding. The underlying bone is intact.Additional rim enhancing multiloculated fluid collection compatible with abscess is also noted along the lateral aspect of the distal radial diaphysis subcutaneous fat, which appears new compared to prior. Associated fat stranding and overlying skin thickening. This abscess measures 3.4 x 2.1 cm. The underlying bone is intact.Additional third rim enhancing multiloculated fluid collection compatible with an abscess is noted within the subcutaneous fat of the dorsal aspect of the first metacarpal bone, not previously imaged. This abscess measures 2.2 x 1.3 cm. The underlying bone appears intact.
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Three discrete abscesses within the left upper extremity as described above. No definite CT evidence of underlying osteomyelitis.
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Generate impression based on findings.
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Female 68 years old; Reason: 68 y.o. with recurring HPT History: HPT Tc-99m sestamibi was injected preoperatively for lesion localization. No images were acquired.
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Successful preoperative injection of Tc-99m sestamibi intravenously.
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Generate impression based on findings.
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Male; 55 years old. Reason: pe? History: Pleuritic chest pain, sob, tachycardia, tachypnea, h/o malignancy PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Interval resolution of mild patchy airspace and interstitial opacity in the right upper lobe. New mild patchy nodular opacities in the left lower lobe. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. Stable anterior metallic density. No mediastinal or hilar lymphadenopathy.CHEST WALL: Stable mildly enlarged bilateral axillary lymph nodes, with the largest again measuring up to 14 mm on the left (series 5/85). Right shoulder arthroplasty.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. G-tube in place. Stable small left renal hypoattenuating lesion, likely a benign cyst. Stable prominent gastrohepatic lymph nodes.
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1. No acute pulmonary embolus.2. New mild patchy nodular opacities left lower lobe, likely related to prior infection or aspiration.3. Interval resolution of patchy opacities in the right upper lobe.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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67 year old with milky right nipple discharge for several months presents for mammographic work up. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Benign calcifications are again noted in right breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound was performed for right periareolar region. There are multiple dilated ducts in the retroareolar region. At least 3 intraductal solid lesions are seen within these ducts; just behind the nipple measuring 4 x 3 mm, at 7 o'clock position 1 cm from the nipple measuring 9 x 2 mm, and at 5 o'clock position 1 cm from the nipple measuring 6 x 3 mm. Blood-flow within these lesions are confirmed with color Doppler study.
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Multiple intraductal lesions in the right breast. Biopsy of one of the lesions is recommended. Breast MRI is also recommended to see the disease extent. Results and recommendations were discussed with Dr. Chhablani. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.
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Generate impression based on findings.
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Reason: Pt has invasive SCC on vocal cord, looking for other cancer History: hoarseness LUNGS AND PLEURA: Mild centrilobular emphysema. No suspicious nodules or masses. No pleural effusions. MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes, some calcified consistent with granulomatous disease. Mild coronary calcifications. CHEST WALL: Scattered small axillary lymph nodes with benign morphologic features. Please see separately dictated neck CT for evaluation of cervical lymph nodes. Bony bridging along the posterior left 6-7th ribs may represent prior trauma. No suspicious bony lesions. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of metastatic disease.
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Generate impression based on findings.
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60-year-old male with history of metastatic renal cell cancer. Baseline exam prior to starting systemic therapy. CHEST:LUNGS AND PLEURA: Multiple diffuse parenchymal lung nodules are seen bilaterally, predominantly micronodules up to a size of 6 mm in right lower lobe (series 4, image 80 and 5 mm in left lower lobe (series 4, 64). Left lower lobe atelectasis is seen distal to left hilar adenopathy. The airspace consolidation may are be due to atelectasis, however an infectious process cannot be excluded. No pleural disease. MEDIASTINUM AND HILA: Left hilar adenopathy (series 3 Image 70) measures 2.4 x 2.7 cm. Less prominent but enlarged subcarinal adenopathy and retrocrural adenopathy is seen. Large paraesophageal lymph node is seen (series 3, image 96) measuring 2.5 x 1.9 cm. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesions are seen in the left lobe superiorly and the inferior right lobe. Reference measurement in right lobe (series 3, image 130) measures 1.6 x 1.5 cm. Patient is status post cholecystectomy without biliary tract abnormality.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Enlarged left adrenal gland with mass measuring 2.9 x 2.7 cm (series 3, image 113). Right adrenal gland is not visualized, however there is a large mass in the region of surgical clips in the bed of prior right nephrectomy (and perhaps right adrenalectomy) (series 3, image 124) with mass measuring 8.7 x 5.2 cm. KIDNEYS, URETERS: Left kidney is pertinent only for mild cortical scarring and benign cortical parenchymal cyst. No abnormal masses, hydronephrosis or calcifications are seen. Patient is status post right nephrectomy -- see adrenal section above for abnormal mass lesion in resection bed of kidney/adrenal region. RETROPERITONEUM, LYMPH NODES: Para-aortic retroperitoneal adenopathy is seen. Reference aorta caval lymph node (series 3, image 143) measures 3.1 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality noted. in the stomach or colon. Intussuscepting mass is seen in the left jejunum (series 3, images 143 through 155 and coronal image 72). In light of extensive metastatic disease seen elsewhere, this most likely represents an additional site of metastases, although nonspecific and other mass lesions cannot be excluded. No free mesenteric fluid is seen, however mesenteric adenopathy is seen predominantly in the left anterior midabdomen. Reference largest lymph node (series 3, image 146) measures 4.0 x 3.3 cm..BONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality notedd in the pelvis. See abdomen discussion above for extensive abnormalities.BONES, SOFT TISSUES: No significant abnormality notedd, however nuclear medicine bone scintigraphy is a more sensitive indicator of metastatic skeletal disease.OTHER: No significant abnormality notedd
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1. Prior right nephrectomy. 2. Numerous small parenchymal lung nodules, most likely represent metastatic disease. 3. Left hilar lymphadenopathy with left basilar atelectasis/air space disease. 4. Probable hepatic metastases with reference measurements above. 5. Intussuscepting jejunal mass common nonobstructing at this time. Most likely an additional site of metastasis. 6. Extensive retroperitoneal and mesenteric lymphadenopathy.
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Generate impression based on findings.
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Incidental note is made of nonspecific relatively symmetric prominence of the lateral ventricles. The posterior body and atrium on the right is slightly larger than the left. Of note, the normal calcifications and enhancement associated with the right lateral ventricular choroid plexus appears to be displaced anteriorly which may suggest that there is a intraventricular cyst resulting in lack of normal choroid location in the atrium.The ventricles and sulci are otherwise within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation or pathological enhancement. There is no extraaxial fluid collection. There is minimal anterior ethmoid opacification. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Filling defects in the external auditory canals bilaterally likely represent cerumen.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There are prominent bilateral PCOM's. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The vertebral arteries are co-dominant. There is no evidence of flow-limiting stenosis or aneurysm.CTA NECK
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1. Incidental nonspecific prominence of the lateral ventricles with additional more focal prominence of the posterior body and atrium of the right lateral ventricle and apparent anterior displacement of the choroid plexus which may indicate a space occupying intraventricular cyst.2. Unremarkable CTA of the head and neck. No CT evidence of cervical arterial dissection.
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Generate impression based on findings.
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Mandibular distraction, eval ng tube and ett placement.VIEW: Abdomen AP (one view) 01/21/15 NG tube with tip in the stomach. Disorganized bowel gas pattern. No evidence of obstruction. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Disorganized bowel gas pattern without evidence of obstruction.
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Generate impression based on findings.
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72-year-old male with history of MM.; pre-auto-SCT evaluation. SKULL: Innumerable punched out lesions involving the skull compatible with innumerable myelomatous lesions.CERVICAL SPINE: Bones appear demineralized. Scattered lucencies suggestive of myelomatous lesions. Vertebral body heights and intervertebral disk spaces are preserved.THORACIC SPINE: The bones are demineralized. Kyphosis appears progressed compared to prior. Interval vertebroplasty of the T10 vertebral body. Severe compression deformity of T8 similar to prior. Mild to moderate compression deformity of T9 similar to prior. Moderate compression deformity of T11, slightly progressed compared to prior.LUMBAR SPINE: The bones are demineralized. Interval vertebroplasty of L4. Compression deformity of L1, slightly progressed compared to prior. Compression deformities of L2 and L5 appear similar to prior. Abdominal aortic calcifications again noted.RIBS: The bones are diffusely mottled compatible with diffuse myelomatous lesions. Multiple bilateral rib fractures of varying ages.PELVIS: Diffuse mottled appearance of the pelvis compatible with diffuse myelomatous lesions. Prostate radiation seeds are noted. Large loose body in the right hip joint. Degenerative changes bilateral hips.UPPER EXTREMITY: Multiple small punched out lytic lesions throughout both shoulders, humeri, and forearms compatible with myelomatous lesions.LOWER EXTREMITY: Multiple small punched out lytic lesions throughout both femora compatible with myelomatous lesions. No definite myelomatous lesions in the bilateral tibia/fibula.
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Diffuse myelomatous involvement of the axial and appendicular skeleton. Compression deformities are slightly progressed in the thoracic and upper lumbar spine with exception of recently treated deformities.
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Generate impression based on findings.
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Reason: HCC screening in a cirrhotic History: HCC ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhosis. 1.2-cm T2 hyperintense lesion in the posterior right hepatic lobe (41:26) likely a small cyst.SPLEEN: Splenomegaly.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: Mild to moderate ascites.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.
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1.Cirrhosis with sequela of portal hypertension. Mild/moderate ascites and anasarca. No suspicious focal hepatic lesions.
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