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Generate impression based on findings.
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Fracture healing. VIEWS: Right humerus AP/lateral (two views) 01/22/15 Healing transverse fracture through the mid humeral diaphysis with mild medial angulation measuring 13 degrees, previously 20 degrees.
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Healing humerus fracture.
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Generate impression based on findings.
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Reason: evaluate hips History: cerebral palsyVIEWS: Pelvis AP/frog leg, thoracolumbar spine supine AP (3 views) 01/22/15 Bilateral coxa valga with posterior dislocation of the right femoral head. The right acetabulum appears dysplastic. The left acetabulum appears well seated into the acetabulum. The left femur is abducted on the right is adducted.Rightward curvature measures approximately 36 degrees from the superior endplate of T7 to the inferior endplate of T12. G-tube and tracheostomy tube are present.Small to moderate stool burden.
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1.Developmental dysplasia of the right hip with dislocation. Bilateral coxa valga.2.Dextroscoliosis of thoracolumbar spine.
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Generate impression based on findings.
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Reason: eval liver lesions masses HCC History: HCC S/P TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhosis with widening of the fissures. Hepatic steatosis and areas of fibrosis. Patent hepatic vasculature. No biliary dilatation.2.8 x 2.1 cm lesion in segment 1 (101:35) demonstrates post-therapeutic changes without enhancement and slight interval decrease in size. Previously this lesion measured 3.2 x 2.2 cm (20:142).1.1 x 1.0 cm lesion in segment 8 (102:26), demonstrates no significant enhancement or interval change in size.SPLEEN: Splenomegaly. Stable nonspecific septated anterior splenic hypodensity.PANCREAS: Stable small cystic lesion in the uncinate process, likely representing a small IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter T2 hyperintensities, likely cysts, stable.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.
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1.No significant change in reference hepatic lesions.
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Generate impression based on findings.
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90 year-old male with lateral ankle pain and swelling Mild soft tissue swelling about the ankle. No fracture is evident. Alignment is anatomic.
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No fracture or dislocation.
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Generate impression based on findings.
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Male; 53 years old. Reason: rule out PE History: chest pain, LLE tenderness PULMONARY ARTERIES: No acute pulmonary embolus. Normal caliber of the main pulmonary artery. No evidence of right heart strain.LUNGS AND PLEURA: Minimal bibasilar dependent subsegmental atelectasis. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No acute pulmonary embolus or other significant cardiopulmonary abnormality.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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Male; 76 years old. Reason: Pt with smooth muscle neoplasm of the distal esophagus. Need to evaluate for change in lesion. History: Mild abdominal pain CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant interval change in distal esophageal biopsy-proven leiomyoma. The mass is partially circumferential though predominately posterior and contains stable internal calcifications. It measures approximately 4.8 x 3.6 cm in greatest axial dimension (series 3/86).Normal heart size without pericardial effusion. Moderate calcifications of the coronary arteries. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative arthritic changes of the visualized spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating lesion in the left lobe of the liver (series 3/94), which is too small to characterize but likely a benign cyst.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: Stable infrarenal abdominal aortic aneurysm measuring up to 4.7-cm (series 3/129).BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative arthritic changes of the visualized spine.OTHER: No significant abnormality noted.
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1. No significant interval change in distal esophageal biopsy-proven leiomyoma.2. Stable infrarenal abdominal aortic aneurysm.
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Generate impression based on findings.
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49-year-old male with history of type 2 diabetes, nausea, vomiting. Question of gastroparesis. Visually there was a significant delay in gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 84.1 % of peak activity (normal >70 %)1 hour: 85.0 % of peak activity (normal 30-90 %) 2 hours: 69.2 % of peak activity (normal <60 %) 4 hours: 35.4 % of peak activity (normal <10 %)
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Significantly delayed gastric emptying.
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Generate impression based on findings.
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57 years, Female. Reason: ng tube placement given tube dysfxn History: tube dysfxn Enteric tube tip in gastric body, unchanged from prior study. Improvement in the mild gaseous distention of the small bowel. Nonobstructive bowel gas pattern. Bilateral pleural effusions noted. Partially visualized two central venous catheter tips seen overlying cavoatrial junction. Remainder of the exam unchanged.
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Enteric tube tip in gastric body, unchanged from prior study. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Male 71 years old; Reason: Pancreas cancer with CT imaging indicative of left iliac bone mets and new onset thoracic and upper back pain please assess History: As above There is a markedly large osteoblastic lesion in the right posterolateral 9th rib which corresponds to a large sclerotic lesion present on CT consistent with metastatic disease.There is a large less intense osteoblastic lesion involving the left iliac wing which correlates with the lytic lesion on comparison CT and consistent with additional osseous metastatic disease.There is a focus of activity along the right aspect of the L3 vertebral body corresponding to a sclerotic pedicle on CT indicative of additional metastatic disease.There is a focus in the superior sternum with mixed increased and decreased activity corresponding to a lytic lesion on CT also indicative of osseous metastatic disease.There is a subtle focus along the medial aspect of the left hip likely in the region of the lesser trochanter also suspicious for metastatic disease. There is evidence of healed fracture deformity with mild uptake in the left posterior 8th-10th ribs.
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Multiple lytic and sclerotic osseous metastases.
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Generate impression based on findings.
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Patella fx? Inferior pole patella tender to palpation.... pain w/ extended periods of running over anterior knee... hx of fall w/ swelling 4wk priorVIEWS: Left knee AP/lateral (two views) 01/22/15 No acute fracture or malalignment. Long secondary apophysis of the anterior and inferior aspect of the patella, normal variant. No joint effusion.
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No acute fracture or malalignment.
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Generate impression based on findings.
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67 year-old female breast cancer. Follow-up after treatment.RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the right anterior chest wall. There is a thin, circumscribed fluid collection in the surgical bed, likely representing postoperative seroma. Several bilateral pulmonary nodules are demonstrated, including a new 1 cm nodule in the left apex anteriorly. Left chest wall port catheter tip at the SVC/RA junction. Calcified mediastinal lymph nodes are compatible with prior granulomatous disease. Numerous hepatosplenic granulomata.Today's PET examination demonstrates complete resolution of markedly hypermetabolic tumor activity seen in the right breast, right axilla, and bilateral lungs. However, there is new moderately hypermetabolic activity associated with a pleural-based left apical nodule (SUV max 4.0), suspicious for tumor progression in this location. No additional suspicious FDG avid lesion is identified.Right anterior chest wall demonstrates uniform, mildly hypermetabolic activity associated with the aforementioned fluid collection, likely reflecting postoperative inflammatory changes.
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1.Complete interval resolution of all previous extensive hypermetabolic tumor involving right breast, right axilla, and lungs, indicating a significant metabolic response to therapy.2.However, a single new significantly hypermetabolic 1-cm pleural-based nodule in the left apex is suspicious for tumor progression in this one location.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 104 cm/sec.Right internal carotid artery: 83 cm/sec.Left middle cerebral artery: 120 cm/sec.Left internal carotid artery: 93 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).
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Generate impression based on findings.
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69-year-old female with history of right breast cancer and lymphadenopathy in the right neck. There are multiple necrotic-appearing lymph nodes in the right supraclavicular and right level 5B regions. For example, a right level 5B node, measures 15 x 13 mm and a right supraclavicular lymph node measures 12 x 11 mm. There is no significant cervical lymphadenopathy on the left side of the neck. The thyroid and major salivary glands are unremarkable. There is multilevel degenerative cervical spondylosis, most significantly at C3-C4, C5-C6, and T1-T2. There is fusion of C6 and C7 vertebrae, which may be congenital or acquired. There is mild canal stenosis, most pronounced at C3-C4. There is a retropharyngeal right carotid artery. The airways are patent. There is a 3-mm nodule in the right lung apex. There is mild biapical scarring. There is a lipoma within the left trapezius muscle that measures up to 12 mm in thickness.
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1. Multiple necrotic appearing right supraclavicular and level 5 lymph nodes are highly suspicious for metastatic involvement. 2. Nonspecific 3-mm nodule in the right lung apex. A dedicated baseline chest CT may be useful for further evaluation.3. Extensive degenerative spondylosis of the cervical spine. 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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Male 33 years old Reason: s/p ACL History: s/p ACL recon Postsurgical changes from an ACL graft. Joint alignment is anatomic. There is a small joint effusion. No acute fracture or dislocation.Mild osteoarthritis affects the left knee.
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Postsurgical changes from ACL graft placementt.
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Generate impression based on findings.
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79 year-old female with left hip pain Severe osteoarthritis affects the left hip with extensive subchondral cyst formation, osteophytes, and severe superior joint space narrowing.Severe degenerative disk disease with vacuum phenomena affects the visualized lower lumbar spine. Mild arthritic changes affect the left SI joint.
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Severe osteoarthritis as described above.
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Generate impression based on findings.
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Female 75 years old Reason: evaluate for OA History: Pain and stiffness Right hip: There is mild joint space loss. There are small superolateral osteophytes. No acute fracture or dislocation.Osteoarthritis affects the right sacral iliac joint.Left hip: There is mild joint space loss. There are superolateral osteophytes. No acute fracture or dislocation.Osteoarthritis affects the left sacral iliac joint.
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Bilateral mild osteoarthritis.
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Generate impression based on findings.
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53-year-old female status post THA Hardware components of a total right hip arthroplasty device are situated in near-anatomic alignment without evidence of hardware complication. Drains and foci of gas in the soft tissues reflect recent surgery.
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THA in near-anatomic alignment.
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Generate impression based on findings.
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59 year-old female with recurrent hyperparathyroidism. Please assess for parathyroid adenomas. No thyroid gland uptake, compatible with history of thyroidectomy. There is otherwise physiologic distribution of the radiopharmaceutical. No abnormal focus of activity consistent with an enlarged parathyroid gland is seen.
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No scintigraphic evidence for parathyroid adenoma.
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Generate impression based on findings.
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22 year old female, evaluate ankle fracture Interval removal of cast. Small ossicle distal to the fibular tip likely represents an avulsion fracture fragment. There is adjacent soft tissue swelling. No additional fracture is noted.
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Interval removal of cast with fibular tip avulsion fracture and adjacent soft tissue swelling as described above.
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Generate impression based on findings.
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66 year old female with history of polymyositis and intermittent dysphagia with solid foods. Scout radiograph of the chest was unremarkable.Double contrast evaluation of the esophagus and gastric cardia/fundus demonstrated an outpouching measuring 18 x 15 mm that filled with and retained contrast, extending from the left anterolateral cervical esophagus. Appearance most compatible with a Killian-Jameson type diverticulum given the location. No esophageal obstruction was identified. No esophageal or gastric mucosal abnormalities were noted. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild proximal escape after primary peristalsis, but a strong secondary peristaltic wave.Incidental note is made of mild spinal degenerative changes and cholecystectomy clips. TOTAL FLUOROSCOPY TIME: 6:09 mm:ss
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1.Left-sided anterolateral cervical esophageal outpouching measuring up to 18 mm, appearance compatible with a Killian-Jameson diverticulum. 2.No evidence of spontaneous or provoked gastroesophageal reflux.3.Findings compatible with minor esophageal motility disorder as described above, of questionable clinical significance.
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Generate impression based on findings.
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22 year-old female with left ankle pain Fine osseous detail is obscured by overlying cast material. An ossicle distal to the fibular tip likely represents an avulsion fracture fragment.
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Casted fibular avulsion fracture as described above.
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Generate impression based on findings.
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Reason: where is pcvc/how is gas pattern History: new pcvcVIEWS: Chest and abdomen AP (two views) 01/22/15, 1324 NG tube tip is in the stomach. Left lower extremity PICC with tip in the right atrium.Cardiothymic silhouette is normal. Minimal bilateral atelectasis.Gas distended stomach and multiple loops of bowel. Persistent bubbly appearance of the bowel contents suggestive for pneumatosis. No pneumoperitoneum or portal venous gas.
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Gas distended loops of small bowel with a persistent bubbly appearance suggestive of pneumatosis. Left lower extremity PICC tip is in the right atrium.
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Generate impression based on findings.
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Female 69 years old; Reason: 69 y/o f with UCTD, APS, and DVTs with chronic dyspnea, please eval for chronic thromboembolic disease. History: see above The comparison chest radiograph performed on 1/22/2015 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion.
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Very low probability for pulmonary embolism.
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Generate impression based on findings.
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72-year-old male with hematuria. Evaluate for stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic granulomata. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are scattered punctate slightly increased density within both kidneys suggestive of nascent stone formation without obstructing nephrolithiasis or ureteral stones. No hydroureteronephrosis. Multiple bilateral renal hypodense lesions consistent with cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: There are changes of partial gastrectomy with Roux-en-Y anastomosis. Evaluation of previously noted soft tissue density at the left upper quadrant Roux-en-Y anastomotic site is difficult to evaluate given lack of oral contrast; attention on subsequent imaging is recommended. No evidence of small bowel obstruction or colitis.BONES, SOFT TISSUES: Nonspecific atrophy of the right rectus muscle.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of small bowel obstruction or colitis. Appendix is normal. Small fat containing left inguinal hernia.BONES, SOFT TISSUES: Previously noted right iliac bone lytic lesion is not identified on the current examination. A smaller lytic focus in the left iliac bone (series 3, image 67) is not as conspicuous on the current examination.OTHER: No significant abnormality noted
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1.Punctate nascent non-obstructing stone formation bilaterally. No hydroureteronephrosis.2.Postsurgical changes of partial gastrectomy with the previously noted probable pseudotumor which is not well evaluated on this noncontrast examination; attention on subsequent imaging is recommended.
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Generate impression based on findings.
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56 year-old female with left hip osteoarthritis Pelvis: Two side plates with screws affix the right acetabulum without evidence of hardware complication, appearing similar to the prior exam. Left hip: Moderate osteoarthritis affects the left hip with superior joint space narrowing.Left knee: There is mild medial tibiofemoral joint space narrowing. Degenerative arthritic changes also affect the right knee as seen on the frontal view.
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Postoperative and arthritic changes as described above without evidence of complication.
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Generate impression based on findings.
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Female 78 years old; Reason: 78 y.o with Right breast cancer lesion , now 3 cm vague density after chemo, need lymph for SLBX sched 1-23-15 History: Right breast cancerRADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.0 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker.
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Sentinel node identified in the right axilla.
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Generate impression based on findings.
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Male 61 years old; Reason: HCV, HCC, eval possible mets History: HCV HCC, cirrhosis No abnormal osseous foci are identified to indicate metastatic disease. Uptake involving the bilateral knees consistent with degenerative changes. Several foci of mild activity in the left hemipelvis seen only on anterior view likely artifact from urine.
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No evidence of bone metastases.
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Generate impression based on findings.
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Reason: assess for colon cancer recurrence History: N/A ABDOMEN:LUNG BASES: Stable small cardiophrenic lymph nodes.LIVER, BILIARY TRACT: No suspicious hepatic lesions. Patent hepatic vasculature. No ductal dilatation. Cholelithiasis.SPLEEN: Granulomas with associated blooming artifact.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter T2 hyperintensities, too small to accurate characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic disease of the aorta. Interval increase in size of infrarenal aortic aneurysm, now measuring 4.0 x 4.2 cm (5:29), previously measuring 3.5 x 3.6 cm (4:24).BOWEL, MESENTERY: Status post right hemicolectomy and ileocolonic anastomosis. No obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Interval increase in infrarenal abdominal aortic aneurysm, now measuring up to 4.2 cm, further detailed above. Otherwise, essentially unchanged exam without definite metastatic disease.
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Generate impression based on findings.
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64-year-old male with prostate cancer with rising PSA. History of T12 compression fracture. ABDOMEN:LUNG BASES: No lung nodules or effusions seen. However, scans through the lung bases did not go high as on prior examination there is mild micronodular was visualized. This is an incomplete evaluation lungs and if concern over parenchymal lung disease exists, chest CT would be recommended.LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Punctate gallstones are seen without other biliary complication.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC stent unchanged in position and appearance. No retroperitoneal adenopathy or masses seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable appearance to the T12 vertebral body compression deformity with patchy sclerosis. Nuclear medicine bone scan would be a more accurate assessment of potential metastatic bone disease..OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered small normal size lymph nodes are seen. No evidence of recurrence of the enlarged obturator lymph nodes as noted on 2009 CT examination which had resolved and 2013.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Patchy sclerosis about the left inferior ischial tuberosity and towards the acetabulum is unchanged in worrisome for metastatic disease. Nuclear medicine bone scintigraphy is a more accurate indicator of extent of metastatic skeletal disease.OTHER: No significant abnormality noted
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1. Scattered sclerotic skeletal abnormalities suggestive of metastatic disease technical medicine bone scintigraphy is a more accurate indicator of extent of skeletal metastatic disease. 2. No evidence of abdominal/pelvic lymphadenopathy. 3. Cholelithiasis.
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Generate impression based on findings.
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65-year-old male with LVAD and sepsis. Evaluate for source of infection. Evaluation of solid organs and for abscess is limited given noncontrast examinationCHEST: Motion artifact and streak artifact from LVAD limits evaluation.LUNGS AND PLEURA: There has been interval worsening of left upper lobe ground glass opacities with interval development of bilateral pleural effusions, large on the left and small on the right, with overlying atelectasis/airspace consolidation.MEDIASTINUM AND HILA: Right internal jugular central venous catheter with tip in the right atrium. Small pericardial effusion.CHEST WALL: Hardware components of the LVAD device noted. Interval improvement in the gas containing fluid collection in the anterior right chest wall. Diffuse anasarca. ABDOMEN: Streak artifact from LVAD limits evaluation of upper abdomen.LIVER, BILIARY TRACT: No focal hepatic lesions. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypoattenuating focus compatible with a cyst. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are unchanged compared to previous examination. Severe atherosclerotic calcifications affect the abdominal aorta and its branches, particularly the superior mesenteric artery.BOWEL, MESENTERY: Enteric tube with tip in the second/third portion of the duodenum. Interval development of moderate sized ascites. No evidence of loculated fluid collections to suggest abscess.Colonic diverticulosis. No specific findings to suggest small bowel obstruction.BONES, SOFT TISSUES: Bullet fragment in the right sacrum again noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above. New moderate size pelvic ascites without evidence of loculated fluid collections to suggest an abscess.Fat containing small right inguinal hernia. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Limited examination given lack of contrast enhancement, motion artifact, and streak artifact from hardware.1.Interval worsening of left upper lobe opacities highly suspicious for infectious etiology.2.Interval development of large left and small right pleural effusion with overlying atelectasis/consolidation.3.Interval development of moderate volume abdominal and pelvic ascites without definite loculated collections to suggest abscess on this limited exam.4.Interval resolution of right chest wall fluid collection, likely hematoma.
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Generate impression based on findings.
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Ms. Levine is a 43 year old female with a personal history of recent left breast excisional biopsy in April 2014 for a complex sclerosing lesion. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on a scar overlying the left breast. There are expected postsurgical changes including architectural distortion, increased density, and surgical clips present within the left excisional biopsy site. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Expected postsurgical changes in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Mandibular distraction.VIEWS: Mandible AP/right lateral/left lateral (3 views) 01/22/15 A marker was placed on the left device.Nasoenteric and nasotracheal tubes are present.The mandibular distractor devices are intact. Several millimeters of distraction are present bilaterally at the osteotomy sites..
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Postoperative changes.
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Generate impression based on findings.
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Male 25 years old Reason: hx of testicular cancer, evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Stable right middle lobe nodule series 5 image 54, 0.5 x 0.3 cm.No new nodules. No effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable hypoattenuating foci in the liver unchanged from 6/11/12. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Postsurgical changes retroperitoneum. Fluid density collection seen in the retrocaval area series image #3 image #122, 1.7 x 2.5 cm. Previously 2.1 x 1.4 cm. This could represent a low-density node, seroma or lymphocele.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Slight increase size of retrocaval fluid collection. It may represent a lymphocele given history of lymph node dissection although timing is somewhat unusual.Stable solitary lung nodule.
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Generate impression based on findings.
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70 year-old male with history of liver transplant. Evaluate vasculature does appear to kidney transplant. Within the limits of a non-IV contrast enhanced examination which limits the ability to the other solid parenchymal organs and vascular structures, following observations can be made:ABDOMEN:LUNG BASES: Small right pleural effusion and basilar atelectasis. Left lung base appears normal.LIVER, BILIARY TRACT: Pneumobilia and inferior vena cava sutures seen compatible with history of prior liver transplantation. Within limits of non-IV contrast enhanced examination, liver parenchyma appears normal. Patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign renal cyst in right kidney unchanged. Lack of IV contrast limits further evaluation of renal parenchyma. Prior noted right renal pelvis calculus is no longer seen.RETROPERITONEUM, LYMPH NODES: Mildly enlarged precaval lymph node (series 4, image 42) measuring 1.7 x 1.3 cm is unchanged dating back to 2009 CT examination, and indicative of benign nature. No other lymphadenopathy is seen. Aorta shows only scattered punctate linear calcifications.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: Left inguinal hernia containing only mesenteric fat. Sutures in the right anterior pelvis while most consistent with prior hernia repair. These are unchanged.OTHER: Common iliac arteries show expected diameter (incompletely evaluated due to lack of IV contrast administration). Left common iliac artery shows no calcifications. The left external iliac artery shows punctate calcifications in the location along the anterolateral. Right common iliac artery shows only mild calcifications along the posterior lateral just proximal to the bifurcation with a right axonal iliac artery with no significant calcifications. Tiny calcifications are again seen in the anterior medial aspect of the common femoral artery.
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1. Minimal calcification seen in the iliac arteries bilaterally as delineated above. 2. Status post liver transplantation with stable appearance. 3. Small right pleural effusion. 4. Left inguinal hernia containing only mesenteric fat.
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Generate impression based on findings.
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22 year-old female with Crohn's disease and fever. Evaluate for abscess or free air. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with mild overlying atelectasis.LIVER, BILIARY TRACT: Liver measures 26 cm in the craniocaudal dimension without focal hepatic lesions. Mild periportal edema. Marked gallbladder wall thickening likely related to periportal edema and ascites.SPLEEN: Small wedge-shaped peripheral hypoattenuation at the inferior aspect of the spleen measuring up to 1.5 cm (coronal series, image 29) raises suspicion for infarct.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild to moderate colonic wall hyperemia and thickening of the transverse and descending colon suggestive of acute on chronic colitis. Majority of the sigmoid colon is normal. The rectum is collapsed and difficult to differentiate under distention versus thickening.Moderate volume perihepatic and right paracolic gutter ascites. No loculated fluid collections or findings to suggest abscess or fistulous disease. No findings 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 suggestive of active Crohn's colitis as above without evidence of abscess or fistulous disease.2.Findings suspicious for a small splenic infarct.3.Marked gallbladder wall thickening likely related to periportal edema and ascites.4.New small bilateral pleural effusions with mild overlying atelectasis.5.Hepatomegaly.
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Generate impression based on findings.
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Male 70 years old Reason: s/p reverse TSA History: s/p reverse TSA Components of a reverse total left shoulder arthroplasty are in near anatomic alignment without radiographic evidence of hardware complication. The left humeral head has been resected. A joint drain is in place. Osteoarthritis affects the left AC joint.
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Status post reverse left total shoulder arthroplasty without radiographic evidence of hardware complication
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Generate impression based on findings.
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Female; 61 years old. Reason: worsening opacity 9/16; completed chemo 8/2014, ILD protocol History: dyspnea LUNGS AND PLEURA: Interval decreased diffuse patchy groundglass opacities in the upper lobes. Bilateral lower lobe mild reticular opacities, traction bronchiectasis, and groundglass are similar to prior study on 7/2/14 and most consistent with an NSIP pattern. The 9/16/14 findings were likely due to under inflation rather than worsening of disease. No pleural effusions. No honeycombing or significant air trapping.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Moderate coronary artery calcifications. No mediastinal or hilar lymphadenopathy. Small hiatal hernia.CHEST WALL: Left chest Port-A-Cath with catheter tip near the superior cavoatrial junction. Scoliosis and degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Stable left hepatic cyst and partially visualized left renal cyst.
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Findings most consistent with an NSIP pattern and similar to prior study on 7/2/14. Findings on CT chest from 9/16/14 were likely due to under inflation rather than worsening of disease.
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Generate impression based on findings.
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63 year old female with history of endometrial carcinoma (stage IA), status post hysterectomy/BSO. Stable lymph nodes on prior exams. CHEST:LUNGS AND PLEURA: No new suspicious pulmonary nodules or masses. Unchanged calcified left lower lobe granuloma.MEDIASTINUM AND HILA: Reference upper right paratracheal/R1 lymph node(3/9) is unchanged in size, at 10 x 8 mm.No new lymphadenopathy or pericardial effusion. The heart size is within normal limits.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Several calcified granulomata. Otherwise, no significant probably.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Reference left retroperitoneal lymph node (3/116) is unchanged in size, measuring 15 x 10 mm.Moderate atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absentBLADDER: No significant abnormality noted.LYMPH NODES: Reference right external iliac lymph node (3/171) measures 15 x 15 mm, unchanged. No new pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Postoperative findings of hysterectomy/BSO without findings of local recurrence or metastases.2.No significant interval change in reference lymph nodes.
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Generate impression based on findings.
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Ms. Fox is a 76 year old female with a personal history of unilateral spontaneous clear nipple discharge for the past one year. Per patient, she has not had any discharge for the past one month. Family history of breast cancer in sister and maternal aunt. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Focal asymmetry in the medial left breast is stable. Scattered benign calcifications are present in both breasts. Benign lymph nodes project over the right axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Male 64 years old; Reason: Prostate Cancer with rising PSA History: History of T12 compression fracture Focus of increased activity in the left skull is unchanged. Intense activity involving the left acetabulum and extending to the left inferior ischial tuberosity is increased compared to prior study and corresponds to the sclerotic lesion on comparison CT. There are no new foci of suspicious activity.
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Interval progression of osseous metastatic disease in the left hemipelvis as described above. Stable focus of activity in the left skull suggestive of stable additional metastatic disease or a benign lesion. No new suspicious osseous foci.
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Generate impression based on findings.
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77-year-old female with back pain and right lower extremity radiculopathy There is multilevel degenerative disk disease with loss of disk height and vacuum phenomenon at its T1-L1, L1-L2, L4-L5, and L5-S1. Multiple anterior osteophytes. Grade 1 anterolisthesis of L4 relative to L5. Small Schmorl's node along the superior endplate of L3 and inferior endplate of L2. Vertebral body heights are intact. Mild rightward curvature of the visualized spine.Overall, multilevel disk bulges, spinal canal or neural foraminal narrowing are better evaluated on recent MRI and are not significantly changed:T12-L1: Mild diffuse disk bulge. Mild facet arthropathy. No spinal canal narrowing. Mild right neuroforaminal stenosis.L1-L2: Mild diffuse disk bulge and mild facet arthropathy. Mild spinal canal narrowing. Mild bilateral neuroforaminal stenosis.L2-L3: Mild diffuse disk bulge and facet arthropathy. Mild spinal canal narrowing. Mild bilateral foraminal stenosis.L3-L4: Mild diffuse disk bulge with left neural foraminal protrusion, which is better seen on prior MRI. Ligamentum flavum thickening. Facet arthropathy. Moderate central canal stenosis. Moderate left neuroforaminal stenosis.L4-L5: Disk uncovering and diffuse disk bulge with ligamentum flavum thickening. Severe spinal canal stenosis and moderate left neural foraminal stenosis.L5-S1: Mild diffuse disk bulge. Facet arthropathy. No spinal canal stenosis. Mild bilateral neuroforaminal stenosis.Atherosclerotic calcifications of the visualized aorta and its branches.
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Multilevel cervical spondylosis with severe spinal canal stenosis at L4-L5 is not significantly changed from the recent MRI.
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Generate impression based on findings.
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Reason: 28 yo female with epigastric abdominal pain and elevated fecal fat. Please assess for signs of pancreatic inflammation or signs of chronic inflammatory change History: Epigastric abdominal pain, elevated stool fat ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal pancreatic ductal response to secretin, and with good exocrine function, as the duodenum fills with fluid. No mass lesion. Normal ductal caliber.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.
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1.Unremarkable pancreas and M.R.C.P.
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Generate impression based on findings.
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Female; 80 years old. Reason: evaluate ILD History: cough soboe fibrosis LUNGS AND PLEURA: Mild scattered streaky subsegmental atelectasis and/or scarring in both lungs. Scattered pulmonary micronodules, some of which are calcified. No suspicious pulmonary nodules or masses. Although there is some subtle subpleural reticulation, there is no specific evidence of ILD and no groundglass opacities. There is mild air trapping, which can sometimes be seen in hypersensitivity pneumonitis or small airways disease.MEDIASTINUM AND HILA: Cardiomegaly without pericardial effusion. Densely calcified native coronary arteries. Postsurgical changes from CABG. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Well-circumscribed right adrenal mass containing calcifications and macroscopic fat, compatible with benign adrenal myeolipoma measuring up to 6 x 4.1 cm (series 3/84).
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No specific evidence of chronic interstitial lung disease other than mild air trapping.
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Generate impression based on findings.
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Female 79 years old; Reason: look for recurrence History: abn CT scans with lung ca s/p XRT X 2RADIOPHARMACEUTICAL: 13.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 107 mg/dL. Today's CT portion grossly demonstrates a pleural-based 1 cm nodule in the posterior right lung apex new from prior study. There is a scarlike left apical density. There are additional right-sided parenchymal areas of consolidation and scarring. There are bilateral atrophic kidneys with bilateral hypodense lesions likely cysts. There is extensive atherosclerotic calcification including an approximately 5.5 cm infrarenal abdominal aortic aneurysm, slightly increased from prior PET/CT study in 2/10/2014 when it measured 5.0 cm in AP dimension. There are degenerative changes of the osseous structures including superior endplate depression of L2 and L3 vertebral bodies. There is a T8 vertebroplasty. An IVC filter is in stable position.Today's PET examination demonstrates marked hypermetabolic activity in the right lung apex corresponding to the right apical nodule, new from prior study with an SUV max of 8.0, highly suspicious for metastatic disease. There is a much milder activity in the right mid and lower lung with a branching curvilinear appearance, also progressed from prior study but given the appearance this is likely inflammatory in nature. In the upper abdomen there are several subcentimeter but significantly hypermetabolic lymph nodes just superior to the IVC filter, very suspicious for additional tumor progression.
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1.New markedly hypermetabolic right apical nodule is highly suspicious for tumor progression. No additional suspicious hypermetabolic activity is noted in the lungs. Additional activity elsewhere in the right lung as described above is likely inflammatory in nature. 2.Several additional significantly hypermetabolic subcentimeter retroperitoneal lymph nodes are new from prior study, also suspicious for tumor progression.3.Large infrarenal abdominal aortic aneurysm increased in size from 5.0 cm to 5.5 cm since last PET/CT study approximately 11 months ago.
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Generate impression based on findings.
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76 year old female s/p Dobbhoff placement. Exam mildly limited by patient motion artifact. Lower pelvis excluded from field of view. Dobbhoff tube tip in the gastric antrum. Nonobstructive bowel gas pattern. Incompletely visualized orthopedic hardware in the left pelvis.
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Dobbhoff tip in gastric antrum. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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69-year-old male with history of mesenteric plasmacytoma and rising paraprotein. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Post cholecystectomy findings.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic and cystic kidneys, unchanged. Mild left hydronephrosis is similar to prior.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node (4/77) measures 2.2 x 1.1 cm unchanged.BOWEL, MESENTERY: Soft tissue mass adjacent to the descending colon (4/83) measures 2 x 1.8 cm, unchanged. Right lower quadrant colostomy appears intact, unchanged.BONES, SOFT TISSUES: Nonspecific T12 vertebral body lucency has increased in size slightly from previous exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate hypertrophy, similar to prior.BLADDER: The prostate is enlarged, and extends into the bladder. Subtle bladder wall thickening, similar to prior.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Stable size of soft tissue mass adjacent to the descending colon, and lymphadenopathy, as above.2.Increased size of T12 vertebral lucency, which in the setting of known multiple myeloma could represent progression of disease. PET imaging or other follow-up would add diagnostic specificity.
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Generate impression based on findings.
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Unilateral sensorineural hearing loss and speech delay. Also mild conductive hearing loss. There is nonspecific opacification scattered throughout the middle ears bilaterally. Specifically, in the right middle ear, there is opacification posterosuperior to the malleus, along the crura of the stapes, adjacent to the tensor tympani muscle and questionably within the sinus tympani. In the left middle ear, there is nonspecific opacification involving Prussak's space caudally to the level of the umbo adjacent to the tympanic membrane, just caudal to the scutum, surrounding the left stapes, and within the sinus tympani and facial nerve recess. There is a prominent more rounded area of opacification just anterior to the left cochlear promontory, confluent with opacification along the head of the malleus.No osseous erosions are noted bilaterally. The ossicular chain is intact. The right oval window is clear but the left oval window is not aerated. The external auditory canals are patent bilaterally. There is bilateral under-pneumatization of the mastoids right greater than left. The inner ear structures are unremarkable. The facial nerve describes a normal course bilaterally. The jugular bulb and carotid canal are intact.
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1.Scattered nonspecific opacities in the middle ears bilaterally which could represent effusions, without osseous erosion. Slightly more rounded appearance of opacification just anterior to the left cochlear promontory. If there is concern for a mass lesion, MRI may provide further information.2.The inner ear structures appear within normal limits.
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Generate impression based on findings.
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Reason: 62 year-old female with large hiatal hernia noted on CT chest 11/2014. History of severe asthma, multiple intubations (last in 2005). Evaluate hiatal hernia. Scout radiograph of the chest unremarkable.There was large sliding type hiatal hernia with approximately 60% of the stomach situated above the hemidiaphragm. No functional obstruction was seen. During the exam, no spontaneous or provoked gastroesophageal reflux was observed.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormality otherwise. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. TOTAL FLUOROSCOPY TIME: 4:29 minutes
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1.Large sliding type hernia without functional obstruction.2.No evidence of gastroesophageal reflux.
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Generate impression based on findings.
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57-year-old male with history of abdominal pain. Evaluate for renal stone. ABDOMEN:Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.LUNG BASES: Mild atelectasis/scarring at the basesLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Several calcified splenic granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral, left greater than right, fat density adrenal gland thickening, most consistent with adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerosis of the aorta and its branches.BOWEL, MESENTERY: No small bowel obstruction or free air, appendix within normal limits.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No nephrolithiasis, hydronephrosis or other findings to explain the patient's pain.
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Generate impression based on findings.
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Evaluate healing torus fractures of the radius and ulna.VIEWS: Right wrist AP lateral (two views) 1/22/2015 Cast material obscures fine bone detail. Increasing sclerosis and periosteal reaction is noted along the distal radial and ulnar buckle fracture lines, consistent with healing. The bones of the wrist are in near-anatomic alignment.
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Healing distal radial and ulnar buckle fractures.
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Generate impression based on findings.
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There is asymmetric enlargement of the lateral ventricles, left greater than right, increased since the prior US exam. There is also enlargement of the third and fourth ventricles. No abnormal T2 signal or diffusion restriction. The aqueduct appears patent with a flow-void which may suggest hyperdynamic flow. CSF flow analysis demonstrates patent biphasic flow anteriorly and posteriorly. Multiple foci of susceptibility along the ventricular margins are consistent with chronic hemosiderin staining. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. No tonsillar herniation. Corpus callosum appears normal. Myelination pattern is normal for age, however there appears to be generalized loss of white matter volume diffusely. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1.Posthemorrhagic ventricular enlargement, increased since the prior exam, with findings suggestive of hyperdynamic flow within the aqueduct.2.Susceptibility along the ventricuar margins likely represents chronic hemosiderin staining from prior hemorrhage. No acute hemorrhage.3.There appears to be generalized diffuse loss of white matter, however the pattern of myelination appears normal for age.
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Generate impression based on findings.
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Patient with acute kidney failure and hypertension, rule out renal vein thrombosis. BLADDER Wall Thickness: Normal Contents: The bladder is distended and a small amount of dependent debris is present. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Observed Left: ObservedKIDNEYS Cortical Echogenicity: Slightly increased bilaterally. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 12.9 cm Left: 11.9 cm Mean for age: 10 cm Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: The bilateral renal veins and arteries are patent, and demonstrate appropriate flow velocities and direction. The resistive indices are within normal limits, indicating no significant renal vein thrombosis.
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1.No evidence of renal vein thrombosis2.Medical renal disease.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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History of enlarging right groin mass / nodule s/p arterial catheterization on 1/12/15. Evaluate for pseudoaneurysm. ANGIOGRAPHY: Mild atherosclerotic calcification affects a normally sized distal abdominal aorta and iliac arteries. Within the right groin at the site of recent arteriotomy, there is induration of the soft tissues compatible with edema. The underlying artery is normal in contour and caliber. No evidence of pseudoaneurysm formation. The distal vasculature has a normal three vessel run-off without focal stenosis or occlusion. Pelvis: The visualized pelvic contents are within normal limits.
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No evidence of pseudoaneurysm or significant hematoma.
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Generate impression based on findings.
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55-year-old male with left hip pain Mild degenerative changes affect the left hip without fracture evident. Alignment is within normal limits. Note is made of a calcified left testis, present on prior exams. Surgical clips project over the pelvis.
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No fracture or dislocation.
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Generate impression based on findings.
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CT head:There is a large enhancing lesion within the soft tissues overlying the left parietal calvarium measuring approximately 5.9 x 1.6 x 6.0 cm (80897/67 and 80854/33) which is new from the prior exam and likely correlates with patient's known squamous cell carcinoma. The lesion extends to the calvarial surface with subgaleal involvement, however there is no definite evidence of osseous invasion.There is an area of hypoattenuation within the right parietotemporal lobe which is new from the prior exam. There is no enhancing intracranial lesions to suggest metastases. No evidence of mass effect or midline shift. Ventricles are normal in size and morphology. No evidence of acute intracranial hemorrhage. There is no extraaxial fluid collection. Mild mucosal thickening of the maxillary sinuses, left greater than right.CT neck:There is skin thickening and soft tissue infiltration within the posterior subcutaneous tissues (80256/39) of the left upper neck with skin retraction. There are several small subcutaneous nodules within the tissues of the occiput, the largest measuring 1.4 x 1.1 cm (80256/24), likely representing lymph nodes. There are prominent bilateral supraclavicular lymph nodes with a borderline enlarged node measuring 1 cm in short axis (80256/62). There are multiple minimally enlarged bilateral level 5 nodes. Postsurgical changes are present in the right neck with fascial thickening, likely from prior carotid endarterectomy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent with atherosclerotic calcifications. There are mild degenerative changes of the visualized spine. The airways are patent. The imaged portions of the lungs are clear.
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1.Enhancing mass overlying the left parietal calvarium likely represents patient's known squamous cell carcinoma and is described above. This lesion abuts the calvarium, however there is no definite calvarial destruction. An MRI may be considered to evaluate for subtle infiltration of the marrow space, as it would be more sensitive.2.Skin thickening and its soft tissue infiltration within the left neck is a nonspecific, but may be related to patient's prior infection. Correlation with clinical exam may be helpful.3.Prominent cervical and suboccipital lymph nodes may be reactive, however metastatic nodes cannot be excluded.4.Linear region of hypoattenuation within the right parietotemporal lobe likely represents an infarct of indeterminate age. MRI may be considered for further evaluation.
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Generate impression based on findings.
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53-year-old female with pain, assess for arthritis or nonunion Orthopedic screws transverse the medial cuneiform, middle cuneiform and base of the first metatarsal. An additional horizontal screw affixes the base of the first and second metatarsals. We see no evidence of hardware complication. There has been fusion of the middle cuneiform and first metatarsal. An obliquely oriented screw extends within the proximal first phalanx. An osteotomy of the medial first metatarsal head is noted.
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Orthopedic fixation as described above with fusion of the medial cuneiform and first metatarsal. No evidence of nonunion or hardware complication.
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Generate impression based on findings.
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Male 65 years old Reason: pt with hx of small cell of the prostate; needs imaging to evaluate for possible biopsy of liver mets History: none LIVER: 14.3 cm in length. Gallbladder is surgically absent. No biliary dilatation. Common bile duct .3 cm in diameterNormal background echotexture and contour, with several discrete lesions visible as follows:Small lesion in the right lobe has an echogenic rim and is visible via an intercostal approach. It corresponds to the lesion seen on CT series 5 image 78/217. On ultrasound it measures 1.6 x 1.8 cm and is avascular on color doppler imaging. It might be amenable to percutaneous biopsy.Lesion in the left lobe just to the right of midline (seen on CT image 74) is visible in a subcostal approach. It is hypoechoic and ill-defined estimated at 2.3 x 2 x 1.8 cm. It would probably not be amenable to percutaneous biopsy.A few small scattered lesions seen on CT more caudally and not visible by ultrasound.The hepatic vasculature and grossly normal. Flow in the portal vein is hepato-pedal peak velocity .2 m/secGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right renal stent in place. 10.9-cm in length. Normal echogenicity. No hydronephrosis.OTHER: Left kidney .2 cm in length. No hydronephrosis.Spleen 11.5 cm. In length.No evidence of ascites.
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At least two of the liver lesions are visible by ultrasound.Right renal stent. Gallbladder surgically absent.
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Generate impression based on findings.
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20 year-old male status post traumatic injury with back pain There is mild kyphosis of the thoracic spine. Vertebral body heights and disk spaces are preserved. No fracture is evident.
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Mild kyphosis of the thoracic spine without evidence of fracture.
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Generate impression based on findings.
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58-year-old female with left lower extremity radiculopathy Lumbar spine: Note is made of an IVC filter. Vertebral body heights and disk spaces are preserved.Left hip: Alignment is anatomic. No fractures evident. Deformity of the superior and inferior pubic rami likely represent old fracture.Pelvis: There is deformity of the left aspect of the pubic symphysis and inferior pubic ramus, likely representing old fracture. The right hip appears unremarkable on the frontal view.Cervical spine: Alignment is within normal limits. There is no evidence of instability on flexion and extension views. Vertebral body heights and disk spaces are preserved.
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Chronic appearing pubic rami fractures without other specific findings to account for the patient's symptoms.
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Generate impression based on findings.
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59-year-old female status post right total hip arthroplasty Hardware components of a total hip arthroplasty device are situated in near-anatomic alignment without evidence of complication. Drain and gas in the soft tissues reflect recent surgery. Severe osteoarthritis affects the left hip as seen on the frontal view.
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THA without evidence of complication.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 166 cm/sec.Right internal carotid artery: 140 cm/sec.Left middle cerebral artery: 164 cm/sec.Left internal carotid artery: 117 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).
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Generate impression based on findings.
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Female 73 years old Reason: RA History: large effusions Left knee: Bone mineralization is normal. Alignment is near-anatomic. There are tricompartmental osteophytes and joint space narrowing resulting in moderate to severe osteoarthritis. No significant joint effusion. No acute fracture or malalignment.Right knee: Bone mineralization is normal. Alignment is near-anatomic. There are tricompartmental osteophytes and joint space narrowing resulting in moderate to severe osteoarthritis. There is a small joint effusion. No acute fracture or malalignment.
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Moderate to severe bilaterally osteoarthritis.
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Generate impression based on findings.
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59-year-old female with history of neoplasm of the esophagus (pathology reviewed and patient with invasive adenocarcinoma of the esophagus) who presents for evaluation. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules with reference left upper lobe nodule measuring 0.8 x 0.7 cm (series 5, image 26). No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Severe distal esophageal wall circumferential thickening with evidence of a gas foci within the wall (series 3, image 69), most likely patient's known esophageal carcinoma. The esophageal wall thickening results in severe narrowing of the distal esophageal lumen.No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Degenerative disease affects the spine. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hypoattenuating lesions in the liver consistent with metastatic disease. Reference segment 8 lesion measures 7.7 x 6.8 cm (series 3, image 85). These masses result in attenuation of the left hepatic vein as it nears the IVC. Additionally, there is attenuation of the distal left portal venous branches. No evidence of occlusion of the hepatic or portal veins.SPLEEN: Accessory splenule is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes. Reference portacaval lymph node measures 0.8 x 1.0 cm (series 3, image 98). Enlarged gastrohepatic lymph node measures 1.1 x 1.6 cm (series 3, image 85).Moderate atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease of the visualized spine.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: Diverticulosis without evidence of diverticulitis or colitis. No small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Diffuse marked distal esophageal wall thickening most likely patient's esophageal carcinoma results in severe narrowing of distal esophageal lumen. 2.Diffuse hepatic metastatic disease. 3.Left upper lobe 8mm pulmonary nodule is nonspecific but metastatic disease not entirely excluded.
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Generate impression based on findings.
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For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. There is mild loss of lumbar lordosis. No spondylolisthesis. There is mild lumbar dextrocurvature as seen on prior radiographs. There are postsurgical changes of laminectomy from L3 to L5.Multilevel degenerative changes are seen with moderate loss of disk height at L3-L4 and mild loss of disk height at L4-L5 and L5-S1. There is evidence of vacuum disk phenomena at L3-L4 L4-L5, and L5-S1 with degenerative changes involving the adjacent endplates. Individual levels as describe below:At L1-2 there is mild disk bulge and ligamentum flavum thickening resulting in mild spinal canal narrowing and mild bilateral neural foraminal narrowing. At L2-3 there is mild disk bulge and ligamentum flavum thickening resulting in mild to moderate spinal canal narrowing. There is mild right and moderate left neural foramina stenosis. At L3-4 spinal canal is surgically decompressed. There is mild right and severe left neural foramina stenosis. At L4-5 spinal canal is surgically decompressed. Disk bulge with endplate and facet osteophytes resulting in severe right and moderate to severe left neural foramina stenosis. At L5-S1 spinal canal is patent. There is disk bulge with endplate osteophytes resulting in moderate to severe left and mild to moderate right neural foramina stenosis.Degenerative changes are also seen at the sacroiliac joints with vacuum phenomenon bilaterally.Vascular calcifications are noted as well as left renal cyst.
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Postsurgical changes of prior laminectomies from L3 to L5. Multilevel degenerative changes are seen throughout the lumbar spine. No high-grade spinal canal stenosis is seen. There is moderate to severe neural foraminal stenosis at multiple levels as detailed above and can be further assessed with MRI if clinically indicated.
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Generate impression based on findings.
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Ms. Lee is a 45 year old female with a personal history of left breast lumpectomy in 2010 for malignant Phyllodes tumor followed by radiation therapy. Family history of ovarian cancer in two maternal aunts. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Two stable benign morphology masses are present in the right upper outer breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes project over the right axilla.
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Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Female 52 years old; Reason: r/o PE History: chronic dyspnea The comparison chest radiograph performed on 1/22/2015 demonstrates no focal pulmonary opacities or pleural fluid. There is moderate matched ventilation perfusion defect in the superior lingular segment of the left lung. Otherwise the remaining segments of the bilateral lungs are normal with no ventilation/perfusion defects noted.
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Low probability for pulmonary embolism.
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Generate impression based on findings.
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Female 57 years old Reason: ra History: oa Left foot: Bone mineralization is normal. Alignment is anatomic. There is mild joint space loss at the first metatarsal phalangeal joint. Mild arthritis affects the midfoot. There is a small calcaneal heel spur. No focal erosive change.Right foot: Bone mineralization is normal. Alignment is anatomic. There is mild joint space loss at the first metatarsal phalangeal joint.Mild arthritis affects the midfoot. There is a small calcaneal heel spur. No focal erosive change.
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No radiographic evidence of rheumatoid arthritis.
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Generate impression based on findings.
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65 real female with right knee pain. Three weight-bearing views of the right knee are provided. Moderate osteoarthritis with joint space narrowing and osteophyte formation greatest in the medial tibiofemoral compartment. No acute fracture or malalignment.Moderate osteoarthritis is also noted in the left knee on the frontal view, slightly less in degree compared to the right.
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Moderate osteoarthritis.
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Generate impression based on findings.
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Female 67 years old; Reason: 67y/o female with right breast cancer; surgery 1/23/15 right breast wire loc lumpectomy and R SNBx in DCAM History: 67y/o female with right breast cancer; surgery 1/23/15 right breast wire loc lumpectomy and R SNBx in DCAMRADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.0 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker.
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Sentinel node identified in the right axilla.
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Generate impression based on findings.
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53 year old female with cough, lung mass. LUNGS AND PLEURA: Thick walled cavitary mass with consolidation in the right upper lobe, with mild bronchiectasis within the cavity. There is associated right lung volume loss and retraction. Moderate centrilobular emphysema. Scattered micronodules measuring less than 4 mm, with clustered micronodules in the right middle lobe suggesting bronchiolitis possibly due to aspiration. Basilar scarring/atelectasis. MEDIASTINUM AND HILA: Rightward mediastinal shift with the right mediastinal border indistinguishable from the right upper lobe mass. Scattered prominent mediastinal lymph nodes, with enlarged paratracheal lymph node measuring 11 mm in short axis (series 3 image 25). Mild coronary calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Wedge shaped areas of abnormal low attenuation involving both kidneys suggest multifocal infarcts but incompletely evaluated.
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1. Thick walled right upper lobe cavitary mass, for which differential considerations include necrotizing infection secondary to pyogenic infection or mycobacteria including tuberculosis, or less likely malignancy. 2. Borderline enlarged nonspecific mediastinal lymph nodes may be reactive in etiology. 3. Moderate centrilobular emphysema. 4. Wedge shaped areas of abnormal low attenuation involving both kidneys suggest multifocal infarcts but are incompletely evaluated.
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Generate impression based on findings.
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78-year-old female with pain, evaluate for fracture There is a cortical step off along the iliopubic line with minimal displacement. The proximal femur appears intact.
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Minimally displaced pelvic/acetabular fracture, CT is recommended for further evaluation.
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Generate impression based on findings.
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Reason: patient with history of endometrial stromal sarcoma and now with an anterior vaginal wall lesion, possibly a urethral diverticulum History: vaginal bleeding PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Within the vaginal cuff, centered more on the left, there is a lobulated, gray T2, low T1 mass, measuring approximately 2.4 x 1.4 x 2.8 cm on sagittal images (701:24 and 901:16). This mass demonstrates some diffusion, and parts of it demonstrate avid enhancement with no significant washout. This mass also apparently has a fat plane between the urethra anteriorly, and rectum, posterior, and seems to be contained within the cuff.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.Approximately 3 cm lobulated mass within the vaginal cuff as described above is suspicious for recurrence in light of given history of endometrial stromal sarcoma.
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Generate impression based on findings.
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Ms. Fox is a 76 year old female with a history of unilateral spontaneous left nipple discharge. On physical exam by Dr. Chhablani today, she had nipple discharge that was slightly blood tinged. The discharge has been sent for cytology. Upon physical exam. Upper left breast, no nipple discharge was able to be expressed. No mass was noted.A targeted left breast ultrasound was performed for the patient’s area of concern. Several mildly ectatic ducts were identified behind the left nipple. The largest duct measured approximately 3 mm in maximal dimension. No intraductal mass or abnormal vascularity was identified.
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Ductal ectasia with no abnormal intraductal mass or vascularity. The patient will follow-up with Dr. Chhablani regarding the nipple discharge and resultant cytology. All results and recommendations were relayed to the patient and Dr. Chhablani.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Male; 77 years old. Reason: Decreased diffusion capacity on PFTs, please examine for parenchymal process History: Shortness of breath LUNGS AND PLEURA: Mild upper lobe predominant paraseptal and centrilobular emphysema. Mild bibasilar bronchiectasis and bronchial wall thickening. Minimal streaky bibasilar subsegmental atelectasis and/or scarring. Stable scattered pulmonary micronodules. No suspicious pulmonary nodules or masses. No evidence of chronic interstitial lung disease. No air trapping or honeycombing. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Old healed left rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild nonspecific left adrenal thickening with calcification, unchanged since the CT abdomen and pelvis from 7/17/12. Renal cysts, partially visualized.
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Emphysema, but no evidence of chronic interstitial lung disease.
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Generate impression based on findings.
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84-year-old male with nonhealing partial distal phalanx amputation Marked soft tissue swelling and irregularity about the distal aspect of the first toe. There is cortical erosion and irregularity of the distal aspect of the residual distal phalanx of the first toe.
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Findings concerning for osteomyelitis of the distal phalanx of the first toe as described above.
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Generate impression based on findings.
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Reason: eval for mediastinal mass History: 15yo F with eye swelling, parotitis, want to r/o mediastinal massVIEWS: Chest PA/lateral (two views) 01/22/15 Aortic arch, cardiac apex, and stomach are left sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate peribronchial cuffing suggestive of the bronchiolitis/reactive airway disease pattern.
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Bronchiolitis/reactive airway disease pattern. No mediastinal mass as clinically questioned.
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Generate impression based on findings.
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Reason: evaluate healing after posterior spinal fusion History: scoliosisVIEWS: Thoracolumbar spine PA/lateral (two views) 01/22/15 Spinal fusion instrumentation extends from T3 to L2. Rods, hooks, and pedicle screws are intact without evidence of hardware complication. Minimal rightward curvature of the lower thoracic spine.
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Spinal instrumentation without evidence of hardware complication.
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Generate impression based on findings.
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Severe headache No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.Small left maxillary mucous retention cyst. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. Calvarium is intact.
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No evidence of acute intracranial hemorrhage or mass effect. If there is continued suspicion for an intracranial structural abnormality, consider MRI for further evaluation.
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Generate impression based on findings.
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50-year-old female with history of benign biopsy of the left breast in 2008 presents for annual mammogram. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. Tomosynthesis images are also obtained. The breast parenchyma is extremely dense, unchanged in pattern and distribution. Percutaneously placed clip within a benign mass in the left lower inner quadrant is in stable position 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. Tomosynthesis is useful for dense breasts. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: 2 right middle lobe nodules seen on previous Chest CT, smoker History: SOB, Cough, known lung nodules LUNGS AND PLEURA: Two elliptically shaped right middle lobe nodules seen previously are unchanged measuring 6 mm (series 5, images 49, 50). There is increased lower lobe bronchial wall thickening now with impaction, with increased basilar atelectasis and areas of subpleural consolidation, and two new right middle lobe nodular opacities measuring 6 mm and 9 mm (both on series 5 image 53). Patchy pulmonary groundglass opacity likely reflects examination in the expiratory phase, somewhat limiting comparison to previous. MEDIASTINUM AND HILA: Enlarged left thyroid lobe. Severe coronary calcification. Scattered mediastinal lymph nodes, some calcified, appear unchanged. CHEST WALL: Segmentation anomaly and degenerative changes of the thoracic spine. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. The two elliptically shaped right middle lobe nodules seen previously are unchanged and likely are intrapulmonary lymph nodes. Two new right middle lobe nodular opacities, along with increased lower lobe bronchial wall thickening/impaction, collectively suggest bronchiolitis possibly secondary to recurrent aspiration. 2. Other chronic findings as described above.
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Generate impression based on findings.
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67 year old female status post OGT placement. Pelvis excluded from field of view. OG tube sidehole at the GE junction and may be advanced at least 8 cm. Nonobstructive bowel gas pattern. Levoscoliosis, spinal degenerative disease and changes from prior laminectomies again noted. Minimal right basilar atelectasis/scarring.
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OG tube sidehole at the GE junction, may be advanced at least 8 cm.
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Generate impression based on findings.
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Male 59 years old; Reason: h/o HNC and CRT History: problems with ORN; has mandibular lesion; see CT neck 11/4/14RADIOPHARMACEUTICAL: 15.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion grossly demonstrates posttherapy changes in the neck, as well as a lytic process in the left mandible not significantly changed as recently described on prior CT. There is scattered parenchymal scarring noted bilaterally in the lungs. There are extensive atherosclerotic calcifications, including coronary artery calcification.Today's PET examination demonstrates interval resolution of the bilateral hypermetabolic pulmonary nodules. In the left anterior mandible corresponding to the lytic process on CT, there is a linear mild to moderate increased activity with an SUV max of 3.2, new from prior study which could represent tumor activity or inflammatory/infectious osseous process. Otherwise no additional evidence of FDG avid activity to suggest new metastatic disease.There is a hypermetabolic colonic lesion, likely sigmoid, with an SUV max of 4.3, new from prior study, may represent an unusually focal benign/inflammatory process or a primary neoplasm.
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1.New mild to moderate hypermetabolic activity corresponding to the lytic process in the left mandible on CT may represent infectious/inflammatory osseous process or tumor. No additional suspicious FDG avid lesion to otherwise suggest metastatic disease.2.New hypermetabolic colonic (likely sigmoid) lesion may represent an unusually focal benign / inflammatory process but a primary colonic tumor is also a possibility. If there has been no recent colonoscopy, this would be recommended for further evaluation as clinically warranted.
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Generate impression based on findings.
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Reason: evaluate healing of fracture History: left humerus x-rayVIEWS: Left humerus AP/lateral (two views) 01/22/15 Overlying cast material obscures fine bone detail. Again seen is a comminuted fracture through the mid diaphysis in near anatomic alignment with mild periosteal reaction and callus formation suggestive of healing.
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Healing left humeral diaphysis fracture.
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Generate impression based on findings.
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Reason: r/o pna History: sobVIEW: Chest AP (one view) 01/22/15 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Minimal peribronchial cuffing suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Reason: eval for metatarsal fracture History: foot pain sports in volleyball and basketball for 2 weeksVIEWS: Right foot AP/oblique/lateral (3 views) 01/22/15 No acute fracture or malalignment is evident.
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Normal examination.
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Generate impression based on findings.
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2 to 3 months of breast tenderness. Family history of breast cancer in mother and sister. 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, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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No mammographic evidence of malignancy. Clinical correlation is recommended regarding the patient's breast tenderness. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: evaluate healing 6 weeks after posterior spinal fusion History: scoliosisVIEWS: Thoracolumbar spine PA/lateral (two views) 01/22/15 Spinal fusion instrumentation extends from T3 to L2. Rods, hooks, and pedicle screws appear intact without evidence of hardware complication. Minimal residual rightward thoracic curve is present.
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Spinal fusion instrumentation without evidence of hardware complication.
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Generate impression based on findings.
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Reason: L Hip Arthritis in Pt w/ CP who quit walking 3mo prior History: L hip painVIEWS: Left hip AP/frog leg (two views) 01/22/15 No acute fracture or malalignment is evident. No findings to account for patient's pain.
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Normal examination.
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Generate impression based on findings.
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87-year-old female with new diagnosis of esophageal cancer. Initial staging.RADIOPHARMACEUTICAL: 14.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 97 mg/dL. Today's CT portion grossly demonstrates mass-like thickening of the mid to distal esophagus, compatible with known esophageal malignancy. Enlarged gastrohepatic lymph nodes are additionally noted. There is extensive atherosclerosis, including coronary arterial calcifications.Today's PET examination demonstrates a large, markedly hypermetabolic mid to distal esophageal lesion, compatible with known primary esophageal malignancy (SUV max 14.0). Markedly hypermetabolic, enlarged gastrohepatic lymph nodes (SUV max 5.9) are compatible with regional lymph node metastases.Several periaortic hypermetabolic lymph nodes in the inferior chest are suspicious for additional metastases (SUV max 3.1). Symmetric bilateral hilar and paratracheal lymph nodes demonstrate mild hypermetabolic activity, and given their symmetrical nature could represent inflammatory lymph nodes, though remain suspicious for additional lymph node metastases.Additional subcentimeter but abnormally hypermetabolic left retroperitoneal lymph nodes are present, extending to the level of the inferior pole of the left kidney, suspicious for additional lymph node metastases (SUV max 2.5).Vague focus of mild radiotracer uptake in the posterior right sacrum (SUV max 2.3) may reflect benign etiology such as sacral insufficiency fracture, though osseous metastasis is a strong diagnostic consideration.Known brain lesion in the left precentral gyrus seen on MRI is not included in the PET field-of-view.
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1.Markedly hypermetabolic mid to distal esophageal mass compatible with known primary esophageal carcinoma. Markedly hypermetabolic, enlarged gastrohepatic lymph nodes are compatible with regional lymph node metastases.2.Numerous smaller, more mildly but still abnormal hypermetabolic lymph nodes in the chest and abdomen extending from the paratracheal level superiorly to the level of the inferior pole of left kidney inferiorly, suspicious for additional lymph node metastases.3.Findings equivocal but suspicious for right sacral osseous metastasis.4.Note the known brain lesion in the left precentral gyrus seen on MRI is not included in today's body PET field-of-view. Dedicated brain PET may be considered to evaluate for brain metastases if clinically indicated.
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Generate impression based on findings.
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54-year-old male with first MTP joint pain and swelling Prominent posterior calcaneal heel spur. The Achilles tendon is not well visualized. There is diffuse soft tissue swelling about the foot. No fracture is evident.
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Diffuse soft tissue swelling without fracture evident.
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Generate impression based on findings.
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57-year-old male with neutropenia and dental pain, rule out abscess Several missing molars are noted. There is no gross bone destruction or other evidence of osteomyelitis. The maxillary sinuses are well-aerated.
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No evidence of osteomyelitis.
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Generate impression based on findings.
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Mild proptosis and concern for thyroid disease. Orbit: There is mild proptosis, with the distance from the infrazygomatic line to the anterior surface of the globe measuring 28 mm bilaterally. There is mild thickening of the inferior, medial, and superior rectus muscles bilaterally. In addition, there is central hypoattenuation in the inferior rectus muscle bellies. There is perhaps mild crowding of the structures in the orbital apex, but otherwise no definite evidence of optic nerve compression. There is no evidence of intraorbital mass lesions. The orbital walls are intact. Head: There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. Findings compatible with thyroid eye disease with proptosis and mild crowding of the structures in the orbital apex, but otherwise no definite evidence of optic nerve compression.2. No evidence of intracranial hemorrhage or mass.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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Female 63 years old; Reason: other cause of RUQ pain History: RUQ pain, pos murphy's, neg RUQ ultrasound ABDOMEN:LUNG BASES: Hazy reticular opacities at the lung bases, likely atelectasis.LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right hepatic lobe (4:29) is too small accurate characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hypodense cystic lesion, presumably in the right adnexa, measures 2.4 cm, previously 1.2 cm in AP dimension. No obvious enhancement. Uterus is 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 acute abdominal or pelvic pathology.2.Interval increase in size of cystic lesion in the right adnexa. Follow up ultrasound is suggested to better assess the lesion.
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Generate impression based on findings.
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60 year-old female with history of metastatic breast cancer CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are again seen, with the reference right lower lobe pulmonary nodule (6/73) measuring 14 x 12 mm, previously 10 x 7 mm.Several small new pulmonary nodules are appreciated.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. Right chest Port-A-Cath with tip in SVC. Marked coronary artery calcifications. No significant mediastinal lymphadenopathy.CHEST WALL: Necrotic left axillary reference lymph node (4/25) measures approximately 31 x 23 mm, previously 28 x 19 mm. Additional necrotic lymph nodes are similar to slightly increased in size. Mildly enlarged right axillary lymph nodes are also seen.ABDOMEN:LIVER, BILIARY TRACT: New approximately 14 x 11 mm hypoattenuating left hepatic dome lesion, in this clinical setting is suspicious for metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left ilium small focus of sclerosis, unchanged. Liquid benign bone island. The skeleton is heterogeneously sclerotic, consider nuclear medicine study for additional specificity.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Multiple pulmonary nodules, some of which have increased in size, in addition to a new left hepatic dome hypoattenuating focus. Bilateral axillary lymphadenopathy as described above. Findings suggestive of progression of disease.
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Generate impression based on findings.
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Female; 57 years old. Reason: PE History: L sided chest pain PULMONARY ARTERIES: Extensive bilateral acute pulmonary emboli with clot seen in the right and left main pulmonary arteries extending into all of the lobar branches. Normal caliber of the main pulmonary artery. Increased caliber of the right ventricle with flattening of the interventricular septum and a large right atrium, compatible with right ventricular strain.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative arthritic changes of the thoracic spineUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Extensive bilateral acute pulmonary emboli with right ventricular strain as described above.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Positive.
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Generate impression based on findings.
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52 year male stem cell transplant patient needing an MRI of sinus. Need x-ray to rule out metal jaw implants from previous procedure. Wire-like device projects over the angle of the mandible bilaterally. Multiple dental amalgam.
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Wire-like device projects over the angle of the mandible bilaterally. MRI compatibility cannot be determined from this radiograph.
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Generate impression based on findings.
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14 year old female with thyroid left wrist pain.VIEWS: Left wrist AP lateral and oblique (3 views) 1/22/2015 A minimally displaced transverse fracture through the distal pole of the scaphoid is evident. Moderate soft tissue swelling is evident about the wrist. No additional fracture is seen.
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Minimally displaced transverse fracture of the distal scaphoid.
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Generate impression based on findings.
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48-year-old female status post explant TSA, Abx spacer placement. Hardware components of a reverse left total shoulder arthroplasty device are situated in near anatomic alignment with no radiographic evidence of hardware complication. New placement of cerclage wire. Metal fragments again noted projecting over the left chest and axilla.
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Postsurgical changes with new placement of cerclage wire. No radiographic evidence of hardware complication.
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Generate impression based on findings.
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Female, 63 years old, with new lethargy and left-sided weakness. Loss of gray-white distinction is seen involving the right insula, perhaps the right putamen, and perhaps within the right temporal lobe. Areas of hypoattenuation are also seen within the right corona radiata. The right MCA is hyperdense at the level of the bifurcation suggesting the presence of thrombus.Elsewhere, patchy white matter hypoattenuation is seen which correlates with findings on prior MRI suggestive of age indeterminate microvascular ischemic disease. No evidence of significant mass-effect is seen. No intracranial hemorrhage or abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.The osseous structures of the skull are intact. The paranasal sinuses are clear with the exception of a small amount of debris in the right sphenoid sinus.
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Findings concerning for acute right MCA distribution ischemia.(Discussed with Dr. Greenberg at 5:00 PM on 1/22/15.)
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Generate impression based on findings.
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Female 63 years old Reason: OA, eval interval change History: knee pain, crepitus Right knee: Bone mineralization is normal. There is genu varus due to severe medial compartment joint space loss where there is bone-on-bone apposition. There is moderate to severe extensor compartment joint space loss. There are tricompartmental osteophytes. No joint effusion. No acute fracture or dislocation.Left knee: Bone mineralization is normal. There is genu varus due to severe medial compartment joint space loss where there is bone-on-bone apposition. There is moderate to severe extensor compartment joint space loss. There are tricompartmental osteophytes. No joint effusion. No acute fracture or dislocation.
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Severe bilateral knee osteoarthritis.
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