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Generate impression based on findings.
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Reason: Eval for PNA History: fever hypotension LUNGS AND PLEURA: Exam is limited by respiratory motion artifact. Mild emphysema.Multiple nodules in the left upper lobe measuring up to 11 mm (solid nodule on image 38/91). Scattered centrilobular nodules are noted in the left upper lobe. Scattered punctate micronodules are present elsewhere. A calcified granuloma is seen in the left upper lobe.Equivocal bronchiectasis involving the anterior portions of the right middle lobe and lingula and upper lobes, presumably post inflammatory.MEDIASTINUM AND HILA: Coronary calcification. Cardiomegaly.CHEST WALL: Compression fracture of T10UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Probable splenomegaly though upper abdominal evaluation is limited.
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1. Multiple nonspecific pulmonary nodules, most numerous in the left upper lobe, measuring up to 11 mm. The findings are suspicious for infection, especially fungal if the patient is immunocompromised. Given the patient's age these should be followed to resolution to exclude underlying malignancy as this is an alternative consideration.2. T10 compression fracture.3. Other findings as above.Findings communicated to Dr. Escue via text paging tool at the time of report.
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Generate impression based on findings.
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51 year old female with chest pain, epigastric pain and upper back pain -- rule out aortic dissection. CHEST:LUNGS AND PLEURA: No significant abnormality noted.No parenchymal masses, nodules or foci of airspace consolidation. No pleural abnormality seen.MEDIASTINUM AND HILA: No significant abnormality noted - no abnormal masses or abnormal fluid collections.CT Angiogram: Ascending aorta, aortic arch and descending thoracic aorta show normal caliber without aneurysm or dissection. Origins of the aortic arch great vessels show no significant narrowing or other abnormality. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology to the liver again seen with no abnormal masses enhancing arterial phase imaging. No portal venous or delayed phases were obtained to document further status of the liver parenchyma or portal or hepatic veins.Low density gas is seen in the gallbladder which appears to be contained within gallstones as demonstrated on prior ultrasound examination. The air in the gallstones is new since 1/11/12, but is doubtful to be of clinical significance. No intrahepatic or extrahepatic biliary dilatation is seen to suggest obstructionSPLEEN: Splenomegaly without focal abnormality.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CT ANGIOGRAM: Aorta is of normal caliber throughout without evidence of aneurysm or dissection. Origins of the celiac axis, superior mesenteric artery, bilateral renal arteries, and inferior mesenteric artery appear normal. Normal bifurcation into normal bilateral, common and internal, and external iliac arteries are noted.BOWEL, MESENTERY: There has been a surgical repair of prior noted ventral wall hernias -- no evidence of bowel obstruction on today's examination. Small amount of scattered free ascites seen without loculation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent uterus, presumably prior hysterectomy. No other abnormalities.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 abnormality seen in the thoracic, or abdominal aorta, without evidence of aneurysm or dissection. 2. Cirrhotic morphology to the liver, unchanged. Incomplete evaluation of the liver parenchyma and vessels due to angiographic phase of imaging only. 3. Repair of prior noted ventral hernias with no evidence of bowel obstruction. 4. Cholelithiasis without other complication. 5. Ascites.
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Generate impression based on findings.
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56-year-old male with LVAD, evaluate for hematoma or fluid collection around LVAD CHEST:LUNGS AND PLEURA: Examination limited by motion artifact. Scattered groundglass and tree in bud opacities suggest small airways disease or aspiration.MEDIASTINUM AND HILA: Left chest wall generator and biventricular ICD leads as well as LVAD are in expected location. Severe coronary arterial calcifications. CHEST WALL: Status post median sternotomy.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: CholelithiasisSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Heterogeneously hyperdense collection within the left rectus abdominis sheath measuring up to 16.4 x 4.3 cm (image 113, series 4) compatible with hematoma. OTHER: No significant abnormality noted.
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Left rectus abdominous sheath hematoma. LVAD in appropriate position.
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Generate impression based on findings.
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53-year-old male. Reason: urothelial cancer, recurrent hematuria, evaluate for recurrence. CT Urogram, 3D reconstruction, delayed views. History: urothelial cancer CHEST:LUNGS AND PLEURA: Mild to moderate centrilobular emphysema is stable. Scattered pulmonary micronodules are unchanged from the prior study.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart size is normal and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is present without complications. Hypodense liver lesions are unchanged from the prior study, however remain too small to characterize. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Severe left hydronephrosis in a nonfunctioning kidney. There is moderate right hydronephrosis, unchanged from the prior study. Bilateral hydroureter. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystectomy with neobladder. The neobladder is markedly distended and extends craniocaudally for more than 13 cm. LYMPH NODES: No pelvic or inguinal lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic focus in the right femoral neck is unchanged. Left fat containing inguinal hernia.
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1.No change in bilateral hydronephrosis.2.No evidence of recurrent or metastatic disease.3.Marked distension of neobladder suggests outlet obstruction. 4.Stable examination. No measurable metastatic disease.
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Generate impression based on findings.
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53 year old female. History of metastatic anal cancer, presenting with worsening right upper quadrant abdominal pain. ABDOMEN:LUNG BASES: Left basilar subsegmental atelectasis.LIVER, BILIARY TRACT: Reference right hepatic lobe necrotic lesion measures 5.5 x 5.3 cm (image 21 series 3) previously 5.3 x 5.0 cm. Non-index lesions have increased even more in size, with new lesions as well.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule appears similar to prior exam and measures 11 x 11 mm (image 31, series 2).KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy appearing similar to prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left perirectal mass measures 3.3 x 2.8 cm (image 94, series 3) unchanged from 10/10/13 exam, and decreased in size from 6/11/13 exam. Rectal wall thickening, with tumoral extension into the perirectal fat appearing similar to prior exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Interval increase size and number of hepatic metastases. 2. Stable appearance of left perirectal mass with rectal wall thickening and perirectal fatty infiltration.
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Generate impression based on findings.
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Reason: r/o PE History: pleuritic constant CP x 1 day, radiating down arm, to back, to epigastric region PULMONARY ARTERIES: The pulmonary artery is of normal caliber.No pulmonary emboli identified.LUNGS AND PLEURA: Nonspecific right upper lobe nodule.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.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 evidence of a pulmonary embolus. No significant pulmonary or pleural abnormalities.
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Generate impression based on findings.
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Reason: rule out PE History: tachycardia, recent DVT, SOB PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: Numerous pulmonary metastatic nodules are similar in size and number compared of exam 4 days earlier.No pleural effusions or evidence of a pneumothorax.MEDIASTINUM AND HILA: Unchanged mediastinal lymphadenopathy with reference left lobe mediastinal lymph node (image 124 series a) measuring 15 mm x 14 mm.Stable left thyroid nodules.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Right chest port with catheter in the SVC.Sclerotic foci within multiple thoracic vertebrae compatible with osseous metastases.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of a pulmonary embolus. Stable numerous pulmonary metastatic nodules and vertebral metastases.
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Generate impression based on findings.
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Reason: 71 female with AML, r/o baseline infiltrate History: AML LUNGS AND PLEURA: Scattered groundglass and interstitial opacities with some nodular components are noted in the right middle lobe. Punctate calcified granuloma in right lower lobe.MEDIASTINUM AND HILA: Scattered small mediastinal nodes. Calcified right hilar and subcarinal nodes consistent with healed granulomatous disease.CHEST WALL: Degenerative changes involving the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Nonspecific right middle lobe opacities suggestive of infection or aspirate.
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Generate impression based on findings.
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89-year-old female patient with fever, night sweats. Evaluate for malignancy. LUNGS AND PLEURA: Biapical scarring. Scattered micronodules, some of which are calcified.Focal air space opacity in the posterior segment of the right upper lung is consistent with aspiration / infection (series 5 image 34). Mild diffuse bronchial wall thickening.Trace right basilar atelectasis. Left basilar atelectasis versus scarring. No pleural effusions.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion. Mitral annular calcifications. There is mild aneurysmal dilatation versus ectasia of the distal aortic arch with maximal diameter 3.5 cm (series 3 image 29). Scattered small mediastinal and hilar lymph nodes, some of which are calcified and consistent with prior granulomatous disease. Small hiatal hernia.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate atherosclerotic changes in the abdominal aorta.Hypoattenuating lesion in the posterior right lobe of the liver is incompletely evaluated on this noncontrast study.
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1.Focal air space opacity in the posterior right lung suggestive of aspiration/infection. Recommend follow-up to resolution.2.Ectasia of the distal aortic arch, measuring 3.5 cm in diameter.
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Generate impression based on findings.
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84-year-old female with head and neck cancer, compared with prior CHEST:LUNGS AND PLEURA: Stable thickening and calcification of the pleura. Mild right middle lobe atelectasis. Unchanged right apical scarring. Unchanged calcified nodules consistent with prior granulomatous disease. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Ossified, mediastinal and hilar lymph nodes consistent with prior granulomatous disease. Moderate coronary arterial calcification and calcifications in the thoracic aorta.CHEST WALL: Healed left scapular fracture and unchanged compression deformities of T4 and T5.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT:Unchanged subcentimeter hypodensities.SPLEEN: Stable small calcifications.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral hypodensities, some too small to characterize, are not significantly changed.PANCREAS: Prominence of pancreatic duct and parenchymal calcification suggestive of chronic pancreatitis appear similar to the prior study.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. No evidence of metastatic disease.2. Stable compression deformities of T4 and T5 vertebral bodies and healed left scapular fracture.3. Mild right middle lobe atelectasis and unchanged pleural calcifications and thickening.
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Generate impression based on findings.
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Reason: pt with lung ca s/p 2 cycles of chemo History: now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Reference left upper lobe mass has decreased to 47 x 42 mm on image 17/96 (63 x 16 mm on prior). Reference right middle lobe mass has decreased to 31 x 15 mm on image 51/96 (71 x 33 mm on prior). Patchy peripheral right upper lobe opacity (image 36/96) is similar. Emphysema. Scattered punctate massive micronodules, some of which are calcified, are similar.MEDIASTINUM AND HILA: Reference prevascular lymph node has decreased to 25 x 12 mm on image 26/126 (36 x 14 mm on prior). Right hilar, subcarinal, right paratracheal lymphadenopathy stable to decreased.Coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Nonspecific wall thickening involving the fundus of the gallbladder (image 99/126) and unchanged.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical scarring involving both kidneys.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small hiatal hernia.BONES, SOFT TISSUES: Degenerative change involving the spine.OTHER: No significant abnormality noted.
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Interval decrease in reference measurements as above.
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Generate impression based on findings.
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55-year-old male with recurrent head and neck cancer, evaluate disease progression CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules consistent with metastatic disease have increased in size. Reference right lower lobe nodule measures 1.2 x 1.0 cm and previously measured 9.0 x 9.0 cm (image 77, series 7). Reference left lower lobe nodule measures 1.0 x 0.7 cm and previously measured 9.0 x 0.7 cm (image 62, series 7).MEDIASTINUM AND HILA: Postoperative changes of the neck dissection are partially visualized. Right central venous catheter tip extends to the SVC. Coronary arterial calcification and dilated left ventricle.CHEST WALL: Status post axillary dissection. Reference left axillary lymph node measures 1.5 cm and previously measured 1.5 cm, now with internal hypodensity suggesting treatment effect (image 31, series 5).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic hypodensity is not significantly changed. Left hepatic dome hemangioma is again noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Increased size of pulmonary metastases. 2. Left axillary lymphadenopathy unchanged in size, but increased in internal hypodensity suggesting treatment effect.
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Generate impression based on findings.
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54-year-old male with metastatic renal cancer status post 4 cycles of investigational therapy. CHEST:LUNGS AND PLEURA: Interval increase in size of multiple lung nodules; reference right middle lobe nodule is only mildly increased in size, measuring 1.5 cm, previously measured 1.2 cm (series 5, image 58). Increase in size is better appreciated in non-index right lower lobe nodule currently measuring 1.2 cm, previously measured 0.5 cm (series 5, image image 90). No new nodules identified. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Heart is normal in size without pericardial effusion.CHEST WALL: Mixed lytic and sclerotic lesion in T9 vertebral body, unchanged (coronal series image 29).ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions in the liver are unchanged, likely benign cysts; previously measured right lobe lesion is unchanged, measuring 1.5 x 1.5 cm, previously measured 1.5 x 1.7 cm (series 3, image 127).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval increase in size of heterogeneous left kidney mass, currently measuring 4.5 x 3 .8 cm, previously measured 4.0 x 3.0 cm. The previously measured cortical defect in lateral aspect of left kidney is less well visualized on current exam and not accurately measurable (series 3, image 127).Right kidney unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion in L2 vertebral body appears unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Centrally hypoattenuating lesions along left pelvic sidewall most consistent with necrotic lymphadenopathy; reference node measures 4.6 x 2.5 cm (series 3, image 199).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip prosthesis again noted.OTHER: Fat-containing inguinal hernias.
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1.Increase in size of multiple lung nodules.2.Increase in size of left renal mass.3.Significant increase in pelvic lymphadenopathy.
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Generate impression based on findings.
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39-year-old female with seizures There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage, mass, or cerebral edema.
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Generate impression based on findings.
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Reason: h/o parotid cancer History: r/o lung mets LUNGS AND PLEURA: Previously noted centrilobular nodules in superior segment of left lower lobe have resolved and were likely due to aspirate. No definitive evidence of pulmonary metastases. Very small bilateral pleural effusions are present.MEDIASTINUM AND HILA: Port tip in high right atrium. Submental lymphadenopathy.CHEST WALL: Right chest wall port. Increase in left axillary lymphadenopathy.Previously noted hyperdense nodule in the left breast (image 36/71) has increased in size to 21 x 20 mm on image 36/71. There are multiple new chest wall/soft tissue nodules (left supraclavicular area image 5/71, right breast image 23/71, left posterior back image 48/71, right posterior back image 17/71, among others).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate hepatic hypodensities are too small to characterize but stable.
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1. Multiple new soft tissue nodules highly suggestive of metastatic disease.2. Interval resolution of pulmonary opacity likely due to aspirate. No definitive evidence of pulmonary metastases.
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Generate impression based on findings.
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50 year-old female with headache for 4 days, concern for bleed. Status post craniotomy for meningioma in 2007. Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. The distal right vertebral artery and right A1 segment of the ACA are mildly hypoplastic. No aneurysms are appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:There is no evidence of intracranial hemorrhage, mass, or cerebral edema. Redemonstration of right frontotemporoparietal craniotomy with small foci of encephalomalacia in the right frontal lobe appearing similar to the prior exam. The ventricles and basal cisterns are normal in size. Mild asymmetry of the CSF spaces is unchanged. There is no midline shift or herniation. The mastoid air cells are clear. A left maxillary mucous retention cyst/polyp is unchanged. Hyperostosis of the inner table of the calvarium is mildly increased.
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1.Stable encephalomalacia of the right frontal lobe without acute abnormality.2.No evidence of aneurysm.
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Generate impression based on findings.
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Reason: chest pain History: SOB, pain on inspiration PULMONARY ARTERIES: There is no evidence of a pulmonary embolus.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of a pulmonary embolus. No significant pulmonary or pleural abnormalities.
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Generate impression based on findings.
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Total thyroidectomy for cancer. Evaluate for metastatic disease. LUNGS AND PLEURA: Several micronodules are identified: right upper lobe (image number 27/82, superior segment right lower lobe (image 37/82 and 4.4 mm in diameter), right lower lobe (image 43/82 40/42, 49/82 and 3.1 mm in diameter).MEDIASTINUM AND HILA: Mediastinal surgical clips are again visualized. The cardiac silhouette size is normal. A calcification of adductus arteriosus is present, normal variant anatomy.CHEST WALL: Multiple surgical clips are present in the thyroid bed.UPPER ABDOMEN: No abnormality identified.
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Continued right micronodules.
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Generate impression based on findings.
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headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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Reason: 25 yo F with ESRD s/p transplant in 2003 and 2013 who p/w colitis. Has lung nodules seen on CT abd. History: 25 yo F with ESRD s/p transplant in 2003 and 2013 who p/w colitis. Has lung nodules seen on CT abd. LUNGS AND PLEURA: New small pleural effusions with patchy ground glass and interstitial opacities at the lung bases. More well-defined subcentimeter centrilobular nodular opacities are noted in the posterior aspects of the upper lobes bilaterally (images 26-30/89). Mild associated bronchial wall thickening.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia, atrophic end-stage kidneys. See recent abdomen CT report for details.
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New bilateral subcentimeter nodules with bronchial wall thickening suggestive of bronchiolitis, likely related to infection or aspirate. Superimposed pulmonary edema with small bilateral pleural effusions.
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Generate impression based on findings.
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intracranial hemorrhage? cva?Altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries.There is reversal of the normal cervical curvature identified on the scout images which is a nonspecific finding
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of hemorrhagic CVA
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Generate impression based on findings.
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87-year-old male with abdominal pain -- ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Low attenuation lesions in the cortex is seen bilaterally -- the larger of these can be categorized as cysts with near water density -- the smaller of these are too small to characterize.RETROPERITONEUM, LYMPH NODES: Atherosclerotic change is seen. The aorta, with peripheral calcifications -- no other abnormality seen. No adenopathy.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal-appearing stomach, small bowel to the right lower quadrant without evidence of obstruction or intrinsic abnormality. Colon is feces filled without other abnormality. No evidence of appendicitis or diverticulitis. No free mesenteric fluid seen.BONES, SOFT TISSUES: Diffuse degenerative changes seen without focal abnormality to suggest neoplastic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal-appearing stomach, small bowel to the right lower quadrant without evidence of obstruction or intrinsic abnormality. Colon is feces filled without other abnormality. No evidence of appendicitis or diverticulitis. No free mesenteric fluid seen.BONES, SOFT TISSUES: Diffuse degenerative changes in the bony skeleton.OTHER: No significant abnormality noted
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1. No findings seen to account for patient's symptomatology. No significant abnormalities identified.
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Generate impression based on findings.
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76 year old male with history of relapsed T-cell lymphoma. Status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: New small left pleural effusion.MEDIASTINUM AND HILA: Increased size and number of enlarged mediastinal lymph nodes. Reference prevascular lymph node measures 5.0 x 2.6 cm (image 28, series 4) previously 2.6 x 2.0 cm. Small supraclavicular lymph nodes are unchanged.CHEST WALL: Gynecomastia is again noted. Central venous catheter tip at the cavoatrial junction. Right axillary lymph node is slightly enlarged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenomegaly is again noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node measures 2.3 x 1.5 cm (image 102, series 4), previously 5.2 x 2.5 cm. While the reference node is smaller, many non index nodes are increased in size from prior exam, for example retroperitoneal lymph node measures 2.2 x 1.9 cm (image 99 series 4) previously 2.0 x 1.4 cm. Interval increase in size of right retrocrural lymphadenopathy. Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Compression fracture of L1 vertebral body is unchanged.OTHER: Bilateral fat containing inguinal hernias.
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1. Interval increase in size and number of enlarged mediastinal lymph nodes2. Mixed response of retroperitoneal lymphadenopathy. 3. New small left pleural effusion.
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Generate impression based on findings.
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anterior cerebral artery and left internal carotid aneurysms, follow up yearly Brain CTA: There is redemonstration of a 2 x 3-mm axial dimension a right distal cavernous internal carotid artery aneurysm with a small neckThere is redemonstration of a 1.5-mm aneurysm off the proximal portion of the left ophthalmic artery.The A1 segments are similar in size. The vertebral arteries are similar in size.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.Stable size of right internal carotid artery cavernous segment aneurysm.2.Stable 1.5-mm left ophthalmic artery aneurysm.3.No evidence for cerebral vascular occlusive disease4.Please note that imaging was repeated due to suboptimal initial images. As a result there are two sets of images
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Generate impression based on findings.
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Reason: Pancreas cancer please assess for any thoracic involvement History: As above LUNGS AND PLEURA: Calcified granuloma left lower lobe. No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Scattered small subcentimeter lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Biliary stent partially visualized. Please see recent abdomen pelvis CT report for further details.
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No evidence of pulmonary metastases.
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Generate impression based on findings.
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Reason: h/o lung cancer with mets to abd, has been givn chemo but in prolonged remission now woth new pain pleuretic in nature History: as above CHEST:LUNGS AND PLEURA: Status post left pneumonectomy. Emphysema. Scattered punctate micronodules are stable. No new pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative disease affects the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hypodensities are too small to characterize but stable and likely benign. Status post cholecystectomy.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: Small upper abdominal lymph nodes are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Postop change. Small ventral hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable postoperative changes. No evidence of measurable disease.
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Generate impression based on findings.
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Reason: TNBC on chemotherapy now with worsening cough, evaluate for PE, pneumonia, interstitial process History: History of breast cancer, with worsening cough. Evaluate for PE PULMONARY ARTERIES: No evidence of PE.LUNGS AND PLEURA: Groundglass and interstitial opacity in superior segment left lower lobe with associated bronchial wall thickening suggestive of bronchiolitis, likely related to aspirate or infection.MEDIASTINUM AND HILA: Port tip at RA/SVC junction. Scattered small subcentimeter mediastinal nodes. Mild bilateral hilar adenopathy.CHEST WALL: Right breast mass consistent with known carcinoma. Left chest wall port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of PE. Groundglass and interstitial opacity in superior segment left lower lobe with associated bronchial wall thickening suggestive of bronchiolitis, likely related to aspirate or infection. Mild bilateral hilar adenopathy.
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Generate impression based on findings.
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68-year-old male with cerebellar degeneration, evaluate for malignancy. Lack of coordination. CHEST:LUNGS AND PLEURA: Calcified granulomata. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Dense atherosclerotic calcification of the coronary arteries. Cardiac size is normal without pericardial effusion.CHEST WALL: Median sternotomy hardware is in place.ABDOMEN: Lack of intravenous contrast material limits the evaluation of abdominal organs.LIVER, BILIARY TRACT: There is prominence of the fissures, as well as right hepatic lobe atrophy. There is also a vessel suspicious for periumbilical portal systemic collaterals. These findings raise the question of chronic liver disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic radiation seeds, with small prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: Fat-containing inguinal hernias.
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1.Prostatic seeds presumed to be from treated prostate cancer, otherwise, no other findings of primary malignancy seen in the chest, abdomen or pelvis.2.Liver morphology suggestive of chronic liver disease.
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Generate impression based on findings.
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Female 65 years old; Reason: 65 y/o F with bilateral lower quadrant abdominal pain. CT abd /pelvis with oral and IV contrast requested. Schedule CT chest at same time. History: as above CHEST:LUNGS AND PLEURA: 6 x 8 mm nodule noted in the right lower lobe. Bilateral pleural thickening and atelectasis is noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in size and morphology. Patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few too small to characterize lesions noted in the kidneys. No hydronephrosis or perinephric fluid collections detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post gastric bypass surgery. No free air or contrast extravasation noted. No obstruction seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus has been resected. 6.5 x 5.5 x 5.2 cm loculated fluid collection measuring 15 Hounsfield units is noted, abutting the right adnexa. No definite soft tissue nodularity is seen. Multiple septations are noted within the lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thickening of the sigmoid colon with multiple diverticula. Surgical clips are noted within this region from prior intervention from prior diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Large multiloculated cystic lesion arising from the right adnexa. Suspicious for a cystic ovarian neoplasm.2.Non specific 6mm nodule right lung base, continued follow up advised
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Generate impression based on findings.
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Male 55 years old; Reason: history of follicular NHL now with increased c/o fatigue in need of scans History: Follicular NHL CHEST:LUNGS AND PLEURA: There are scattered pulmonary nodules. The right lower lobe micronodule (image 76 series 5) measures 4-mm.The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Small right axillary lymph node measures 1.4 x 1.2 cm (image 42/series 3). OTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Large left pelvic lymphadenopathy. Left external iliac lymph node measures 4.9 x 2.6 cm (image 201/series 3). BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Post operative changes in the left inguinal area.
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1.Enlarged pelvic lymphadenopathy.2.Small pulmonary nodules ; followup is suggested.
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Generate impression based on findings.
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53-year-old male with prostate cancer and rising PSA. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Well-defined hypodensities in the right lobe of the liver and are most compatible with benign cysts. No suspicious lesions identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific nodular thickening of left adrenal gland (series 3, image 48).KIDNEYS, URETERS: Hypoattenuating lesions in the right kidney compatible with benign cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal nodes in the abdomen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large heterogeneous prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged pelvic lymph nodes, right more than left; for reference, right internal iliac node measures 1.5 x 1.9 cm (series 3, image 127).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Pelvic lymphadenopathy suspicious for involvement by prostate cancer.
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Generate impression based on findings.
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10-year-old female with recurrent facial myxoid sarcoma, status post excision with flap reconstruction, evaluate reconstruction with 3-D techniques The patient is status post exophytic left facial tumor growth resection with subsequent flap reconstruction. There has been interval resection of a majority of the left-sided mastoid air cells as well as middle ear contents, left temporomandibular joint, the left zygomatic arch, left pterygoid plates, a portion of the inferolateral left orbit, a majority of the left maxilla, left hemipalate, and left mandible. Two bone graft fragments are present, one partially reconstituting the anterior left maxillary sinus region wall, and the other partially reconstituting the resected left mandible. Within the operative resection cavity, fat/soft tissue is consistent with placement of flap reconstruction. There is new reticulation within the left orbital intraconal fat with new left proptosis. The visualized intra-cranial contents remain unremarkable. Paranasal sinuses and mastoid air cells are opacified. Postoperative changes are noted including multiple surgical clips, air within the soft tissues, a nasopharyngeal airway, a presumed surgical drain, and significant soft tissue swelling.
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Extensive postoperative changes including excision of exophytic facial sarcoma with flap reconstruction including soft tissue and osseous elements.
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Generate impression based on findings.
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72-year-old male with history of metastatic esophageal cancer status post chemo, radiation and esophagectomy CHEST:LUNGS AND PLEURA:. Patchy right basilar opacities suggest aspiration. Unchanged right middle lobe nodule. Right lower lobe nodule measures 7 x 6 mm (image 76, series 4) and previously measured 2 x 3 mm.MEDIASTINUM AND HILA: Subcentimeter right hilar lymph node is unchanged. Prominent subcarinal lymph nodes are mildly decreased in size.Mild esophageal dilatation and interval decrease in diffuse wall thickening. Postoperative changes of partial esophagectomy. Reference retrocrural lymph node measures 1.5 x 2.2 cm and previously measured 1.6 x 2 .2 cm, not significantly changed (image 94, series 3). Additional retrocrural lymph nodes are not significant changed. Severe atherosclerotic calcification of the coronary arteries.CHEST WALL: Degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic dome hypodensity measures 1.0 x 0.7 cm and previously measured 0.9 x 1.2 cm (image 86 is 3). Additional hepatic hypodensities too small to characterize, are unchanged, but may represent a site of previous hepatic metastases.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreatic head calcifications and prominent duct suggestive of chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: Excessive atherosclerotic calcification of the aorta and its branches. Enlargement of a lymph node adjacent to the pancreatic head appears similar to the prior study (image 106, series 3).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Post operative changes and gastroesophageal anastomosis are again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Status post partial esophagectomy with unchanged retrocrural lymphadenopathy. A subcentimeter right lower lobe nodule is mildly enlarged, nonspecific but continued follow up is recommended.
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Generate impression based on findings.
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2 year-old male with history of ALL and status post transplant with rising EBV level. Evaluate for lymphoproliferative disease. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement. The orbits are unremarkable. The mastoid air cells are clear. The previously seen bubbly fluids and mucosal thickening in the paranasal sinuses have resolved. The Waldeyer ring appears mildly prominent but appropriate for the patient's age. There are small lymph nodes in the neck soft tissues, which have mildly increased in size since prior. The largest one is seen at level V on the left, measuring 13 x 7 x 15 mm (AP x TR x CC), compared to 8 x 5 x 10 mm on the prior. No mass is noted. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Enlarged axillary lymph nodes. Please refer to dedicated chest CT for pulmonary findings.
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1. No intracranial abnormality. 2. Mild interval increase in size of multiple small lymph nodes in the neck, with the largest one at left level V. The finding can be seen in PTLD or reactive in etiology. 3. Resolution of paranasal sinus inflammatory disease and acute sinusitis.
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Generate impression based on findings.
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72-year-old female with head and neck cancer status post treatment, pancreatic head mass, compare to prior, CHEST:LUNGS AND PLEURA: Biapical scarring, possibly related to prior radiation. Scattered micronodules, some of which are calcified, likely representing prior granulomatous disease. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Moderate atherosclerotic calcifications of the coronary arteries.CHEST WALL: No axillary adenopathy. Moderate degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal hypodensity, likely representing a cyst. Status post left nephrectomy.PANCREAS: Cystic pancreatic head mass measures 2.5 x 2.2 cm and previously measured 2.6 x 2.3 cm (image 103, series 3). No peripheral pancreatic duct dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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1. No evidence of metastatic disease.2. Cystic pancreatic head lesion not significantly changed, likely representing an IPMN.
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Generate impression based on findings.
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60 year-old male with gross hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal calcifications are seen. There is a subcentimeter left hypoattenuating lesion which is too small to characterize, but most likely represents a cyst. No suspicious renal masses are seen. We visualize nearly the entire length of the right ureter, and on the left we do not see the majority of the mid and distal ureter. Within these limitations, no ureteral abnormality is seen.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is heterogeneous and markedly enlarged, measuring 6.3 x 6.3 cm (image 131, series 6).BLADDER: The bladder is partially nondistended, but there is apparent diffuse mild to moderate bladder wall thickening. There are also multiple stones within the bladder.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.Markedly enlarged heterogeneous prostate.2.Diffuse bladder wall thickening, which may be due to chronic outlet obstruction or possibly non distention of bladder.3.Bladder stones.
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Generate impression based on findings.
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60-year-old male with gross hematuria and smoking history. Status post prostatectomy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities in the right lobe are incompletely characterized but most likely represent benign cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Thickening of anterior bladder wall with mucosal thickening extensions into lumen (series 9, image 117).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.Thickening of anterior bladder wall. Neoplasm is a possibility and follow up is suggested.2.Status post prostatectomy.
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Generate impression based on findings.
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50 year-old male with AML, pretreatment evaluation LUNGS AND PLEURA: Focal left lower lobe bronchial dilatation with adjacent opacity likely postinflammatory in etiology. Mild biapical scarring. No suspicious nodules or masses.MEDIASTINUM AND HILA: Mediastinal or hilar lymphadenopathy. Scattered atherosclerotic calcifications of the aortic arch. Residual thymus tissue is noted.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of acute infection.
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Generate impression based on findings.
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82-year-old female patient with history of right sided infiltrate on chest x-ray. Evaluate for hemothorax. CHEST:LUNGS AND PLEURA: Endotracheal tube with tip 5 cm above the carina.Moderate to large right pleural effusion and pneumothorax which could represent hemo/hydropneumothorax. New multifocal consolidation, worst in the right middle and lower lobes. On the left there are multifocal airspace, interstitial, and ground glass opacities. Multiple new pulmonary nodules are noted bilaterally measuring up to roughly 2 cm. Air extending into the chest wall presumably at the old chest tube site (image 65/107).MEDIASTINUM AND HILA: Heart size within normal limits without significant pericardial effusion. Mild right heart enlargement. Marked pulmonary artery enlargement, consistent with pulmonary hypertension. Tricuspid and mitral valve annuloplasty.Scattered prominent mediastinal and hilar lymph nodes. Debris in central airways consistent with aspiration.CHEST WALL: Multilevel degenerative changes in the thoracic spine. Subacute rib fractures on right consistent with recent surgery.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Gallbladder incompletely visualized with sludge/gallstones.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing renal calculus in the inferior pole of the left kidney. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes in the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Enteric tube with tip in the body of the stomach.BONES, SOFT TISSUES: Multilevel degenerative changes in the thoracic and lumber spine.OTHER: No significant abnormality noted.
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1. Right hydro vs hemopneumothorax with air tract into right chest wall soft tissues. Superimposed infection/empyema cannot be excluded.2. Multifocal, right worse than left, air space, groundglass and nodular opacities suggestive of infection.
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Generate impression based on findings.
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Reason: CT abd and pelvis with and without contrast ADRENAL PROTOCol Pt s/p left adrenalectomy myxoid adrenocortical tumor looking for recurrence History: adrenal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Stable lesion in the spleen is hypodense on portal venous phase of imaging and isodense to the remainder of the spleen on delayed phase, and may be a hemangioma or lymphangioma.PANCREAS: No significant abnormality notedADRENAL GLANDS: Stable postoperative changes of left adrenalectomy. Unremarkable right adrenal gland.KIDNEYS, URETERS: Duplicated left renal collecting systemRETROPERITONEUM, LYMPH NODES: Stable soft tissue interspersed with fat in the left retroperitoneum, at the level of the superior mesenteric artery adjacent to the medial crus of the left hemidiaphragm, is favored to be postsurgical.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable postoperative changes of left adrenalectomy. No evidence of recurrent or metastatic disease in the abdomen or pelvis.
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Generate impression based on findings.
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20 year-old male with metastatic germ cell tumor (seminoma) of mediastinum. Evaluate response to BEP. CHEST:LUNGS AND PLEURA: Interval decrease in nodular left upper lobe opacities; left apical nodule measures 1.3 cm, previously measured 1.9 cm (series 6, image 24).No new suspicious nodules identified.Unchanged elevation of left hemidiaphragm, consistent with paralysis due to phrenic nerve involvement by tumor.MEDIASTINUM AND HILA: Right chest wall port catheter tip in right atrium.Significant interval decrease in anterior mediastinal mass, which currently measures approximately 3.4 x 6 .3 cm, previously measured 9.4 x 8.2 cm (series 4, image 36).Interval decrease in upper mediastinal adenopathy. Previously measured left supraclavicular and superior mediastinal nodes are decreased and cannot be accurately measured on current exam. Right paratracheal node measures 7 mm, previously measured 9 mm (series 4, image 29). Persistent enlarged left paratracheal nodes (series 4, image 37).Heart is normal in size without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Ill-defined periaortic soft tissue does not appear significantly changed; reference left periaortic lesion measures 1.5 x 2.2 cm, previously measured 1.5 x 2.0 cm (series 4, image 106). 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: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Significant interval decrease in size of anterior mediastinal mass and mediastinal lymphadenopathy.2.Interval decrease in nodular left upper lobe lung opacities.3.Stable ill-defined retroperitoneal soft tissue.
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Generate impression based on findings.
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Clinical question: Rule out bleed after history of fall. Signs and symptoms: Fall yesterday at 7 p.m.. Unenhanced head CT:No detectable acute posttraumatic intracranial or calvarial findings.There is however a small hematoma/edema in the right super orbital soft tissues of the scalp measuring at 26 times 11 mm size.Mild age indeterminate small muscle ischemic strokes are noted evident by periventricular and subcortical low attenuation of white matter. Mild prominence of ventricular system and cortical sulci.Paranasal sinuses demonstrate a small retention cyst in the right posterior ethmoid and unremarkable otherwise.Bilateral mastoid air cells and middle ear cavities are well pneumatized.Images through the orbits are unremarkable.
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1.No detectable acute posttraumatic intracranial or calvarial findings.2.Right supraorbital scalp hemorrhage/edema measuring 11 x 26 mm.3.mild age indeterminate small muscle ischemic stroke is noted.4.Small retention cyst in the right posterior ethmoid and unremarkable paranasal sinuses and mastoid air cells otherwise.
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Generate impression based on findings.
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Female 78 years old; Reason: LLQ abd pain most when urinating History: LLQ abd pain most when urinating ABDOMEN:LUNGS BASES: Calcified granuloma right lung base.LIVER, BILIARY TRACT: Normal morphology without focal lesion detected. Granuloma are noted in the liver.SPLEEN: Granuloma are noted in the spleen.PANCREAS: Small lipoma the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few too small to characterize lesions in the kidneys. No hydronephrosis or fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No obstruction seen. Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No obstruction seen. Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of acute intraabdominal pathology detected.
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Generate impression based on findings.
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Male 72 years old; Reason: lung cancer follow-up History: followup scan after chemotherapy CHEST:LUNGS AND PLEURA: Severe upper lobe predominant centrilobular emphysema.The previously referenced spiculated nodule in the right lung apex is smaller, measuring 10 x 4 mm (series 4 image 32, previously 10 mm x 9 mm nodule in the right upper lobe . Scattered micronodules in both lungs are stable, however no other suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: Prominent precarinal lymph node is much smaller measuring 6 mm in short axis (image 42, series 3) previously measuring 11 mm.Cardiac size is normal without evidence of a pericardial effusion.Severe coronary artery calcification.Small hypodensity in the left lobe of the thyroid gland.CHEST WALL: No axillary lymphadenopathy.Sclerotic focus in the T5 vertebrae.ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a 2.1 x 1.4 cm hypoattenuating focus in segment 6 of the liver, which is stable since 8/13, however new since 2/13. Stable perihepatic ascites. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post partial left nephrectomy. Hypoattenuating lesions in both kidneys are incompletely characterized given lack of IV contrast, however not significantly changed and likely cysts. Stable hyperdense lesions in the kidneys likely represent proteinaceous or hemorrhagic cyst.Duplicated ureters are noted bilaterally, and incompletely visualized.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: New haziness in the mesentery as well as nodularity is noted in the right upper quadrant as best seen on images 130-133 of series 3. Soft tissue nodule measuring 3.6 x 2.1 cm in the anterior mesentery (series 3 image 111) is worrisome for peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. New onset nodularity in the anterior mesentery, worrisome for peritoneal carcinomatosis.2. Bilateral renal lesions, most likely cysts, unchanged. No suspicious renal masses are identified.3. Interval decrease in the right upper lobe nodule.Dr. Cohen notified with the findings at 12:30 on 11/25/13
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Generate impression based on findings.
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history of ALL status post transplant with rising EBV levels Evaluate for post-transplant lymphoproliferative disease CHEST:LUNGS AND PLEURA: Dependent atelectasis in the right lower lobe and left lower lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left chest port with tip in the SVC. Multiple enlarged lymph nodes in the axillary regions with the largest measuring 2 x 1 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple subcentimeter lymph nodes in the inguinal region bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple enlarged lymph nodes in the axillary regions bilaterally which can be seen in PTLD. Findings communicated to Caitlin Beaudoin at the time of dictation.
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Generate impression based on findings.
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Robotic assisted left pyeloplasty with stone formation on sonography. ABDOMEN:LUNG BASES: No focal lung opacity is present.LIVER, BILIARY TRACT: Distended gallbladder with no gallstones.SPLEEN: Normal in size.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left renal pelvis faces anteriorly. A double J. left nephroureteral stent is present. Multiple stones are identified. A string of several stones is approximately 0.9 cm in length and has a maximum width of 0.6 cm located anterior to the stent. In the lower pole of the left kidney there are 4 stones. The largest measures 1.1 cm in diameter. The other 3 measure 0.4, 0.5, and 0.2 cm in diameter. Mild dilatation of the left renal pelvis and calices is noted.The right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No dilated bowel loops are seen. The appendix is normal in appearance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free peritoneal fluid is present.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and containing the end of the stentLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple stones in the left pelvicaliceal system, the largest of which is 1.1-cm in diameter.
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Generate impression based on findings.
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Ventriculomegaly and hydrocephalus. Craniotomy for clipping of left PCA. Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. There is a two tandem foci of 50% narrowing along the middle cerebral artery inferior division at the M2 segmentThe anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment. The A1 segments are approximately equal in size.Atherosclerotic calcifications are present along the distal internal carotid arteries. The left vertebral artery is larger than the right vertebral artery. Atherosclerotic calcifications are present along the distal right vertebral artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. A small focus of encephalomalacia is present along the left anterior temporal lobe associated with ex vacuo effect along the temporal horn of the left lateral ventricle. There is a small focus of encephalomalacia along the left orbital gyrus posteriorly which is also stable. There are left-sided and to a much lesser degree right-sided periventricular and subcortical white matter hypodensities present which are stable since the previous exam. This is stable since previous exams.The patient is status post left-sided craniotomy for aneurysm clip placement adjacent to left posterior communicating artery.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses and ethmoid air cells which has developed since the prior exam compared some thickening of the walls of the right maxillary sinus suggest chronic sinusitis. There is thickening of the walls of the maxillary sinuses right more than left. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.
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1.The patient is status-post left posterior communicating artery aneurysm clipping. Please note that in the setting of aneurysm clip placement CTA is insensitive in detecting residual or recurrent aneurysm. Overall there is no interval change since the previous year's exam.2.There are two foci of approximately 50% stenosis of the proximal inferior division of the left middle cerebral artery. These are new since the prior exam.3.Periventricular and subcortical white matter hypodensities are nonspecific they are asymmetric towards the left side. They are stable since the previous exam.4.Small foci of encephalomalacia involving the left temporal lobe anteriorly and left orbital gyrus posteriorly.
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Generate impression based on findings.
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Male 58 years old; Reason: Hx pancreatitis and pancreatic pseudocyst History: abd pain ABDOMEN:LUNGS BASES: Trace pericardial effusion.LIVER, BILIARY TRACT: Hepatic contour is smooth. Probable right hepatic lobe cysts.SPLEEN: Multiple hypodense splenic lesions are incompletely characterized without contrast. Well-circumscribed cystic appearing lesion, and geographic less hypoattenuating lesions are stable.PANCREAS: No discrete fluid collections. Several stents project adjacent to the pancreatic head. Stable peripancreatic drain.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Probable right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stents project into the gastric lumen. Displaced stent within the descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Study limited without intravenous contrast. No discrete fluid collection adjacent to the pancreas.2.Nonspecific splenic lesions.
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Generate impression based on findings.
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Clinical question: NPH? Signs and symptoms: Off balance and headaches. Nonenhanced head CT:Mildly dilated supratentorial ventricular system demonstrate no convincing evidence of interval change.The largest transverse diameter of the third ventricle measures approximately 13 mm identical to prior exam. The measurements of bilateral frontal horns of lateral ventricles at the level of foramen Monro are 27.8-mm compared to prior study measurement of 26. The trigone of right lateral ventricle measures at 23-mm which is identical to prior exam as well. No detectable acute intracranial process. Cortical sulci remain widely patent and stable since prior exam.Unremarkable calvarium and soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.
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1.No evidence of any acute intracranial process.2.Stable mildly dilated supratentorial ventricular system primarily of the lateral ventricles since prior study.3.Unremarkable and stable exam otherwise.
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Generate impression based on findings.
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Altered mental status. History includes myelofibrosis. There is very mild patchy periventricular hypoattenuation which is stable from previous and most likely represents sequela of non-acute small vessel ischemic disease. There is no intracranial mass, edema or hydrocephalus. The midline is intact. Orbits, paranasal sinuses and mastoid air cells are unremarkable.
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No acute intracranial abnormality which would account for the patient's symptoms. Nonspecific mild hypoattenuation which could represent sequela of chronic small vessel ischemic disease.
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Generate impression based on findings.
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Clinical question: Status post fall. Signs and symptoms: Headache. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp.Unremarkable images through maxillofacial region and including orbits.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.
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Negative nonenhanced head CT.
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Generate impression based on findings.
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Clinical question: Rule out chronic sinusitis. Signs and symptoms: Recurrent sinus infection not responding to antibiotics. Chronic nasal obstruction; right-sided facial pain/pressure. Medtronic fusion sinus CT:Examination demonstrate a single small focus of mucosal thickening in the right chamber of the sphenoid sinus. All paranasal sinuses are otherwise well pneumatized and without evidence of acute or chronic sinusitis. Patent bilateral ostiomeatal units of maxillary sinuses and bilateral sphenoid recesses of the sphenoid sinus.Images through the nasal passage demonstrates significant rightward nasal septum deviation and a prominent bony septal spur projecting to the right and with mucosal contact with the superior aspect of right inferior turbinate. The bony spur measures 3-mm in length and projecting to the right and 4.3-mm in thickness.There is also concha bullosa of the left middle turbinate.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable.Unremarkable images through the orbits.
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1.Start summary very small focus of mucosal thickening in the right chamber of sphenoid sinus and unremarkable all paranasal sinuses otherwise are acute or chronic sinus.2.Significant rightward nasal septum deviation and a bony septal spur projecting to the right and with mucosal contact with the superior aspect of right inferior turbinate. Contralateral concha bullosa of the left middle turbinate.
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Generate impression based on findings.
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55-year-old patient post craniotomy. History includes atypical meningioma. A craniectomy defect is demonstrated overlying the left frontal lobe. There's been resection with placement of a prosthetic with localized extradural air demonstrated over the left frontal lobe in addition to a small amount of subarachnoid air. There is a drain superficial to the graft material with an overlying row of surgical staples visualized. There is a small amount of hyperattenuating material within the anterior and posterior/dependent aspect of the resection cavity most likely representing a small amount of blood product. There is no other intracranial hemorrhage or hydrocephalus. There is hypoattenuation within white matter of the left frontal lobe in addition to sulcal effacement which likely represents a small component of edema in addition to the encephalomalacia demonstrated on the preoperative exam. There is no midline shift or herniation. Visualized portions of the paranasal air sinuses, orbits and mastoid air cells are unremarkable. There are no aggressive appearing bony lesions.
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Expected postoperative changes including intracranial air, a small amount of blood product and left frontal edema as result of the left partial craniectomy with skull prosthetic placement.
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Generate impression based on findings.
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Reason: tongue cancer History: r/o chest mets LUNGS AND PLEURA: Scattered punctate micronodules are stable and presumably postinflammatory. No new pulmonary nodules.MEDIASTINUM AND HILA: Coronary calcification. Scattered small mediastinal nodes are unchanged.CHEST WALL: Degenerative change involving the thoracic spine. Scattered vertebral body hemangiomas. Nonspecific coarse calcifications involving the breasts are unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in left hepatic lobe is stable and likely a cyst. Pancreatic ductal dilatation is only partially visualized. Please see prior abdomen pelvis CT for further details.
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1. No evidence of metastatic disease.2. Known pancreatic ductal dilatation is only partially visualized. Please see prior abdomen pelvis CT for further details.
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Generate impression based on findings.
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Reason: lung ca, s/p resection and adj chemo, pls c/w previous study to evaluate dz status. History: lung ca LUNGS AND PLEURA: Reference mixed solid groundglass opacity in the right upper lobe superior to the suture line (image 30/88) measures 3.7 cm x 3.0 cm, unchanged. Multiple surrounding small solid nodules are unchanged and are suspicious of metastatic disease. Ground glass nodule in medial right lower lobe (image 55/88) is stable to marginally increased. Left lower lobe nodule (image 56/88) stable. Emphysema.MEDIASTINUM AND HILA: Coronary calcification.Reference right paratracheal lymph node measures 13 x 9 mm on image 20/88 (13 x 8 mm on prior).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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Stable CT with findings suggestive of indolent lung adenocarcinoma with intrapulmonary metastases.
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Generate impression based on findings.
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Male 71 years old; Reason: Pt is a 71 y/o male with met prostate cancer, evaluate for worsening disease on abiraterone History: met prostate cancer CHEST:LUNGS AND PLEURA: Stable subcentimeter nodular opacity within the left upper lobe (image 50 ,series 5). Interval decrease in size of the spiculated lesion in the right middle lobe along the fissure which measures 1.3 x 0 .5 cm (series 5 image 54), previously 2 x 0.9 cm.MEDIASTINUM AND HILA: Mediastinal adenopathy is smaller with reference subcarinal lymph node measuring 1.8 x 1 .0 cm, previously 1.4 x 2.7 cm (image 49, series 3). CHEST WALL: Retroclavicular adenopathy with reference left retroclavicular lymph node measuring 1.3 x 1.9 cm previously 2.5 x 1.3 cm (image 4, series 3). ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy appears smaller in size. Reference cavoatrial lymph node measures 1.7 x 2.4 cm (series 3 image 115) previously 1.8 x 2.7 cm. BOWEL, MESENTERY: Ventral hernia containing mesenteric fat. Diverticulosis without seen complication. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Calcifications within the prostate. Stable appearance of the fiducials in the prostate. Non-specific hyperdense foci in the posterior aspect of the prostate are unchanged. BLADDER: Cystolith is unchanged from the prior exam. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without seen complication. BONES, SOFT TISSUES: Stable appearance of the sclerotic bone lesionsOTHER: No significant abnormality noted
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1. Stable to slightly smaller retroclavicular and mediastinal lymph nodes with reference nodes measured.2. Stable to slightly smaller size of retroperitoneal lymph nodes.
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Generate impression based on findings.
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Diffuse MAI infection with positive HIV status Diffuse scattered numerous lytic lesions observed throughout the lower lumbar, sacrum and iliac, greater on the left of midline.The few overlapping lesions previously identified on the abdomen and pelvis CT appear similar in appearance. Including the reference L5 for tubal body measuring 1.7 cm in diameter. Majority of these lesions are also intra-medullary with only one small lesion appearing cortically in the iliac wing on the left. The lesion demonstrates significant cortical loss to suggest impending fracture, however cortical thinning is observed, specifically in the left ischial lesion (image 107 series 5).No discrete new soft tissue abnormality, incompletely visualized and similar in appearance of the multiple bowel changes with extensive bowel wall thickening and mild overlying dilatation and fluid retention. Appearance remains consistent with the known MAI arthritis. Minimal ascites. Extensive lymphadenopathy is not well visualized given field of view.
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Extensive scattered lytic lesions throughout the lower lumbar spine, sacrum and pelvis consistent with patient's known underlying infection
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Generate impression based on findings.
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Unsteadiness. History of lung cancer. Rule out metastatic disease. There is patchy periventricular hypoattenuation in keeping with sequela of chronic small vessel ischemic disease in addition to a more focal area of hypoattenuation within the anterior limb of the right internal capsule. There stable hyperattenuation within the medial lentiform nuclei representing mineralization. There is no intracranial mass, edema, hydrocephalus or focus of pathologic enhancement. Midline is intact. The visualized portions of paranasal sinuses and mastoid cells are aerated. Orbits are unremarkable.Incidental note is made of a small radiodense foreign body within the right cheek which is unchanged the prior exam.
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Findings most likely representing sequela of chronic small vessel ischemic disease without any lesions suspicious for metastatic disease. No definite parenchymal or leptomeningeal disease.
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Generate impression based on findings.
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Reason: PT with NPX ca. s/p CRT 4 months ago. please re-eval History: as above CHEST:LUNGS AND PLEURA: Punctate micronodules are unchanged and presumably benign. No new pulmonary nodules. Scarring at left base unchanged. Emphysema.MEDIASTINUM AND HILA: Coronary calcification.CHEST WALL: Degenerative change involving the thoracic spine. Left chest wall port has been removed.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypodense hepatic lesions are too small to characterize but stable and presumably benign. The reference right lobe lesion measures 8 x 6 mm (image 80/100). Nonspecific subcentimeter splenic hypodensity unchanged (image 80/100).
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Stable CT with no definitive evidence of metastatic disease.
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Generate impression based on findings.
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No intra-abdominal masses, aorta, prior to VAD and pretransplant Limited study. Intravenous contrast was not administered. This limits sensitivity to detect small lesions in solid organs and bowel.CHEST:LUNGS AND PLEURA: Bilateral mild pleural effusion. Calcified granuloma in the right lower lung. Bi- basilar atelectasis noted.Mild ground glass opacities in bilateral lower lobes could be related to atypical infection, edema, or hemorrhage.MEDIASTINUM AND HILA: Coronary artery calcification. Mild cardiomegaly. Bilateral hilar calcified lymph nodes. Few coarse calcifications also noted within the left breast tissue.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple calcified granulomas within the liver, consistent with prior granulomatous disease.SPLEEN: Calcified granulomas within the splenic parenchyma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hilar vascular calcifications noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified Fibroids within the uterus.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. Mild bilateral pleural effusion. Mild cardiomegaly. Mild ground glass opacities in bilateral lower lobes could be related to atypical infection, edema, or hemorrhage.
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Generate impression based on findings.
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Clinical question: Left craniotomy for meningioma resection. Signs and symptoms: Post op surveillance scan. Nonenhanced head CT:Examination demonstrate interval improvement in postoperative changes of left temporal -- parietal craniotomy.There is interval complete resolution of patchy foci of peri-surgical parenchymal hemorrhage and postsurgical expected blood product in the surgical cavity since prior exam.There is mild parenchymal low-attenuation of the left frontal lobe at the surgical site consistent with parenchymal encephalomalacia. Expanded subarachnoid space at the site of resected tumor is again noted with interval decrease size and measuring approximately 35 in AP and 12-mm in transverse axis dimensions.There is complete resolution of previously noted mass effect and with reexpansion of the left lateral ventricle and resolution of midline shift.Mild periventricular and subcortical low attenuation of white matter in the age indeterminate small vessel ischemic strokes are again noted.
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1.Interval improvement of postoperative changes and including complete resolution of patchy peri-surgical site parenchymal hemorrhage and blood product from the surgical cavity.2.Mild residual left frontal encephalomalacia at the site of surgery.3.Complete resolution of mass effect and maintained midline.4.Age indeterminate small vessel ischemic strokes remains grossly similar to prior study.
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Generate impression based on findings.
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Male 61 years old; Reason: abnormal cytology urine History: urge incontience The absence of intravenous contrast limits evaluation of the solid organs and vascular structures. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No adenopathy noted. Coronary artery calcifications seen.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Calcifications are noted throughout the pancreatic body, with dilation of the pancreatic duct and atrophic tail compatible with pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Changes compatible with chronic pancreatitis.2.No other abnormality seen on this limited non contrast examination.
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Generate impression based on findings.
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56-year-old female with solitary pulmonary nodule LUNGS AND PLEURA: Mild apical scarring and small subpleural cysts. Reference nonspecific right upper lobe nodule measures 1.0 x 0.5 cm (previously 1.0 x 0.5 cm) in axial dimensions (image 38, series 4). No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Unchanged pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Extensive pancreatic calcifications and prominent duct compatible with chronic pancreatitis. Cholelithiasis. Left adrenal adenoma.
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1. Unchanged nonspecific 10 mm right upper lobe nodule. Though the reportedly negative PET and short stability favor a benign nodule, typically nodules are followed to at least 2 years to confirm stability before malignancy can be definitively excluded. 2. Pericardial effusion also appears similar to the prior study.
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Generate impression based on findings.
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30 year-old male with chest pain, history of pneumothorax, evaluate for blebs. LUNGS AND PLEURA: 2 - 4 cm bleb at right medial lung apex. Conceivably this could represent a small residual loculated pneumothorax, though there are some associated small subpleural cysts or very small blebs, making this less likely. Calcified granuloma on right.The left lung is negative. MEDIASTINUM AND HILA:No mediastinal or hilar lymphadenopathy. Heart size is normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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2 - 4 cm bleb at right medial lung apex. Conceivably this could represent a small residual loculated pneumothorax, though there are some associated small subpleural cysts or very small blebs, making this less likely. The left lung is negative.
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Generate impression based on findings.
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81-year-old female with history of malignant neoplasm of the anterior two thirds of the tongue, status post surgery, rule out recurrence Limited orbital and intracranial views are unremarkable. The visualized mastoid air cells and paranasal sinuses are clear.Redemonstration of postsurgical changes of a right neck dissection. Extensive postsurgical changes of an interval left hemiglossectomy with flap reconstruction. There is some narrowing of the oropharyngeal airway due to flap. The previously identified enhancing lesion along the anterior and posterior left hemitongue has been resected. No residual suspicious enhancement is present. Diffuse reticulation of subcutaneous fat and obscuration of fascial planes compatible with post therapy changes. Nonspecific focal region of hypoattenuation within the left sternocleidomastoid muscle may represent post therapy changes. No soft tissue masses are present in the neck.Reference left level 4 lymph node measures 6 x 9 mm (series 7 image 51), previously measured 11 x 8 mm. No evidence of lymphadenopathy by CT size criteria. Aside from the postsurgical changes, no exophytic mass or focal effacement of the aerodigestive tract. The thyroid gland is free of focal lesions. The left parotid gland is unremarkable. Atrophy of the right parotid gland, unchanged. Submandibular glands are not well identified and likely surgically absent, unchanged.The major cervical vasculature is patent. Atherosclerotic vascular calcifications at the carotid bifurcations. Multilevel degenerative changes of the visualized cervicothoracic spine, most pronounced at C5 through C7, resulting in at least mild central canal stenosis and multilevel neuroforaminal narrowing. No significant interval change in erosions along the anterior aspect of the mandible. Marked degenerative changes at the right temporomandibular joint.The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details.
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1. Postsurgical changes of a left hemiglossectomy and flap reconstruction without evidence of residual enhancing tumor.2. No evidence of cervical lymphadenopathy by CT size criteria.
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Generate impression based on findings.
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49-year-old female with large abdominal mass. Evaluate for vascular involvement. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hypervascular liver lesions are identified; for reference right lobe lesion measures 1.4 x 1.7 cm (series 9, image 27). Comparison is difficult to prior exam given difference in technique and timing of contrast bolus, however, some of these were present on 2009 exam. Several of these lesions appear to follow blood pool attenuation and could represent hemangiomas. However, lack of characteristic appearance on single phase contrast study and multiplicity of lesions raises possibility of adenomas, FNH, or metastatic lesions. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesion in left kidney consistent with cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large, well circumscribed solid mass centered in the mid abdomen measures 18 x 11 cm and displaces surrounding bowel loops (series 9, image 60). There is close associated of this mass with adjacent jejunal bowel loop, best appreciated along its left margin (series 9, image 74). Branches of the superior mesenteric artery extend into posterior-superior aspect of the mass (series 9, image 48); however, the main superior and inferior mesenteric artery branches appears uninvolved by the mass and are patent.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: Diverticulosis affects the colon, without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Large mass in the midabdomen which is closely associated with adjacent small bowel loop, raising possibility of small bowel as origin of this mass, possibly GIST. However, etiology remains uncertain. Small branches of the SMA feed this mass; main celiac, main SMA, and IMA branches remain uninvolved. 2.Multiple hypervascular liver lesions are of unclear etiology. Several, but not all, of these lesions follow blood pool attenuation and could represent hemangiomas. However, with single contrast phase and multiplicity raises possibility of adenomas, FNH, or metastatic lesions. Further characterization with dedicated liver MRI using hepatobiliary agent (Eovist) is recommended.
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Generate impression based on findings.
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75-year-old male with pain. Evaluate for lateral tibial plateau fracture. Comminuted, intraarticular nondisplaced fracture of the lateral tibial plateau. The fracture fragments are separated by less than 2 mm. There is also a less than 2-mm depression at the articular surface. There is a moderate-sized joint effusion. Tricompartmental osteophytes are consistent with mild osteoarthritis.
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Fracture of the lateral tibial plateau, as described above.
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Generate impression based on findings.
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75-year-old female with epigastric and suprapubic pain -- history of gastric B-cell lymphoma in 2003. ABDOMEN:LUNG BASES: Stable appearance to lung base micronodules as demonstrated overpass. Series of examinations. No new abnormalities. No pleural disease seen.LIVER, BILIARY TRACT: Stable appearance to the 3 small subcentimeter hypodensities in segment 4 and right lobe of the liver, which are most likely benign cysts. No new lesions randomizer seen. Vascular structures appear normal. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No change in the enhancing left adrenal gland nodule (series 4, image 35) measuring 1.9 x 1 .5 cm -- this is unchanged in 2009 and therefore of benign nature.Normal right adrenal gland.KIDNEYS, URETERS: Stable appearance to the bilateral cortical scarring, left greater than right, and in the bilateral benign appearing cortical cysts. No other abnormalities or change is seen.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification seen. No evidence of aneurysm or other vascular disease. No adenopathy seen.BOWEL, MESENTERY: Orally administered contrast rapidly progresses to normal-appearing stomach and small bowel to the colon. No evidence of obstruction or intrinsic abnormality in the small bowel. Diverticular changes are seen in the right colon, descending colon and sigmoid colon with similar distribution and without complication. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prior hysterectomy -- no other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. No abnormality seen to account for patient's symptomatology. 2. Diffuse diverticular changes in the colon without complication seen, unchanged in appearance. 3. Stable examination without change.
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Generate impression based on findings.
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59 year old female with right laryngeal squamous cell carcinoma, status post CRT 4 months ago Limited intracranial and orbital views are unremarkable. The visualized mastoid air cells and paranasal sinuses are clear.No exophytic mass or focal effacement of the aerodigestive tract. No evidence of lymphadenopathy by CT size criteria. The parotid, submandibular and thyroid glands are within normal limits. No soft tissue masses are present in the neck.The major cervical vasculature is patent. Multilevel degenerative changes of the visualized cervicothoracic spine without identification of suspicious lesions. Chronic nonunion at the left lateral mass of C1.Centrilobular emphysema of the lung apices. Please see dedicated chest CT from today's date for further details.
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No evidence of residual cervical or metastatic disease.
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Generate impression based on findings.
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84-year-old male with new onset cervical neck pain. History of lung cancer. No acute intracranial abnormalities are seen within the skull base, cavernous sinuses, and limited view of the brain parenchyma. The right lens is thin. There is minimal mucosal thickening of the maxillary sinuses.Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. There is mild atherosclerotic calcification at the carotid bifurcations, however the carotid arteries are patent. There is severe degenerative changes of the cervical spine, most prominent at C4-C5, C5-C6 and C6-C7. A large sialolith in the right submandibular duct and a punctate sialolith in the left submandibular duct are unchanged. There is atrophy of the right submandibular gland relative to the left.A calcified plaque along the left anterior pleura is not significantly changed measuring 6 mm in thickness. Right sided dependent atelectasis is noted.
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1.No evidence of metastatic disease in the neck.2.Severe degenerative changes of the cervical spine.3.Left apical pleural thickening is stable.4.Bilateral sialoliths in the sub-mandibular ducts are stable.
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Generate impression based on findings.
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68 year-old female with left jaw pain, headache, swelling, mass, evaluate Limited intracranial and orbital views are unremarkable. The visualized paranasal sinuses and orbits are clear.No soft tissue masses are present in the neck. No lymphadenopathy by CT size criteria. No exophytic mass or focal effacement of the aerodigestive tract. Prominent pharyngeal lymphoid tissue. The thyroid, submandibular and parotid glands are unremarkable. No mandibular or perimandibular lesions are present. The mandible is intact.Bilateral atherosclerotic calcifications of the carotid bifurcations. The visualized lung apices are clear. Multilevel degenerative changes of the visualized cervicothoracic spine without suspicious osseous lesions.
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1. No mandibular/perimandibular lesions or cervical lymphadenopathy is present.2. Nonspecific prominence of the pharyngeal lymphoid tissue.
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Generate impression based on findings.
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chronic sinusitis, h/o radiation for CNS lymphoma The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. The patient is status post paranasal sinus surgery. There are bilateral uncinectomies present in the partial exenteration of the left ethmoid air cellsThe frontal sinuses demonstrate opacification of the right frontal sinus which is new since the previous exam. The left frontal sinus remains clear.Maxillary sinuses demonstrate mucosal thickening bilaterally right more than left associated with wall thickening. Previously seen air fluid level on the left side has resolved. Ethmoid air cells demonstrate mucosal thickening in the right ethmoid air cell. Sphenoid sinuses demonstrates a mucus retention cyst in the left sphenoid sinus which is since the prior exam. Comparing to an MRI from 12/17/12 on that exam there is more mucosal thickening in the left maxillary sinus and less mucosal thickening in the right frontal sinus are comparing to MRI from 5/9 / 13 there is significantly more paranasal sinus mucosal thickening on the current examVisualized portions of the mastoid air cells and middle ears demonstrate mild opacities not present on the prior exam but were present on the MRIs of the brain from May 2013 and December 2012. Visualized orbits are intact and the visualized intracranial structures are within normal limits.The patient is status post posterior fossa surgery for a cerebellar mass.
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1.Findings are compatible with chronic sinusitis involving predominantly right-sided sinuses. This appears to wax and wane over time2.partial opacification of some mastoid air cells has been present on prior exams over the past year.3.Status post paranasal sinus surgery.4.Status post posterior fossa surgery for intracranial mass. Please refer to MRI of the brain for further comments
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Generate impression based on findings.
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36-year-old female with metastatic adenocystic carcinoma status post chemoradiation and laser ablation The skull base, cavernous sinuses, and limited view of the brain parenchyma are unremarkable.Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. There is infiltration of multiple fat planes in the anterior neck, likely treatment related. The parotid glands are unremarkable. Small calcified nodule is seen in the left thyroid measuring 8 x 5 mm. The carotid arteries and jugular veins are patent. For lung findings, please see chest CT performed on the same day. A tracheostomy tube is partially visualized. There is mild kyphosis of the cervical spine.
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1.Infiltration of multiple fat planes throughout the neck is likely treatment related.2.No lymphadenopathy.3.For lung findings, please refer to dedicated lung CT performed on the same day. There are metastatic lesions, post radiation scarring and pleural thickening present.4.Partially calcified left thyroid nodule.
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Generate impression based on findings.
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44-year-old female patient with history of breast cancer presents with shortness of breath and syncope. LUNGS AND PLEURA: Right middle lobe with minimal linear scarring and bronchiectasis. Scattered pulmonary micronodules, some of which are calcified. No suspicious nodules.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post right modified radical mastectomy with reconstruction with surgical clips in the right breast and right axilla. Dextroscoliosis of the thoracic spine with sclerotic foci in the C7 and T1 vertebral bodies and in the right pedicles and posterior elements of T5, T6 and T7, stable. Otherwise, mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis.
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No evidence of pulmonary metastases no new sites of disease identified.
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Generate impression based on findings.
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Reason: pt history of prostate cancer, currently receiving treatment. please eval for response/progression and compare with previous using measurements if applicable History: see above LUNGS AND PLEURA: Scattered punctate calcified and noncalcified pulmonary nodules are unchanged. Residual scarring at the site of the index pulmonary nodule (image 65/103) in the left lower lobe, no longer measurable/0 mm.MEDIASTINUM AND HILA: Stable borderline mediastinal lymph nodes. Coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Degenerative changes noted in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips.
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No evidence of metastatic disease.
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Generate impression based on findings.
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35-year-old male with slurred speech, rule out hemorrhage versus ischemia Hypoattenuating region within the medial aspect of the left thalamus compatible with an acute infarct and has become more well defined. No findings to suggest hemorrhagic transformation.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No additional foci suspicious for ischemia are identified. Unchanged hypoattenuating focus in the right basal ganglia is likely a prominent perivascular space.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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Evolving acute left thalamic non-hemorrhagic stroke. If clinically desired, an MRI may be obtained for further characterization.These findings were discussed with the referring clinical ICU service at 3:15 p.m. on 10/25/2013
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Generate impression based on findings.
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53 year old male with hip pain. Evaluate for osteomyelitis. Post surgical findings from amputation through the mid pelvis and sacrum are again noted. The distal osteotomy margin of the left ilium is poorly defined compared to the prior exam, with increased patchy lucency and sclerosis throughout the lower left iliac wing (image 314, series 2), highly suspicious for acute osteomyelitis. At the osteotomy margin there is also a complex fluid collection measuring approximately 3.7 x 2.4 x 3.2 cm (image 107, series 80317 and image 41, series 80316). This fluid collection communicates with the other small fluid collections in the soft tissues of the left pelvis (image 33, series at 80316). These fluid collections are consistent with abscesses. There is also extensive surrounding soft tissue swelling.Compared to the prior exam there is also new irregularity and widening of the left sacroiliac joint, concerning for infectious arthritis. There is fusion of the superior right sacroiliac joint. Extensive heterotopic bone formation in the pelvis appears similar to the prior exam.The large sacral decubitus ulcer, just to the left of the midline, appears increased in size since the previous exam. The left hydrocele is again noted. A bullet fragment is again noted to the L5 vertebral body.
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1.New heterogeneity in the left iliac osteotomy margin, highly suspicious for acute osteomyelitis.2.Communicating abscesses in the soft tissues of the left pelvis, including an abscess along the left osteotomy margin.3.Widening and irregularity of the left sacroiliac joint, suspicious for infectious arthritis.
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Generate impression based on findings.
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52-year-old male with stage IV colon cancer, please provide index lesion measurements. CHEST:LUNGS AND PLEURA: Interval decrease in size and number of numerous bilateral small pulmonary nodules. Reference left lower lobe pulmonary nodule measures 6 mm (image 51, series 4), previously 10 mm. Reference right lower lobe pulmonary nodule measures 6 mm (image 56, series 4), previously 9 mm.MEDIASTINUM AND HILA: Interval decrease in mediastinal lymphadenopathy. Reference AP window lymph node measures 6 mm (image 40, series 3) previously 16 mm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval decrease in size of numerous hypoattenuating confluent liver masses. Reference right hepatic lobe lesion measures 4.0 x 2.8 cm (102 series 3) previously 4.1 x 3.9 cm. There is no biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Minimal nodularity of left adrenal gland is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild enlarged retroperitoneal lymph nodes are not significant changed. Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: New long segment colonic wall thickening (177 series 3). No loculated fluid collection is seen. 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: New long segment colonic wall thickening (177 series 3). No loculated fluid collection is seen. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic ascites.
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1.New long segment colonic wall thickening, suggestive of colitis, which could be related to post treatment changes vs infectious/inflammatory etiology. 2.Numerous liver metastases, which have decreased in size.3.Decreased size of pulmonary nodules.4.Decreased mediastinal lymphadenopathy.
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Generate impression based on findings.
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Male 74 years old; Reason: assess ongoing pancreatitis History: cholestatis liver failure, pancreatitis, s/p ercp ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs and of the vessels. Given these limitations, the following observations were made:LUNGS BASES: Bilateral pleural effusions with bibasilar atelectasis versus consolidation are slightly increased since the previous.LIVER, BILIARY TRACT: Stable significant pneumobilia of the intra-and extrahepatic biliary system, with patent common duct stent. Residual contrast is noted in the gallbladder from vicarious excretion.SPLEEN: No significant abnormality noted.PANCREAS: Limited noncontrast evaluation of the pancreas suggests no interval change in the edematous pancreas without peripancreatic fluid collections or necrosis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral round hyperdense renal lesions bilaterally are incompletely evaluated on this noncontrast exam. No nephrolithiasis or hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A 2.4-cm round, well-circumscribed hypodense lesion identified in the L3 vertebral body demonstrates peripheral cortical thickening and is likely degenerative in etiology.OTHER: Subtle increase in the amount of ascites in the left paracolic gutter.PELVIS:Streak artifact from bilateral hip prostheses significantly limits evaluation of the pelvis.PROSTATE/SEMINAL VESICLES: Prostate beads are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Stable appearance of the pancreas although limited given lack of IV contrast. 2.Stable extensive pneumobilia with patent common duct stent.3.Subtle increase in the bilateral small pleural effusions with atelectasis/consolidation.4.Stable bilateral hyperdense renal lesions are incompletely evaluated. If clinically warranted, contrast enhanced exam would be recommended.5.Stable hypodense L3 vertebral body lesion favors degenerative etiology.
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Generate impression based on findings.
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56-year-old male with history of bladder cancer status post cystectomy and neobladder. CHEST:LUNGS AND PLEURA: Scarlike opacity in right upper lobe but no suspicious nodules.MEDIASTINUM AND HILA: Cardiac size normal. No pericardial effusion. Atherosclerotic calcifications affect coronary arteries and thoracic aorta. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Diffusely decreased attenuation of parenchyma consistent with hepatic steatosis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right pelvic kidney again noted.Mild perinephric fat stranding around left kidney is decreased. Persistent focal poor corticomedullary differentiation in the left apex and left mid kidney, most consistent with resolving focal infection (series 8, image 111, 99). No suspicious lesions identified. Collecting system appears unremarkable, without evidence of filling defects or lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Foley catheter present in decompressed neobladder. No suspicious filling defects or lesions identified.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild wall thickening of sigmoid colon is likely due to collapsed lumen and diverticular disease (series 8, image 179).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No evidence of recurrence or metastatic disease.2.Decreased left perinephric fat stranding and persistent foci of poor corticomedullary differentiation in left renal parenchyma, most consistent with resolving infection/inflammation.
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Generate impression based on findings.
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60 year-old female with metastatic breast cancer. Baseline exam prior to starting new treatment. CHEST:LUNGS AND PLEURA: Bilateral basilar scarring/atelectasis. Several punctate micronodules are noted, which are most likely benign in nature (series 4, image 47).MEDIASTINUM AND HILA: Multiple mildly enlarged supraclavicular and upper mediastinal lymph nodes; for reference, paratracheal node measures 1.0 x 1.4 cm (series 3, image 34).Heart is normal in size without pericardial effusion.CHEST WALL: Mild enlarged right internal mammary node (series 3, image 39). Ill-defined nodule in the right breast noted (series 3, image 41).Multiple small collateral vessels in upper chest and lower neck, which raises possibility of venous stenosis. However, central venous vasculature appears patent. ABDOMEN:LIVER, BILIARY TRACT: Well-defined, subcentimeter hypodensities in inferior edge of left lobe and liver dome incompletely characterized but most likely represents benign cyst (series 3, image 104, 73). Focal fatty infiltration around fissure for falciform ligament.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal hypodensity incompletely characterized but most likely represents benign cyst (series 3, image 93).RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes; left para-aortic node measures 1.1 x 1.4 cm (series 3, image 118).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Several mildly enlarged pelvic lymph nodes; for reference, left pelvic node measures 1.0 x 1.4 cm (series 3, image 163).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Multiple enlarged mediastinal, internal mammary, and retroperitoneal lymph nodes, suspicious for involvement by tumor.2.Several punctate lung micronodules are not specific but most likely benign in nature.
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Generate impression based on findings.
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Reason: Evaluate for metastatic disease History: pain CHEST:LUNGS AND PLEURA: Multiple large bilateral pulmonary and pleural nodules, greater on the left, compatible with metastases, not significantly allowing for differences in technique.A large posterior pleural lesion is eroding the left seventh rib. Several of the lesions are invading the pleura and the tumor extends deep into the left costophrenic angle.Tracheostomy tube in place.Paramediastinal radiation reaction.MEDIASTINUM AND HILA: Moderate lymphadenopathy in the subcarinal region with bulky pulmonary or pleural tumor adjacent to the aortic arch and proximal descending aorta which may be invading it.No pericardial effusion.CHEST WALL: Erosion of the left seventh rib as described above.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Marked hepatomegaly secondary to diffuse metastatic involvement of the liver, which is largely replaced by tumor. Thickened and mildly enhancing gallbladder wall.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are not clearly visualized due to lack of body fat.KIDNEYS, URETERS: Right renal cyst and small nonobstructing right renal calculus.PANCREAS: Limited visualization with no gross abnormalities.RETROPERITONEUM, LYMPH NODES: Limited visualization due to lack of body fat and I cannot exclude lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Extensive metastatic disease in the lungs, pleura, and liver.
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Generate impression based on findings.
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Patient with history of sickle cell anemia. Status post synangiosis bypass for moyamoya. There are postoperative findings including stranding and swelling within the temporoparietal soft tissues and a bony defect from the right temporal craniotomy. There is focal air within subcutaneous tissues in the right parietal area as well as relatively small amount of pneumocephalus within the subarachnoid space anteriorly. There is unchanged right-sided sulcal prominence and ill-defined parenchymal hypoattenuation in keeping with chronic right-sided ischemia as well as an unchanged lacunar infarct within the anterior limb of the right internal capsule. There is no intracranial hemorrhage, hydrocephalus or edema. The midline is intact. Visualized portions of the orbits, paranasal sinuses and mastoid air cells are unremarkable.
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Expected postoperative changes following synangiosis surgery in this patient with moyamoya syndrome.
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Generate impression based on findings.
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Headache. History of breast cancer. There is no intracranial mass, hemorrhage, hydrocephalus, edema or focus of pathologic enhancement. The midline is intact. The paranasal sinuses, mastoid air cells and orbits are unremarkable.
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No intracranial pathology demonstrated.
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Generate impression based on findings.
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Reason: h/o Left Breast Ca, s/p left MRM in 1/2013, s/p neo adj chemo for ypT3(m)N2, now with new left chest wall skin lesion, s/p biopsy with benign results, r/t metastatic disease History: h/o Left Breast Ca, s/p left MRM in 1/2013, s/p neo adj chemo for ypT3(m)N2, now with new left chest wall skin lesion, s/p biopsy with benign results, r/t metastatic disease CHEST:LUNGS AND PLEURA: Subpleural reticulation in the anterior left upper lobe likely related to radiation change. Punctate calcified granuloma left lower lobe.MEDIASTINUM AND HILA: Heterogeneous predominantly hypodense nodule involving the left thyroid (image 15/150), this area was negative on PET report.CHEST WALL: Postop change left breast. Fluid collection in the lateral chest wall deep to the incision likely a seroma or hematoma. Residual skin thickening and edema without discrete mass. Correlate with dedicated breast imaging results. No pathologically enlarged left axillary lymph nodes are seen. Small subcentimeter right axillary lymph nodes are present.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Subcentimeter heterogeneous density involving the left iliac wing (image 152/158) and is presumably benign. This was negative on PET.OTHER: No significant abnormality noted.
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No definitive evidence of metastatic disease. Other findings as above.
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Generate impression based on findings.
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55 year-old female with breast cancer LUNGS AND PLEURA: Extensive scarlike opacities at the lung bases. Small apical cysts and peripheral scarlike opacity in the left upper lobe. No suspicious nodules or masses..MEDIASTINUM AND HILA: Nonspecific left thyroid hypoattenuating lesion. No mediastinal or hilar lymphadenopathy. The heart size is normal. Central venous catheter tip extends to the cavoatrial junction.CHEST WALL: Skin thickening overlies the left breast. Right chest wall port. Sclerotic focus along the inferior endplate of the T6 vertebral body is nonspecific.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple bilateral hypoattenuating hepatic lesions likely representing metastatic disease are partially visualized, of the largest measuring 11.7 x 9.0 cm (image 86, series 3) in the right hepatic lobe.
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Extensive hepatic lesions, likely representing metastatic disease are only partially visualized. Posttreatment change of the left breast.
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Generate impression based on findings.
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85-year-old male with altered mental status, weakness, no focal findings Patchy hypoattenuation in the periventricular and subcortical white matter is most compatible with small vessel ischemic disease of indeterminate age. Redemonstration of prominence of the sulci with ex-vacuo dilatation of the lateral ventricles compatible with age-related parenchymal loss.Nonspecific soft tissue within the nasal cavity with nasal septal defect and hypoplastic turbinates.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Empty sella.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact, right staphyloma.
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1. No acute intracranial abnormalities. Please note CT is insensitive for the detection of acute ischemia.2. Brain parenchymal volume loss and moderate small vessel ischemic disease of indeterminate age.
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Generate impression based on findings.
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64-year-old female with cervical cancer status post chemotherapy. CHEST:LUNGS AND PLEURA: Multiple bilateral lung masses, many of which are cavitary, as well as multiple punctate nodular and tree in bud opacities, not significantly changed since 11/6/2013.Reference left lower lobe masslike consolidation measures 11.8 x 7.5 cm, previously measured 11.8 x 7.7 cm (series 4, image 54).MEDIASTINUM AND HILA: No significant change in mediastinal lymphadenopathy; reference precarinal node measures 1.7 cm, previously measured 1.6 cm (series 3, image 37). Right chest wall port catheter tip in distal SVC. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodensities throughout the liver are not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No significant change in extensive metastatic disease affecting the lungs, mediastinum, and liver.
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Generate impression based on findings.
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Reason: Patient has right-sided pulmonary nodule from 10/12. Needs follow-up exam. History: Pulmonary nodule LUNGS AND PLEURA: Demonstration of 5-mm nodule along the fissure and right middle lobe and most likely representing pulmonary lymph node.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.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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Small right middle lobe nodule, unchanged from a prior Cardiac CT dated 5/18/12 and most likely represents an intrapulmonary lymph node. No suspicious pulmonary nodules or masses.
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Generate impression based on findings.
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52 year-old female with leukocytosis, abdominal pain, tachycardia. History of urothelial cancer. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, moderate on the left and small on the right, mildly decreased. Overlying basilar subsegmental atelectasis/consolidation in both bases, left more than right.MEDIASTINUM AND HILA: Right chest wall port tip in upper right atrium. Heart is normal in size without pericardial effusion. No significant lymphadenopathy.CHEST WALL: Surgical clips in left axilla. Compression deformity of T6 vertebral body unchanged.ABDOMEN:LIVER, BILIARY TRACT: Small to moderate amount of fluid in or on the liver. Hypoattenuating 1 cm lesion in right lobe not significantly changed compared to 7/18/2013 (series 3, image 98).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal has been resected. Left adrenal unremarkable.KIDNEYS, URETERS: Status post right nephrectomy. Left percutaneous nephroureterostomy tube is in place, with resolution of previously seen left hydronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes. Atherosclerotic calcifications affect the aorta and its branches.BOWEL, MESENTERY: No bowel obstruction. Postsurgical changes in the left lower quadrant. Small amount of ascites fluid. No loculated fluid collection to suggest abscess.Infiltrative changes involving the omentum and mesentery, best appreciated in the upper pelvis, not significantly changed and consistent with carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Infiltrative changes involving the omentum and mesentery, best appreciated in the upper pelvis, not significantly changed, consistent with carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Bilateral pleural effusions, left more than right, with overlying consolidation/atelectasis.2.No specific evidence of intra-abdominal infection. 3.Left percutaneous nephroureterostomy tube in place, with resolution of hydronephrosis.4.Mesenteric and omental thickening compatible with carcinomatosis, not significantly changed.5.Moderate ascites fluid around liver, not significantly changed.
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Generate impression based on findings.
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50 year-old female with left lower quadrant pain. Evaluate for diverticulitis, pyelonephritis. ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs. Given these limitations, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Solitary left kidney. Surgical or congenital absence of the right kidney is noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis of the descending and sigmoid colon. Contained pericolonic fat stranding surrounds two diverticula in the sigmoid colon with no associated fluid collection or intraperitoneal free air, consistent with uncomplicated diverticulitis (images 93 and 96, series #3; coronal image 56).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Inflammatory changes of the sigmoid colon, as detailed above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Diverticulitis of the sigmoid colon without evidence of abscess or perforation.2.Solitary left kidney.
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Generate impression based on findings.
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46-year-old female with nonspecific abdominal pain. ABDOMEN:LUNG BASES: Mild groundglass opacities in right lung base most consistent with mild, subsegmental atelectasis. LIVER, BILIARY TRACT: Diffuse low-attenuation of liver parenchyma consistent with steatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodensity in right kidney most compatible with benign cyst. Calcification in calix of left kidney measuring 3 mm consistent with non-obstructing stone (series 3, image 36).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple foci of free intraperitoneal air, consistent with perforated viscus. Small amount of free fluid is seen in right pericolic gutter and pelvis. Inflammatory changes seen around the distal stomach/proximal duodenum (series 3, image 53), which makes this region most suspicious for source of perforation although this is uncertain. However, additional mild inflammatory changes are also seen in left pericolic gutter (series 3, image 63).No loculated fluid collection to suggest abscess.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 described above, multiple foci of free intraperitoneal air consistent with perforated viscus. Small amount of free fluid is seen in right pericolic gutter and pelvis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple foci of free intraperitoneal air, consistent with perforated viscus. Inflammatory change seen around the distal stomach/proximal duodenum makes this region most suspicious for source of perforation although this is uncertain. Findings were discussed with clinical service (Dr.Podolej) at time of dictation.
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Generate impression based on findings.
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57 year old male with right lower quadrant abdominal pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progressive through normal appearing stomach, small bowel, and colon without intrinsic abnormality. Small, approximate cecum appears to represent an aborted small appendix without complication. No inflammatory findings are seen in the right lower quadrant. No evidence of diverticulitis with feces filled colon throughout without other abnormality. No free mesenteric fluid.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: Orally administered contrast rapidly progressive through normal appearing stomach, small bowel, and colon without intrinsic abnormality. Small, approximate cecum appears to represent an aborted small appendix without complication. No inflammatory findings are seen in the right lower quadrant. No evidence of diverticulitis with feces filled colon throughout without other abnormality. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. No sinus abnormality seen in the abdomen or pelvis. No findings seen to account for patient's symptomatology.
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Generate impression based on findings.
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48 year-old male with kidney stones. ABDOMEN:LUNG BASES: Status post cholecystectomy.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Collection of high density material in the upper pole of right kidney measures 1.7 x 1 .4 cm, most consistent with innumerable stone fragments; interval decrease in size of calyx or calyceal diverticulum in which these fragments are located(series 3, image 54). No obstructing stones or hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Surgical clips present in the inguinal canal bilaterally, consistent with prior vasectomy.
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Collection of high density material in the upper pole of right kidney, most consistent with multiple kidney stone fragments. No evidence of obstructing stones or hydronephrosis.
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Generate impression based on findings.
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Ataxia. Evaluate vasculature given previous posterior circulation stenosis. Unenhanced CT head: There is cerebellar atrophy which has increased since the prior exam. There is no intracranial mass, hemorrhage, hydrocephalus or edema. The midline is intact. Paranasal sinuses, mastoid air cells and bony structures are unremarkable. Incidental note is made of stable bilateral staphyloma. Orbits are otherwise unremarkable.CTA neck: There is a 3 vessel aortic arch. At the right carotid bifurcation there is atherosclerotic plaque resulting in a 30% stenosis of the right internal carotid artery by NASCET criteria. There is an additional focal calcification related to a plaque within the proximal right internal carotid 1.9 cm from its origin. The left proximal common carotid is obscured by artifact related to contrast in the subclavian. There is mild irregularity related to plaque without significant stenosis at the left carotid bifurcation. The right vertebral artery is hypoplastic, measuring approximately 1.8 mm. The left artery demonstrates irregularity along its V1 segment without focal stenosis more distally. CTA Head: The internal carotid arteries demonstrate atherosclerosis and calcification within cavernous and supraclinoid portions bilaterally. There is a normal carotid bifurcation bilaterally with normal MCA and ACAs. There is no aneurysm or steno-occlusive lesion within the anterior circulation bilaterally.There has been recannulation of the left V4 segment since the prior examination which extends to the vertebro-basal junction though the basilar artery is occluded. Basilar occlusion extends from the vertebral confluence to the level of the PICA where it is reconstituted by patent posterior communicating arteries. The right AICA and SCA are branches off of the basilar artery. The left are not visualized with their territories instead of being supplied by extensive pial collaterals. The left PCA is occluded at the P2 segment and the right PCA is diminutive at its P2 segment. Multiple vessels are demonstrated within the left and right PCA territories consistent with extensive pial collateralization. There is no aneurysm of the posterior circulation.
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1.Basilar artery occlusion extending from immediately superior to the vertebro-basilar junction to the level of the AICAs. 2.Since the previous exam the V4 segment of the left vertebral artery has recanalized.3.Perfusion of the distal basilar presumably on the basis of collateral flow from patent small posterior communicating arteries. Of note the posterior communicating arteries are smaller than on the prior exam4.Diminutive right and occluded left AICA and SCA with vascular territories supplied by pial collaterals from the left PICA.5.Occluded left P2 with diminutive right PCA at P2 segment. PCA territories predominantly perfused by pial collaterals from ACA and MCA territories. 6.Cerebellar atrophy which has progressed since the prior exam. There is relative preservation of occipital lobe volume. 7.30% stenosis of the right internal carotid artery (by NASCET criteria) at the right carotid bifurcation. No significant left carotid stenosis.8.Atherosclerotic calcification of the distal cavernous/supraclinoid ICAs. 9.Bilateral staphyloma not significant changed from the previous exam. 10.If clinically appropriate MRI may help identify and acute or subacute foci of infarction, underlying microhemorrhage and perfusion defects.
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Generate impression based on findings.
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76-year-old male with rectal discharge, elevated WBC. Evaluate for infection or bleeding cause. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesion. The gallbladder is surgically absent, with cholecystectomy clips in the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter hypodensities are too small to further characterize. A soft tissue density exophytic renal mass is redemonstrated in the upper pole of the left kidney measuring 2.3 x 3.4 cm, contains internal fat density, is unchanged, and likely represents an angiomyolipoma.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Orally administered contrast passes freely throughout the bowel into a right lower quadrant ostomy, without evidence of obstruction or ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Decompressed with Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from recent low abdominal resection are redemonstrated. Interval increase in size of previously seen paracolonic fluid and air collections in the low pelvis, which now fill with rectally administered contrast. Communication with the rectum is visualized near the suture line on image 156, series #3, consistent with an anastomotic leak. The collection extends from the suture line anteriorly around the rectum bilaterally, and courses cephalad for approximately 21 cm in a para-aortic location.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Anastomotic leak with fluid and gas collection extending anteriorly and superiorly for approximately 21 cm.2.Left renal mass likely represents an angiomyolipoma, unchanged.
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Generate impression based on findings.
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Male 69 years old; Reason: 69 yo male with a hx of metastatic clear cell RCC s/p complete nephrectomy on pazopanib recently dx with psoas abscess, check for progression of RCC as well as resolution of psoas abscess History: metastatic cancer and psoas abscess CHEST:LUNGS AND PLEURA: Right-sided pleural thickening along the major fissure, unchanged compared to prior exam. Reference right lower lobe pulmonary nodule is stable in size now measuring 1.2 x 1.3 (series 5 image 66), previously 1.1 x 1.3 cm. This lesion measured 1.3 x 1.2 cm on 8/1/13. Reference left upper lobe nodule remain stable in size and measuring 1.0 x 1.1 cm (series 5 image 45), previously 1.0 x 1.0 cm from 8/1/13. MEDIASTINUM AND HILA: Scattered mediastinal lymphadenopathy is stable. Reference subcarinal lymph node has remained stable in size measuring 1.8 x 1 .1 cm, previously measuring 1.8 x 1.0 cm in August 2013. Few scattered subcentimeter mediastinal lymph nodes are also stable. Atherosclerotic calcification of the aortic arch. CHEST WALL: No significant abnormality notedABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LIVER, BILIARY TRACT: Calcification in the right lobe of the liver stable. Left hepatic lobe hypodense lesion is stable in size measuring 1.9 x 1.8 (series 3 image 83), previously measuring 1.9 x 1.8 cm. Caudate lobe hypodense lesion also remain stable to slightly decreased in size. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post right adrenalectomy with stable nodularity in the right adrenal bed. This is not well visualized given the lack of IV contrast, however appears grossly stable since previous exam. Nodular thickening of the left adrenal gland is again demonstrated, unchanged compared with prior examKIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and iliac arteries bilaterally. The right psoas muscle is enlarged and amorphous, however stable in size compared to prior exam. The previously seen drain in this region has been removed.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical clips in the right inguinal area.OTHER: No significant abnormality noted
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1.Stable thickening right psoas muscle from 9/26/13 with interval removal of the previously seen drain.2.Relatively stable pulmonary nodules, mediastinal lymph nodes, and liver lesions.
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Generate impression based on findings.
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64-year-old female with G-tube placed recently and now with abdominal distention -- please evaluate for free air or fluid in abdomen. Evaluate for bowel obstruction. Within the limits of a non-IV contrast enhanced examination, limiting evaluation of solid organs parenchyma and vascular structures, following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Residual excretion of IV contrast material from remote examination is seen in the urinary collecting system. Kidneys otherwise show no diagnostic abnormality. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Since prior CT examination is been interval insertion of a percutaneous gastrostomy tube. Balloon appears to be in proper position in the anterior aspect of the stomach pinned against the anterior abdominal wall. The gastropexy fixtures appear to lie in the anterior abdominal wall, but this most likely is artifactual with the stomach wall blending imperceptibly and stretched into the anterior rectus wall. No abnormal fluid collections are seen about the insertion site. No significant amount of free air is seen in the abdomen -- a single, punctate foci in the left subdiaphragmatic region (see series 3, image 14) is seen, and amount often seen remaining in the days following placement of a percutaneous gastrostomy tube. Contrast material administered through gastrostomy tube outlines a normal-appearing stomach and progresses rapidly through normal small bowel, and colon without other intrinsic abnormalities. No signs of obstruction.No free mesenteric fluid is seen.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: Contrast material administered through gastrostomy tube outlines a normal-appearing stomach and progresses rapidly through normal small bowel, and colon without other intrinsic abnormalities. No signs of obstruction.No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Interval insertion of percutaneous gastrostomy tube without signs of leak or other abnormality. 2. No evidence of bowel obstruction or findings to correlate with abdominal distention.
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Generate impression based on findings.
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57-year-old female with right-sided weakness and paresthesias, evaluate for CVA. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage, mass, or cerebral edema. Please note that CT is not sensitive for the early detection of nonhemorrhagic acute ischemic stroke and if clinically warranted, an MRI may be considered.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 70 years old; Reason: Pt is a 69 y/o male with kidney cancer, evaluate for recurrence History: kidney cancer CHEST:LUNGS AND PLEURA: Stable micronodules. Scarring versus atelectasis is stable in the right lung base.MEDIASTINUM AND HILA: Dilated esophagus again noted without wall thickening or distal obstructing lesion. Stable surgical clips at the GE junction.CHEST WALL: No significant abnormality notedABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site reference nodularity has decreased in size measuring 1.2 x 2.4 cm is a 1.7 x 2.6 cm soft tissue focus with a central fat nidus. While this may represent resolving postoperative change, an inflammatory process, such as fat necrosis cannot be excluded.RETROPERITONEUM, LYMPH NODES: Interval resolution of left periaortic hypoattenuation focus.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Moderately large prostate, unchangedBLADDER: 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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Stable examination without overt recurrence or metastatic disease. Resolving postoperative change versus focal fat necrosis within the left nephrectomy site.
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