Datasets:
cp500
/
CT-samples

Dataset card Data Studio Files Community
1
instruction
stringclasses
1 value
input
stringlengths
6
8.98k
output
stringlengths
5
3.11k
Generate impression based on findings.
49-year-old female with history of cholangiocarcinoma and pancreatic neuroendocrine tumor, who presented with bright red blood per rectum and melena. ABDOMEN:LUNG BASES: Small right pleural effusion/pleural thickening.LIVER, BILIARY TRACT: Status post cholecystectomy. Left lobe hemangioma unchanged, measuring 1.5 x 1 .7 cm, previously measured 1.5 x 1.7 cm (series 11, image 25).Interval removal of biliary stent; persistent left liver lobe pneumobilia. New hypoattenuating lesion in left lobe measures 1.0 x 1.2 cm (series 11, image 31). The previously measured hypoattenuating lesion in left lobe is not significantly changed, measuring 1.0 x 0.7 cm (series 11, image 44). As described below, there is thrombosis of extrahepatic portal vein with reconstitution of intrahepatic portal vein flow through collateral vessels. Arterial phase images reveal multiple peripheral, wedge-shaped areas of hyperenhancement, most consistent with perfusion abnormalities/THADs due to multiple thrombi seen in peripheral branches of intrahepatic portal vein (series 11, image 20, 23).The hepatic artery remains patent.SPLEEN: Status post splenectomy.PANCREAS: Status post pancreatectomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. Circumaortic left renal vein noted.RETROPERITONEUM, LYMPH NODES: As described below, infiltrative soft tissue in upper retroperitoneum suspected to represent tumor. BOWEL, MESENTERY: No bowel obstruction.There is a large thrombus in the superior mesenteric vein which extends superiorly into the portal vein, with complete occlusion of portal vein lumen (series 11, image 50). Intrahepatic portal vein flow is maintained through multiple collateral vessels. Multiple thrombi also extend into intrahepatic portal vein branches (series 11, image 42). New infiltrative soft tissue around the superior mesentery vein and superior mesenteric artery suspected to represent tumor, measuring 2.1 x 4.0 cm (series 11, image 52). There is also increased stranding in the root of the mesentery, suspected to represent edema.Multiple prominent mesenteric lymph nodes in collateral vessels in the upper abdomen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1.New ill-defined soft tissue in upper retroperitoneum suspected to represent tumor.2.Complete thrombosis of portal vein and SMV. Several intrahepatic portal vein branches in the right lobe are also thrombosed, with resultant perfusion abnormalities in liver parenchyma.3.New hypoattenuating lesion in left liver lobe, suspicious for metastatic focus.4.Extensive postsurgical changes in the upper abdomen.Findings were discussed with Dr. Gibson at 10 a.m. 11/26/2013.
Generate impression based on findings.
Speech disturbance and headache. Head CTA: There is a 2-mm outpouching along the left anterior aspect of the anterior communicating artery complex. No additional aneurysms are evident. There is no significant steno-occlusive lesion. The major venous sinuses are patent. There is mild paranasal sinus mucosal thickening.Neck CTA: There is a two vessel aortic arch with the brachiocephalic and left common carotid arteries arising directly from the arch. The major cervical vessels are patent. There is a multinodular goiter with a large nodule on the left measuring 2.9 cm. There is no significant cervical lymphadenopathy. There are multiple dental caries and periodontal lucencies, including probable periapical abscess at ADA 25 and 26. The imaged portions of the lungs are clear.
1.A 2-mm outpouching along the left aspect of the anterior communicating artery complex may represent a prominent infundibulum or aneurysm. No significant steno-occlusive lesions in the head and neck vasculature.2.Multinodular thyroid with a dominant left thyroid nodule that measures 2.9 cm. Further evolution via ultrasound is recommended.3.Extensive dental disease with evidence of periapical abscess formation.
Generate impression based on findings.
68-year-old male, evaluate for progression of aspergillosis or evidence of disseminated mucormycosis LUNGS AND PLEURA: Interval near resolution of right upper lobe pneumonia with few residual tree in bud opacities. Mild basilar atelectasis/scarring.MEDIASTINUM AND HILA: Retrosternal scarring is again noted with pericardial thickening along the anterior mediastinum. Postoperative changes of orthotopic heart transplant.CHEST WALL: Sternal fixation hardware is unchanged. Presternal Loop recorder again noted.Short metallic structure arises off the proximal subclavian, unchanged. There is a second structure which appears to be a vascular conduit with the terminal portion in the left subclavian artery and the proximal portion buried in the left subpectoral fat.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Severe atherosclerosis of the abdominal aorta. Status post cholecystectomy. Small sliding-type hiatal hernia. Degenerative changes of the thoracolumbar spine.
Near interval resolution of right upper lobe pneumonia with few residual tree in bud opacities. No evidence of disseminated disease.
Generate impression based on findings.
32-year-old female with history of nephrolithiasis presents with right flank pain radiating to the groin, nausea, vomiting. ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs. Given this limitation, 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: No renal or ureteral calculi are identified bilaterally. No hydronephrosis or perinephric stranding. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A small umbilical hernia is identified containing only mesenteric fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: A punctate calcification is identified in a dependent portion of the urinary bladder (image 147, series #3), likely representing a bladder stone.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Tiny bladder stone.2.No renal or ureteral calculi identified.
Generate impression based on findings.
68-year-old female with abdominal pain and diarrhea -- evaluate source for diarrhea. 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: Benign-appearing, small renal cysts -- no other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal-appearing stomach, small bowel, and colon without signs of wall thickening to suggest enteritis or colitis. No evidence of obstruction. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prior hysterectomy without other abnormality.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal-appearing stomach, small bowel, and colon without signs of wall thickening to suggest enteritis or colitis. No evidence of obstruction. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1. No findings seen to account for patient's symptomatology. 2. No diagnostic abnormalities seen in the abdomen or pelvis.
Generate impression based on findings.
62-year-old male patient with tachycardia and DVT. Evaluate for pulmonary embolus. PULMONARY ARTERIES: Technically adequate study. No evidence of pulmonary embolism. Bibasilar trace atelectasis.LUNGS AND PLEURA: Mild centrilobular emphysema. Calcified nodule in the left upper lobe consistent with prior granulomatous disease.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Prominent prevascular lymph node. CHEST WALL: Multilevel degenerative changes in the thoracic spine. Scattered small axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Liver with multiple small hypoattenuating foci are too small to characterize. Punctate liver calcifications consistent with prior granulomatous disease.Bilateral renal hypoattenuating lesions consistent with cysts. Right superior pole cyst with internal complexity.Bilateral enlarged adrenal glands, left greater than right, are incompletely evaluated on this examination. Left adrenal gland with punctate calcification.
No evidence of a pulmonary embolus.Mild centrilobular emphysema.
Generate impression based on findings.
15-month-old male with fever and complex seizures, evaluate size of CNS lipoma. There is redemonstration of a fat density lesion centered in the velum interpositum, encasing the internal cerebral veins. The lesion measures 2.4 x 2.8 x 1.5 cm (transverse x AP x CC), increased overall in absolute size and perhaps relative size from 1.9 x 0.8 RL x 0.8 cm in August 2012, accounting for differences in technique. In addition, the morphology of the mass has changed somewhat. There is no evidence of intracranial hemorrhage or cerebral edema. There is no evidence of hydrocephalus. 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.
The midline fat density mass centered in the velum interpositum is compatible with a lipoma and has slightly increased in absolute size and perhaps relative size.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.
Backache, unspecified Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. At L5-S1 there are bilateral pars interarticularis defects present associated with a broad-based central disk protrusion and anterior subluxation of L5 on S1 by approximately 7 mm. There is narrowing of the neural foramina bilaterally at this level with encroachment of the exiting nerve roots in the neural foramina. Fat surrounding the exiting nerve roots within the neural foramina is partially effacedAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disk protrusion present at this level. The fat of the lateral recesses and the fat surrounding the exiting nerve roots is preserved. There is loss of disk space height present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and a diffuse disk bulge present at this level associated with a Schmorl's nodeAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is a spondylolysis with grade I spondylolisthesis present at L5-S1 associated with a central disk protrusion resulting in encroachment of the pitting nerve roots within the neural foramina bilaterally
Generate impression based on findings.
Recurrent neuroendocrine small cell cancer of the palate admitted for chemoradiation for recurrence to right neck confirmed with FNA 9/27/13, s/p right radical neck dissection, right pectoralis major myocutaneous flap on 10/23/13. There has been interval repeat right neck dissection with resection of the necrotic right cervical lymph nodes and interval appearance of an air and fluid collection in the surgical bed that measures 52 AP x 22 RL x 62 SI mm. There is no definite evidence of residual lymphadenopathy or significant cervical lymphadenopathy elsewhere. The right parotid gland is mildly swollen and hyperemic, perhaps due to inflammation. There is diffuse mild pharyngeal mucosal edema that is likely related to radiation therapy, without significant airway narrowing. There is no definite residual mass in the oropharynx. The thyroid gland is unremarkable. There is partial opacification of the right mastoid air cells. The osseous structures are unchanged with multilevel degenerative spondylosis. There is a right subclavian venous catheter in position. The superior portions of the right internal jugular vein is not opacified and was likely sacrificed. The partially imaged intracranial structures are grossly unremarkable. The remaining mandibular teeth are carious. There are emphysematous changes in the lung apices.
Interval right neck dissection for resection of metastatic lymph nodes with an air and fluid filled collection in the surgical bed and inflammatory changes in the adjacent parotid gland. An abscess cannot be excluded. Otherwise, no definite evidence of residual lymphadenopathy or locoregional tumor recurrence in the oropharynx.
Generate impression based on findings.
71-year-old female patient with shortness of breath. Evaluate for emphysema in location and may be responsive to valves or surgery. LUNGS AND PLEURA: Moderate centrilobular and paraseptal emphysema, most prominent in the apices. Calcified nodules in the right upper lobe consistent with prior granulomatous disease. Mild bronchial wall thickening and bronchiectasis, right greater than left.MEDIASTINUM AND HILA: Cardiac size is within normal limits without pericardial effusion. Moderate to severe coronary artery calcifications. Moderate atherosclerotic changes in the thoracic aorta. Scattered small mediastinal lymph nodes. Calcified hilar lymph nodes consistent with prior granulomatous disease.Thyromegaly, right lobe greater than left.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine.Coarse calcification within the left breast is likely benign in etiology. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate atherosclerotic changes of the abdominal aorta and its branches.
Moderate centrilobular and paraseptal emphysema, upper lobe predominant.
Generate impression based on findings.
46-year-old male with history of ALL. Progressive crampy abdominal pain and neutropenic fever. Evaluate for typhlitis, other abdominal pathology. ABDOMEN: The absence of intravenous limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: Bilateral pleural effusions, left greater than right.LIVER, BILIARY TRACT: Hepatic steatosis is noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches. An IVC filter is noted in the expected location.BOWEL, MESENTERY: Orally administered contrast passes freely throughout the bowel without evidence obstruction or ileus. No intrinsic abnormality of the bowel is identified. The appendix is normal. The terminal ileum is normal in caliber.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.
1.No CT evidence of bowel pathology, as clinically questioned.2.Bilateral pleural effusions, left greater than right.3.Hepatic steatosis.
Generate impression based on findings.
Female; 17 years old. Reason: Please evaluate for pseudocyst around site History: Abdominal pain and vomiting ABDOMEN:LUNG BASES: No focal air space opacity or pleural effusions in the partially visualized lung bases. The visualized heart is normal in size without pericardial effusion.LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary dilation. Normal CT appearance of the gallbladder.SPLEEN: No focal splenic lesions.PANCREAS: No focal pancreatic lesions. No pancreatic duct dilation.ADRENAL GLANDS: No adrenal masses.KIDNEYS, URETERS: No focal renal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No abdominal or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No free fluid or loculated fluid collections. Ventriculoperitoneal shunt catheter courses down the right anterior chest wall, enters the peritoneal cavity at the midline, and terminates in the right upper quadrant anteroinferiorly to the liver. No pseudocyst at its tip.
1. No acute abdominal abnormality is evident.2. Ventriculoperitoneal shunt catheter without evidence of malfunction. No pseudocyst at its tip.
Generate impression based on findings.
Malignant neoplasm of head, face, and neckPersonal history of irradiation, presenting hazards to health CT neck:Numerous surgical clips are redemonstrated in the left neck. The left sternocleidomastoid muscle is not readily identified. The left and jugular vein is not readily identified there is old likely related to prior radical neck dissection. The appearance of the left neck with infiltration of fat adjacent to the left carotid space is stable. The left trapezius muscle is atrophicWithin the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.A pacemaker device is in placeThe carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact . There are multilevel degenerative changes present with endplate and uncovertebral osteophytes predominantly at C4-5, C5-6 and C6-7 where there is neural foramina encroachment and narrowing of the spinal canal and spinal canal narrowing is worse at C4-5. This is stable since the prior exam. There is fusion of the facet joints at C2-3CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy. There is soft tissue thickening along the left neck is likely posttreatment related2.No evidence for brain metastases.
Generate impression based on findings.
70 year-old male with head and neck cancer, likely tonsil primary, status post treatment CHEST:LUNGS AND PLEURA: Unchanged coarsely calcified right lower lobe granulomas. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. No mediastinal or hilar lymphadenopathy. Enlargement of the pulmonary artery compatible with pulmonary arterial hypertension. Cardiomegaly.Center venous catheter tip extends to the SVC. Pacemaker leads are unchanged in position. Severe coronary arterial calcifications and atherosclerotic calcifications of the aorta are again noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified hepatic granulomata.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal cyst.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: Pagetoid changes in the L1, L4, and L5 vertebral bodies are again noted.OTHER: No significant abnormality noted.
No evidence of metastatic disease or significant interval change.
Generate impression based on findings.
Female 59 years old; Reason: SBO, large bowel obstruction History: generalized abdominal pain, history of unspecified colitis ABDOMEN: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: A few too small to characterize lesions in the kidneys bilaterally. No radiopaque stones or hydronephrosis detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific mild proximal small bowel dilation without transition or free air. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Soft tissue attenuation noted in image, which could represent fibroid although incompletely characterized on CT examination. The bilateral adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Soft tissue attenuation projecting into the endometrial canal, incompletely characterized on CT examination. Correlation with ultrasonographic imaging advised.2.Nonspecific small bowel dilation, without evidence of zone of transition or frank obstruction. Correlate for enteritis.
Generate impression based on findings.
71 year old female with Hurthle cell thyroid cancer, evaluate and compare with prior studies. CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule measures 9 x 7 mm and previously measured 1.2 x 1.0 cm (image 52, series 5), decreased in size. Reference left lower lobe nodule measures 2.0 x 2.8 cm (image 51, series 5) and previously measured 2.0 x 2.6 cm when measured in greatest dimensions, not significantly changed. Multiple additional pulmonary metastases, the majority of which are not significantly changed in size. No new pulmonary nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal. Moderate coronary arterial calcification.CHEST WALL: Degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without CT evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule.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: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
Multiple pulmonary metastases, the majority of which are not significantly changed. One reference lesion has decreased in size. No evidence of new sites of disease.
Generate impression based on findings.
61-year-old male with melanoma. CHEST:LUNGS AND PLEURA: Several calcified and noncalcified lung micronodules bilaterally, of unclear etiology but may be result of prior granulomatous infection.Mild basilar pleural thickening/scarring.MEDIASTINUM AND HILA: Multiple calcified mediastinal and hilar lymph nodes, consistent with prior granulomatous infection. No significant lymphadenopathy.Heart size normal. 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: No significant abnormality noted.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 notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerosis and heterogeneity in left iliac bone with associated partial ankylosis of left SI joint and cortical thickening, not specific but could represent Paget's disease (series 3, image 168). OTHER: No significant abnormality noted
1.Calcified and noncalcified lung micronodules, likely result of prior granulomatous infection.2.Sclerosis and heterogeneity in left iliac bone with partial ankylosis of left SI joint; this does not appear typical of metastatic disease and most likely represents Paget's disease. 3.No convincing evidence of metastatic disease.
Generate impression based on findings.
79-year-old male with all and no metastatic non-small cell lung cancer status post chemoradiation. CHEST:LUNGS AND PLEURA: Pleural-based spiculated mass involving posterior right upper and lower lobes does not appear significantly changed. Associated bronchiectasis also appears similar. Stable elevation of left hemidiaphragm.No new suspicious lung nodules or lesions. Mild centrilobular emphysema.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size within normal limits. Mild coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multilobulated right lobe cystic lesion unchanged. Several other scattered punctate hypodensities are too small to characterize but unchanged and most likely represent cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal nodularity unchanged. Previously measured right adrenal gland nodule currently measures 1.2 x 2.3 cm, previously measured 1.2 x 2.2 cm (series 3, image 115).KIDNEYS, URETERS: Horseshoe kidney. Hypodensities in inferior poles of both kidneys unchanged, most consistent with cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Infrarenal abdominal aortic aneurysm unchanged, measuring 4 cm in maximal diameter (series 3, image 153).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status-post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Multiple surgical clips again noted in the pelvis. Fat containing inguinal hernias.
1.Pleural-based spiculated mass in right lung not significantly changed. 2.Bilateral adrenal nodules are stable since most recent exam but significantly decreased since remote exams.3.Stable infrarenal abdominal aortic aneurysm.
Generate impression based on findings.
52 year old female with history of cirrhosis. Monitoring for HCC. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: Left lobe and caudate hypertrophy with fissural prominence and undulation of liver contours are consistent with history of cirrhosis. Features of portal hypertension: None. Portal vein: Patent with normal caliber. Hepatic veins: Patent with normal caliber.Hepatic artery: Patent with normal caliber.Lesions: None.Cholelithiasis is noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Cirrhotic liver morphology without focal lesion.2.Cholelithiasis.
Generate impression based on findings.
Resected stage 3 melanoma, s/p left neck dissection. There are postoperative findings related to left neck dissection with resection of the left submandibular gland. There is diffuse skin thickening of the left neck in the region of the surgical bed that is likely treatment related and in the left temporal region that corresponds to solar elastosis, but no discrete mass lesion is identified. There is nonspecific mild prominence of a left parotid lymph node, which may be reactive. Otherwise, there is no evidence of significant cervical lymphadenopathy by size criteria. The oral cavity, pharynx, and larynx appear unremarkable. The thyroid gland is unremarkable. The left internal jugular vein appears to have been sacrificed. The other major cervical vessels are otherwise intact. There is an air fluid level in the right maxillary sinus. The mastoid air cells are clear. There is mild multilevel degenerative spondylosis. The partially imaged portions of the orbits and intracranial structures are grossly unremarkable.
1. Postoperative findings related to left neck dissection without evidence locoregional tumor recurrence of residual significant cervical lymphadenopathy.2. An air-fluid level in the right maxillary sinus may represent acute sinusitis in the appropriate clinical setting.
Generate impression based on findings.
72-year-old male patient with history of head and neck cancer status post chemoradiation therapy. Please reevaluate and compare to previous scans. CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules, some of which are calcified, are not significant changed. Calcified granulomas in the right lung are unchanged.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Moderate coronary artery calcifications. Minimal atherosclerotic changes in the thoracic aorta. Scattered small mediastinal lymph nodes. Scattered calcified mediastinal and hilar lymph nodes.CHEST WALL: Dextroscoliosis and multilevel degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered punctate calcifications in the liver parenchyma. Cholelithiasis.SPLEEN: Scattered punctate calcifications, consistent with prior granulomatous disease.ADRENAL GLANDS: Small left adrenal nodule is not significantly changed.KIDNEYS, URETERS: Right renal cysts are not significantly changed.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: Moderate to severe multilevel degenerative changes in the lumbar spine. Small fat filled umbilical hernia.OTHER: No significant abnormality noted.
No evidence of metastases or significant interval change.
Generate impression based on findings.
65-year-old female with nausea and vomiting, C. difficile. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions and basilar consolidation/atelectasis, improved since 11/22/2013.Stable cardiomegaly. Partially visualized metallic lead terminates in right atrium.LIVER, BILIARY TRACT: Stable small amount of ascites fluid around the liver. Diffuse low attenuation of hepatic parenchyma consistent with steatosis, which makes evaluation for liver lesions difficult. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland thickening unchanged. Right adrenal unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Several enlarged retroperitoneal nodes not significantly changed, with reference to left paraaortic node measuring 1.2 x 2.0 cm, previously measured 1.3 x 1.9 cm (series 6, image 81).BOWEL, MESENTERY: Multiple dilated loops of small bowel in the upper abdomen, with maximal diameter measuring 3 cm (series 6, image 77); transition point appears to be located in anterior lower abdomen, most likely due to compression by large lower abdominal and pelvic masses (series 6, image 117). No significant bowel wall thickening. Small to moderate amount of mesenteric free fluid (series 6, image 77).Interval increase in size of multiple mesenteric masses, consistent with marked carcinomatosis. The reference soft tissue lesion along the right lower abdomen measures 10.3 x 6.5 cm, previously measured 9.5 x 4.7 cm (series 6, image 101). The other non-index lesions are also increased.Multiple new enlarged mesenteric lymph nodes in (series 6, image 79). Increased moderate ascites fluid. NG tube terminates in distal stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Increased size of large bilateral adnexal masses, which occupy the majority of the pelvis.BLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac node not significantly changed, measuring 1.7 x 1.2 cm, previously measured 1.5 x 0.9 cm (series 6, image 137).BOWEL, MESENTERY: As described above, distal small bowel obstruction with transition point in anterior lower abdomen/upper pelvis, due to large pelvic and mesenteric masses.BONES, SOFT TISSUES: Diffuse anasarca. Lytic lesion in the left iliac bone again noted (series 6, image 118). Lucency in right humeral head unchanged, may be degenerative in nature.OTHER: No significant abnormality noted
1.Distal small bowel obstruction with transition point in anterior lower abdomen/upper pelvis, due to large pelvic and mesenteric masses.2.Increase in size of large pelvic and mesenteric masses. 3.Increased mesenteric lymphadenopathy and ascites fluid.
Generate impression based on findings.
Female 65 years old; Reason: History of pancreatic cancer History: na CHEST:LUNGS AND PLEURA: Bilateral scattered pulmonary micronodules, stable in size with no new nodules identified. Largest nodule in right lower lobe measures 7 mm, unchanged. Nonspecific right middle lobe ground glass opacity is unchanged. MEDIASTINUM AND HILA: Superior mediastinal soft tissue encasing left subclavian and common carotid arteries is stable and remains significantly decreased from exam dated 2/26/13. Reference posterior mediastinal lymph node is unchanged measuring 5 mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in segment 8 near the dome in the right lobe measures 1.5 x 1.4 cm, demonstrating continued decrease in size from 2.3 x 1.8 cm. However innumerable diffuse bilobar new hypodensities are identified, largest measuring 1.1 x 1.0 cm in the right lobe (image 84, series #11), representing progression of metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: Hypodense lesion of the pancreatic head is redemonstrated, stable in size and appearance encasing the superior mesenteric vessels, measuring 3.2 x 1.3 cm (image 94, series #11).ADRENAL GLANDS: Left adrenal nodularity and diffuse thickening is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches. Index left para-aortic lymph node measures 0.8 x 0.4 cm, not increased from prior study. Other small retroperitoneal lymph nodes are unchanged.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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Progression of metastatic disease in the liver.2.Stable pulmonary micronodules, mediastinal adenopathy, and retroperitoneal adenopathy.
Generate impression based on findings.
62-year-old male with history of tonsillar squamous cell carcinoma, status post induction chemo, reevaluate Diffuse low attention of the cerebellum and cerebellar atrophy, unchanged. Chronic deformity of the nasal bones with the nasal septum intact. Atherosclerotic intracranial vascular calcifications. Limited views of the orbits are unremarkable. The visualized paranasal sinuses are clear. The right mastoid air cells are clear. Opacification of a portion of the left mastoid air cells.The previously measured left neck mass at the level of the TMJ with multiple areas of low central attenuation has significantly decreased in size and is difficult to accurately measure on the current examination without contrast. Asymmetric fullness of the left parotid gland which has decreased since the prior study. A portion of the left sternocleidomastoid muscle is again inseparable from conglomerate necrotic lymphadenopathy. Interval decrease in soft tissue fullness of the left tonsillar/peritonsillar region with some residual asymmetry and soft tissue fullness.Interval decrease in extensive cervical lymphadenopathy with residual bilateral enlarged necrotic left cervical lymph nodes at levels 2, 3 and 4. Interval decrease in right cervical lymphadenopathy with residual small scattered right cervical nodes. Reference left level 3 necrotic appearing lymph node measures 1.7 x 1.4 cm (series 6 image 46), previously measured 2.1 x 1.7 cm. Reference left submandibular enlarged lymph node measures 1.6 x 1.4 cm (series 6 image 30), previously measured 2.2 x 2.1 cm.Submandibular glands, right parotid gland and thyroid are within normal limits. Aside from the left tonsillar soft tissue fullness, no exophytic mass or focal effacement of the aerodigestive tract. Mild cervical carotid atherosclerotic calcifications. Atherosclerotic vascular calcifications of the proximal cervical vertebral arteries.Multilevel degenerative changes without suspicious osseous lesions. Chronic right mandibular condyle deformity.Right apical volume loss, scarring and bronchiectasis. Please see dedicated chest CT from today's date for further details.
Significant interval decrease in size of ill-defined left tonsillar soft tissue mass and cervical lymphadenopathy, left greater than right.
Generate impression based on findings.
40-year-old patient following resection of meningioma. There are expected postoperative changes from resection of the right frontal meningioma which previously extended from the orbital roof. There is a resection cavity filled with CSF attenuating fluid. There are hyperattenuating blood products medially overlying the falx as well as at the dura. There is a stable degree of midline shift (2.0 cm) and intracranial air both within the subarachnoid and epidural spaces. There is soft tissue stranding and subcutaneous emphysema overlying the craniotomy defect.There is stable hypoattenuation within the left frontal lobe representing edema. There is no new intracranial mass or intraparenchymal hemorrhage. There is disconjugate gaze and at the time of exam which was not demonstrated on prior exams. Orbits, mastoids and paranasal sinuses are unremarkable.
Expected postoperative changes including a small amount of hemorrhage associated with the resection cavity of the large meningioma. Stable midline shift.
Generate impression based on findings.
Assess EVD. Prior intracranial hemorrhage. The EVD is in unchanged position extending to the midline from a right frontal approach. There has been interval evolution of blood intraventricular and intraparenchymal blood products. Intraparenchymal hemorrhage extends through the left thalamus, extending through the cerebral peduncle, left midbrain and left cerebellar peduncle. A second focus is unchanged at the insertion site of the EVD with in the right frontal lobe. Intraventricular hemorrhage layers dependently within the atria bilaterally. There has been no interval change in dimension of the ventricular system and there is no mass effect including midline shift or herniation.There is unchanged patchy hypoattenuation within the corona radiata bilaterally as well as the right basal ganglia. Secretions layering within the ethmoid, sphenoid, and right maxillary sinus are unchanged. There is scattered opacification of mastoid air cells. Orbits are unremarkable.
Interval stability in ventricular size from EVD position with evolution of intraventricular and intraparenchymal blood products as described.
Generate impression based on findings.
Male 73 years old; Reason: pt with melanoma History: melanoma CHEST:LUNGS AND PLEURA: 4-mm nodule is noted along the major fissure in the right lobe (series 4 image 43). While this may be intrapulmonary node, follow-up suggested.Atelectasis and scarring noted in the right lung base. Calcified granulomas noted in the lungs.MEDIASTINUM AND HILA: Borderline adenopathy in the mediastinum is noted including subcarinal nodes measuring up to 8 mm in short axis.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Few too small to characterize lesions in the liver are noted. Granuloma noted in the liver.SPLEEN: Numerous hypoattenuating lesions are noted throughout the spleen which are compatible with the patient's known history of metastatic melanoma.PANCREAS: No significant abnormality notedADRENAL GLANDS: 2.5 x 1.7 cm nodule in the right adrenal gland measures 40 Hounsfield units, incompletely characterized on this examination. The left adrenal gland is nodular, nonspecific.KIDNEYS, URETERS: Few too small to characterize lesions in the kidneys. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitisBONES, SOFT TISSUES: Marked S-shaped scoliosis with degenerative disease throughout the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked S-shaped scoliosis with degenerative disease throughout the spine.OTHER: Right-sided inguinal hernia containing fat and a portion of the bladder is noted.
1.Multiple splenic lesions compatible with metastatic melanoma. 2.Non specific right adrenal nodule incompletely characterized. MR or dedicated adrenal CT advised.3.The right inguinal hernia containing a portion of the the bladder.4.Non specific 4mm nodule in the right lung base. Continued follow up advised.5.No other metastatic disease detected in abdomen or pelvis
Generate impression based on findings.
33 year old patient post subarachnoid hemorrhage. There is a trace amount of residual hemorrhage products layering within the basal cistern. There is no new intracranial hemorrhage, mass, fluid collection or hydrocephalus. The midline is intact. Visualized portions of the orbits, mastoids and paranasal sinuses are unremarkable.
Evolution of subarachnoid blood products within the basal cistern. No new abnormality including acute hemorrhage.
Generate impression based on findings.
68 year old female with atypical chest pain and inconclusive stress echocardiogram. Patient is referred to evaluate coronary anatomy.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and trifurcates into the left anterior descending, ramus intermedius, and left circumflex coronary arteries. There are no significant stenoses present in the left main. There is a calcified, non-obstructive plaque in the distal left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is a partially calcified plaque in the ostial LAD resulting in a nearly 50% stenosis. The plaque is associated with mild positive remodeling. There is a calcified, non-obstructive plaque in the proximal portion of the mid LAD. There is a non-calcified plaque resulting in a nearly 50% stenosis in the mid LAD which also has mild positive remodeling. There is a <50% stenosis in the major diagonal artery.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx. There is a calcified, non-obstructive plaque in the mid LCx and OM1.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the mitral valve. There is minimal aortic valve calcification.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
1. There are are 2 separate nearly 50% stenoses in the LAD (one at the ostium and the second in the mid-vessel). 2. Mild coronary calcification noted in the diagonal, LCx, and OM arteries. 3. Mild aortic valve calcification. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
Generate impression based on findings.
69-year-old female with history of ovarian cancer, status post 6 cycles chemotherapy followed, with suboptimal surgery with two cycles of Taxol/carbo post surgery. Evaluate disease CHEST:LUNGS AND PLEURA: Stable appearance to the scattered pulmonary micronodules with no new or suspicious pulmonary nodules seen to suggest metastatic disease. No parenchymal airspace disease. No pleural effusions.MEDIASTINUM AND HILA: The prior to reference mediastinal nodes show minimally change. The referenced precarinal node (series 3, image 39) measures 1.1 x 1 .4 cm, previously 1.7 x 1.1 and the more cephalad pretracheal lymph node (series 3, image 34) measures 0.9 x 0 .7 cm, duplicating prior measurement. No new foci of lymphadenopathy is seen.No change in the enlarged paraesophageal lower mediastinal lymph node (series 3, image 71) and the enlarged right cardiophrenic angle lymph nodes (series 3, image 68)..CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Slight thickening of the peritoneum along the anterior liver margin extending into the fissure for the ligamentum teres is seen, unchanged and may represent scarring or residual disease from prior omental/peritoneal involvement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No change noted in the bilateral punctate nonobstructing calculate. Kidneys are otherwise unremarkableRETROPERITONEUM, LYMPH NODES: Enlarged Gastro-hepatic lymph nodes are again seen with the referenced conglomerate mass (series 3, image 88) measuring 3.3 x 2 .5 cm, previously 3.4 x 2.6 cm. scattered smaller retroperitoneal, periaortic lymph node enlargement is stable and unchanged.BOWEL, MESENTERY: Persistent thickening is seen about the mesentery (series 3, image 105) and anterior to the left colon more inferiorly (series 3, image 110 anteriorly -- these appear unchanged compared to 10/15/13 and is not been measured. They are minimal residual. When compared with the presenting CT examination of 5/5/13 where extensive omental cake draped across the entire omentum. As patient has had prior omentectomy -- these residual densities may represent postoperative scarring versus residual disease.No evidence of bowel obstruction or intrinsic disease in the visualized. Bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy. No other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged lymph nodes are seen bilaterally in the external iliac chains. Prior referenced right external iliac lymph node (series 3, image 159) is slightly larger, measuring 1.5 x 1.1 cm compared with previous 1.5 x 0.9 cm. Other lymph nodes show similar slight increase in size, particularly when compared with 9/9/13 rather than 10/15/13.BOWEL, MESENTERY: Persistent thickening of the peritoneal wall along the left inferior lateral extent is seen (series 3, image 16) with a similar distribution. This is diffusely thickened and not amenable to focal measurement, but is concerning for residual disease. Decreased ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Stable appearance to chest mildly prominent, lymph nodes and micronodules. 2. Stable appearance to gastrohepatic lymph nodes and retroperitoneal lymph nodes, but slight increase in size in bilateral external iliac, lymph nodes, particularly when compared with 9/9/13. 3. Residual thickening seen in several areas involving the omentum following omentectomy, and may represent residual disease or post procedural scarring. This is stable compared with 10/15/13. 4. Increased thickening of the peritoneal wall in the left pelvis, slightly progressive.
Generate impression based on findings.
62-year-old male patient with history of head and neck cancer, status post induction chemotherapy. Please compare to prior examinations and provide measurements if applicable. CHEST:LUNGS AND PLEURA: Right upper lobe apical scarring, pleural thickening and traction bronchiectasis with associated volume loss is stable compared to PET scan 10/3/2013 and is likely post-inflammatory in nature. Given some nodularity within the linear opacities, recommend continued attention to this area on follow up imaging.Debris within the right bronchus intermedius and segmental right lower lobe bronchi consistent with aspiration.Focal calcified pleural thickening in the posterior right lower lobe with adjacent atelectasis and pleural calcification in the right lung base likely due to asbestos exposure.MEDIASTINUM AND HILA: Mediastinum is shifted to the right in the setting of right lung volume loss. Mild left atrial dilatation without pericardial effusion. Mild coronary artery calcifications.Scattered small mediastinal lymph nodes. No significant hilar lymphadenopathy in this limited examination.Prominent supraclavicular lymphadenopathy that demonstrated increased activity on prior PET scan. Index right lymph node measures 8 mm (series 2 image 20).CHEST WALL: Mild multilevel degenerative changes in the thoracic and lumbar spine.Left humeral head hardware in place.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Multiple areas of calcifications along the liver capsule may be post-traumatic in nature or peritoneal calcifications from asbestos exposure.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mild left adrenal gland nodularity.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes of the abdominal aorta and its branches. Moderate atherosclerotic changes at the branches of the celiac trunk and right renal artery.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.
1.Stable right upper lobe scarring with mild nodularity that demonstrated mild uptake on PET is likely post-inflammatory in nature. Recommend continued attention to this area on follow up and correlation with PET scan.2.Right bronchus intermedius and right lower lobe segmental bronchial debris consistent with aspiration.
Generate impression based on findings.
60 year-old male with renal cancer. CHEST:LUNGS AND PLEURA: Stable 4-mm in micronodule and right lower lobe (series 5, image 54). No new nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy. Calcified nodes consistent with prior granulomatous infection. Mild coronary artery calcifications. Heart size normal.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hepatomegaly with decreased parenchymal attenuation likely result of fatty infiltration. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. No abnormal soft tissue in the surgical bed to suggest recurrence.RETROPERITONEUM, LYMPH NODES: Multiple prominent retroperitoneal lymph nodes are unchanged.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: Prominent pelvic lymph nodes unchanged. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1.No evidence of recurrence in left nephrectomy bed.2.No lymphadenopathy.3.Stable right lower lobe micronodule, which may be result of prior granulomatous infection.4.Findings suggestive of fatty liver infiltration; correlation with LFTs recommended if clinically indicated to see if clinical suspicion for NASH.
Generate impression based on findings.
History of right UPJ obstruction 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: Right-sided marked hydronephrosis. No evidence of stones. Right ureter is unremarkable in size. These findings are consistent with patient's known history of right UPJ obstruction.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Right UPJ obstruction. No evidence of stones.
Generate impression based on findings.
Reason: mets lung ca, EGFR +, on Erlotinib, had chemo and RT. Pls c/w previous study and evaluate dz status and tx response. History: lung ca CHEST:LUNGS AND PLEURA: Further fibrotic conversion of radiation reaction in the right lung.The previously referenced right lower lobe nodule has decreased in size, currently 3 mm (series 5 image 50), as compared to 6 mm. However, multiple new micronodules suggestive of metastases are noted throughout the right lung. Several of the previously noted micronodules have increased in size. The right pleural effusion persists.On the left, several previously noted micronodules have slightly increased by 1 mm (series 5 image 37 and 58). No interval left pleural effusion.MEDIASTINUM AND HILA: The heart size is normal. No interval pericardial effusion. Slight rightward mediastinal shift from right sided volume loss.No interval mediastinal or hilar lymphadenopathy.CHEST WALL: Epidermoid inclusion cyst anterior chest wall unchanged. No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There has been prior cholecystectomy.SPLEEN: Stable low density lesions, incompletely characterized.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: No significant abnormality noted.OTHER: No significant abnormality noted.
Although the previously referenced right lower lobe nodule has decreased in size, there are multiple bilateral pulmonary nodules that have become larger. Several additional nodules are new. Stable right pleural effusion.No mediastinal or hilar lymphadenopathy.
Generate impression based on findings.
73-year-old male with melanoma. Additional history obtained from EPIC: history of melanoma of the left forehead with metastasis to the left back, status post left parotidectomy and neck dissection. Within the visualized brain, there is no acute hemorrhage, masses or edema.There are postsurgical changes of a left parotidectomy with surgical clips and effacement of fat planes in the surgical bed extending to the left submandibular space. Scattered small cervical lymph nodes are noted. Mediastinal and supraclavicular lymph nodes are borderline enlarged, up to 9 mm in short axis. There are no enlarged lymph nodes by CT criteria.The orbits are unremarkable. The mastoid air cells are clear. Mild right maxillary mucosal thickening is present. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The submandibular and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. A small amount of atherosclerotic arterial calcifications are present at the carotid bifurcations. Severe degenerative changes affect the cervical spine with posterior subluxation at C3-C4, C4-C5 and C5-C6 and large disk osteophyte complexes. There is multilevel facet joint hypertrophy.
1.Infiltration of fat planes in the left neck is likely post treatment related.2.Severe degenerative changes of the cervical spine.3.Bordeline sized lymph nodes in the left supraclavicular region and the mediastinum do not meet size criteria for lymphadenopathy.
Generate impression based on findings.
History of kidney stones 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: Punctate stone in the right upper pole. No evidence of hydronephrosis. No evidence of ureteral or bladder stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Punctate stone in the right upper pole without evidence of hydronephrosis.
Generate impression based on findings.
T4aN2b SCCa of the left oral tongue s/p TFHX completed in 8/2011. There are stable post-treatment findings in the oral cavity region, including hyperemia of the submandibular and parotid glands. There is no evidence of discrete masses or cervical lymphadenopathy by size criteria. The airways are patent. The thyroid gland is unremarkable. The paranasal sinuses are clear, apart from a right maxillary sinus mucus retention cyst. The mastoid air cells and middle ear cavities are clear. The patient is partially edentulous. The partially imaged orbital and intracranial contents appear unremarkable. The major cervical vasculature is patent. The partially imaged lung apices are clear. The osseous structures are unremarkable.
Stable post-treatment findings without evidence of locoregional tumor recurrence or cervical lymphadenopathy.
Generate impression based on findings.
60-year-old male with history of bladder neoplasm CHEST:LUNGS AND PLEURA: Mild emphysema. Punctate micronodule is unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Small infrarenal abdominal aortic aneurysm measuring 2.6-cm in largest AP dimension.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
No significant change from previous study.
Generate impression based on findings.
Reason: h/o vocal cord cancer History: r/o chest mets LUNGS AND PLEURA: Unchanged calcified granulomata and centrilobular predominant emphysema.Mild basilar scarring or fibrosis is unchanged. TheMEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.Mild to moderate coronary calcifications are present.CHEST WALL: Moderate degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis.
No evidence of metastases, or other significant abnormality. No significant change.
Generate impression based on findings.
Chronic sinusitis and nasal polyps. There are postoperative findings related to bilateral uncinectomy, partial ethmoidectomy, middle turbinectomy, and likely septoplasty. There is moderate mucosal thickening within the bilateral maxillary sinuses as well as hyperattenuating secretions within the right maxillary sinus. There is near complete opacification of the ethmoid air cells, with relative sparing of the posterior right ethmoid sinus. There is complete opacification of the right frontal sinus. The left frontal sinus is not pneumatized. There is also complete opacification of the bilateral sphenoid sinuses with hyperattenuating secretions as well. There are polypoid opacities within the upper nasal cavity. There is mild nasal septal deviation anteriorly. The right ethmoid roof is 2 mm lower than the left, but are otherwise intact. The carotid grooves and optic canals are covered by bone. The mastoid air cells are middle ear cavities are clear. The imaged portions of the intracranial structures and orbits are grossly unremarkable.
Pansinus opacification and polypoid opacities in the nasal cavity are compatible with sinonasal polyposis and sinusitis.
Generate impression based on findings.
Status post laser resection of a T1 vocal cord cancer. There is an unchanged truncated appearance of the left vocal cord, likely attributable to laser resection. There is an also unchanged punctate defect and adjacent mild sclerosis in the left thyroid cartilage, which is also likely post-treatment in nature. No discrete mass lesion is identified. There is no significant cervical lymphadenopathy. The airways are clear. The major salivary glands and thyroid are unremarkable. There is approximately moderate stenosis of the bilateral carotid bifurcations secondary to atherosclerotic plaque. The partially imaged intracranial structures are grossly unremarkable. The osseous structures are unchanged. There is an unchanged partially calcified nodule in the left lung apex as well as emphysematous changes in the lungs bilaterally.
Stable post-treatment findings in the larynx without evidence of locoregional tumor recurrence of significant cervical lymphadenopathy.
Generate impression based on findings.
64-year-old male history of metastatic urothelial cancer Limited study due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Biapical scarring, unchanged. Micronodules in the right middle lobe, unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.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: Atrophic right kidney, unchanged.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 prostatectomyBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Previous described, platelike soft tissue density in the left obturator region has near completely resolved.
Limited study due to lack of IV contrast. No evidence of metastatic or recurrent disease within the limitations.Micronodules in the lungs and biapical scarring are unchanged.
Generate impression based on findings.
73-year-old male with history of bladder and prostate cancer. Status post postero-cystectomy -- CHEST:LUNGS AND PLEURA: Stable appearance to the micronodules with no development of new nodules. No lesions, suspicious for metastases seen and no significant air space disease or pleural effusions noted.MEDIASTINUM AND HILA: Mildly prominent lymph node nodes are again seen in the right hilum (series 3, image 50, 1) where the prior reference lymph node now measures 1.8 x 1.4, previously 1.9 x 1.3 cm. No new foci of lymph node enlargement noted.Coronary artery calcification seen. Port-A-Cath catheter tip located in the distal superior vena cava.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Homogeneous liver parenchyma again seen with normal portal and hepatic veins. No evidence for metastatic disease. Multiple gallstones again seen without other complication. Biliary tract otherwise appears normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The relatively diffuse periaortic and aortocaval clustered lymph nodes are again seen, unchanged in their appearance, with mildly prominent, lymph nodes diffusely. The reference lymph node (series 3, image 139), in the aortocaval space is unchanged, measuring 1.4 x 1.2 cm.While the periaortic lymph nodes appear unchanged, there is extensive, new mesenteric lymphadenopathy seen diffusely in the root of the mesentery (see series 3, image 126 of the largest of these measures 3.2 x 1.2 cm and represents a newly enlarged lymph node.). BOWEL, MESENTERY: Administered contrast progresses through normal appearing stomach, small bowel to the colon with bowel, only, demonstrating expected postoperative changes. No free mesenteric fluid is seen. Extensive new mesenteric lymphadenopathy is seen as described in lymph nodes above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy without evidence of abnormal mass in surgical bed.BLADDER: Prior cystectomy without evidence of abnormal mass in surgical bed. Ileal loop. Bladder is seen in the right lower quadrant.LYMPH NODES: Enlarged pelvic mesenteric lymph nodes are seen. New since prior examination (see series 3, image 160) where the largest measures 2.3 x 1.1 cm representing a new focus of lymph node enlargement. No neck chain adenopathy is seen.BOWEL, MESENTERY: Administered contrast progresses through normal appearing stomach, small bowel to the colon with bowel, only, demonstrating expected postoperative changes. No free mesenteric fluid is seen. Extensive new mesenteric lymphadenopathy is seen as described in abdomen lymph nodes above. Mesenteric lymphadenopathy is seen in the pelvis as well.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1. Moderately extensive new mesenteric adenopathy seen in the abdomen and superior pelvis worrisome for metastatic disease. 2. Minimal change in the prior referenced, mediastinal and retroperitoneal lymphadenopathy. 3. Gallstones. 4. No other changes since prior examination.
Generate impression based on findings.
Pancreas cancer CHEST:LUNGS AND PLEURA: Stable scattered calcified and not calcified micronodules. Linear atelectasis at the lung bases.MEDIASTINUM AND HILA: Calcified lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic mass is difficult to measure, but smaller compared to previous study, measuring 2.5 x 2 .5 cm, image number 95, series number 3. Metallic stent in the common bile duct. The mass invades the hepatic artery and main portal vein.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: 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.
Interval decrease in the size of the locally invasive pancreatic head cancer.
Generate impression based on findings.
74-year-old male with history of stage IV gastric cancer CHEST:LUNGS AND PLEURA: Index left lower lobe subpleural nodule is stable measuring 7 x 6 mm on image number 50, series number 4. No new nodules. Other subcentimeter nodules are also stable.MEDIASTINUM AND HILA: Left supraclavicular adenopathy is increased in size and now measures 1.9 x 1.7 cm on image number 15, series number 3. Previously, it was, measuring 1 cm in diameter image number 10, series number 3.Index left hilar lymph node measures 1.2-cm in short axis on image number 58, series number 3, unchanged. Other, mediastinal and hilar lymph nodes are also unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver are again seen. Index lesion in the right lobe measures 1.4 x 1.4 cm on image number 110, series number 3, not significantly changed. Other ill-defined, hypodense lesions are suspicious for metastatic disease, but are unchanged from previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index portacaval lymph node measures two by 1.1 cm, image number 107, series number 3, not significantly changed. Index left para-aortic lymph node measures 3 by 2.3 cm on image number 126, series number 3, not significantly changed from previous study. Other retroperitoneal lymph nodes are also grossly unchanged.BOWEL, MESENTERY: Large gastric mass involving the lesser curvature of the stomach. Again noted, unchanged.Carcinomatosis and multiple mesentery lymph nodes are grossly unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.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
Extensive metastatic disease in the lungs, liver, mediastinum, hilum, retroperitoneum, peritoneum and small bowel, mesentery, are grossly stable. Patient's large known gastric cancer is stable. Minimal interval increase in the size of the left supraclavicular lymph node.
Generate impression based on findings.
72-year-old female with history of colo-pericardial fistula. Status post exploratory laparotomy and drain placement CHEST:LUNGS AND PLEURA: Bilateral moderate-sized pleural effusions, slightly increased compared to previous CT study. Dependent atelectasis is present.MEDIASTINUM AND HILA: Changes secondary to colonic interposition. NG tube is in place. Small amount of pericardial fluid and small amount of air is present within the pericardium. There is a drain with its tip in the pericardial cavity.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
The slight interval increase in the amount of bilateral pleural effusions.Small amount of pericardial fluid with pericardial drain in place.
Generate impression based on findings.
49 year-old female with metastatic melanoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The clusters of small enhancing lymph nodes in the left axilla and are seen, unchanged with the. Reference left axillary node (series 3, image 27) measuring 1.3 x 1 .0 cm, previously 1.1 x 1.0. Other smaller lymph nodes appear unchanged.No change in the right anterior chest wall subcentimeter nodule.ABDOMEN:LIVER, BILIARY TRACT: Benign cyst segment two liver, unchanged. Liver parenchyma shows no worrisome lesions from metastatic disease. No other parenchymal abnormalities. Gallbladder and biliary tract appear normal.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: Diffuse left para-aortic lymph node, clusters, and enlargement are again seen, unchanged. The referenced lymph node (series 3, image 112) measures 2.2 x 1.2 cm, previously 2.3 x 1.4. No new foci of lymph node enlargement is seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Prior noted large solid/cystic mass in the left posterior lateral body wound subcutaneous fat (series 3, image 130) is again seen, unchanged and measures 10.6 x 16.0 cm, previously 16.0 x 9.7 cm. in dependent edema is seen in the subcutaneous fat, but no other mass lesions identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large right adnexal heterogeneous mass is again seen, unchanged in size over the past several examinations, and measures 10.2 x 9.9 cm (series 3, image 162). This appears to be in the right adnexa to represent either a primary ovarian lesion or metastatic disease. No left adnexal abnormality is seen and no uterine abnormality is noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged enhancing left external iliac lymph nodes are again seen, unchanged in size (series 3, image 178). The enhancing left inguinal lymph node (series 3 , image193) referenced previously is also unchanged and measures 2.4 x 0.8 cm (previously 2.2 x 0.8 cm). Other lymph nodes in the right and left inguinal area appear unchanged as well. No new areas of lymph node enlargement are seen. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Stable appearance to lymphadenopathy as measured in the left axilla, retroperitoneum, and pelvis. No new areas of lymphadenopathy seen. 2. No change in the large left posterolateral abdominal wall mass. 3. No change in the large right adnexal mass of uncertain etiology.
Generate impression based on findings.
Reason: small cell Ca, s/p chemo and RT, followup History: none CHEST:LUNGS AND PLEURA: Postsurgical changes reflect left lower lobectomy with associated volume loss. Subpleural reticulation in left upper lobe compatible with radiation fibrosis is stable. Right anterior paramediastinal reticulation and bronchiectasis also favors that of post radiation change. Mild paraseptal and centrilobular emphysema.Nodular fissural opacities on the right favor intrapulmonary lymph nodes, unchanged. Recent referenced nodule within the medial right upper lobe has remained stable.No interval pleural effusion.MEDIASTINUM AND HILA: Stable heart size without interval pericardial effusion. Native coronary artery calcification. Stable saccular aneurysm arising from the left lateral aspect of the distal transverse arch without interval dissection.No mediastinal or hilar lymphadenopathy. Hiatal hernia unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Heterogeneous exophytic mass arising from the intra-pole the left kidney measuring 2.4 x 2.5 cm (series 4 image 128) has increased in size. It measured 2.1 x 2.1 cm on the prior study. This is highly suspicious for renal cell carcinoma. The left renal vein appears free of thrombus. Additional exophytic cysts throughout the left and right kidneys are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Porta hepatis lymph nodes are stable, with the largest measuring 15 mm in short axis (series 4 image 93).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic spine.OTHER: Stable position of an infrarenal abdominal aortal iliac modulated stent graft.
Continued interval growth of a heterogeneous, exophytic mass arising from the intra-pole the left kidney highly suspicious for renal cell carcinoma.No suspicious pulmonary nodules.
Generate impression based on findings.
Reason: lung cancer with liver met, ck response to therapy History: cough CHEST:LUNGS AND PLEURA: Status post right lower lobectomy. Apical and basilar scarring, unchanged.Mild centrilobular upper lobe predominant emphysema. 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.Severe coronary artery calcification.Left subclavian bypass graft. Redemonstrated.CHEST WALL: Stable sclerotic focus anteriorly and inferiorly within the T12 vertebrae. Sclerotic T11 right lamina and spinous process, unchanged since exam of 5/8/13 and probably representing metastatic disease as well.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right lobe hepatic metastasis (image 105, series 3) is decreased in size, now measuring 14 mm x 9 mm, previously, measuring 21 mm x 17 mm.. Other scattered small hepatic hypodensities are unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small right upper pole renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable left periaortic lymph node (image 120, series 3) measuring 10 mm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.No evidence of recurrence or pulmonary metastatic disease.2.Interval decrease in size of hepatic metastasis.3.Stable T11 and T12 vertebral metastases.4.No new sites of disease identified.
Generate impression based on findings.
Acute change in mental status, evaluate for intracranial hemorrhage. There is cortical and subcortical welling and hypoattenuation in the right occipital lobe as well as the left orbito-frontal gyrus and pars triangularis. There is a punctate hyperattenuating focus in the left circular gyrus may represent a calcified thromboembolus. There is no evidence of acute intracranial hemorrhage. There is disproportionate enlargement of the temporal horn of the left lateral ventricle, but no evidence of hydrocephalus and is perhaps developmental in nature. There is no midline shift or herniation. There is partial opacification of the bialteral mastoid air cells. The skull and extracranial soft tissues are unremarkable.
Edema within the right occipital lobe and left frontal lobes likely represent recent embolic infarcts without evidence of intracranial hemorrhage or midline shift. Brain MRI and cerebrovascular imaging is recommended for further evaluation if feasible. Discussed with Dr. Skelly at 1:25 PM on 11/26/13.
Generate impression based on findings.
52-year-old female with history of chordoma CHEST:LUNGS AND PLEURA: Left upper lobe mass measures 2.7 by 1.5-cm on image number 17, series number 5, not significantly changed from previous study.Lobulated index lingular mass abutting the pericardium measures 3.9 by 2.8 cm on image number 59, series number 5, slightly smaller compared to previous study.Index right lower lobe mass measures 5.1 by 3.9 cm on image number 76 on series number 5, not significantly changed from previous study.Index left lower lobe mass measures 2.5 by 2 cm on image number 84, series number 5, not significantly changed from previous study. Other bilateral numerous nodules are also grossly stable.MEDIASTINUM AND HILA: Index right hilar lymph node measures 2.5 x 2 cm on image number 43, series number 3, not significantly changed. Other mediastinal and hilar adenopathy is also grossly unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable small hypodensities in the liver.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: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mixed sclerotic/lytic lesion involving the sacrum, again noted. Left femur lesion, unchanged.OTHER: No significant abnormality noted.
Extensive metastatic lung lesions and mediastinal and hilar adenopathy, grossly unchanged except for minimal interval increase in the size of the left lingular mass.Mixed lytic/sclerotic sacral lesion in left femur lesion are unchanged.
Generate impression based on findings.
Reason: asess for HCC recurrence History: Recent TACE/RFA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Features of portal hypertension: Enlarged portal vein with multiple portosystemic collaterals consistent with portal hypertension. Increased moderate ascites.Portal vein: Attenuated anterior branch of right portal vein, likely thrombosed. Hepatic veins: Patent.Hepatic artery: Patent. Mild focal biliary dilation.Lesions: Tumor cavity measures 2.8 x 3.1 cm (image 23 , series 11 ), previously 3.4 x 2.6 cm in segment 7, arterial enhancement - none; washout - none ; peripheral rim enhancement - none .There is a wedge-shaped area of hypoattenuation superior to the treated lesion, likely resulting from portal venous occlusion. Redemonstration of numerous low attenuating, nonenhancing lesions are seen throughout the liver likely representing hepatic cysts. Status post cholecystectomy. Common bile duct is dilated and may be normal given post-cholecystectomy state.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 descending abdominal aorta and bilateral iliac arteries. BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality notedOTHER: New metallic coils in left upper quadrant, likely due to embolization of previously seen large collateral vessels. Associated metallic streak artifact obscures adjacent structures.
1.Segment 7 hepatic lesion status post chemoembolization without residual nodular enhancement, washout or rim enhancement.2.Redemonstration of numerous hypodense lesions, likely hepatic cysts.3.Redemonstration of thrombosis of the intrahepatic right portal vein.4.Interval coiling of splenorenal shunt collaterals and increase in ascites fluid.
Generate impression based on findings.
Reason: pt with MBC on treatment please assess response and compare to previous imaging History: metastic breast cancer CHEST:LUNGS AND PLEURA: Solid, rounded nodules occupy the lower lobes. On the left, the nodule measures 10 x 11 mm (series 6 image 57). This is increased from the prior PET/CT of 7/25/2013, when it measured approximately 6 x 8 mm. Within the posterior basal segment of the right lower lobe, there is a new pulmonary nodule measuring 7 x 8 mm (series 6 image 61). These demonstrated increased metabolic activity on the PET CT performed the same day and are highly compatible with metastases.MEDIASTINUM AND HILA: Small cyst in the right lobe of the thyroid gland.New nodular anterior mediastinal soft tissue density measures 19 x 29 mm (series 41 image 34), also demonstrates increased embolic activity on recent PET consistent with lymphadenopathy.The heart size is normal. No pericardial effusion. No hilar or subcarinal lymphadenopathy.CHEST WALL: A right port terminates within the right atrium.Small bilateral axillary, supraclavicular and subpectoral lymph nodes that demonstrate increased metabolic activity.Spiculated nodule within the inferior left breast at the nipple line measuring 13 x 21 mm (series 41 image 59). This is not changed since 7/25/13.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Arterially enhancing lesion within the right hepatic lobe measuring 15 x 18 mm (series 41 image 96), unchanged from 8/12/11 and favoring a hemangioma. Additional multiple low density lesions compatible with cysts, also stable.SPLEEN: Low density lesion not well visualized on the prior CT of 8/12/11.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrolithiasis.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: Sclerosis involving the anterior two thirds of T12 vertebral body and a punctate focus with an L2, right iliac bone and right scapula compatible with metastases.OTHER: No significant abnormality noted.
Bilateral lower lobe nodules, increasing on the left and new on the right, compatible with pulmonary metastases.Osseous metastases involving T12, L2, right iliac bone and right scapula.Interval development of anterior mediastinal lymphadenopathy which demonstrates increased metabolic activity on the PET performed on the same day. Mildly enlarged subpectoral, bilateral axillary and supraclavicular lymphadenopathy also demonstrates increased metabolic activity.Spiculated nodule within the inferior left breast at nipple line unchanged from immediate prior study of 7/2013.
Generate impression based on findings.
47 year-old female status post fall and head trauma. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
No acute intracranial abnormality.
Generate impression based on findings.
62-year-old male status post descending colon resection and Hartmann's procedure at outside hospital. Evaluate for malignancy prior to reversal. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypoattenuating lesions, some of which are too small to characterize, but most likely represent benign cysts. No suspicious liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several subcentimeter renal hypodensities are too small to characterize but most likely represent benign cysts. Exophytic, hyperdense lesion arising from the inferior pole of right kidney measures 1.2 cm; this is incompletely characterized but likely represents proteinaceous or hemorrhagic cyst (series 3, image 74). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post descending colon resection. Hartmann's pouch and left lower quadrant ostomy appear unremarkable.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: Status post descending colon resection. Hartmann's pouch and left lower quadrant ostomy appear unremarkable. Multiple diverticula noted in sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1.Postsurgical changes status post resection of descending colon. Hartmann's pouch and left lower quadrant ostomy appear unremarkable.2.1.2-cm exophytic, hyperdense lesion arising from right kidney is incompletely characterized on this exam, but likely represents proteinaceous or hemorrhagic cyst.3.Multiple well-defined hypodensities in liver, some of which are too small to characterize, but most likely represent benign cysts.
Generate impression based on findings.
Renal cell carcinoma status post nephrectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Right nephrectomy site clear. Stable left renal cystRETROPERITONEUM, 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
Status post right nephrectomy. No evidence for acute, inflammatory, or metastatic process.
Generate impression based on findings.
Pterygomaxillary fossa tumor. There is a well-defined soft tissue attenuation prestyloid parapharyngeal mass within the left trigeminal fat pad that measures 11 AP x 15 RL x 15 SI mm. There may be punctate calcification along the periphery of the mass. There is mild asymmetric widening of the left pterygomaxillary fossa without a discrete mass in this location. There is mild prominence of the suprahyoid cervical lymph nodes diffusely, although these are not significantly enlarged by size criteria. The oral cavity, pharynx, and larynx are unremarkable. The major salivary glands and thyroid are unremarkable. The major cervical vessels are patent. There is an air-fluid level within the left maxillary sinus. The imaged intracranial structures and orbits are grossly unremarkable. There is reversal of the normal cervical lordosis with fusion of the C5 and C6 vertebral bodies and degenerative spondylosis at C6-7. The imaged portions of the lungs are clear.
1. A well-defined soft tissue attenuation mass within the let trigeminal fat pad that measures up to 15 mm may represent a peripheral nerve sheath tumor and less likely a minor salivary gland tumor or lymphatic malformation. High-resolution MRI with contrast may be useful for further characterization. 2. An air-fluid level within the left maxillary sinus may represent acute sinusitis in the appropriate clinical setting.
Generate impression based on findings.
Reason: advanced NSCLC on most recent PET imaging; re-evaluate to assess pace of growth of identified lesions History: none CHEST:LUNGS AND PLEURA: Large right suprahilar mass (series 5/37) with evidence of internal necrosis and dystrophic calcification measuring 46 x 56 mm, increased from 41 x 47 mm previously. The mass is invading the mediastinum in the lower right paratracheal region and there is adjacent lymphadenopathy.A small irregular subpleural nodule in the high left paraspinous area, probably increased even a line for marked differences in technique since the previous scans (series 5/20).5-mm nonspecific nodule adjacent to the left hemidiaphragm (series 5 image 78) unchanged and most likely benign.MEDIASTINUM AND HILA: The interval resolution of a right apical hydropneumothorax. Residual loculated small pleural effusion with pleural thickening at the right apex.Moderately enlarged lower right paratracheal lymph node measuring 12 mm in short axis, unchanged.Mild enlarged subcarinal and right hilar lymph nodes also unchanged.Moderate coronary artery calcifications.Small pericardial effusion, new from previous.CHEST WALL: Postsurgical rib deformities on the right hemithorax.Wedge deformity of the T11 vertebra with associated degenerative change.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right lobe (arrow), not clearly visible previously but most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral nonobstructing calculi.PANCREAS: Marked ductal dilatation and multiple calcifications compatible with chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease in the spine.OTHER: No significant abnormality noted.
1.Interval growth in a large right suprahilar necrotic mass.2. Suspicious right upper lobe subpleural nodule with questionable interval growth which may represent a second primary carcinoma.
Generate impression based on findings.
Reason: pneumonia? History: neutropenic fever LUNGS AND PLEURA: Motion limits sensitivity.Again noted are bilateral pleural effusions with underlying atelectasis. Effusions have increased compared to the abdominal CT dated 11/25/13.Previously noted right lower lobe nodule is not identified.MEDIASTINUM AND HILA: Large left lobe thyroid mass unchanged.No hilar or mediastinal lymphadenopathy.Calcified mediastinal and hilar lymph nodes compatible with old granulomatous disease.Left central venous catheter with its tip in the SVC.Mild cardiac enlargement 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.
Bilateral pleural effusions, increased from the abdominal CT, dated 11/25/13. No specific evidence of acute infection.
Generate impression based on findings.
69-year-old male with aortic stenosis, chest pain, shortness of breath. VESSELS:DISTAL AORTA PROXIMAL TO BIFURCATION: 1.6 X 1.4 cmPROXIMAL RIGHT COMMON ILIAC ARTERY: 1.2 X 0.9 cmDISTAL RIGHT COMMON ILIAC ARTERY: 1.1 X 1.0 cmPROXIMAL RIGHT EXTERNAL ILIAC ARTERY: 1.2 X 1.0 cmMID RIGHT EXTERNAL ILIAC ARTERY: 1.1 X 1.0 cm.DISTAL RIGHT EXTERNAL ILIAC ARTERY: 1.1 X 1.1 cm.PROXIMAL RIGHT COMMON FEMORAL ARTERY: 0.9 X 0.9 cm.PROXIMAL LEFT COMMON ILIAC ARTERY: 1.1 X 0.9 cmDISTAL LEFT COMMON ILIAC ARTERY: 1.1 X 1.0 cmPROXIMAL LEFT EXTERNAL ILIAC ARTERY: 1.0 X 0.8 cmMID LEFT EXTERNAL ILIAC ARTERY: 1.1 X 1.1 cm.DISTAL LEFT EXTERNAL ILIAC ARTERY: 1.1 X 1.2 cm.PROXIMAL LEFT COMMON FEMORAL ARTERY: 0.9 X 1.2 cm.CHEST:LUNGS AND PLEURA: Evaluation is limited by imaging acquired in the expiratory phase. There is a small layering left pleural effusion and a moderate right pleural effusion with overlying compressive atelectasis. There is mild septal thickening and ground glass opacities compatible with mild edema.Debris is noted in the dependent portions of the trachea consistent with aspiration. MEDIASTINUM AND HILA: Postoperative changes of coronary artery bypass graft surgery are noted with a LIMA-LAD anastomosis and two venous grafts extending to an O. M. branch and the PDA. There is mild bi-atrial enlargement with severe native coronary arterial calcifications. The aortic valve is heavily calcified. There is lipomatous hypertrophy of the interatrial septum. The main pulmonary artery measures 3.5 cm in diameter which can be seen with pulmonary hypertension.Scattered mildly enlarged mediastinal lymph nodes are present with reference pretracheal lymph node measuring 1.1 cm in short axis (series 12, image 225). There is mediastinal lipomatosis. The quantity of adipose tissue raise the question of steroid use.The thoracic aorta is normal in caliber without evidence of dissection. Atherosclerotic calcifications are noted along the aortic arch with dense calcifications along the origins of the great vessels.CHEST WALL: Sternal fixation wires are noted with mild diastasis of the inferior sternum. There is no evidence of active infection. Mild gynecomastia is present. Mild multilevel degenerative changes affect the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and attenuation. The gallbladder is distended.SPLEEN: No significant abnormality noted.PANCREAS: A low attenuation lesion is noted along the head of the pancreas measuring 1.4 x 1.3 cm (series 7, image 172) with peripheral coarse calcifications. There is no pancreatic ductal dilatation or biliary ductal dilatation. The pancreatic body and tail are mildly atrophic without focal lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mild bilateral perinephric fat stranding. No focal renal lesions are identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease affects the abdominal aorta and iliac arteries with eccentric mural thrombus formation. There is no retroperitoneal lymphadenopathy. BOWEL, MESENTERY: Scattered colonic diverticula are present without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes affect the lumbar spine.OTHER: A pannus is present which ends approximately at the inguinal level. PELVIS:BLADDER: The bladder is collapsed. A Foley catheter is visualized in the bladder lumen. A small focus of gas is present in the bladder compatible with instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted.
1.Atherosclerotic disease with reference measurements as detailed above.2.There is a 1.4 x 1.3 cm cystic lesion in the pancreatic head with peripheral coarse calcifications. The differential considerations include papillary and mucinous neoplasms, as well as lesions within the cystadenoma spectrum. Further evaluation is recommended with MRCP in 3-6 months, if clinically appropriate.
Generate impression based on findings.
Male; 17 years old. Reason: restaging of tongue and bladder cancer History: asymptomatic CHEST:LUNGS AND PLEURA: No pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion. Normal CT appearance of the gallbladder. No intra-or extrahepatic biliary ductal dilation.SPLEEN: No focal splenic lesion.PANCREAS: No focal pancreatic lesion. No pancreatic ductal dilation.ADRENAL GLANDS: No adrenal masses.KIDNEYS, URETERS: Stable left renal cyst. No suspicious renal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder contains numerous calculi, the largest of which measures 1.6-cm.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction. A surgical suture row of the cecum is noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: A punctate calcification in the right scrotum is partially visualized, possibly a benign tunica albuginea calcification.
1. No metastatic disease is evident in the chest, abdomen, and pelvis.2. Numerous bladder calculi.3. Partially visualized punctate calcification within the right scrotum, which can be further evaluated with scrotal ultrasound.
Generate impression based on findings.
Other postprocedural status Other postprocedural status OR planningLeft tremor The CSF spaces are appropriate for the patient's stated age with no midline shift. Images obtained following placement of a DBS indicates a presence of intracranial air burr hole along the right frontal bone through the right frontal lobe, into the right thalamus and the tip of the stimulator at the level of the right cerebral peduncle.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
No evidence for acute intracranial hemorrhage mass effect or edema following placement of a DBS with placement as indicated above. Images are somewhat degraded by metal artifact.
Generate impression based on findings.
History of laryngeal cancer status post radiation, reevaluate Limited intracranial and orbital views are unremarkable. Small right sphenoid sinus mucus retention cyst, otherwise the visualized paranasal sinuses and mastoid air cells are clear.Scattered small cervical lymph nodes without lymphadenopathy by CT size criteria. Interval development of nonspecific symmetric prominence of Waldeyer's ring which completely effaces the nasopharyngeal airway. The glottic space is tight with minimal asymmetry of the vocal cords. However, the paraglottic spaces are grossly preserved. There is no enhancing measurable focal exophytic mass of the aerodigestive tract. No soft tissue masses are present in the neck. The thyroid gland, submandibular and parotid glands are free of focal lesions. The major cervical vasculature is patent. Atherosclerotic vascular calcifications of the carotid bifurcations.Multilevel degenerative changes of the visualized cervicothoracic spine resulting in neuroforaminal narrowing without suspicious osseous lesions. Periodontal disease along the left mandible.Atherosclerotic vascular calcifications of the aortic arch. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details.
1. No enhancing measurable laryngeal mass or cervical lymphadenopathy is present.2. Interval development of nonspecific symmetric prominence of Waldeyer's ring which completely effaces the nasopharyngeal airway. Correlate clinically.
Generate impression based on findings.
64-year-old female with cough, compared to previous organizing pneumonia LUNGS AND PLEURA: Interval resolution of right lower lung consolidation and diffuse groundglass opacities. Diffuse mosaic attenuation is again noted, likely due to small airways disease. No suspicious pulmonary nodules or masses. Mild bronchial wall thickening. Scattered micronodules some of which are calcified consistent with prior granulomatous disease.MEDIASTINUM AND HILA: Central venous catheter tip extends to the SVC. Moderate coronary arterial calcifications. Interval decrease in mediastinal lymphadenopathy with reference paratracheal lymph node now measuring 1.2 cm and previously measuring 1.8 cm (image 27, series 3).CHEST WALL: Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small splenule again noted.
Interval resolution of pulmonary consolidation and groundglass opacities. Mild diffuse mosaic attenuation and areas of bronchial wall thickening, most likely reflective of underlying small airways disease. No evidence of primary or metastatic tumor.
Generate impression based on findings.
84 year-old female with chronic cough, evaluate in the setting of advanced COPD and nodular lung disease. LUNGS AND PLEURA: Severe centrilobular emphysema. Marked diffuse bronchiectasis and bronchial wall thickening with foci of subpleural scarring/atelectasis. Scattered calcified micronodules compatible with prior granulomatous disease. No suspicious nodules or masses. Several suture lines likely from prior lung biopsy or resection are noted on the left.MEDIASTINUM AND HILA: Marked atherosclerotic calcifications of the aorta and coronary arteries. Mediastinal lymphadenopathy measuring up to 1.1 cm (image 38, series 3). No pericardial effusion. Dilated esophagus.CHEST WALL: Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the abdominal aorta and its branches.
Severe emphysema with diffuse bronchiectasis, bronchial wall thickening, and bronchiolitis suggestive of chronic bronchitis. Correlation for underlying infection with MAI is recommended.
Generate impression based on findings.
59 year-old female with metastatic colon cancer. Follow-up exam. CHEST:LUNGS AND PLEURA: Several bilateral pulmonary nodules are unchanged; reference pleural-based left lower lobe nodule measures 8 x 8 mm, previously measured 9 x 7 mm (series 4, image 60). No new nodules identified.MEDIASTINUM AND HILA: No significant lymphadenopathy. Heart is normal in size without pericardial effusion. Right chest wall port catheter tip in distal SVC.CHEST WALL: Again seen is thrombosis of partially visualized right internal jugular vein. Interval resolution of previously seen hematoma in the right lower neck.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic metastatic lesions are decreased in size. The reference segment 4 lesion measures 4.3 x 3.3 cm, previously measured 5.5 x 4.0 cm (series 3, image 101).Cholelithiasis.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: There is apparent wall thickening of segment of colon along the hepatic flexure and proximal transverse colon, which is likely due to collapse given lack of associated inflammatory change in surrounding fat (series 3, image 125).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: Rectal wall thickening with adjacent infiltrative changes in the perirectal fat, consistent with known neoplasm (series 3, image 175).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.No significant change in lung nodules.2.Decrease in size of hepatic metastatic lesions.3.Persistent thrombosis in right internal jugular vein; resolution of previously seen right lower neck hematoma. 4.Circumferential rectal mass with surrounding infiltrative changes in perirectal fat, consistent with know carcinoma. 5.Apparent wall thickening colon along the hepatic flexure is likely due to collapsed lumen given lack of inflammatory change in surrounding fat.
Generate impression based on findings.
Reason: history of laryngeal cancer s/p radiation History: cough CHEST:LUNGS AND PLEURA: Scattered areas of bronchial wall thickening with intrabronchial debris most pronounced in the right lower lobe.Scattered nonspecific calcified and noncalcified micronodules. No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Moderate atherosclerotic changes of the aortic arch.CHEST WALL: Moderate degenerative changes throughout the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild fatty infiltration of the liver.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 changes of the distal bowel, aorta and visualized iliac arteries.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.
No evidence of metastatic disease.
Generate impression based on findings.
Degeneration of lumbar or lumbosacral intervertebral disc Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The patient is status post posterior intraspinous fusion at L4-5. There is a mild anterior subluxation of L4 on L5At L5-S1 there is no significant compromise to spinal . There is loss of disk space height and a diffuse disk bulge present at this level associated with narrowing of the neural foramina and encroachment of the exiting nerve roots left more than right. There is bilateral facet hypertrophy at this level left more than right.At L4-5 the patient is status post intraspinous fusion. No osseous bridging is identified. There is a diffuse disk bulge present at this level associated bilateral facet hypertrophy. There is effacement of the fat of the lateral recesses bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat. Note is made of bilateral vacuum joint phenomenon at the facet joints. There is a bony extrusion are present along the left posterolateral aspect of the spinal canal measuring 8 x 15 mm axial dimensions which is immediately anterior to the left facet joint at the ligamentum flavum.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are osteophytes present at the sacroiliac joints bilaterally associated with vacuum joint phenomenon.Atherosclerotic calcifications are present in the aorta and some of the branches.
1.There is moderate spinal stenosis at L4-5 related to disk bulge mild anterior subluxation and facet hypertrophy. There is a bony extrusion present within the left posterior lateral aspect of the spinal canal at L4-5 this partially contributes to spinal stenosis at this level.2.Patient is status post intraspinous fusion at L4-53.There is encroachment of the left-sided exiting nerve at L5-S1 related to combination of disk disease and facet disease
Generate impression based on findings.
Metastatic RCC s/p left nephrectomy, IL-2 therapy, and sunitinib with progression of disease. There has been slight interval increase in size and degree of necrosis of the left level 3 lymphadenopathy, which measures 17 AP x 20 RL , previously 15 x 19 mm. Likewise, there has been interval increase in size of the necrotic left level 4 lymphadenopathy, which measures 26 x 38 mm, previously 24 x 34 mm. The airways are patent. The major cervical vascular structures are intact. The major salivary glands and thyroid are unremarkable. There are no focal osseous lesions. The partially imaged intracranial structures are orbits are unremarkable. There is a partially imaged new large right pleural effusion.
1. Continued interval increase in size of the left level 3 and 4 metastatic lymphadenopathy.2. Partially imaged new large right pleural effusion. Refer to the separate chest CT report for additional details.
Generate impression based on findings.
Tremor for 30 years, worse for 4 years with parkinsonism. Images are degraded by motion artifact. There is significant ventricular prominence which is out of portion to the degree of atrophic change of the overlying sulci (which is mild). The third and fourth ventricles are prominent as well. There is no periventricular hypoattenuation. Pituitary is unremarkable. There is minimal white matter hypodensity, which could partially be on the basis of motion artifact. There is no focal intracranial mass, edema or hemorrhage. The midline is intact. Paranasal sinuses and mastoids are unremarkable. Incidental note is made of questionable bilateral staphyloma of globes.
Ventricular prominence out of proportion to overlying sulcal atrophy. Correlation for normal pressure hydrocephalus as clinically indicated. Ventricular prominence on the basis of volume loss is less likely given the relative paucity of white matter hypoattenuation. Motion degraded exam.
Generate impression based on findings.
Chronic sinusitis history of surgery in past. There are postoperative findings related to right partial uncinectomy and possibly middle turbinectomy with a clear neo-infundibulum. There is a small left maxillary sinus retention cyst. The right maxillary sinus is clear. Likewise, the frontal, ethmoid, and maxillary sinuses are clear. Thre is mild nasal septal deviation to the right. The nasal cavity is clear. The ethmoid roofs and The mastoid air cells are clear. The carotid grooves and optic canals are covered by bone. The orbits and imaged intracranial structures are grossly unremarkable.
Small left maxillary sinus retention cyst, but otherwise clear paranasal sinuses.
Generate impression based on findings.
Nasal congestion and discharge; s/p sinus surgery for fungus. There are postoperative findings related to functional endoscopic sinus surgery, including bilateral uncinectomy, partial ethmoidectomy, and sphenoidotomy. There has been interval decrease in the degree of the mucosal thickening within the left maxillary sinus, now mild to moderate. There has also been interval clearance of the hyperdense secretions within the right maxillary sinus with residual moderate mucosal thickening. There has been interval partial clearance of the right ethmoid air cell and right frontal sinus opacification. he left frontal sinus remains clear. There is slight interval increase in the degree of mucosal thickening within the left ethmoid cavity. In addition, there has been interval opacification of the left sphenoidotomy and left sphenoid sinus, now with moderate to severe opacification. There is persistent complete right sphenoid sinus opacification. There is diffuse thickening and sclerosis of the paranasal sinus walls, consistent with chronic sinusitis. The inferior nasal cavity is clear. The nasal septum is no significantly deviated and intact. The ethmoid roofs are intact and symmetric. The carotid grooves and optic canals are intact. The imaged portions of the orbits and intracranial structures are grossly unremarkable.
Postoperative findings related to endoscopic sinus surgery with interval partial clearance of right osteomeatal complex opacification and decrease left maxillary sinus opacification, but increased left ethmoid and sphenoid sinus opacification.
Generate impression based on findings.
37-year-old male with metastatic renal cancer. Restaging. CHEST:LUNGS AND PLEURA: Moderate right and small left pleural effusions. Punctate calcified focus in the right upper lobe is unchanged and suggests prior granulomatous disease. Previously seen ground glass opacity of the right lower lobe is no longer seen. No suspicious pulmonary nodules identified.MEDIASTINUM AND HILA: Left supraclavicular lymphadenopathy has increased in size, currently measuring 3.8 x 2.2 cm (image 4, series #3) from previously 2.6 x 2.3 cm. A second adjacent conglomeration of nodes is also slightly increased measuring 3.2 .5 cm (image 14, series #3). Right mediastinal reference node continues to decrease in size, now measuring 1.0 x 0.5 cm from 1.4 x 1.0 cm previously.CHEST WALL: No significant abnormality notedOTHER: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesion. Pneumobilia is noted, new from prior exam, with air limited to the gallbladder. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney is surgically absent. Postoperative changes are noted in the surgical bed without evidence of recurrence or residual tumor. No significant abnormality the right kidney.RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node mass measures 2.5 x 1.5 cm, grossly unchanged (image 117, series #3).BOWEL, MESENTERY: Evaluation of the mesentery is limited due to relative paucity of intra-abdominal fat. Previously measured left posteriolateral omental conglomerate mass is grossly unchanged measuring 3.6 x 1.9 cm.There is diffuse peritoneal carcinomatosis with trace ascites identified (series #3, image 122).BONES, SOFT TISSUES: Lytic lesions in the vertebral bodies of L1-L2 are redemonstrated with peripheral sclerosis, unchanged.OTHER: No significant abnormality notedPELVIS: Streak artifact from left hip prosthesis significantly limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left inguinal adenopathy is grossly unchanged measuring 2.3 x 1.4 cm.OTHER: No significant abnormality noted
1.Evidence of worsening metastatic disease including enlarging cervical lymphadenopathy, progression of diffuse peritoneal carcinomatosis.2.New bilateral pleural effusions, right greater than left.3.Pneumobilia of uncertain etiology.
Generate impression based on findings.
Reason: r/o PE History: sob, tachypnea, chest tightness/pressure PULMONARY ARTERIES: The pulmonary artery is of normal caliber. There is no evidence of a pulmonary embolus.LUNGS AND PLEURA: Mild dependent atelectasis. No significant pulmonary or pleural abnormalities.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Calcified mediastinal lymph nodes, compatible with a prior granulomatous disease.Mild cardiac enlargement 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.
No evidence of a pulmonary embolus. No significant pulmonary or pleural abnormalities.
Generate impression based on findings.
67 year old female with dyslipidemia referred to assess burden of atherosclerosis as part of a research study.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. There is a non-obstructive partially calcified plaque in the mid LAD, resulting in <20% stenosis.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx. There is a non-obstructive (<20% stenosis), calcified plaque in the mid LCx.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 124ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
1.There are no significant coronary artery stenoses present. 2.Minimal coronary calcification noted. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
Generate impression based on findings.
Recurrent sinusitis, chronic nasal congestion, sinus pain/pressure. The paranasal sinuses are clear. There is mild right lamellar conchae bullosa. The nasal cavity is clear. There is minimal nasal septal deviation. The right ethmoid roof is 2 mm lower than the left, but these are intact. The carotid grooves and optic canals are covered by bone. The orbits and intracranial structures are grossly unremarkable. There are bilateral tonsilloliths.
No evidence of sinusitis.
Generate impression based on findings.
76-year-old male patient presented with cough and has outside study with concern for interstitial lung disease/tree in bud appearance. LUNGS AND PLEURA: Mild septal thickening and bronchiectasis most prominent in the lower lung. Patchy areas of consolidation/atelectasis in the right middle lobe suggestive of prior inflammation. Nodules within the left major fissure likely represent intrapulmonary lymph nodes. Pleural-based round nodule in the left upper lobe.No evidence of air trapping on expiratory imaging.MEDIASTINUM AND HILA: Cardiac size within normal limits with trace pericardial effusion. Severe coronary artery calcifications. Mild atherosclerotic changes in the thoracic aorta.Prominent mediastinal lymph nodes. No significant hilar lymphadenopathy.CHEST WALL: Extensive multilevel degenerative changes in the thoracic spine. Scattered prominent bilateral axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Right renal cyst.
1.Patchy areas of consolidation/atelectasis in the right middle lobe.2.Mild septal thickening and bronchiectasis most prominent in the lower lung.
Generate impression based on findings.
45 year old man with chest tightness referred to rule out coronary artery disease. He is participating in the GLOBAL trial.CPT Code: 75574 Coronary Calcium:No coronary calcification is present.Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
1.There are no significant coronary artery stenoses present. 2.There is no coronary calcification.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
Generate impression based on findings.
71 year-old female status post fall. There is mild patchy hypodensity in the periventricular white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age.
Generate impression based on findings.
68-year-old female with nasopharyngeal soft tissue swelling, evaluate Limited intracranial and orbital views are unremarkable. Partial opacification of the ethmoid air cells, right greater than left. Mucosal thickening of the right maxillary sinus with left maxillary mucous retention cyst. Partial opacification of the right mastoid air cells and right middle ear cavity. The left mastoid air cells are clear.Somewhat ill-defined hypoattenuation extends from the right skull base to the level of the hypopharynx and involves the right prevertebral, retropharyngeal and parapharyngeal spaces. The hypoattenuation does not appear to extend into the mediastinum. There is narrowing of the nasopharyngeal and oropharyngeal airways as a result of this collection which remain patent. The right internal jugular vein is partially effaced by this collection but remains patent. The right internal carotid artery is surrounded by the collection but remains patent. Along the right hemi-neck, there is diffuse inflammatory stranding of the subcutaneous soft tissues and fascial planes likely reactive in etiology to the aforementioned collection.Small scattered lymph nodes are present in the neck. Multinodular thyroid goiter appearing similar to prior examinations. The parotid glands are free of focal lesions. The right submandibular gland is mildly enlarged and hyperemic, likely reactive. Multilevel degenerative changes of the visualized cervicothoracic spine resulting in neuroforaminal narrowing and at least mild central canal stenosis without suspicious osseous lesions.Partially visualized bilateral pleural effusions with associated subsegmental atelectasis/consolidation. Interlobular septal thickening compatible with pulmonary edema. Please see dedicated chest CT from today's date for further details.
1. Hypoattenuating deep neck space collection extending from the right skull base to the hypopharynx which is compatible in appearance with a large phlegmon. The airway is narrowed by this collection, but remains patent.2. Opacification of the right mastoid air cells and right middle ear cavity is suggestive of otomastoiditis and may be the source of the aforementioned deep neck space infection.3. Diffuse inflammatory changes in the right neck which are likely reactive in etiology. The major cervical vasculature remains patent.
Generate impression based on findings.
62 year-old female with acute systolic failure, evaluate for PE PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus.LUNGS AND PLEURA: Moderate bilateral pleural effusions and atelectasis. Patchy groundglass opacities suggestive of edema with underlying emphysema. Debris is noted in the bronchi.MEDIASTINUM AND HILA: Endotracheal tube tip is 1 cm above the carina. Enteric tube extends to the stomach. No mediastinal or hilar lymphadenopathy. Cardiomegaly. Moderate coronary arterial calcifications. Central venous catheter extends to the SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Abdominal ascites and reflux of contrast into the hepatic veins. Calcified granulomas in the liver and spleen.Dependent subcutaneous edema.
1. No pulmonary embolus. 2. Cardiomegaly, bilateral pleural effusions with atelectasis and ground glass opacities, consistent with CHF.3. Emphysema.4. Endotracheal tube 1 cm above the carina.
Generate impression based on findings.
69-year-old female tobacco use, shortness of breath, left axillary lymphadenopathy. PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus.LUNGS AND PLEURA: Moderate centrilobular emphysema. Scattered micronodules and 5-mm right upper lobe nodule.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No pericardial effusion. Small right Bochdalek hernia. Cardiomegaly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific hypoattenuating right hepatic lesion is incompletely evaluated due to contrast phase.
Moderate emphysema. 5-mm right upper lobe nodule for which follow-up imaging may be obtained in 6 to 12 months in light of patient's smoking history.
Generate impression based on findings.
24 year-old female with diffuse abdominal pain, fever, nausea. Rule-out 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: Administered oral contrast rapidly progresses through normal stomach and small bowel through to the cecum. No intrinsic abnormalities seen and no evidence of obstruction. Normal appendix is seen in the right lower quadrant with out associated inflammatory changes. 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: No significant abnormality notedBONES, SOFT TISSUES: Administered oral contrast rapidly progresses through normal stomach and small bowel through to the cecum. No intrinsic abnormalities seen and no evidence of obstruction. Normal appendix is seen in the right lower quadrant with out associated inflammatory changes. No free mesenteric fluid is seen.OTHER: No significant abnormality noted
1. No abnormality seen in abdomen and pelvis. A
Generate impression based on findings.
84-year-old male with abdominal distention for 3 days. ABDOMEN:LUNG BASES: Small bilateral pleural effusions. Postsurgical changes in the right lower lobe. Bilateral basilar scarring/subsegmental consolidation.LIVER, BILIARY TRACT: Multiple large cysts in liver parenchyma; largest of these measures 12 cm in diameter.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple dilated loops of colon with diameter measuring up to 9.6 cm; transition point is seen in distal colon and due to sigmoid volvulus (series 3, image 104).NG tube tip in stomach. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is a soft tissue lesion base of the bladder which measures 3.6 x 3.1 cm; this appears to arise from the base of the right aspect of the prostate (series 3, image 152; coronal series image 47).Large fluid-filled collections posterior to the bladder, right more the left, suspected to represent large bladder diverticula (series 3, image 144).LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple dilated loops of colon with transition in sigmoid colon due to sigmoid volvulus (series 3, image 104).BONES, SOFT TISSUES: Severe degenerative changes in the lumbar spine, with multiple lucencies along the endplates most likely degenerative in nature.OTHER: No significant abnormality noted
1.Distal colonic obstruction due to sigmoid volvulus.2.Soft tissue lesion in base of bladder appears to arise from the prostate gland and likely represents hypertrophied median lobe. 3.Multiple large liver cysts.4.Large bladder and fluid density structures posterior to bladder suspected to represent large bladder diverticula, likely due to prostate hypertrophy causing bladder outlet obstruction.
Generate impression based on findings.
54-year-old male with history of gist CHEST:LUNGS AND PLEURA: Subpleural scarring in bilateral upper lobes and lower lobes has slightly progressed compared to previous study. Interval development of small amount of pleural effusions.MEDIASTINUM AND HILA: Ill-defined soft tissue density mass in the right apex adjacent. The mediastinum is again noted and measures 2.9 x 1.5 cm image number 14, series number 3, not significantly changed from previous study. The etiology of this lesion is unknown.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: Left renal stone is unchanged.RETROPERITONEUM, LYMPH NODES: Right iliac stent is unchanged. Soft tissue mass adjacent to the aorta measures 3.4 x 1.9 cm image number 152, series number 3, unchanged.BOWEL, MESENTERY: Index soft tissue density adjacent to the surgical clips now measures 3.1 x 1.2 cm image number 110, series number 3 inferior to the portal confluence, slightly smaller compared to previous study.BONES, SOFT TISSUES: Anterior abdominal wall postsurgical changes, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Interval development of small amount of bilateral loculated pleural effusions and slight interval increase in the scarring in the lungs.Mesentery. Index lesion is slightly smaller compared to previous study. Superior mediastinal and retroperitoneal soft tissue index lesions are stable.
Generate impression based on findings.
Chronic nasal congestion and PND; deviated nasal septum. There is a 3 mm wide right maxillary sinus retention cyst and mild scattered bilateral ethmoid sinus opacification. The other paranasal sinuses and nasal cavity are otherwise clear. There is minimal nasal septal deviation. There is bilateral lamellar type conchae bullosa. The mastoid and middle ears are clear. The imaged portions of the intracranial structures and orbits are grossly unremarkable.
1. No evidence of sinusitis. 2. Minimal nasal septal deviation.
Generate impression based on findings.
56 male with history of pulmonary emboli in right lower extremity deep venous thrombosis. Evaluate IVC filter for retained clot. 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: Bilateral renal scarring with cortical thinning. High density in the calices are seen on May initial postcontrast images, which may be early excretion of contrast although punctate calculus cannot be differentiated. Bilateral benign cysts -- no other renal mass is seen. RETROPERITONEUM, LYMPH NODES: In vena cava filter seen slightly lower than typically seen below the renal veins. Enhancement about the filter is seen without evidence of thrombus. Five minute delayed imaging shows enhancement of vena cava distal to the filter without evidence of thrombus. No evidence of venous abnormality. Proximal to the thrombus is seen to suggest obstruction.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
1. Inferior vena cava filter in the proximal inferior vena cava -- no evidence for any retained thrombus about the filter or any visible abnormality in the abdominal/pelvic venous
Generate impression based on findings.
62 year-old female status post bowel resection. Evaluate for fluid collections. ABDOMEN:LUNG BASES: Large bilateral pleural effusion and bilateral lower lobe consolidation/atelectasis. LIVER, BILIARY TRACT: CholelithiasisSPLEEN: No significant abnormality notedPANCREAS: Focal hypoattenuating foci in the pancreatic head and uncinate process along course of pancreatic duct are incompletely characterized but may represent cystic pancreatic neoplasm such as IPMN (series 13, image 72); this does not appear significantly changed since 2004.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter in place. Severe atherosclerotic calcifications affect the aorta and its branches.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant.Multiple dilated loops of small bowel with diameter measuring up to 3.7 cm. The transition point appears located distal to anastomosis site in right lower quadrant (series 13, image 133). Moderate free fluid is present in the abdomen and pelvis, with partial loculation of pelvic fluid along right aspect (series 13, image 142).Several foci of free intraperitoneal air may be related to recent surgery.BONES, SOFT TISSUES: Diffuse anasarca. Postsurgical changes with open midline abdominal wound.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in place. Air in bladder likely due to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple dilated loops of small bowel with transition point distal to anastomosis site in right lower quadrant (series 13, image 133). Moderate right free fluid is present in the abdomen and pelvis, with partial loculation of pelvic fluid along right aspect of pelvis with associated mild peripheral wall thickening/enhancement (series 13, image 142).BONES, SOFT TISSUES: Diffuse anasarca. Enhancing soft tissue lesion located within subcutaneous fat of lateral proximal thigh is only partially visualized but measures approximately 6 cm (series 13, image 172).OTHER: No significant abnormality noted
1.Moderate grade distal small bowel obstruction with transition point occurring distal to anastomosis site in the right lower quadrant. Moderate amount of free fluid in the abdomen and pelvis, with partial loculation along right aspect of pelvic fluid. 2.Postsurgical changes in the right lower quadrant with open midline abdominal wound.3.Partially visualized soft tissue mass in the proximal left thigh; further imaging follow-up with contrast-enhanced MRI should be considered for better characterization. Findings communicated to Dr. Adeleke at 5 p.m., 11/26/2013.
Generate impression based on findings.
Spinal stenosis, lumbar region, with neurogenic claudication. h/o fall, severe pain at L2-L3 Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is osseous bridging the two anterior osteophytes present along the sacroiliac joints bilaterally. There is old of osseous bridging along the right sacroiliac joint There are hypoplastic ribs present at the thoracolumbar junction. There is a partial sacralization of the lowest lumbar vertebrae which will be called L5 for the purpose of this exam. As a result of L5 is considered to be a transitional vertebra with hypoplastic ribs at T12.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge present at this level associated facet hypertrophy and are shown effacement of fat at the lateral recess left more than right. Overall there is a mild degree of spinal stenosis at this level. There is a preservation of fat surrounding the exiting nerve roots within the neural foramina . At L3-4 there is diffuse disk bulge present associated bilateral facet hypertrophy and vacuum joint phenomenon in the facet joints with effacement of fat of the lateral recess these. Overall there is a moderate degree of spinal stenosis at this level exiting nerve roots within the neural foramina are partially surrounded by fat. There is mild encroachment of the exiting nerve roots within the neural foraminaAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is diffuse disk bulge present at this level associated ligamentum flavum hypertrophy overall there is mild degree of spinal stenosis at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Atherosclerotic calcifications are present in the R. and some its branches .
1.There are multilevel degenerative changes present in the lumbar spine and sacrum worse at L3-4 where there is a moderate degree of spinal stenosis related to disk bulge and facet hypertrophy.2.There is a mild to moderate degree of spinal stenosis at L4-5 related to disk bulge and facet hypertrophy3.bridging osteophytes are present along the sacroiliac joints associated with some osseous bridging at the right sacroilac joint. This is likely degenerative in nature.4.Please not that there is a transitional vertebra present which is labelled as L5 on this exam. There is partial sacralization of the left side of L5.
Generate impression based on findings.
57-year-old male patient with history of DVTs and PE. Please evaluate for residual clot burden in the lungs. PULMONARY ARTERIES: Technically adequate study without evidence of a pulmonary embolus.LUNGS AND PLEURA: Minimal bilateral scarring/atelectasis. No focal air space opacity or pleural effusion.MEDIASTINUM AND HILA: Moderate cardiomegaly without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral renal scarring and cysts.
No evidence of a pulmonary embolus.
Generate impression based on findings.
74 year old female with perineal cellulitis/abscess. UTERUS, ADNEXA: Multiple calcifications in uterus consistent with fibroids. 2 cm cystic appearing lesion is seen arising from left adnexa (series 3, image 47).BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Ill-defined fluid and soft tissue stranding in the left buttock most consistent with cellulitis (series 3, image 75). There is also is stranding, swelling, and hypoattenuation in the left gluteus musculature, concerning for myositis (series 3, image 75).Extensive swelling is present in both labia. A loculated fluid collection is seen extending from the left aspect of mons pubis to the left perineum, measuring approximately 2.2 x 2.9 cm (series 3, and at 79); consistent for abscess.No evidence of soft tissue gas.OTHER: No significant abnormality noted
1.Extensive inflammatory change involving the subcutaneous fat of left buttock as well as left gluteus musculature, most consistent with cellulitis and myositis. A loculated fluid collection extending from mons pubis into left perineum consistent with small abscess.2.2-cm left adnexal cystic lesion is nonspecific and follow-up with pelvic ultrasound for better characterization should be considered.
Generate impression based on findings.
58 -year-old female with abdominal pain and fever. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. There is mild intra-and extrahepatic biliary ductal dilation, unchanged.SPLEEN: Status post splenectomy, with multiple associated surgical clips in left upper quadrant.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged scarring and atrophy of right kidney. Left kidney unremarkable.RETROPERITONEUM, LYMPH NODES: Multiple prominent upper retroperitoneal lymph nodes are not significantly changed. The reference left para-aortic node is unchanged and measures 10 x 14 mm, previously measured 9 x 11 mm (series 3, image 72).Scattered atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
1.No acute abnormality to account for patient's fever and abdominal pain.2.Multiple prominent upper retroperitoneal lymph nodes not significantly changed.
Generate impression based on findings.
58-year-old male with abdominal pain and rectal bleeding. Evaluate for diverticulitis. ABDOMEN:LUNG BASES: Bilateral basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse thickening and surrounding inflammatory change in the colon, predominantly affecting the transverse and descending colon, consistent with colitis. No fluid collection to suggest abscess. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse thickening and surrounding inflammatory change in the colon, predominantly affecting the transverse and descending colon, consistent with colitis. Small amount of free fluid in the pelvis but no fluid collection to suggest abscess. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Extensive wall thickening or of the colon, predominantly affecting the transverse and descending, consistent with colitis which is likely infectious in etiology.Findings communicated to Dr. Hogan at 8:17 a.m., 11/27/2013.
Generate impression based on findings.
47-year-old with advanced metastatic non-small cell carcinoma and pelvic mass status post resection and radiation therapy. Bladder and ureteral injury and abscess. Fever and rigors. Please evaluate. ABDOMEN:LUNG BASES: Unchanged left lower lobe nodule measuring 8 x 6 mm (image 17; series 4). LIVER, BILIARY TRACT: There is no definitive evidence of hepatic metastasis. The hepatic vasculature appears patent. There is no evidence of intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Indwelling right ureteral stent.RETROPERITONEUM, LYMPH NODES: Unchanged peri-pancreatic (previously described as aortocaval) lymph node measures 1.5 x 2.1 cm (image 47, series 6). Left para-aortic lymph node (image 52; series 3) measures 1.7 x 1.6 cm, equivocally larger compared to prior. The majority of these lymph nodes demonstrate a hypo-attenuating central focus consistent with necrosis as noted previously. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical changes consistent with prior hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: Interval enlargement of pelvic lymphadenopathy. For reference purposes, a precaval lymph node (image 88; series 3) currently measures 2.1 x 1.6 cm previously measured 1.2 x 0.8 cm (image 82; series 6; I/13/2013 study).BOWEL, MESENTERY: There is evidence of persistent mesenteric fat stranding which appears to have improved an intervening period to prior examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a 2.7 x 3.5 cm presumed fluid collection adjacent to the distal right ureter (image 127; series 3). Two additional tiny collections versus necrotic lymph nodes are also noted. The first measures 1 cm in diameter (image 131; series 3) and is located in the left anterior pelvis. A second measures 2.2 x 1.5 cm (image 121; series 3) and is located along the left external iliac artery.
1.No substantial interval change in abdominal lymphadenopathy or pulmonary nodules.2.Interval placement of right ureteral stent which is in good position.3.Several small pelvic fluid collections.4.Interval enlargement of pelvic adenopathy.5.Clinical service notified of these findings at the time of dictation (pager 8228)
Generate impression based on findings.
52 year-old male with syncope and fall at home. There is prominence of the superior cerebellar cistern with flattening of the underlying vermis, which raises possibility of an arachnoid cyst in the cistern. The ventricles, sulci, and cisterns are otherwise symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is partial opacification of the paranasal sinuses, which contain some hyperdense materials. Clinical correlation for fungal sinusitis.
No acute intracranial abnormality.
Generate impression based on findings.
52-year-old female with cirrhosis. Monitoring for HCC. UTERUS, ADNEXA: Myomatous uterus. 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
No significant abnormality in the pelvis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.
46 years old female s/p TAH/BSO and appy at OSH on 6/30 p/w abdominal pain, vaginal bleeding and possible cuff dehiscence. ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs. Given this limitation, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.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: Orally administered contrast passes freely through the bowel without evidence of traction or ileus. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intraperitoneal free air.PELVIS:UTERUS, ADNEXA: Postsurgical changes status post TAH/BSO. No loculated fluid collection is identified. 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 free air in the pelvis.
Postsurgical changes without CT evidence of dehiscence or abscess seen in this study limited by lack of intravenous contrast.
Generate impression based on findings.
29 year-old female with history of trauma. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The neural foramen are patent. The intervertebral disk spaces are preserved. The paraspinal soft tissues are unremarkable.Foci of hyperdensity inferior to the C1 anterior arch are likely accessary ossicles or calcification of longus coli. The orbits are unremarkable. The mastoids are clear. There is comminuted nasal bone fracture with probable nasal septal hematoma. The maxilla, mandible, sphenoid boned, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
1. No acute intracranial abnormality. 2. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended.3. Comminuted nasal bone fracture with probable nasal septal hematoma.
Generate impression based on findings.
Altered mental status. History of falls. There is diffuse symmetric volume loss and periventricular/subcortical white matter hypoattenuation which most likely represents sequela of chronic small vessel ischemic disease. There is dolichoectasia of the vertebrobasilar system and significant atherosclerotic calcification within cavernous and supraclinoid ICAs. There is no focal intracranial abnormality including mass, edema, hemorrhage or hydrocephalus. The midline is intact. Orbits, paranasal sinuses and mastoids are clear. Bones are unremarkable.
Unchanged chronic sequela of small vessel ischemia. No acute abnormality including mass or hemorrhage.
Generate impression based on findings.
67-year-old male with history of laryngeal cancer status post total laryngectomy and radiation with right neck pain and erythema, evaluate for right neck abscess/cellulitis There is a large heterogeneous fungating multilocular enhancing mass measuring 7.1 x 7.4 x 6.9 cm in the right neck extending from the paraglottic region superiorly to the oropharynx and inferiorly in the infrahyoid neck to the level of the thyroid. There has been extensive growth since the prior exam, in which a small amount of paraglottic soft tissue thickening was noted. There is involvement of the right carotid space, parapharyngeal space, posterior triangle and submandibular space as well as the submandibular glands. The musculature of the right neck was infiltrated with involvement of the sternocleidomastoid. This mass crosses the midline with circumferential involvement and obliteration of the oropharynx and hypopharynx. The esophagus is displaced leftward but remains patent. The right carotid arteries are partially encased and narrowed within the mass but remain patent. The right internal jugular artery is not visualized and likely thrombosed. The mass abuts the right mandible, however there is no evidence of osseous destruction. There are scattered foci of air and fluid filled components within the mass with a loculated collection measuring 3.8 x 2.9 cm. There is likely ulceration, either cutaneous or to the airway, with a questionable sinus tract from the skin surface to the loculated collection.There are numerous small lymph nodes throughout the neck. An enlarged right level 5 node measures 1.1 x 1.0 cm (5/25). An enlarged left level 2 node measures 1.8 x 1.6 cm (5/22). Due to the extensive nature of this lesion, potential lymphadenopathy in the right neck in the region of the tumor cannot be excluded.There is evidence of a total laryngectomy, right thyroidectomy and tracheostomy. A left chest port is partially visualized. There is straightening of the cervical spine with mild degenerative changes. Mild centrilobular emphysema is seen within the lung apices. Extensive periodontal disease is again seen. The visualized mastoid air cells are clear. There is mild mucosal thickening of the right maxillary sinus.The visualized brain parenchyma is unremarkable without edema, masses or hemorrhage.
1.Large heterogeneous fungating mass in the right neck containing enhancing components likely represents recurrent tumor. This mass completely obliterates the aerodigestive tract. The right carotid arteries are partially encased and narrowed but patent.2.There are foci of air within the mass with a loculated collection measuring 3.8 x 2.9 cm. There is likely ulceration. Underlying infection and abscess cannot be excluded entirely.3.Cervical lymphadenopathy.4.Interval postsurgical changes of total laryngectomy and tracheostomy.