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Generate impression based on findings.
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26-year-old with history of sickle cell disease, fever and chest pain. LUNGS AND PLEURA: Please note superior most aspects of the lung apices are not included in the field-of-view of the exam. Somewhat nodular opacity in the right upper lobe posteriorly may be related to an infarct, though nonspecific in appearance. Other areas of scarring in each lung could also be related to prior infarcts. No pleural effusion or pneumothorax is seen. No evidence of an acute infection is apparent.MEDIASTINUM AND HILA: Mild enlargement of the cardiac silhouette size. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nonspecific hypodensity in the liver is probably benign such as a cyst. No splenic tissue is visualized.
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No clearly acute finding to suggest pneumonia. Small right upper lobe opacity is more likely an area of scarring related to previous infarct.Please note that this exam was not performed with PE protocol and technique was not optimized to exclude that diagnosis.
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Generate impression based on findings.
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Increasing oxygen requirement, evaluate for pneumonia. Motion artifact significantly degrades the evaluation.LUNGS AND PLEURA: Since the prior CT, there is decrease in bilateral groundglass opacity, though some persists. Bibasilar consolidation is increased compared to the prior study. Right lower lobe cavitary lesion may be slightly decreased compared to the prior study. Small bilateral pleural effusions.MEDIASTINUM AND HILA: Severe cardiomegaly. Aortic atherosclerotic calcifications are present. Tracheostomy tube in place. Right jugular catheter tip near the SVC/RA junction and AICD with leads not changed in positions. Stable size right paratracheal lymph node. Left ventricular assist device at the apex. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hardware artifact also significantly limits the evaluation.No significant abnormality noted.
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Worsening basilar consolidation compared to the last CT. These findings could be due to infection and aspiration as an underlying etiology could be considered. Stable to slight improvement in right lower lobe cavitary lesion. Small pleural effusions and interstitial opacities elsewhere that could relate to a component of edema.
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Generate impression based on findings.
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40 year-old with chest pain and shortness of breath. PULMONARY ARTERIES: This exam is of acceptable diagnostic quality for ruling out central PEs and lobar and some segmental level PEs. No filling defect to suggest an embolism is apparent.LUNGS AND PLEURA: There are several scattered nodular opacities in the lungs. Additional streaky opacities likely represent atelectasis or scarring. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Upper limits normal cardiac silhouette size. No pericardial effusion. Multiple small mediastinal lymph nodes are present, notable in their number, and with a mildly enlarged prevascular node. Right hilar lymph node is mildly prominent.CHEST WALL: An enlarged right axillary lymph node is seen.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The spleen is not visualized.
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1. No filling defect to suggest PE, see discussion above.2. Bilateral nodular opacities in the lungs. Right hilar, small mediastinal and right axillary lymph nodes. Depending on the patient's history, infectious etiologies, including atypical infections could be considered. Alternatively, metastases are a consideration. An underlying inflammatory process could also be possible.
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Generate impression based on findings.
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Syncope. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild nonspecific cerebral white matter hypoattenuation that is likely related to microangiopathy. There is also mild bilateral basal ganglia mineralization. The ventricles and basal cisterns are mildly prominent diffusely, reflecting cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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Mild nonspecific cerebral white matter hypoattenuation that is likely related to microangiopathy and mild cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or cerebral edema.
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Generate impression based on findings.
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Acute myeloid leukemia. Deep neck phlegmon treated with antibiotics. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There is new non opacification of the superior right internal jugular vein and jugular bulb. There is no abnormal brain parenchymal enhancement. There is no midline shift or herniation. There is opacification of the right mastoid air cells, which has increased. There is unchanged scattered paranasal sinus opacification. The skull and extracranial soft tissues are unremarkable. Neck: There has been slight interval decrease in the extent of the ill-defined area of hypoattenuation involving the right parapharyngeal, retropharyngeal, and prevertebral spaces. There is no discrete rim-enhancing fluid collection or evidence of extension to the mediastinum. The process surrounds the right internal carotid artery, which appears to be severely narrowed. There is new non opacification of the superior right internal jugular vein and jugular bulb. There is persistent non opacification of the right pterygoid venous plexus. There is moderate narrowing of the oropharyngeal airway. There is mild retropharyngeal lymphadenopathy. There is an unchanged heterogenous left thyroid nodule that measures 4.5 cm. The major salivary glands are unremarkable. The osseous structures are unchanged. There are bilateral pleural effusions.
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Slight interval decrease in the extent of the right deep neck presumed phlegmon without evidence of drainable fluid collection. However, there is now apparent severe right internal carotid artery and thrombosis of the right right internal jugular vein and jugular bulb. Dedicated vascular imaging is recommended for more precise delineation. Increased opacification of the right mastoid air cells may be due to mastoiditis.Discussed with Dr. Drazer at 11:20 AM on 11/29/13.
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Generate impression based on findings.
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65 year-old male with syncope 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.
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No acute intracranial abnormality.
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Generate impression based on findings.
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34-year-old female with left lower quadrant pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver parenchyma consistent with steatosis. Punctate, subcentimeter hypodensity in left lobe is too small to characterize, but most likely represents benign cyst (series 3, image 18).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The left ovary appears somewhat enlarged, measuring 3.1 x 4.9 cm. There is a peripherally enhancing hypodensity in the left ovary a which measures 1.6 cm, most consistent with corpus luteum (series 3, image 107). The right ovary appears unremarkable.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of free fluid is seen in the pelvis, which is likely physiologic in nature.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Corpus luteum in left ovary, which may explain patient's pain. The left ovary appears somewhat enlarged, which is nonspecific but may be seen in the setting of torsion. Consider further evaluation with pelvic ultrasound.
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Generate impression based on findings.
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55 year-old male with clamped EVD. The right frontal approached EVD is in unchanged position. The hemorrhage extends through the left thalamus, extending through the left cerebral peduncle, midbrain and cerebellar peduncle has been stable. A second focus is unchanged at the insertion site of the EVD with in the right frontal lobe is unchanged. Intraventricular hemorrhage layers bilaterally has been unchanged. No new hemorrhage. 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 cerebral white matter bilaterally as well as the right basal ganglia and right thalamus. Secretions layering within the ethmoid, sphenoid, and right maxillary sinus are unchanged. There is scattered opacification of mastoid air cells. Orbits are unremarkable.
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Stable decreased intracranial hemorrhages as described above. No new hemorrhage. Stable ventricular size. Stable right thalamic, right basal ganglial and cerebral white matter hypodensities.
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Generate impression based on findings.
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52 year-old female with cellulitis. Evaluate for abscess. ABDOMEN:LUNG BASES: No significant abnormality LIVER, BILIARY TRACT: Hepatic steatosis. Hypodensity in left lobe unchanged and consistent with cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodensity in left renal pole unchanged, too small to characterize but most likely cysts.RETROPERITONEUM, LYMPH NODES: Multiple prominent retroperitoneal lymph nodes, not significantly changed.Scattered atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes and inflammation in the anterior abdominal wall. There is an ill-defined, soft tissue attenuation collection in the subcutaneous tissues of the anterior abdominal wall to the left of the incision which measures 3.6 x 2.3 cm, consistent with phlegmon (series 3, image 73). No centrally hypodense, drainable fluid collection is identified.There is also ill-defined inflammatory tissue in the soft tissues of the lower right back, measuring 1.7 x 7.8 cm (series 3, image 78).Degenerative changes affect the lower lumber spine, predominantly affecting facet joints.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Phlegmon in the anterior bowel wall, but no drainable fluid collection identified.2.Inflammatory changes in soft tissues right lower back.
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Generate impression based on findings.
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17 year-old male with headaches and nystagmus. Motion degraded exam. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement. The osseous structures are unremarkable. There appears some soft tissue density in the right aspect of the suprasellar cistern, which could be due to volume averaging from the hypothalamus. If there is any concern for suprasellar lesion, a dedicated MRI pituitary gland can be obtained. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for mild sphenoid sinus mucosal thickening.
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No intracranial abnormality on this motion degraded exam.
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Generate impression based on findings.
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54-year-old male with rectal pain. PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a rim enhancing, multiloculated fluid collection in the right ischioanal fossa located posterior to the anal canal and predominantly below pelvic diaphragm, measuring 3.2 x 5.7 x 5 cm, with foci of internal gas and adjacent fat stranding, compatible with perianal abscess. A small portion of the abscess extends superiorly above the pelvic diaphragm /levator ani musculature (series 3, image 58).Tract of inflammatory tissue extending inferiorly from abscess to skin of right ischioanal fossa suspicious for cutaneous fistula (series 3, image 77).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiloculated perirectal abscess extending into the right ischioanal fossa, with likely cutaneous fistulous tract. MRI may be obtained for characterization and localization if clinically indicated.
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Generate impression based on findings.
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74-year-old male with erythema near LVAD device. Evaluate for cellulitis/abscess around driveline site. CHEST:LUNGS AND PLEURA: Again seen are small bilateral pleural effusions with underlying atelectasis/consolidation, slightly decreased on the right when compared to the prior study. Calcified micronodules in the right lung suggestive of prior granulomatous disease.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Coronary calcification. Orphaned ICD device is present. Again seen are prominent mediastinal lymph nodes, appearing similar to the prior study.CHEST WALL: Evaluation is limited by streak artifact from the LVAD.Note is made of a 6.0 x 2.3 cm fluid collection along the inferior margin of the LVAD device which appears increased in size when compared to the prior study. The patient is status post sternotomy. The LVAD is in unchanged position.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. SPLEEN: The previously described peri-splenic fluid has resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Note is made of a large amount of stool throughout the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: Mild concentric thickening of the bladder may be related to chronic outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. No is made of a large amount of stool throughout the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Note is made of a small left inguinal hernia which contains fat and a small amount of fluid.
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Interval increase in a 6-cm nonspecific fluid collection along the inferior margin of the LVAD device. Superimposed infection cannot be excluded.
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Generate impression based on findings.
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Male 68 years old; Reason: r/o hydronephrosis, urinary obstruction History: AKI, oliguria, urology unable to place foley ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: Pleural thickening and focal calcifications are consistent with history of mesothelioma. Mediastinal involvement is suggested by indistinct left cardiophrenic angle soft tissue mass. There is asymmetric pleural thickening, left greater than right, with invasion of the left chest wall including infiltration of the left seventh rib. The left crus of the diaphragm is thickened and likely involved by tumor, closely abutting the abdominal aorta.High attenuation material in the left cardiophrenic angle is incompletely evaluated though may represent either leaked or aspirated contrast from a prior exam, which is also noted throughout the bowel. May also represent herniated gastric contents. Alternatively, may represent another focus of confluent pleural calcifications.Left lower lobe consolidation and nodular opacities. Small bilateral pleural effusions. Mild cardiomegaly with left atrial enlargement. Coronary artery and aortic valve calcifications identified.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense lesions of the kidneys are incompletely evaluated. No renal calculi or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Residual contrast material is seen throughout the bowel, most concentrated in the stomach.There is extensive peritoneal soft tissue and mesenteric/omental nodularity and thickening, suggestive of diffuse involvement of known mesothelioma.Multiple dilated loops of proximal small bowel with distally collapsed bowel loops in the right lower quadrant. Residual contrast is seen distally to the rectum. While this study is extremely limited due to the lack of oral or IV contrast, these findings support a partial small bowel obstruction, which may be secondary to diffuse mesenteric and peritoneal involvement of mesothelioma. No intraperitoneal free air or pneumatosis is identified.BONES, SOFT TISSUES: Subcutaneous emphysema in the right lower quadrant. Clinical correlation is recommended. Degenerative changes of the thoracolumbar spine.OTHER: Anasarca with extensive ascites. Peritoneal soft tissue likely represents mesothelioma involvement.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: Extensive ascites involves the pelvis.
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1.Exam is severely limited due to lack of oral or IV contrast.2.No hydronephrosis, as clinically questioned.3.Findings suggestive of partial small bowel obstruction.4.Extensive ascites with diffuse peritoneal and mesenteric involvement of known mesothelioma.5.High density material in the left cardiophrenic angle may represent a leak, herniated gastric contents, or less likely aspiration of previously administered contrast. If any of these is clinically suspected, dedicated chest CT may be used for further characterization. Alternatively, may represent pleural calcifications from tumor involvement.6.Mediastinal and left chest wall involvement of known mesothelioma.7.Anasarca with subcutaneous emphysema of the right lower quadrant. Clinical correlation is recommended.Findings were discussed with Dr. Elliott via telephone at 10:00 on November 29, 2013.
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Generate impression based on findings.
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Reason: rule out PE History: chest pain, sob PULMONARY ARTERIES: No pulmonary embolus to the subsegmental level.LUNGS AND PLEURA: Subsegmental atelectasis involving the lingula and medial segment right middle lobe. Associated bronchial wall thickening in these locations. Respiratory motion artifact is present. Possibility of reactive airway disease or bronchitis is raised. No suspicious pulmonary nodule or pleural effusion. MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Small mediastinal lymph nodes. Mildly enlarged right hilar lymph node at 12 mm (series 7 image 93). Prominent right supraclavicular lymph node at 8 mm.The main pulmonary artery is normal in caliber.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hila hernia. Low-density lesion arising from the right adrenal gland measuring 2.6 x 3.4 centimeters. There is a focus of dependent high density which may represent hemorrhage.
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No evidence of pulmonary embolus.Subsegmental atelectasis involving the lingula and medial segment right middle lobe with associated bronchial wall thickening. This raises the question of reactive airway disease or bronchitis.Borderline enlarged mediastinal lymph nodes and right hilar lymph node are nonspecific.Low-density lesion arising from the right adrenal gland containing a dependent focus of high density, possibly hemorrhage. This can be further characterized with an opposed phase imaging if clinically appropriate.
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Generate impression based on findings.
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63 year-old male status post fall and syncope. There is few patchy hypodensity in the cerebral white matter. There is a focus of hypodensity in the left lower basal ganglia. 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 except for mild sphenoid sinus mucosal thickening.
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1. No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Minimal small vessel ischemic disease of indeterminate age. 3. A focus of hypodensity in the left lower basal ganglia may present a perivascular space versus an age indeterminate lacunar infarct.
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Generate impression based on findings.
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Headache after trauma. There is an unchanged depressed right orbital floor fracture with herniation of 7 mm of orbital fat medially towards the infundibulum. The right inferior rectus contours are slightly rounded, but the muscle is not herniated. There is no retrobulbar hemorrhage. There is minimal residual irregularity of the left mandibular ramus related to the remote fracture. However, there has been interval resorption of a carious ADA 17 and there are multiple other carious teeth with associated periodontal lucencies. The temporomandibular joints are intact. The mastoid air cells are clear. The partially imaged intracranial structures and facial soft tissues are grossly unremarkable.
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1. Chronic depressed right orbital floor fracture with herniation of orbital fat and healed left mandibular ramus fracture, but no evidence of acute fracture or dislocation.2. Multiple dental caries and periodontal disease.
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Generate impression based on findings.
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25-year-old female patient with right lower rib pain, worse with movement and inspiration. Evaluate for a pulmonary embolus. PULMONARY ARTERIES: Slightly limited examination with incomplete opacification of the upper lobe subsegmental branches of the pulmonary artery. No evidence of a pulmonary embolus.LUNGS AND PLEURA: Minimal scattered ground glass opacities in the left lower lobe at the costophrenic angle are consistent with scarring.MEDIASTINUM AND HILA: Heart size is within normal limits without pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: Scattered small axillary lymph nodes.Mild multilevel degenerative changes in the thoracic spine.There is focal asymmetry/thickening of the right eighth rib at the costochondral joint without associated edema or soft tissue changes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy.
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No evidence of pulmonary embolus.Asymmetry at the right eighth rib costochondral joint may be secondary to prior trauma or much less likely a cartilaginous tumor. Suggest correlation with point tenderness on physical exam. If symptoms persist, consider follow up imaging.
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Generate impression based on findings.
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41-year-old male with abdominal pain and nausea. Evaluate for dissection. CHEST:LUNGS AND PLEURA: Mild basilar atelectasis and scarring.MEDIASTINUM AND HILA: No aortic dissection. No lymphadenopathy. Mild cardiomegaly.CHEST WALL: Deformity of T11 vertebral body, most consistent with prior trauma (coronal series image 65).ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with small amount of pericholecystic fluid along hepatic surface, which is equivocal for acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific left adrenal nodule measures 1.1 x 1.8 cm (series 7, image 163).KIDNEYS, URETERS: Several peripheral areas of hypoattenuation in the right kidney with associated small amount of perinephric fat stranding, suspicious for pyelonephritis. Focus of hypoattenuation in right apex measures 2.4 x 3 .4 cm, suspicious for devitalized renal tissue/phlegmon formation (series 7, image 190).RETROPERITONEUM, LYMPH NODES: IVC filter noted. No evidence of dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Severe inflammatory changes and dystrophic calcifications are seen around both hips. Absence of right femoral head most consistent with prior girdle stone procedure. Dystrophic calcifications are also seen superficial to the sacrum.Severe degenerative changes hand and ankylosis affect SI joints bilaterally.BONES, SOFT TISSUES: Multiple round soft tissue foci are seen in the anterolateral wall, likely injection granulomas.OTHER: No significant abnormality noted
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1.No evidence of aortic dissection.2.Several peripheral foci of hypoattenuation in the right kidney with associated mild perinephric fat stranding, suspicious for pyelonephritis. Larger focus of hypoattenuation in right apex suggestive of devitalization/phlegmon formation. Interval follow-up is recommended to confirm resolution and rule-out underlying malignancy. 3.Cholelithiasis and small amount of fluid around non-distended gallbladder, equivocal for acute cholecystitis. If there is strong clinical suspicion for cholecystitis, consider US. 4.Severe inflammatory changes and dystrophic calcifications around both hip joints and superficial to sacrum.5.Deformity of T11 vertebral body most consistent with prior trauma.
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Generate impression based on findings.
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76-year-old male with history of prostate cancer. Known anterior rectal ulcer with bleeding. Evaluate for progression or metastasis. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes of the thoracolumbar spine, most prominent in L2 to L4.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged, heterogeneous prostate gland.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: . A short segment of the anterior wall the rectum cannot be traced image 134, series #3). Anterior to and contiguous with this segment there is an extraluminal collection of air and fluid which extends superiorly and involves the right seminal vesicle. These findings are suggestive of a contained perforation of the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Findings suggestive of a contained perforation of the anterior rectum with possible extension of the collection into the right seminal vesicle
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Generate impression based on findings.
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40 year-old male with right lower quadrant pain. Evaluate for colitis, diverticulitis. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is extensive inflammatory changes of approximately a 10-cm segment of the terminal ileum and extending into the cecum, including marked wall thickening and adjacent fat stranding (coronal image 65). An adjacent soft tissue phlegmon with air and fluid appears to arise from the inflamed cecum with likely early abscess formation measuring 4.1 x 3.2 cm (image 96, series #3). Adjacent fibrofatty proliferation and adenopathy favors Crohn's terminal ileitis as underlying etiology. Cecal diverticulitis is deemed less likely.Mild secondary involvement of the appendix is noted, which is normal in caliber and is not central to the inflamed territory.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Extensive inflammation of the terminal ileum and cecum with adjacent phlegmon and early abscess formation. Etiology favors Crohn's disease.
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Generate impression based on findings.
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52-year-old male patient with chest pain, dyspnea and dizziness. Evaluate for a pulmonary embolus. PULMONARY ARTERIES: Technically adequate study. Small filling defect in a right middle subsegmental branch (series 7 image 168).LUNGS AND PLEURA: There is a subpleural focal airspace opacity at the costophrenic angle distal to the suspected pulmonary embolus in the right middle lobe base, which is suspicious for infarct versus pneumonia.Mild right and left lower lobe atelectasis with associated volume loss.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion.No mediastinal or hilar lymphadenopathy. CHEST WALL: Mild 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. Moderately large sliding hiatal hernia.Left kidney with hypoattenuating lesion, likely resenting a cyst.Colonic diverticulosis without evidence of diverticulitis.Pancreatic lipoma versus fatty infiltration.
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Small right middle lobe subsegmental, nonocclusive pulmonary embolus. Subpleural focal air space opacity at the right costophrenic angle is most compatible with infarct in the absence of infectious symptoms.
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Generate impression based on findings.
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12-year-old male with history of facial swelling, evaluate for lymphatic malformation of the neck and lower face. Mandibular hypoplasia status post free fibula reconstruction. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The paranasal sinuses and mastoid air cells are clear. Underdeveloped left mastoid air cells, normal anatomic variant. The maxilla is somewhat hypoplastic.Therapeutic changes are identified in the right hemi-neck including surgical suture and clips along the anterior aspect of the right carotid space and right floor of the mouth. Postsurgical changes of a fibular flap mandible reconstruction. Bilateral TMJs are preserved. Cleft lip with steep hard palate. Tracheostomy tube in place.Slight interval decrease in the size of an ill-defined trans-spatial mass with soft tissue stranding involving a significant portion of the anterior neck. The mass extends anteriorly into the soft tissues overlying the mandible and to the skin surface, superiorly to the skull base on the left, inferiorly to the trachea, and posteriorly to the pharyngeal mucosal space. Similar to the prior, the mass insinuates within the left parapharyngeal, bilateral masticator spaces, right tongue root, bilateral submental space, bilateral submandibular space, and left parotid space. There is no involvement of the larynx or lung apices. Similar to the prior, there are nodular foci of enhancement within this ill-defined mass in the region of the left submandibular space. A larger ill-defined enhancing focus involves the oral cavity centered at the root of the tongue similar to the prior. No phleboliths are identified.The visualized lung apices are clear. The cervical vasculature is patent. The thyroid gland is within normal limits.
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1. Slight interval decrease in the size of an extensive trans-spatial neck mass compatible with a veno-lymphatic malformation2. Postsurgical changes of a mandibular reconstruction with a fibular graft.3. Unremarkable CT of the brain.
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Generate impression based on findings.
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Pulmonary embolus in segmental branch of right lower lobe. Evaluate for dissection. CHEST:LUNGS AND PLEURA: Mild scarring along left minor fissure. Minimal basilar atelectasis. No suspicious nodules or masses.Fillings defects in segmental branches of the right lower lobe, consistent with small pulmonary emboli (series 9, image 75). No lung opacities to suggest infarction.MEDIASTINUM AND HILA: No dissection. Heart size normal without pericardial effusion. Minimal coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Nonspecific diffuse wall thickening. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No aortic dissection.2.Small pulmonary emboli in segmental branches of right lower lobe.Findings were discussed with patient and Dr. Gomez at 11 am 11/29/2013.
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Generate impression based on findings.
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64-year-old male with back pain and metastatic prostate cancer. CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified punctate micronodules bilaterally, largest located in right lower lobe measuring 4 mm and unchanged (series 5, image 68).MEDIASTINUM AND HILA: Severe coronary artery calcifications. Mild cardiomegaly unchanged. No pathologically enlarged mediastinal lymph nodes.CHEST WALL: Sclerotic focus in right aspect of T12 vertebral body unchanged, presumed metastatic focus (coronal series image 38). Sclerotic focus in anterior aspect of right sixth rib also unchanged (coronal series image 95).ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions in liver are unchanged, compatible with cysts. No new or suspicious liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. RETROPERITONEUM, LYMPH NODES: Reference aortocaval node measures 17 x 17 mm, previously measured 16 x 17 mm (series 3, image 133).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Radiation seeds within the 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
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1.Stable aortocaval lymph node.2.Stable sclerotic focus in T12 vertebral body, presumed metastatic lesion.3.Multiple punctate calcified and noncalcified lung micronodules, nonspecific but likely due to prior granulomatous disease.
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Generate impression based on findings.
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MUD alloSCT with persistent fevers. There is no significant paranasal sinus opacification. There is a 10 mm long anterior nasal septal defect with adjacent linear opacities that may represent secretions and rhinotillexomania, although this is nonspecific. There is moderate nasal septal deviation to the left with a leftward bony spur measuring 5 mm, which contacts the left nasoantral wall. The mastoid air cells are clear. There is persistent opacification of the bilateral external auditory canals, which likely represents cerumen. The partially imaged intracranial structures and orbits are grossly unremarkable. The overlying facial soft tissues are unchanged.
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No evidence of acute sinusitis.
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Generate impression based on findings.
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Male 73 years old; Reason: metastatic Prostate Cancer, Evaluation of disease after 9 cycles of investigational therapy. History: metastatic Prostate Cancer, CHEST:LUNGS AND PLEURA: Minimal basal atelectatic changes. Calcified granuloma in the right lung base. No dominant lesion has developed. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Calcified coronary artery disease. No mediastinal lymphadenopathy.CHEST WALL: Extensive sclerotic metastases involving the thoracic spine and ribs.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No new hepatic lesions have developed. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the abdominal aorta. Infrarenal abdominal aortic aneurysm measures a 3.2-cm, unchanged. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic osseous metastatic disease. Compression fractures of T8, T9, T12, and, L4 and L5.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Coarse calcifications in the prostate bed.BLADDER: No significant abnormality notedLYMPH NODES: No new pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Post operative changes in the right inguinal canal.OTHER: No significant abnormality noted
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1.Extensive osseous metastatic disease. No new lymphadenopathy or definite solid organ involvement.
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Generate impression based on findings.
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Reason: characterization of effusion History: pleural effusion, anemia, recent trauma LUNGS AND PLEURA: Consolidation of the right apex with associated scarring and mild traction bronchiectasis (series 80316 image 25) favoring post inflammatory change. Adenocarcinoma is considered much less likely.Moderate left pleural effusion with associated atelectasis. No definite hematocrit level within the left effusion. Subsegmental atelectasis within the posterior basal segment right lower lobe is also present.Several calcified granulomas occupy the left lung with associated left apical pleural thickening.MEDIASTINUM AND HILA: Nonorthogonal dimension of the ascending thoracic aorta is 42 x 40 mm, aneurysmal. The main pulmonary artery is normal in size. The heart size is normal. Significant mitral annular and coronary arterial calcification. Mild aortic valve calcification. No pericardial effusion. No significant mediastinal lymphadenopathy. Low-density blood pool consistent with stated history of anemia.CHEST WALL: No evidence of displaced rib fracture. There is loss of height of a superior thoracic vertebral body. Likely posttraumatic deformities of the right clavicular head and right glenohumeral joint.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nodularity of the left adrenal gland.
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Moderate left pleural effusion without definite hematocrit level.No evidence of acute fracture. Chronic deformity of the right glenohumeral joint and medial right clavicular head.Masslike consolidation at the right apex favoring postinflammatory change with adenocarcinoma much lower in the differential.
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Generate impression based on findings.
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63-year-old male patient with history of cough and syncope. Evaluate for lung pathology. LUNGS AND PLEURA: Lower lobe predominant mild bronchiectasis and bronchial wall thickening.Left lower lobe posterior pleural thickening with minimal atelectasis and scarring.Calcified right apical micronodule.No consolidation, pleural effusion or suspicious lesions.MEDIASTINUM AND HILA: Heart size within normal limits without pericardial effusion. Mild coronary artery calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There is small hiatal hernia.Subcentimeter right lipid rich adrenal adenoma.Colonic diverticulosis without evidence of diverticulitis.
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Mild bronchial wall thickening and bronchiectasis suggestive of bronchitis.
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Generate impression based on findings.
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29-year-old female with a history of metastatic rectal cancer. Evaluate extent of disease prior to starting chemotherapy. CHEST:LUNGS AND PLEURA: There is interval increase in size and number of bilateral pulmonary nodules with the largest measuring 5 mm in the lingula (series 5; image 72).MEDIASTINUM AND HILA: There is a small pericardial effusion.CHEST WALL: Right chest port in place with the tip terminating at the junction of the SVC and right atrium. Note is made of a subcentimeter nodule in the inferior pole of the right lobe of the thyroid, appearing similar to the prior study.ABDOMEN:LIVER, BILIARY TRACT: Reference lesions are at the junction of the caudate lobe and left lobe of the liver measures 2.9 x 2 .1 cm, previously 2.4 x 2.3 cm (90; series 3). The second reference lesion in segment 4A measures 3.0 x 2 .8 cm, previously 1.7 x 1.3 cm (100; series 3).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral percutaneous nephroureterostomy tubes in place.Right nephroureteral stent in place, unchanged. Interval removal of left nephroureteral stent. Again seen are foci of gas density within the collecting systems bilaterally. Note is made of postoperative changes consistent with the history of LAR with ureterectomy and bladder reconstruction.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy measures 18 x 11 mm, previously 17 x 11 mm (137; series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXAE: Surgically absent.BLADDER: Foley catheter. Note is made of postoperative changes consistent with the history of LAR with ureterectomy and bladder reconstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Expected postsurgical changes. Rectal suture line. Right lower quadrant ileostomy. Oral contrast has progressed through the stomach and jejunum to the ostomy. No evidence of mechanical obstruction. Fat stranding and small fluid collections consistent with recent surgery redemonstrated in the pelvis. Loculated fluid collections in the right hemipelvis contain a small bubble of gas and are decreased in size/nearly completely resolved and are now difficult to accurately measure, previously 8.4 x 3.8 cm. These findings presumably represent postsurgical change, however, recurrence cannot be completely excluded.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval increase in size and number of pulmonary nodules and increase in size of reference liver lesions consistent with the stated history of metastatic disease.
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Generate impression based on findings.
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56-year-old male with history of bladder cancer status post cystectomy and neobladder. CHEST:LUNGS AND PLEURA: Scarlike opacity in right upper lobe but no suspicious nodules.MEDIASTINUM AND HILA: Cardiac size normal. No pericardial effusion. Atherosclerotic calcifications affect coronary arteries and thoracic aorta. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Diffusely decreased attenuation of parenchyma consistent with hepatic steatosis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right pelvic kidney again noted.Mild perinephric fat stranding around left kidney is decreased. Persistent focal poor corticomedullary differentiation in the left apex and left mid kidney, most consistent with resolving focal infection (series 8, image 111, 99). No suspicious lesions identified. Collecting system appears unremarkable, without evidence of filling defects or lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Foley catheter present in decompressed neobladder. No suspicious filling defects or lesions identified.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild wall thickening of sigmoid colon is likely due to collapsed lumen and diverticular disease (series 8, image 179).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No evidence of recurrence or metastatic disease.2.Decreased left perinephric fat stranding and persistent foci of poor corticomedullary differentiation in left renal parenchyma, most consistent with resolving infection/inflammation.
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Generate impression based on findings.
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60-year-old 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
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No significant change from previous study.
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Generate impression based on findings.
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Reason: Pt with hx of MUD alloSCT, persistent fevers. History: Pnuemonia evaluate for progression - PCP vs. fungal. LUNGS AND PLEURA: Previously described groundglass opacities have become less dense when compared to 6 days earlier. Increasing left, now moderate, pleural effusion with associated atelectasis. Trace right pleural effusion is stable. MEDIASTINUM AND HILA: Heart size is upper limits of normal with low density blood pool consistent with anemia. Moderate coronary artery calcification. No interval pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Stable diffuse osseous changes reflecting patient's known myelofibrosis. Right central catheter is unchanged in position. No axillary lymphadenopathy. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites unchanged. Partial visualization of the gallbladder reveals cholelithiasis. Splenomegaly.
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Decreasing bilateral groundglass opacities compared to 6 days earlier suggestive of partial resolution of pneumocystic pneumonia or other atypical infection.Increasing, now moderate left pleural effusion with associated atelectasis in. Trace right pleural effusion is stable.
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Generate impression based on findings.
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69-year-old male patient with new AML. Assess for lung pathology prior to initiation of chemotherapy. LUNGS AND PLEURA: There is a left apical pleural-based irregularly shaped soft tissue density that measures 12 mm in short axis (series 5 image 14).Calcified nodule in the right upper lung is consistent with prior granulomatous disease.Left lower lobe nodule measures 6 mm (series 5 image 62), stable compared to 10/30/2013.Left lower lobe scattered ground glass opacities are new compared to prior examination and may be secondary to aspiration.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Mild coronary artery calcifications. Mitral annulus and aortic valve calcifications.Mild atherosclerotic changes in the thoracic aorta.Right PICC line with catheter tip at the cavoatrial junction.Calcified pretracheal lymph node consistent with prior granulomatous disease.Scattered small mediastinal lymph nodes. No significant perihilar lymphadenopathy.Multiple subcentimeter hypoattenuating foci within the right lobe of the thyroid are nonspecific.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine. Degenerative changes and height loss of the T4 vertebral body.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate calcification within the spleen consistent with prior granulomatous disease.
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1.Left apical soft tissue density may represent postinflammatory change; however, lung neoplasm cannot be excluded. Recommend PET scan for further evaluation.2.Left lung base changes suggestive of aspiration.3.T4 vertebral body height loss consistent with osteoporotic compression fracture.Findings discussed with Dr. Drazer via telephone on 11/29/2013 at 11:40AM by Dr. McCann.
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Generate impression based on findings.
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Reason: Head and neck CA. Disease evaluation follow up. History: as above CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Enlarged and heterogeneously enhancing thyroid, further described on the concurrent neck CT.Unchanged thymic enlargement, probably rebound hyperplasia.Moderate coronary calcification is present.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: Accessory splenule and calcified splenic granulomas.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.
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No sign of metastases. Large heterogeneous enhancing thyroid nodules, further characterized on the neck CT scan.
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Generate impression based on findings.
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43-year-old male with leiomyosarcoma. CHEST:LUNGS AND PLEURA: Volume loss in left lung due to scoliosis. No suspicious nodules or masses.MEDIASTINUM AND HILA: Interval increase in mediastinal lymphadenopathy, most notable in right cardiophrenic angle node, which currently measures 2.8 cm, previously measured 9 mm (series 3, image 74).Heart size normal. Right port catheter tip terminates in the right atrium.CHEST WALL: Interval increase in supraclavicular and axillary lymphadenopathy; right axillary node measures 4.5 x 3.1 cm, previously measured 3.0 x 2.0 cm (series 3, image 31). Reference right body wall mass is incompletely included in field of view (series 3, image 34).Severe rightward scoliosis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Increased size of left suprarenal soft tissue which measures 3.0 x 1.1 cm, previously measured 2.1 x 0.9 cm (series 3, image 100).KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval increase in size of multiple retroperitoneal lesions; reference left iliac mass measures 7.2 x 6.1 cm, previously measured 4.7 x 4.3 cm (series 3, image 141).BOWEL, MESENTERY: Increase in size of multiple mesenteric masses/lymphadenopathy.BONES, SOFT TISSUES: Interval increase in size of multiple lesions in the posterior subcutaneous fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As noted above, increase in size of left iliac mass. Reference soft tissue adjacent to left ischium is increased in size, measuring 3.4 x 2.6 cm, previously measured 3.3 x 2.1 cm (series 3, image 178).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Increase in size of lymphadenopathy and lesions in the chest, abdomen, and pelvis.
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Generate impression based on findings.
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Female 59 years old; Reason: Evaluate vasculature to support kidney transplant History: Pre-Kidney evaluation of iliac vessels ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Coarse calcification adjacent to the IVC in the right hepatic lobe is unchanged.SPLEEN: Innumerable punctate foci in the spleen likely represent calcified prior granulomatous disease.PANCREAS: Dense lobulated calcifications of a previous pancreatic pseudocyst are redemonstrated and unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral cystic lesions are incompletely characterized due to lack of IV contrast.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and iliac arteries, grossly unchanged from prior study.BOWEL, MESENTERY: Diverticulosis of the descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Interval hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis of the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Moderate atherosclerosis of the abdominal aorta and bilateral iliac arteries.
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Generate impression based on findings.
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14-year-old female with neck swelling, evaluate for thyroglossal duct cyst. Limited intracranial views are unremarkable. Limited orbital views are unremarkable. Mucosal thickening of the right maxillary sinus with a suggestion of bubbly secretions. Trace opacification of the ethmoid air cells. The visualized mastoid air cells are clear.Midline well-defined simple cystic appearing lesion just inferior to the hyoid bone measures 1.6 x 2.4 cm (series 5 image 32) and is compatible with the stated history of thyroglossal duct cyst. The surrounding subcutaneous fat is preserved without findings to suggest superinfection/inflammation. Nonspecific prominence of the nasopharyngeal and oropharyngeal lymphoid tissue.No additional masses or cystic lesions are present in the neck. No lymphadenopathy by CT size criteria. No exophytic mass or focal effacement of the aerodigestive tract. The salivary and thyroid glands are within normal limits. The major cervical vasculature is patent. The visualized lung apices are unremarkable. The osseous structures are within normal limits.
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1. Midline simple cystic lesion just inferior to the hyoid bone is compatible in appearance with a thyroglossal duct cyst. No CT findings to suggest superimposed infection/inflammation.2. Right maxillary sinus mucosal thickening with a suggestion of bubbly secretions may represent acute sinusitis.
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Generate impression based on findings.
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Reason: h/o vocal cord cancer History: r/o chest mets, previous smoker LUNGS AND PLEURA: Mild subpleural basilar reticular opacities, chronic and unchanged.No suspicious nodules or masses.MEDIASTINUM AND HILA: Moderate coronary artery and aortic calcifications are noted. Cardiac size is normal without evidence of pericardial effusion.No significant mediastinal, or hilar lymphadenopathy.CHEST WALL: Mild to moderate degenerative disease in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable small right adrenal nodule, likely benign. Incompletely visualized hypodense renal lesions, most compatible with cysts.
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No sign of metastases and no significant change.
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Generate impression based on findings.
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84 year-old male with skin cancer and status post CRT. CT brain: No evidence of enhancing cerebral lesions, edema or mass effect. Minimal periventricular hypodensities, as seen on the prior study, likely represent the sequelae of chronic white matter ischemic disease. No focal parenchymal abnormalities identified. Gray-white matter differentiation is preserved. The ventricles and sulcal sulci are stable in size. No evidence of extra-axial abnormality.CT neck:Soft tissue thickening with overlying focus of hyperdensity (possibly a surgical clip) posterior to left mastoid air cells within the subcutaneous fat (series 9, image 8). Findings are stable in appearance and likely relate to prior biopsy site.Orbits are unremarkable. Stable minimal clouding of the left mastoid air cells. Right mastoid air cells are clear. Mucosal thickening along with mucous retention cysts/polyps in the bilateral maxillary sinuses. Findings were seen on the prior study.There is no evidence of deep neck space mass or fluid collection. There appears some thickening of the vocal cords, with no discrete mass. The visualized aerodigestive tract is unremarkable without exophytic mass mass or focal effacement. Focal air-containing structure in the left paraglottic space which likely represents an internal laryngocele. There is no evidence of cervical lymphadenopathy by CT criteria. Cervical vasculature once again demonstrates tortuous course of the right common artery which transverses the right tracheoesophageal groove. Atherosclerotic calcifications are seen at the carotid bifurcations and cavernous portions of the carotid areas bilaterally. Cavernous carotid arteries are slightly ectatic.Stable small calcification in the right lobe of the thyroid gland. Slight asymmetric atrophy of the left submandibular gland. Otherwise, thyroid and salivary glands are unremarkable. Lung apices are clear. Degenerative changes of the cervical spine including large anterior osteophytes. Degenerative changes lead to fusion of the facets at C3-4 and vertebral body fusion at C4-5. In addition, degenerative changes cause encroachment on the spinal canal and neural foraminal encroachment at multiple levels. This study is not tailored further detailed evaluation of these findings. No focal blastic or lytic osseous lesions identified.
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1. Stable examination from the prior study without evidence of cerebral metastasis, neck mass or lymphadenopathy.2. No intracranial metastasis. 3. Thickening of the vocal cords with no discrete mass.
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Generate impression based on findings.
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41 year-old female with cervical radiculopathy. Slight straightening of cervical spine curvature is present, possibly positional. Alignment is preserved. There is normal mineralization of the vertebral bodies. No compression fractures are identified. The cervicomedullary junction is normal. Degenerative endplate changes are as follows:C2-3: Mild broad-based disk bulge. No foraminal narrowing or spinal stenosis.C3-4: Minimal broad-based disk bulge. Mild right neuroforaminal narrowing secondary to uncovertebral joint hypertrophy. No spinal stenosis. C4-5: No disk herniation. No spinal stenosis or foraminal narrowing.C5-6: Broad-based posterior disk bulge. Mild loss of disc height. Mild spinal stenosis. No foraminal narrowing.C6-7: Circumferential disk osteophyte complex. Loss of disc height. Left worse than right uncovertebral hypertrophy. Moderate left and mild right foraminal narrowing. Mild spinal stenosis. C7-T1: No disk herniation, thecal sac effacement, or foraminal narrowing.Bilateral hypoattenuating thyroid lesions are again seen. These are nonspecific findings, and if clinically indicated, further evaluation with ultrasound could be considered.Mild prominence of the nasopharyngeal soft tissues is likely benign. Ventral focus of gas at right esophagus is unchanged and may represent an esophageal diverticulum (series 5 image 45).
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No significant change of cervical spine degenerative disc disease, most prominent at C6-7 as described above.
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Generate impression based on findings.
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Reason: metastatic SCC. Need re-staging scans prior to new treatment regimen. History: as above CHEST:LUNGS AND PLEURA: Left perihilar mass measuring 60 x 47 (series 3/68) not significantly changed from 58 x 48 mm previously when using comparable measurement parameters. The mass markedly narrows or occludes the lower lobe bronchi.Reference right lower lobe nodule (series 5 /97) measures 18 x 15 mm, not significantly changed from 19 x 14 mm previously.However, multiple non-reference nodules in the partially collapsed left lower lobe have markedly increased in size and their appearance is now highly compatible with tumor.Several other non-reference nodules in the right lung also increased in size.Small left effusion and enhancing pleural metastases at the left costophrenic angle have not significantly changed.MEDIASTINUM AND HILA: Subcarinal lymphadenopathy, not significantly changed.Right hilar mass/lymphadenopathy unchanged.Port catheter tip in the SVC.CHEST WALL: Left axillary lymphadenopathy, unchanged.Destructive lesions at T3 (previously called T2) and at T12, with partial collapse of T12 since the previous scan.Focal nonspecific sclerosis of the right seventh rib laterally, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple small hypodensities compatible with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Multiple small calcifications compatible with chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: Multiple small nonspecific retrocrural lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Focal jejunal intussusception without evidence of an associated mass or proximal obstruction, and therefore most likely transient.BONES, SOFT TISSUES: Degenerative disease in the lumbar spine.OTHER: No significant abnormality noted.
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1. Interval progression of several non-reference pulmonary nodules bilaterally, though reference lesions have not significantly changed.2. Jejunal intussusception, most likely transient.
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Generate impression based on findings.
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56 year old female with increased left drain output and decreased right drain output. Status post sleeve gastrectomy and development of gastrocutaneous fistula. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with basilar consolidation/atelectasis.LIVER, BILIARY TRACT: Interval decrease in size of right sub-diaphragmatic abscess, which currently measures approximate 4.2 cm in craniocaudal dimension, previously measured 7.5 cm (coronal series image 44). However, the percutaneous drain has retracted out of the collection, with tip currently located in the subcutaneous fat.Diffuse, homogeneous decrease in attenuation of right lobe it is not significantly changed and due to focal fatty infiltration/perfusion abnormality. Small amount of pneumobilia in the left lobe.SPLEEN: Status post splenectomy.PANCREAS: Inflammatory changes surrounding the pancreatic tail not significantly changed, likely due to post surgical changes in the left upper quadrant.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter in place. Multiple small retroperitoneal lymph nodes not significantly changed.BOWEL, MESENTERY: Extensive postsurgical changes are again seen in the left upper quadrant and stomach. Interval placement of gastric stent, which traverses fistulous defect along greater curvature.Percutaneous drain tip is in left upper quadrant collection, which has decreased in size and currently measures approximately 4.6 x 4.2 cm, previously measured 5.5 x 5.3 cm (series 3, image 41). Again seen is in communication of this collection with the greater curvature of the stomach, which was better appreciated on prior exam ( series 3, image 42).BONES, SOFT TISSUES: Multiple round soft tissue attenuation foci in the anterior abdominal wall, likely representing injection granulomas. Postsurgical changes in anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enhancing lesions in the uterus, most consistent with fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality noted
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1.Interval decrease in size of large right sub-diaphragmatic abscess. However, there has been retraction of percutaneous drain out of collection into soft tissues of right chest wall.2.Decrease in size of left upper quadrant abdominal collection. Percutaneous drain tip is located in collection. 3.Placement of gastric stent which traverses fistulous communication from greater curvature to left upper quadrant collection. Findings discussed with Dr. Bryan at 12pm, 11/29/2013.
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Generate impression based on findings.
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60 year old female with a history of renal cell carcinoma and lung nodules. Status post right partial nephrectomy. CHEST:LUNGS AND PLEURA: Note is made of biapical scarring/atelectasis. There is centrilobular and paraseptal emphysema with an upper lobe predominance. Note is made of scattered bilateral pulmonary micronodules. No focal consolidation, pleural effusion, or pneumothorax.MEDIASTINUM AND HILA: No evidence of lymphadenopathy. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple hypodensities in the liver, which likely represent simple cysts. Multiple subcentimeter hypodensities in the liver are too small to characterize, but likely represent simple cysts. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter hypodensity in the head of the pancreas is too small to characterize but likely represents a simple cyst or IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of postsurgical changes consistent with the stated history of partial right nephrectomy. There is a 2.8 x 2.3 cm collection along the inferior pole of the right kidney, which may represent a post surgical fluid collection, however, follow-up examination to establish resolution is recommended (121; series 3). Note is made of a nonobstructing left renal calculus. RETROPERITONEUM, LYMPH NODES: Note is made of vascular calcifications of the aorta and its branches. Note is made of prominent retroperitoneal periaortic lymph node measuring 13 x 7 mm (series 3; image 113).BOWEL, MESENTERY: There is diverticulosis, without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Fluid collection along the inferior pole of the right kidney likely represents a post surgical fluid collection, however, follow up examination to establish resolution is recommended to exclude the possibility of residual disease.
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Generate impression based on findings.
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14 year-old male with mandibular hypoplasia and status post mandibular recontruction. Since prior, there has been removal of the external mandibular distractor and mandibular condylar reconstruction with rib graft. There is redemonstration of postsurgical changes of the mandible osteotomy, left mandibular condylar process and right coronoid process resection. The resected right coronoid process has fused. There is redemonstration of severely abnormal appearance to the mandible with marked foreshortening of the mandibular body/symphysis and to a lesser extent the rami. There is fusion of the right mandibular condyle to the right temporal bone. The dentition is markedly abnormal. Since prior exam, there has been improvement of the severe overbite, with the mental portion of the mandible being in the normal position, persistent overbite at the left mandibular body and underbite at the right mandibular body. The retroglossoptosis has been mildly increased compared to the prior. There has been also increased airway narrowing at the naso and oropharynx. No gross neck mass or cervical lymphadenopathy, the cervical nodal prominence is common for age.There is partial opacification of the left mastoid. Paranasal sinuses and right mastoid air cells are clear.Visualized intracranial contents are unremarkable. Gray-white matter differentiation is preserved. There is no focal parenchymal lesion or mass. There is no mass-effect or midline shift. Ventricles and sulci fall within normal range for age. No abnormal fluid collection. Cerebellar tonsils terminate above the foramen magnum. Orbital contents unremarkable. No proptosis or intraorbital mass lesion.The major cranial sutures are fused, but there is no evidence of cranial vault deformity.
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1. Interval removal of the external mandibular distractor and mandibular condylar reconstruction with rib grafts. 2. Stable findings of prior multiple surgeries. 2. Mildly increased retroglossoptosis and airway narrowing at the naso and oropharynx, however, this could be positional. Clinical correlation is advised
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Generate impression based on findings.
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Chronic sinusitis and allergies. There is a small amount of opacification within the left anterior ethmoid air cells. Otherwise, there no significant paranasal opacification. The nasal cavity is clear and there is no significant nasal septal deviation. The carotid grooves and optic nerve canals are covered by bone. There is a left mesiodens. The partially imaged portions of the intracranial structures and orbits are grossly unremarkable. The overlying facial structures are unremarkable.
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No evidence of sinusitis.
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Generate impression based on findings.
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pT3N1 SCCa of the right oral tongue, status post FHX completed on 10/30/13, and radiation therapy. There are post-treatment findings in the oral cavity with heterogeneous enhancement in the right oral tongue that may represent a combination of necrotic tumor, myositis, and mucositis. There is no evidence of residual significant cervical lymphadenopathy. For example, the previously demonstrates enlarged right level 1 lymph node is no longer apparent and a right supraclavicular fossa lymph node measures 9 x 8 mm, previously 15 x 13 mm. The right submandibular gland appears hyperemic, likely due to radiation effects. There is a punctate fluid collection in the left tonsillar fossa, which may represent retained tonsillar crypt secretions. The airways are patent. There is a right internal jugular venous catheter. The osseous structures are unremarkable. The partially imaged intracranial structures are grossly unremarkable. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear.
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Interval post-treatment findings in the oral cavity with heterogeneous enhancement in the right oral tongue that may represent a combination of necrotic tumor, myositis, and mucositis. No evidence of residual significant cervical lymphadenopathy.
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Generate impression based on findings.
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Reason: Evaluate for progression of metastatic disease; compare to previous scan History: None CHEST:LUNGS AND PLEURA: Postsurgical changes compatible with left lower lobectomy and right upper lobe segmental resections. Increasing size and number of the innumerable, small solid and ground glass pulmonary nodules compatible with diffuse metastatic disease. Right middle lobe reference nodule measures 7 mm (series 5 image 53), increased from 5 mm. Increased thickening along an accessory fissure within the medial segment of the left lower lobe.No interval pleural effusion.MEDIASTINUM AND HILA: Near complete resolution of the previously noted pulmonary emboli with only minimal residual low density within a upper lobe segmental branch (series 80292 image 34).Bilateral low density lesions within lobes of the thyroid gland stable.Small hiatal hernia. The heart remains upper limits of normal normal size with right atrial chamber dilatation. No interval pericardial effusion.Reference low right paratracheal lymph node slightly increased in size, 9 mm (series 3 image 37) as compared to 7 mm. Stable left hilar lymph node size. Right hilar lymph node and slightly increased, now 9 mm. CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild central intra-hepatic biliary ductal dilatation, stable. Hypodensities unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Increasing size and number of the innumerable, small solid and ground glass pulmonary nodules compatible with diffuse metastatic disease. Reference low right paratracheal lymph node slightly increased in size. Right hilar lymph node increased, now 9 mm. Near complete resolution of the previously noted pulmonary emboli with only minimal residual low density within a upper lobe segmental branch.
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Generate impression based on findings.
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Left parotid adenoid cystic carcinoma status post surgery and adjuvant RT in 2010. There are post-treatment findings related to left parotidectomy, resection of the left submandibular gland and left neck dissection. The known perineural tumor spread along the left facial nerve is better delineated on the prior MRI exams. Otherwise, no discrete mass lesion is discerned in the parotidectomy bed. There is no significant cervical lymphadenopathy. The right parotid gland and right submandibular gland are unremarkable. The thyroid is unremarkable. The airways are patent. The internal jugular vein appears to have been sacrificed. There is extensive degenerative spondylosis in the cervical spine. There are chronic maxillofacial deformities, including right orbital floor fracture and left zygomaticomaxillary complex fracture. There is partially calcified biapical scarring opacity and several scattered pulmonary micronodules.
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No evidence of recurrent tumor in the parotidectomy bed and no evidence of significant cervical lymphadenopathy. The known treated perineural tumor spread along the left facial nerve is better delineated on the prior MRI exams.
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Generate impression based on findings.
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75-year-old male with gastric cancer. CHEST:LUNGS AND PLEURA: Poorly marginated millimeter ground-glass opacity in the left upper lobe is unchanged (series 5, image 39). There is adjacent pleural thickening. Scattered punctate micronodules unchanged. Bilateral basilar scarring/atelectasis. No new suspicious nodules.MEDIASTINUM AND HILA: No lymphadenopathy. Moderate coronary artery calcifications. Right chest wall port terminates in distal SVC. 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: Enlarged upper retroperitoneal lymph nodes are smaller, as described below. Atherosclerotic calcifications are scattered throughout the aorta and its branches.BOWEL, MESENTERY: Improvement in wall thickening of the distal stomach as well as surrounding infiltrative changes, consistent with known gastric carcinoma. Interval decrease in size of multiple enlarged gastrocolic and gastrohepatic lymph nodes; reference gastrohepatic node measures 1.3 cm, previously measured 1.9 cm (series 3, image 99).Status post gastrojejunostomy. No obstruction.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: No significant abnormality notedOTHER: No significant abnormality noted
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1.Improved wall thickening of distal stomach and decrease in size of multiple perigastric/upper retroperitoneal lymph nodes.2.Stable nonspecific ground-glass opacity in left upper lung lobe, which may represent scarring.
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Generate impression based on findings.
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Reason: h/o HNC, s/p CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodule or interval pleural effusion.MEDIASTINUM AND HILA: Interval placement of a right port catheter that terminates at the superior caval atrial junction. Immediately inferior and possibly contiguous to the tip, there is a well-circumscribed filling defect within the right atrium measuring 2.6 x 2.4 cm (series 3 image 53). It abuts the posterior wall of the right atrium but does not obstruct the coronary ostium or encroach upon the tricuspid valve. Given the short time interval, the interval appearance is suspicious for large thrombus. It spares the right atrial appendage. It is atypical of that for venous mixing. The study was not optimized for evaluation of pulmonary embolus; however, no central filling defects within the pulmonary arteries are detected. The right ventricle is free of filling defect. Findings were discussed with Dr Salgia covering for Dr. Villaflor at time of image interpretation.The heart size is normal. There is no pericardial effusion. No mediastinal or hilar lymphadenopathy.Small hypodensity within the left lobe of the thyroid gland, stable. CHEST WALL: No actually lymphadenopathy.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: Stable nodularity of left adrenal gland. 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.Interval placement of a percutaneous gastrostomy tube. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval appearance of a large low density lesion within the right atrium, appearing to be contiguous with the tip of the right port catheter. No filling defect within the right ventricle or the central pulmonary arteries. This is suspected to represent a large thrombus.No evidence of pulmonary metastatic disease.
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Generate impression based on findings.
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78-year-old male patient with left lung nodule. Please evaluate. LUNGS AND PLEURA: Severe upper lobe predominant centrilobular and paraseptal emphysema. Interval increase in right apical pleural thickening with course calcifications, scarring and traction bronchiectasis with volume loss is likely related to prior infection.There is peripheral basilar fibrosis and minimal honeycombing.Diffuse bronchial thickening compatible with bronchitis.In an area of prior pleural thickening in the left upper lobe there is a pleural-based lesion with irregular margin that measures 39 x 14 mm (series 5 image 37). This lesion corresponds to the suspicious nodule on chest radiograph on 11/28/2013.The there is an area of focal pleural thickening in the anterior right upper lobe (series 5 image 30), not significantly changed.MEDIASTINUM AND HILA: The heart size within normal limits without pericardial effusion. Mild coronary artery calcifications Moderate atherosclerotic changes of the thoracic aorta and its branches.Multiple calcified mediastinal and hilar lymph nodes, consistent with prior granulomatous disease. No mediastinal or hilar lymphadenopathy.CHEST WALL: Interval increase in moderate degenerative changes in the thoracic spine. Interval height loss in the T5, T6 and T9 vertebral bodies.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple subcentimeter hypoattenuating foci within the liver parenchyma are nonspecific and too small to characterize.Hypoattenuating lesion in the superior pole of the right kidney likely represents a cyst. Left kidney with irregular hypoattenuating contour (series 3 image 99), may represent and exophytic cyst and is incompletely evaluated.
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1.Left upper lobe pleural-based lesion is very suspicious for neoplasm given increase in size compared to 2011. No evidence of metastatic disease.2.Severe centrilobular and paraseptal emphysema with minimal basilar predominant fibrosis raises the possibility of combined pulmonary fibrosis and emphysema (CPFE).
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Generate impression based on findings.
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Reason: h/o met ACC, compare to previous, measurements pls, h/o chemo History: none CHEST:LUNGS AND PLEURA: Interval appearance of a lobulated solid nodule within the anterior left upper lobe (series 5 image 40) measuring 12 x 15 mm, suspicious for metastasis. Additional new suspicious nodule inferior to this (series 5 image 48) measures 5 mm.Right apical scarring. Mild emphysema. Several pulmonary nodules without significant change in right upper lobe index lesion measuring 4 x 8mm on both the current and prior study (series 5 image 32). Previously described lobulated nodule in the right upper lobe is smaller in size, currently 2 mm as compared to 5 mm, favoring inflammatory etiology (series 5 image 43).Resolution of previously described groundglass lesions in the right middle and left upper lobes. Basilar scarring on the left.MEDIASTINUM AND HILA: Right hilar lymph node measures 10 mm, stable. Othersmall lymph nodes are unchanged. No pericardial effusion. Heart size remains normal.Small hiatal hernia.CHEST WALL: Scattered sclerotic foci in the spine and ribs.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating lesions in the liver too small to characterize but most likely cysts. Hypoattenuating cystic lesion in the right hepatic lobe unchanged.SPLEEN: Small hypoattenuating lesions unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable, indeterminate lesion in the apex of the left kidney measuring 8 x 14 mm, not significantly changed in size but does not meet the criteria for a benign simple cyst. Additional subcentimeter lesions bilaterally are too small to accurately characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and its branches. A left para-aortic lymph node measures 9-mm, stable. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Previously described lucency within the right iliac bone partially visualized.OTHER: No significant abnormality noted.
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Interval appearance of a lobulated solid nodule within the anterior left upper lobe and new, adjacent 5-mm nodule suspicious for metastases.Previously described lobulated nodule in the right upper lobe has become smaller. This, along with resolution of the previously described ground glass on the left, likely postinflammatory in etiology.Right hilar lymph node remains stable in size at 10 mm. No new mediastinal lymphadenopathy.
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Generate impression based on findings.
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48 year-old female with chest pain radiating to back. CHEST:LUNGS AND PLEURA: Mild basilar scarring/atelectasis. No suspicious nodules or masses. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No evidence of aortic dissection. Thin peripheral atherosclerotic plaque is seen in the proximal descending thoracic aorta. Status post right coronary artery bypass surgery; stent noted in the proximal right coronary artery. Heart is normal in size without pericardial effusion.CHEST WALL: Status post median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct dilation, with maximum diameter measuring up to 7 mm, is mildly increased since 2009. No evidence of obstructing mass. Several calcifications around pancreatic head and uncinate process may be related to chronic pancreatitis. There is also suggestion of pancreatic divisum (series 9, image 174).ADRENAL GLANDS: Hypoattenuating left adrenal nodule is unchanged, likely adenoma.KIDNEYS, URETERS: Cyst noted in the posterior aspect of the left kidneyRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in plaque throughout the aorta and its branches, worst in both internal iliac arteries. No evidence of dissection.BOWEL, MESENTERY: Status post colectomy and left lower quadrant ostomy.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: Atherosclerotic us patients and plaques affect the aortic branches.
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1.No aortic dissection.2.Nonspecific dilation of pancreatic duct, mildly increased since 2009; no obstructing lesion is identified and etiology is unclear. This may be due to chronic pancreatitis, stenosis, or pancreatic divisum. Further imaging work-up with pancreas protocol MRI/MRCP can be considered for better characterization. 3.Status post colectomy.
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Generate impression based on findings.
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76 year-old male with altered mental status and dysphasia. There is patchy hypoattenuation in the cerebral white matter. The ventricles and sulci are symmetric and are prominent. The ventricles have minimal increased in size. For instance, the maximal transverse bifrontal horn dimension has increased from 45 mm to 49 mm. The transverse dimension of the third ventricle has increased from 14 mm to 16 mm. 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. Lens prosthesis.
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1. No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Moderate small vessel ischemic disease of indeterminate age. Moderate brain volume loss. 3. Minimal increase in size of the ventricles. While this could be due to sampling error, clinical correlation for hydrocephalus is advised.
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Generate impression based on findings.
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20 year-old female with frequent sinus infection. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. 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 except for minimal nasal septal deviation. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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No evidence of sinusitis.
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Generate impression based on findings.
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Reason: 71F with metastatic rectal cancer with possible new lung mets History: possible new lung mets LUNGS AND PLEURA: Right lower lobe reference lesion measuring 8 x 10 mm, not significantly changed using comparable measurement parameters since the previous scan but significantly increased since 1/15/2013.New 2-mm micro-nodule anteriorly in the lingula (series 4/75), indeterminate, but further follow-up is recommended.MEDIASTINUM AND HILA: Asymmetric thyroid enlargement with inhomogeneous texture, nonspecific but unchanged.No significant lymphadenopathy.Catheter tip at the SVC/RA junction.Mild coronary artery calcification.CHEST WALL: Very mildly enlarged nonspecific left axillary lymph nodes, unchanged and likely benign.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Non-reference metastasis in the right hepatic lobe measuring approximately 20 5 x 20 6 mm, slightly decreased from previous with hepatic capsular retraction. Reference lesions are not completely imaged on the scan.
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1.Stable right lower lobe reference nodule.2. New indeterminate micronodule anteriorly at the left base which may be inflammatory or possibly metastatic. Further follow-up is recommended.
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Generate impression based on findings.
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Reason: Pre OLT evaluation HCC eval possible mets History: HCC, cirrhosis LUNGS AND PLEURA: Focal cluster of centrilobular nodules within the right posterior costophrenic sulcus may represent previous aspirated material. No other evidence to suggest active bronchiolitis. No pleural effusion. No suspicious pulmonary nodule. MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Moderate coronary artery calcium.CHEST WALL: Slight asymmetry in breast tissue within the tail of the left breast. Correlation with physical examination and mammography is recommended.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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A cluster of centrilobular nodules within the right posterior costophrenic angle favor that of prior aspirated material rather than active bronchiolitis.No suspicious pulmonary nodules. No mediastinal lymphadenopathy.
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Generate impression based on findings.
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42-year-old male with tachycardia, pain, leukocytosis, pancreatic leak. ABDOMEN:LUNG BASES: Bilateral pleural effusions, moderate on the right and small on left, with overlying basilar consolidation/atelectasis.LIVER, BILIARY TRACT: Loculated fluid around liver. Status post cholangiojejunostomy, with small amount of pneumobilia. SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple surgery. Large amount of free fluid is seen in the upper abdomen and retroperitoneum. No loculated fluid collection identified. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Large amount of free fluid is seen in upper retroperitoneum and extending inferiorly along right perirenal space. BOWEL, MESENTERY: Status post Whipple surgery. Free fluid in the upper abdomen mesentery. No loculated fluid collection identified. Two percutaneous drains present in upper abdomen. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the lower lumbar spine.OTHER: No significant abnormality noted
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Status post Whipple surgery; larger than expected amount of free fluid seen in upper abdomen and retroperitoneum suspicious for anastomotic leak.
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Generate impression based on findings.
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Reason: h/o skin ca, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Mild dependent atelectasis and basilar scarring unchanged.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification.CHEST WALL: Well circumscribed lucency in posterior elements of T9 (series 3/67) presumable due to a benign perineural cyst, dural ectasia or meningocele unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic cyst in the right lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease in the spine.OTHER: No significant abnormality noted.
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No change and no sign of metastases.
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Generate impression based on findings.
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Reason: assess for evolution of ILD History: SOB and increased O2 requirement LUNGS AND PLEURA: Diffuse interstitial disease with reticular opacity and traction bronchiectasis, indicating fibrosis, most evident in the left upper lobe area.Interlobular septal thickening and ground glass opacity is also present.Extensive new areas of atelectasis and consolidation are present especially in the lower lobes bilaterally with associated pleural thickening, into the pleural fissures.Lung volumes remain small.No significant air trapping.MEDIASTINUM AND HILA: Diffuse mediastinal lymphadenopathy with lymph nodes measuring up to 15 mm in short axis diameter, unchanged and likely reactive.Dilated main pulmonary artery measuring 43 mm in diameter compatible with pulmonary hypertension, not significantly changed.Severe coronary artery calcification.CHEST WALL: Coarse benign-type calcification in the left breast unchanged.Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Very limited evaluation with no gross abnormalities. Previously described hyperdense renal nodules are not imaged on the scan.
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Markedly increased bilateral nonspecific airspace opacity with atelectasis and pleural thickening, superimposed on underlying interstitial fibrosis.
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Generate impression based on findings.
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Reason: 82 year old woman with history of bilateral early stage NSCLC (LUL and RLL) treated with SBRT 9 months ago complicated by radiation pneumonitis 3 months ago. Please compare to prior CT for interval change History: post treatment lung cancer surveillance CHEST:LUNGS AND PLEURA: Extensive scarring, emphysema and bronchiectasis, unchanged.Focal left upper lobe consolidation and architectural distortion consistent with radiation reaction, not significantly changed.Minimal interval increase in right lower lobe reference nodule, measuring 19 x 14 mm (series 5 image 51), not significantly changed.Mild interval increase in focal pleural thickening in the posterior left lower lobe.MEDIASTINUM AND HILA: Cardiac size is upper limit of normal without pericardial effusion. Moderate coronary calcifications. Moderate atherosclerotic changes of the thoracic aorta.No mediastinal lymphadenopathy. Reference right hilar lymph node measures 14 mm (series 3 image 48), unchanged.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate to severe atherosclerotic changes in the abdominal aorta and branches. Left-sided IVC.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small hiatal hernia.Mild colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild multilevel degenerative changes in the thoracic and lumbar spine.OTHER: No significant abnormality noted.
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1.No significant change in scattered pulmonary abnormalities. Bronchiectasis and bronchiolitis raises the possibility of MAI infection.2.Reference right lower lobe nodule is not significantly changed.3.Mild interval increase in focal left pleural thickening for which follow-up is recommended.
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Generate impression based on findings.
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Reason: evaluate for bronchiectasis History: chronic productive cough; severe sinus disease and immunoglobulin deficiency LUNGS AND PLEURA: Multiple nonspecific micronodules, some of which are calcified, compatible with previous infection.Very mild bronchial wall thickening and a very mild focal bronchiectasis in the medial segment of the middle lobe. No other bronchiectasis is identified.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.CHEST WALL: Healed right rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Very mild diffuse bronchial wall thickening, and minimal bronchiectasis in the medial segment of the right middle lobe
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Generate impression based on findings.
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Check for healing Post surgical placement of two screws involving the inferior and anterior aspect of the glenoid are again observed with out associated hardware complication. Artifact limits sensitivity, however the fracture plane is not well visualized consist with fusion and interval healing. Only a minimal shallow groove is observed along the inferior aspect.Mild osteoarthritis of the shoulder and AC joint. Narrowing and sclerosis with small subchondral cysts.Emphysema incompletely visualized.
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Healed glenoid rim fracture with screw fixation.
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Generate impression based on findings.
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Reason: lung sarcoid? patient wiht cough and fatique, cardaic MRI very suggestive of sarcoid wiht typical LGE History: cough, fatique CHEST:LUNGS AND PLEURA: Mild focal scarring in the posterior basal segment of the right lower lobe.No other significant pulmonary abnormalities.MEDIASTINUM AND HILA: No significant lymphadenopathy.Mild nonspecific anterior pericardial thickening.CHEST WALL: Multiple small axillary lymph nodes bilaterally.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.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: Several subcentimeter mesenteric and retroperitoneal lymph nodes, which are nonspecific.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of pulmonary sarcoidosis and no significant lymphadenopathy.
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Generate impression based on findings.
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Diffuse metastatic disease, please check for progression Interval placement of a knee arthroplasty with an associated long stem tibial component functioning as a intramedullary rod extending through the length of the right tibia extending into the distal metaphysis. Associated methacrylate fills multiple larger lytic lesions up to the metaphyseal junction distally and the larger lesions proximally underlying the tibial plateau components. A reference distal anterior cortical lesion remains 1.9 cm in cranial caudal length (image 41 series 80494). Additionally numerous multiple confluent scattered medullary and cortical lesions appear grossly unchanged given differences in technique and artifact. Moderate soft tissue swelling is otherwise observed, mildly more pronounced than previously described and likely secondary to the recent surgery. No distinct abnormal fluid collections although evaluation and detail is limited due to streak artifact.Scattered and incompletely visualized lytic lesions are observed in the calcaneus and midfoot, yet to a lesser extent the fibula.
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Status post right total knee arthroplasty a longstem tibial component
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Generate impression based on findings.
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33 year-old female with new left sided facial numbness and left arm numbness. 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. Some suboccipital subcutaneus nodes.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Reason: Hx of AML s/p induction chemo, felt to have fungal PNA post-chemo, getting anti-fungal treatment. Pls reasses. History: Cough LUNGS AND PLEURA: Marked interval improvement in bilateral nodular and groundglass opacities compatible with infection. Focal residual atelectasis in the medial segment of the right middle lobe remains in addition to scattered small nodular and mild groundglass opacities.No pleural effusion.MEDIASTINUM AND HILA: No significant lymphadenopathy.New very small pericardial effusion.PICC line tip in SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly.
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Marked interval improvement in diffuse pulmonary abnormalities compatible with infection.
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Generate impression based on findings.
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Stem cell transplant, now with URI/sinus symptoms. There are new air-fluid levels and bubbly secretions within the right maxillary and bilateral sphenoid sinuses. There is also moderate mucosal thickening within the left frontal sinus and frontoethmoid recess. The nasal cavity and partially imaged mastoid air cells are clear. The partially imaged intracranial structures and orbits are grossly unremarkable. The facial soft tissues are unremarkable. The patient is edentulous.
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New air-fluid levels and bubbly secretions within the right maxillary and bilateral sphenoid sinuses are compatible with acute sinusitis.
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Generate impression based on findings.
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33 year old female with headache since MVA 5 days age. There is minimal asymmetry of the lateral ventricles. 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 paranasal sinuses and mastoid air cells are clear. There appears minimal left cerebellar tonsil ectopia.
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No acute intracranial abnormality.
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Generate impression based on findings.
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35 year old female with pain near left frontal sinus with rhinorrhea. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is mild mucosal thickening in the ethmoid, sphenoid and maxillary sinuses. The remainder of the sinuses are 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 except for minimal nasal septal deviation. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Unremarkable CT paranasal sinus apart from minimal sinus mucosal thickening.
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Generate impression based on findings.
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68 year-old male with altered mental status. There is patchy hypodensity in the periventricular white matter. The ventricles, sulci, and cisterns are symmetric and prominent, representing brain volume loss. The gray-white matter differentiation is normal. Basal ganglial calcification. 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 except for maxillary sinus retention cysts.
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No acute intracranial abnormality. Small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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27 year-old female with recent intracranial bleed. New since prior exam is a focus of hemorrhage and edema in the posterior left cingulate gyrus. Stable appearance to hemorrhage at the left caudate head and subarachnoid blood in the parasagittal right occipital lobe adjacent to the sinus confluence. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect or midline shift. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. New hemorrhage and edema in the posterior left cingulate gyrus. 2. Stable hemorrhage at the left caudate head and subarachnoid blood in the parasagittal right occipital lobe adjacent to the sinus confluence.
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Generate impression based on findings.
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52 year-old male status post fall. 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 mastoid air cells are clear. There appears a right sided oroantral fistula with right maxillary sinus mucosal thickening. There is left nasal bone fracture with no soft tissue swelling. 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.Severe periodontal disease. There is fracture of the left zygomatic arch.
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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. Left nasal bone and left zygomatic arch fractures with no soft tissue swelling, likely chronic. 4. Right sided oroantral fistula
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Generate impression based on findings.
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34-year-old male. Reason: UC POD#7 s/p ileostomy takedown, now with persistent nausea/vomiting. Assess for obstruction, abscess, leak, acute intraabdominal process. History: Persistent nausea/vomiting ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis. Patchy airspace opacity at the left lung base suggests infection or atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesion. No intra-or extrahepatic biliary ductal dilatation. No specific evidence of cholecystitis.SPLEEN: Splenic hypodensity on image 15 the study and may be a small cyst.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy with ileoanal anastomosis. The small bowel is fluid-filled and dilated up to 5 cm in diameter. The transition point is in the mid abdomen, compatible for small bowel obstruction (series 3 image 79). No pneumatosis intestinalis, intraperitoneal free air, or bowel wall thickening/edema to suggest ischemia.BONES, SOFT TISSUES: Mild degenerative changes in the thoracolumbar spine. OTHER: No free fluid, free air or drainable fluid collection. Surgical staples are present in the right lower quadrant at the ileostomy takedown site.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered prominent but not pathologically enlarged inguinal lymph nodes.BOWEL, MESENTERY: Post-surgical changes from total colectomy and ileoanal anastomosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free fluid in the pelvis.
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Small bowel obstruction with transition point in the mid abdomen. No specific evidence of ischemia or perforation.
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Generate impression based on findings.
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76 year old male. Reason: Persistent bacteremia of unknown origin, looking for sources. CHEST:LUNGS AND PLEURA: Moderate bilateral pleural effusions. Compressive atelectasis in the lower lobes.MEDIASTINUM AND HILA: Coronary artery calcifications.CHEST WALL: Mass at right nipple may be a cyst.ABDOMEN:LIVER, BILIARY TRACT: Hypodense mass in the right hepatic lobe measuring 2.5 cm in diameter and is incompletely characterized but may represent a benign simple cyst. No other focal hepatic parenchymal lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace of ascites is present.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in a decompressed urinary bladder. Bladder wall thickening with perivesicular fat stranding and fluid suggests cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No bowel obstruction, appendicitis or free air. Bladder wall thickening and perivesicular fluid suggests the presence of cystitis. Bilateral pleural effusions.
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Generate impression based on findings.
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72 year old female. Reason: Eval for obstruction, stage lung mass History: abdominal pain, bloating CHEST:LUNGS AND PLEURA: Paraseptal emphysema. Spiculated mass in the left upper lobe measures 2.5 x 2.5 cm on image 46 of series 5.Nonspecific 1 cm diameter pleural based nodule at the right lung base posteriorly on image 50 of series 5.MEDIASTINUM AND HILA: Coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hydropic gallbladder measures more than 10 cm in length.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is left lower pole nephrolithiasis. The left kidney is anomalous with malrotation. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated loops of small bowel the small bowel feces sign and a transition point in the right lower quadrant. This point is present at axial image 160 of series 3. There is mild wall thickening and enhancement of a loop of small bowel in the right lower quadrant, seen best on coronal image 60. These findings in the terminal ileum suggest active Crohn's disease or other inflammatory bowel disease. The abnormal terminal ileum is the site of partial small bowel obstruction.No significant free fluid, free air or drainable fluid collection.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: Status post ventral hernia repair.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: Status post right total hip replacement with a prosthesis in the expected position. Metallic streak artifact from the prosthesis obscures adjacent detail. Degenerative changes of the lumbosacral spine and pelvis.OTHER: No significant abnormality noted.
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Left upper lobe mass is compatible with a primary malignancy. Status post repair of anterior abdominal wall. Partial small bowel obstruction with transition at the terminal ileum.
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Generate impression based on findings.
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25 year old female. Reason: Rule out choledocholithiasis. History: Abdominal pain ABDOMEN:LUNG BASES: Mild atelectasis and scar like opacities in the lung basesLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or hydroureter. There is no renal or ureteral stone identified.There is mild fat stranding posterior to the right kidney. This is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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 noted
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No acute intra-abdominal abnormality. No bowel obstruction, free air, free fluid or appendicitis.No evidence of renal or ureteral stone. No hydronephrosis or hydroureter.No specific evidence of cholelithiasis or cholecystitis. If concern persists, right upper quadrant ultrasound examination is more sensitive and may be helpful for further evaluation.
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Generate impression based on findings.
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Male 71 years old; Reason: history of metastatic cancer, r/o acute process History: altered mental status, abdominal pain, and acute hypoxia ABDOMEN:LUNG BASES: Scattered pulmonary granulomata. Bibasilar lower lobe atelectasis and small pleural effusions. Heart size is normal. No pericardial effusion. Extensive coronary calcifications. Calcified left hilar lymph nodes. For further details, please see CT-PE report from the same date. LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Few scattered hepatic granulomata.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Fat-containing right adrenal mass measures 5.5 x 5-cm (image 282/series 9) with imaging features compatible with a myelolipoma.KIDNEYS, URETERS: Complex cystic mass with enhancing nodular components at the upper pole of the right kidney measures 3 x 3 cm on image 47/series 13 and is suspicious for a cystic renal cell carcinoma (Bosniak 4).Other hypodense lesions in both kidneys do not meet the criteria for simple cyst and may also represent small renal neoplasms.RETROPERITONEUM, LYMPH NODES: Calcific arterial sclerotic disease of the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. Enteric tube is coiled in the stomach. BONES, SOFT TISSUES: Sclerotic metastatic disease in the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in a decompressed urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic osseous metastatic disease in the pelvis.OTHER: No significant abnormality noted
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1.Osseous metastatic disease.2.Stable right renal cystic renal cell carcinoma since 10/29/2013.3.Right adrenal myelolipoma.4.No acute intra-abdominal abnormality. Specifically, no evidence of bowel obstruction, free air, free fluid, appendicitis or drainable fluid collection.
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Generate impression based on findings.
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79 year old male. Reason: CT CYSTOGRAM assess for bladder perforation in the setting of intraperitoneal free air after cystoscopy, clot evacuation. ABDOMEN: LUNG BASES: Basilar atelectasis, left greater than right.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral percutaneous nephrostomy tubes are in the expected position. Multiple calcifications are likely present in the lower pole of the right kidney, compatible with intrarenal stones, stable. RETROPERITONEUM, LYMPH NODES: Mild prominence of the retroperitoneal lymph nodes without definite adenopathy. BOWEL, MESENTERY: Bilateral fat containing inguinal hernias.Colonic diverticula without evidence of acute inflammation.BONES, SOFT TISSUES: No significant abnormality notedThere is extensive subcutaneous and intraperitoneal air. There is a collection of perivesicular free air or anteriorly in the pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: A Foley catheter is seen in the bladder. Large filling defects in the bladder, compatible with clots. Intraperitoneal contrast extravasation after retrograde filling of the bladder with iodinated contrast is consistent with intraperitoneal bladder rupture. The site of bladder wall penetration is on the left seen best at image 118 of series 4 and coronal image 57.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted
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Intraperitoneal contrast extravasation after retrograde filling of the bladder with iodinated contrast is consistent with intraperitoneal bladder rupture. Free intraperitoneal air from bladder wall defect. Bilateral nephrostomy tubes.
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Generate impression based on findings.
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77 year old female. Reason: intraabdominal bleed History: abd pain, supratherapeutic INR ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The gallbladder is hydropic measuring more than 13 cm in length. There are numerous radiodense gallstones in the gallbladder neck. No significant gallbladder wall thickening or pericholecystic fluid. Several gallstones are present in the common bile duct seen best on coronal image 52, compatible with choledocholithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Marked hydronephrosis of the right kidney. Nephroureteral stent in the right renal collecting system terminates in the urinary bladder.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: Status post hysterectomy.BLADDER: The urinary bladder is mildly distended with a Foley catheter in place. There is diffuse wall thickening with associated fatty infiltration consistent with cystitis. Hypodense collection anterior and superior to the bladder is consistent with simple fluid. This large collection may represent an adnexal cyst, urinoma, bladder diverticulum or other etiology. Further evaluation with a CT cystogram may be helpful, if clinically indicated.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: Numerous buttock soft tissue calcifications compatible with injection granulomata.
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Cholelithiasis without cholecystitis. Choledocholithiasis. Cystic collection anterosuperior to the urinary bladder. No hematoma. Probable cystitis.
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Generate impression based on findings.
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57 year old female. Reason: eval for lll pna, cholecystitis, pancreatitis History: sob, abd pain LUNGS AND PLEURA: Right middle lobe nodular scarring is unchanged from multiple prior studies. No new suspicious pulmonary nodules or masses are identified. Subpleural micronodule in the superior segment of the left lower lobe is unchanged. Small right pleural effusion.MEDIASTINUM AND HILA: Nonspecific hypodense thyroid lesions are stable. The trachea is again slightly narrowed and deviated to the left by a right thyroid lesion. There are numerous enlarged mediastinal and hilar lymph nodes, stable compared with recent examinations..The pulmonary artery is dilated consistent with pulmonary arterial hypertension. Cardiomegaly is unchanged and there is now a small pericardial effusion. Coronary artery calcifications are present.Prior CT shows an aortic dissection which is incompletely evaluated on this noncontrast examination. The descending aorta remains unchanged in diameter.CHEST WALL: No significant abnormality.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Large gallbladder lesion with calcifications appear similar to the prior exam. No biliary ductal dilation is evident.SPLEEN: No significant abnormality notedPANCREAS: Multiple pancreatic lesions appear grossly similar to the recent prior exams. The reference pancreatic head lesion cannot be accurately measured secondary to lack of IV contrast. The pancreas is displaced and compressed by the large left renal mass.ADRENAL GLANDS: The reference left adrenal mass appears stable.KIDNEYS, URETERS: Status post right nephrectomy. Enlarged left kidney with multiple masses which appears stable. Note that accurate measurement of the renal lesions is difficult to perform secondary to the lack of IV contrast. An exophytic mass arising from the superior pole of the left kidney is partially visualized and measures up to 6.5 cm in diameter. This likely represents the patient's known metastatic renal cell carcinoma. A left nephroureteral stent is in the expected position.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes appear similar to the prior exam. Previously described mass in the gastrohepatic ligament likely lies within the pancreas and has decreased in size now measuring 4.6 x 3.6 cm (image 74, series 4). This likely represents a metastasis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable L4 vertebral body hemangioma. Sclerotic lesion in the left iliac bone also appears similar to the prior exam.OTHER: Type B aortic dissection extending into the right common iliac artery is is incompletely evaluated on this exam. Atherosclerotic calcification of the abdominal aorta and its branches.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small fat-containing umbilical hernia. Nonspecific sclerotic focus is seen in the left iliac wing.OTHER: Type B aortic dissection extending into the right common iliac artery is is incompletely evaluated on this exam. Atherosclerotic calcification of the abdominal aorta and its branches.
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1.Stable large left kidney mass, adrenal mass and pancreatic mass. Please see dedicated MR abdomen report for further details.2.Other findings appear stable. No definite acute findings of pancreatitis on this noncontrast CT exam. Cholelithiasis appears stable, without evidence of cholecystitis.
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Generate impression based on findings.
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74-year-old male. Reason: evaluate for infectious process History: s/p cholecystectomy, ex-lap for pancreatic CA, presenting with fever, RUQ tenderness ABDOMEN:LUNG BASES: Bibasilar atelectatic changes.LIVER, BILIARY TRACT: Status post cholecystectomy with a new collection measuring 4 x 7 cm in the gallbladder fossa at axial image 53 of series 3. The collection contains multiple gas bubbles and is most compatible with an abscess. Common bile duct stent is in the expected position with associated pneumobilia, stable.SPLEEN: No significant abnormality noted.PANCREAS: Dilatation of the pancreatic duct extending to the pancreatic head. The SMA, SMV, portal vein, splenic vein, and celiac axis are patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification and plaque of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Surgical skin staples are present in the abdominal and pelvic wall. There is intraperitoneal free air consistent with the history of recent surgical procedure.PELVIS:PROSTATE/SEMINAL VESICLES: The prostate is enlarged.BLADDER: The bladder is moderately distended. A small amount of gas is present, probably due to recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right inguinal hernia.OTHER: No significant abnormality noted
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1.Status post cystectomy. New abscess in the gallbladder fossa. 2.Common bile duct stent in the expected position. The stent contains debris. Other findings are stable.
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Generate impression based on findings.
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55 year-old male with clamped EVD. The right frontal approached EVD is in unchanged position. The hemorrhage extends through the left thalamus, extending through the left cerebral peduncle, midbrain and cerebellar peduncle has been attenuated. A second focus is unchanged at the insertion site of the EVD with in the right frontal lobe has been less. Intraventricular hemorrhage layers bilaterally has been unchanged. No new hemorrhage. 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 cerebral white matter bilaterally as well as the basal ganglia and thalami. Secretions layering within the ethmoid, sphenoid, and right maxillary sinus are unchanged. There is scattered opacification of mastoid air cells. Orbits are unremarkable.
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Stable to decreased intracranial hemorrhages as described above. No new hemorrhage. Stable ventricular size. Stable thalamic, basal ganglial and cerebral white matter hypodensities.
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Generate impression based on findings.
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79 year-old female status post fall. There is patchy hypodensity in the cerebral 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. Lens prostheses. The mastoid air cells are clear. There is postsurgical change at the left mastoid. There is postsurgical change of sinus surgery. There is moderate inflammatory disease of the paranasal sinuses.
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No acute intracranial abnormality. Small vessel ischemic disease of indeterminate age.
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Generate impression based on findings.
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79 year-old female with CVA. Motion degraded exam. There is patchy hypodensity in the cerebral 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.
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Motion degraded exam. A repeat is recommended. With the limitation, there is no gross acute intracranial abnormality. Small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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26 year-old female with headache. 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. The cerebellar tonsils are low lying. Apparent hypodensity in the left cerebellum may be artifactual.
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No acute intracranial abnormality. Probable cerebellar tonsil ectopia.
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Generate impression based on findings.
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6 year-old female with head injury. 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 except for bubbly fluids in the sphenoid sinus. The bilateral sigmoid sinuses appear ectatic and bulge into the mastoid air cells.
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No acute intracranial abnormality.
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Generate impression based on findings.
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33 year-old female with neck pain. 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 except for focal opacification of the right OMU. There is straightening of the 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.There is mild subcutaneous fat stranding overlying the C6 and C7 spinous process. There is mild disc bulge at C5-C6.
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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. Mild subcutaneous fat stranding overlying the C6 and C7 spinous processes.
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Generate impression based on findings.
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14 year-old female with MVC. 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 mastoid air cells are clear. There is right periauricular soft tissue swelling. There are fluids in the frontal, ethmoid and sphenoid sinuses.
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1. No acute intracranial abnormality. 2. Fluids in the frontal, ethmoid and sphenoid sinuses. If there is clinical concern for maxillofacial injury, a dedicate CT can be obtained. 3. Right periauricular soft tissue swelling.
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Generate impression based on findings.
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52-year-old female patient status post ex lap, LOA, small bowel resection. Evaluate for PE. PULMONARY ARTERIES: Technically adequate study. No evidence of a pulmonary embolus. Pulmonary artery size is within normal limits.LUNGS AND PLEURA: Bilateral dependent atelectasis, right greater than left. No pleural effusions.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Minimal atherosclerotic changes of the thoracic aorta.Right-sided chest port with catheter tip at the cavoatrial junction.No mediastinal or hilar lymphadenopathy.Enteric tube in the esophagus.CHEST WALL: Scattered small axillary lymph nodes.Multilevel degenerative changes of the thoracic spine. T10 vertebral body hemangioma. Lateral right fifth rib deformity is stable compared to 2003 and is likely post-traumatic.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Water density lesion in the right lobe of the liver is better characterized on dedicated CT abdomen, has increased in size since 2006 and likely are present a cyst (series 8 image 215).Enteric tube in the stomach. Tip extends beyond the inferior margin of this examination.
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Technically adequate study without evidence of a pulmonary embolus.Mild dependent basilar atelectasis and no other acute abnormalities.
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Generate impression based on findings.
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24 year-old female with MVC. 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. There is straightening of the 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.
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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.
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Generate impression based on findings.
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35-year-old female patient with palpitations, elevated d-dimer. Evaluate for PE. PULMONARY ARTERIES: Technically adequate study. No evidence of a pulmonary embolus. Pulmonary artery size within normal limits.LUNGS AND PLEURA: No focal opacity or pleural effusion.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy.
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No evidence of a pulmonary embolus or other acute abnormalities.
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Generate impression based on findings.
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Syncope and collapse with head trauma, left orbital fractures seen on head CT. Limited views of the intracranial structures demonstrates no new acute findings; please see CT head from the same date for full description of findings.There is a left supraorbital soft tissue hematoma containing a small nonspecific hyperdensity (series 5, image 52) which could represent a foreign body. There are multiple facial fractures including a comminuted left lateral orbital wall fracture, comminuted left zygomatic arch fracture, left orbital floor blowout fracture with descent of orbital floor, and fracture of the anterior wall of the maxillary sinus. There are scattered foci of gas in the fracture sites suggesting an accompanying laceration. There is no entrapment of the extraocular muscles. The globes are without hematoma or indication of retinal detachment. Fluid within the left maxillary sinus is compatible with blood. There is thickening of the left mandibular condyle suggesting degeneration or prior trauma. There is a chronic appearing fracture within the body of the left mandible without adjacent soft tissue swelling or edema. The right maxilla, pterygoid plates, nasal bones, and visualized cervical spine and TMJs are intact, without fracture. There is ossification of the anterior longitudinal spinal ligament. A large amount of cerumen is present in the right external auditory canal with partial opacification of the middle ear. The ethmoid sinuses demonstrate scattered mucosal thickening. The mastoid air cells are underdeveloped.
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1.Left facial tripod fracture with blood in the left maxillary sinus and left supra-orbital hematoma with possible foreign body.2.Chronic-appearing left mandibular fracture.
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Generate impression based on findings.
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Male; 9 years old. Reason: r/o stone History: right CVAT, gross hematuria 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 duct dilation. Normal CT appearance of the gallbladder.SPLEEN: No focal splenic lesions.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No adrenal masses.KIDNEYS, URETERS: The kidneys are symmetric in size and attenuation without perinephric stranding. No focal renal lesions. No hydronephrosis. No renal or ureteral stones.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or abdominal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel inflammation or obstruction. Very dense foci of bowel content noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No bladder stones.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel inflammation or obstruction. Very dense foci of bowel content noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No ascites.
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Normal examination.
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Generate impression based on findings.
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71-year-old male patient with acute hypoxia. Evaluate for a pulmonary embolus. PULMONARY ARTERIES: Technically adequate study. No evidence of a pulmonary embolus.LUNGS AND PLEURA: Diffuse bilateral airspace opacities, right greater than left, with small bilateral pleural effusions.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion. Severe coronary artery calcifications. Moderate atherosclerotic changes of the thoracic aorta.CHEST WALL: Sclerotic metastatic disease in the thoracolumbar spine. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enteric tube coiled in the stomach.Redemonstration of a fat containing right adrenal mass that measures 5.5 x 5.0 cm (series 9 image 282), previously 5.3 x 2.9 cm, consistent with a myelolipoma. Thickened left adrenal gland is incompletely visualized and is not significantly changed.Moderate atherosclerotic changes in the abdominal aorta and its branches. No significant retroperitoneal lymphadenopathy.
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Technically adequate study without evidence of a pulmonary embolus.Diffuse bilateral airspace opacities suggestive of cardiogenic versus noncardiogenic pulmonary edema (aspiration, ARDS, acute drug reaction) or and less likely hemorrhage or infection.
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Generate impression based on findings.
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80 year-old female patient with chest pain. Evaluate for pulmonary embolism. PULMONARY ARTERIES: Technically adequate study. No evidence of a pulmonary embolus.LUNGS AND PLEURA: Stable moderately severe predominately apical centrilobular and paraseptal emphysema. Mild bronchiectasis and minimal bibasilar atelectasis/scarring.Reference right upper lobe nodule (series 10 image 49) is stable since 2009, is presumably benign and no longer needs to be followed.Nonspecific scattered micronodules.MEDIASTINUM AND HILA: Heart size within normal limits without pericardial effusion. Moderate coronary artery calcifications. Mild atherosclerotic changes of the thoracic aorta. Mildly tortuous descending thoracic aorta with mural thrombus, unchanged compared to prior.Scattered small mediastinal lymph nodes. No hilar lymphadenopathy.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine, unchanged.Scattered small axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypoattenuating subcentimeter foci within the liver parenchyma are too small to characterize, likely represent cysts and are unchanged.Marked colonic diverticulosis without evidence of diverticulitis.
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Technically adequate study without evidence of a pulmonary embolus.Emphysema and bibasilar scarring without other acute abnormalities to account for symptoms.
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Generate impression based on findings.
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69-year-old female patient with syncope. Evaluate for a pulmonary embolus. PULMONARY ARTERIES: Technically adequate study. No evidence of a pulmonary embolus. Pulmonary artery size within normal limits.LUNGS AND PLEURA: Moderate centrilobular emphysema. Nonspecific scattered micronodules. Chronic mild bilateral subpleural atelectasis/scarring.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion. Minimal coronary artery calcifications. Mild atherosclerotic changes in the thoracic aorta.No mediastinal or hilar lymphadenopathy.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy.
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Technically adequate study without evidence of a pulmonary embolus.Moderate centrilobular emphysema with chronic subpleural scarring.
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Generate impression based on findings.
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69 year old with anaplastic thyroid cancer please evaluate for progressive disease. CT brain:VENTRICLES/CSF SPACES:No midline shift. CSF spaces are prominent and symmetric but likely appropriate for patient age.BRAIN PARENCHYMA:No abnormal mass lesions, edema, or hemorrhage. Mild to moderate periventricular and subcortical hypodensity likely is a sequela of chronic small vessel disease.EXTRA-AXIAL SPACE:No fluid collections. No evidence of hemorrhage.BONE:No fractures. Visualized bony structures are normal.CT NECK:SOFT TISSUES:Postsurgical changes are identified from thyroidectomy, right radical neck dissection, and right pectoralis flap reconstruction. In the interim, there has been development of peripheral enhancing collection with solid enhancing components within the right pectoralis surgical bed that extends across midline just anterior to the left sternocleidomastoid muscle. Again evident are the multiple fluid collections within the right neck, however when compared to the prior exam these have significantly progressed and now demonstrate nodular rim enhancement. In addition sheet like amorphous enhancement is seen extending from the right neck into the supraclavicular fossa, the superior mediastinum along the great vessels, into the prevertebral space and superiorly to the right submandibular space. In total this abnormality measures approximately 64 x 127 X 117 mm. There is complete encasement of the fascial planes of the neck with partial effacement of the airway. There is encasement of the right common, external and internal carotid arteries. The right jugular vein is not identified which may be postsurgical or be secondary to thrombosis/occlusion. The enhancement in the prevertebral space abuts the right vertebral artery but does not encase it. However, this tumor does extend to involve the right neural foramina and into the epidural space at upper cervical levels, for example at C4. At C7 there is irregular lucency seen within the vertebral body highly concerning for tumor involvement, this is similar in appearance to the prior exam. LYMPH NODES:A right tracheoesophageal groove node has increased in size, previously measuring 7 mm now measuring 1.3 cm. there are other approximately 1 cm right tracheoesophageal lymph nodes. No other lymphadenopathy by CT size criteria are low evaluation is limited. Nodular thickening of the right platysma which may represent necrotic lymph nodes.GLANDS:The parotid and submandibular glands appear within normal limits. There is postresection changes within the thyroid.BONES:Multilevel degenerative changes of the cervical spine with anterolisthesis of C3 on C4 and C4 on C5. At C7 there is irregular lucency seen within the vertebral body highly concerning for tumor involvement, this is similar in appearance to the prior exam. OTHER:There is a right-sided pleural effusion or pleural thickening. There is mild bilateral atelectasis.
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Increase in size and interval development of extensive peripheral nodular enhancement in previously described fluid collections within the right neck; increase in size and development of enhancing nodularity within the hypodense collections at the site of the right pectoralis flap reconstruction and extending across midline; interval increase in size of extensive sheetlike enhancement extending into the supraclavicular fossa, superior mediastinum, prevertebral space, upper cervical spine neural foramina and epidural space at C4 and complete encasement of the fascial planes of the neck up to the level of the right submandibular space. The constellation of these findings is highly concerning for tumor although superimposed abscess cannot be entirely excluded. These findings result in partial effacement of the airway.Tumor encases the right common carotid artery, right internal carotid artery, right external carotid artery, and abuts the right vertebral artery. The right jugular vein is not identified, findings may represent postsurgical changes, or alternatively the vein may be thrombosed. Please correlate with surgical history.Multiple right tracheoesophageal groove nodes that have increased in size, measuring up to 1.3 cm. Nodular thickening of the right platysma, likely secondary to necrotic lymph nodes.Irregular lucency within the C7 vertebral body concerning for tumor involvement. This was seen on the prior CT exam.Further evaluation with a cervical spine MRI is indicated to further characterize tumor into neural foramina and epidural spaces of the upper cervical spine as well as to evaluate tumor involvement of the C7 vertebral body.
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Generate impression based on findings.
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52-year-old male with history of head and neck cancer, evaluate and compare to prior. Visualized intracranial contents are unremarkable. Paranasal sinuses and mastoid air cells are clear.Evaluation of the larynx demonstrates no focal area of hyper enhancement or new area of soft tissue density suggests recurrent tumor.Right paratracheal lymph node cluster which was reported as measuring 12 x 6 mm previously currently measures 12 x 6 mm which is stable compared to the prior examination when measured in the same manner (series 4, image 172). No enlarged lymph nodes are seen by CT criteria or interval lymph node enlargement. Thickening of the epiglottis and pharyngeal mucosal surfaces as well as infiltration of the neck fat planes/thickening of the platysma represents post treatment effects. Mild hyperemia of the submandibular glands are noted, unchanged. Parotid glands are stable in appearance. Calcification and wall thickening of the carotids are noted at the bifurcation. Jugular veins are patent.No lytic lesions are seen within the cervical vertebral bodies. Degenerative disease of cervical spine is redemonstrated most significant at C5/C6 asymmetric to the left right.The visualized lung apices appear clear.
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Stable examination without evidence of locally recurrent tumor or development of interval lymphadenopathy.
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Generate impression based on findings.
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58-year-old male patient with known invasive fungal mass, monitoring for interval changes. LUNGS AND PLEURA: Diffuse centrilobular emphysema.Interval increase in air space disease and consolidation in the previously affected areas of the right lung with new central cystic changes. Multiple new solid nodules in the right lower lobe are consistent with new sites of fungal infection.Stable left upper lobe pulmonary nodule (series 5 image 48).MEDIASTINUM AND HILA: Left-sided central venous catheter with tip at the cavoatrial junction. Cardiac size within normal limits without pericardial effusion. Mildly enlarged mediastinal lymph nodes with fatty hila are stable.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Interval increase in size and prominence of two hypoattenuating lesions in the right hepatic lobe, retrospectively visible on prior examination.
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1.Interval progression of fungal infection with increased consolidation with central cystic changes and new nodules.2.Interval increase in hypoattenuating liver lesions, new compared to examination on 10/27/2013, suggestive of abscesses.
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