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cp500
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CT-samples

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instruction stringclasses 1 value	input stringlengths 6 8.98k	output stringlengths 5 3.11k
Generate impression based on findings.	76 are old male with recurrent head and neck cancer, right tonsillar cancer status post chemoradiation and neck dissection 6/13, on therapy. Head:There is no evidence of mass or cerebral edema. Ventricular asymmetry is unchanged. There is no midline shift or herniation. There is no pathological enhancement. The imaged paranasal sinuses and mastoid air cells are clear.Neck:There are posttreatment changes of radiation therapy in the right neck dissection with flap reconstruction and submandibular gland resection. Extensive soft tissue thickening and infiltration along fascial planes in the right neck in the region of the surgical cavity appear similar to the prior exam, however they are less confluent than the exam from 8/13/2013. No discrete mass is identified. A minimally prominent round left paratracheal node is unchanged in size measuring 0.9 x 0.8 cm (4/197). No new enlarged lymph nodes are identified.The right internal jugular vein is not visualized with a filling defect seen in the right sigmoid sinus, likely due to chronic thrombosis. The bilateral carotid arteries are patent with calcifications at the bifurcations. The left internal jugular vein is patent. The small amount of atherosclerotic calcification is seen at the origin of the right vertebral artery.The aerodigestive tract is patent with a small amount of retained contrast within the pharynx. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The left submandibular, parotid, and thyroid glands are unremarkable. The right submandibular gland is surgically absent. Mild degenerative changes affect the cervical spine. A sclerotic focus in C6 is unchanged from 4/19/2011. For findings in the thorax, please see dedicated chest CT performed on the same day.	1.Stable appearance of extensive soft tissue infiltration in the right neck without a discrete mass lesion identified.2.Mildly prominent left paratracheal lymph node. No new lymphadenopathy.3.No evidence of intracranial metastasis.4.For findings in the thorax, please see dedicated chest CT performed on the same day.
Generate impression based on findings.	56-year-old female with productive cough, pseudomonas infection, evaluate for progression of bronchiectasis LUNGS AND PLEURA: Bronchial thickening and basilar bronchiectasis, unchanged. Several new areas of atelectasis or scarring are identified. Scattered micronodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: Bilateral breast implantsUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	Unchanged bronchial wall thickening and bronchiectasis and scattered new foci of scarring/atelectasis.
Generate impression based on findings.	56 year old female with history of rectal cancer, restaging examination. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusion or focal lung consolidation.MEDIASTINUM AND HILA: Cardiac size is normal without pericardial effusion. Small, nonspecific mediastinal lymph nodes are unchanged. Extensive atherosclerotic calcification of the coronary arteries.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes in the rectum.BONES, SOFT TISSUES: Soft tissue thickening in the presacral space, similar to prior exam. Right hip pinning is again noted.OTHER: No significant abnormality noted.	Stable postoperative changes in the rectum without evidence of metastatic disease in the chest, abdomen or pelvis.
Generate impression based on findings.	81 year-old female with dyspnea, evaluate for recurrent effusion LUNGS AND PLEURA: Bilateral pleural effusions are mildly increased in size with associated compressive atelectasis. Dependent left lingular and lower lobe consolidation.MEDIASTINUM AND HILA: Cardiac leads in expected location.CHEST WALL: Left chest wall generator.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the aorta and its branches.	Bilateral pleural effusions mildly increased from prior CT. Dependent left pulmonary opacities indicate aspiration or infection.
Generate impression based on findings.	Head and neck carcinoma CHEST:LUNGS AND PLEURA: Stable upper lobe fibrosis with bronchiectasis.MEDIASTINUM AND HILA: Stable reference precarinal lymph node best seen on image 42 series 3 measuring 1.3 x 0.7 cm. Stable hiatal herniaCHEST 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: Stable right renal cysts.RETROPERITONEUM, LYMPH NODES: Interval decrease in size of reference left periaortic retroperitoneal lymph node best seen on image 130 of series 3 measuring 2.3 x 1.2 cm; this is in comparison to 2.5 x 1.9 cm on 6/3/2013.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: Stable mildly enlarged pelvic lymph nodes. Reference left obturator lymph node best seen on image 187 of series 3 measures 0.8 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	Slight interval decrease in size of reference left para-aortic lymph node when compared to 6/3/2013. Stable mildly enlarged retroperitoneal lymph nodes and pelvic lymph nodes when compared to 12/7/2012.
Generate impression based on findings.	65-year-old male with history of prostate cancer with metastases to lymph nodes. ABDOMEN:LUNG BASES: Trace bibasilar atelectasis. Calcification of the aortic root is noted.LIVER, BILIARY TRACT: Probable diffuse fatty infiltration of the liver. No focal hepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: Age related fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculi in upper and lower poles. Right upper pole renal cortical scarring. Bilateral hypoattenuating renal lesions, which are too small to characterize, but most likely represent cysts.RETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes in the left periaortic and aortocaval region. For reference left iliac chain node measures 1.8 x 1.5 cm (image 86, series 3).BOWEL, MESENTERY: Nonobstructive small bowel adhesive disease is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral inguinal hernia repairs are noted with soft tissue plugs.	1.Retroperitoneal lymphadenopathy.2.Probable fatty infiltration of the liver.
Generate impression based on findings.	84-year-old male with metastatic prostate cancer. Also has kidney and bladder cancer. Evaluate for progression. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules are unchanged.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the thoracic aorta. Small, non-pathologically enlarged mediastinal lymph nodes are redemonstrated.CHEST WALL: No significant abnormality notedOTHER: 6-mm left lobe thyroid nodule, unchanged in size and appearance.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys. Right lower pole fat containing lesion is unchanged in size measuring 1.9 x 1.7 cm, compatible with angiomyolipoma (image 129, series #4). Exophytic left renal cystic lesion demonstrates increased attenuation, no unchanged in size and likely represents a complex cyst, though attention on future surveillance scans is warranted. RETROPERITONEUM, LYMPH NODES: Bulky retroperitoneal lymphadenopathy is minimally decreased in size, measuring 5.3 x 3.5 cm (image 141, series #4) from previously 6.2 x 3.2 cm. Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small bilateral fat containing inguinal hernias.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneous, enlarged prostate measuring 5.1 cm in maximal AP diameter.BLADDER: No significant abnormality notedLYMPH NODES: Reference right pelvic lymph node measures 1.5 x 1 .3 cm, previously 2.3 x 1.7 cm, slightly decreased in size (image 158, series #4).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.Stable scattered bilateral pulmonary micronodules.2.Minimal interval decrease in retroperitoneal and pelvic lymphadenopathy.3.Interval increase in attenuation of left renal cystic lesion, likely representing a complex cyst, though attention on future surveillance scans is warranted.4.Heterogeneous, enlarged prostate gland.Contrast extravasation description:Patient suffered minor contrast extravasation in the right antecubital fossa approximately 68 cc Omnipaque 350 IV contrast. Patient denied pain, paresthesias, or cold hand. Exam reveals non-tender, fluctuant, 8 cm swelling in the right antecubital fossa. 2+ bilateral radial pulses. Sensation and strength intact and symmetric bilaterally in the distal upper extremities. Patient declined ice pack. Discharge structures including reason for return to ED were given. Patient was discharged home in stable condition.
Generate impression based on findings.	70-year-old male with history of head and neck cancer, status post CRT, evaluate for recurrence Limited view of the intracranial structure is unremarkable. Calvarium, orbits and mastoid air cells are unremarkable. Again noted is a calcified retention cyst/polyp in the left maxillary sinus, stable in appearance. Redemonstrated are posttreatment changes within the neck soft tissues with no discrete mass to suggest local recurrence. Asymmetry of the fossa of Rosenmuller in the nasopharynx is again noted, and appears unchanged.No lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The visualized portion of the lungs again show bilateral apical scarring. Previously seen erosion of the left sternoclavicular joint has become sclerotic since prior exam. Please refer to dedicated CT chest for details. The visualized osseous is otherwise negative for lytic destruction. Redemonstration of significant degenerative disease in the cervical spine, unchanged.	Stable post treatment changes in the neck soft tissue. No cervical lymphadenopathy or local recurrence.
Generate impression based on findings.	71-year-old male. Reason: Rheumatoid arthritis. question of bronchiectasis. HRCT with ILD protocol History: cough LUNGS AND PLEURA: Left lower lobe mild bronchial wall thickening and bronchiectasis is not significantly changed compared to prior.No suspicious pulmonary nodules.No evidence of air trapping on expiratory images.MEDIASTINUM AND HILA: Cardiac size upper limit normal without pericardial effusion. Status post CABG with severe coronary artery calcifications. Moderate atherosclerotic changes of the thoracic aorta.Scattered small mediastinal and hilar lymph nodes.CHEST WALL: Median sternotomy wires in place without abnormality. 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. Cholelithiasis without evidence of cholecystitis.Moderate first chronic changes of the abdominal aorta and its branches.	Left lower lobe bronchial wall thickening and bronchiectasis is not significantly changed compared to prior.
Generate impression based on findings.	75-year-old male with history of urothelial cancer. Status post chemo. On surveillance. CHEST:LUNGS AND PLEURA: Multiple calcified granulomas are unchanged. No new suspicious pulmonary nodules or masses. No pleural effusion or focal lung consolidation. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged large right renal cyst. Additional bilateral renal attenuations are too small to characterize, most likely represent cysts and are unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Thickening and stranding of the anterior pelvic soft tissues is similar to prior exam. Fluid collection in the right inguinal region is nearly completely resolved.OTHER: No significant abnormality noted	1.No lymphadenopathy in the abdomen or pelvis.2.Near complete resolution of fluid collection in the right inguinal region.
Generate impression based on findings.	71-year-old male with history of prostate cancer and recurrence. ABDOMEN:LUNG BASES: Multiple new pulmonary nodules in the lung bases. For reference, left basilar lung nodule measures 1.6 x 1.4 cm (image 12, series 4).LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta. Small scattered retroperitoneal lymph nodes are slightly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Broad based ventral hernia containing nonobstructive loops of bowel. Degenerative changes in the spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: The bladder is incompletely distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: New right iliac sclerotic lesion. New ill-defined patchy sclerotic areas involving the spine.OTHER: No significant abnormality noted	1.New lung nodules and sclerotic bone lesions compatible with metastases as detailed above.2.Interval increase in size of non-enlarged retroperitoneal lymph nodes.
Generate impression based on findings.	72 year old female with history of metastatic breast cancer on systemic therapy. Worsening of chronic low back pain and hip pain. CHEST:LUNGS AND PLEURA: 5-mm right apical reference nodule is unchanged (image 18, series 5). Scattered granulomas are unchanged. No new pulmonary nodules or masses. No pleural effusion or focal lung consolidation. Nodularity along the left major fissure is unchanged.Stable left upper lobe pleural parenchymal scarring.MEDIASTINUM AND HILA: Enlarged heterogeneous nodular thyroid is unchanged. Calcified mediastinal lymph nodes. No enlarged mediastinal or hilar lymph nodes.CHEST WALL: Right chest port with tip at the cavoatrial junction. Left mastectomy. Stable appearance of sclerotic and lytic lesions involving L1, T3, and T5. Old left eighth rib fracture.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant change of retroperitoneal adenopathy. Reference right periaortic lymph node measures 1.5 x 1.2 cm (image 99, series 3) previously 1.8 x 1.3 cm. Left periaortic lymph node measures 1.8 x 1.6 cm (image 113, series 3) previously 1.8 x 2.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable appearance of mixed lytic/sclerotic lesion in L1 vertebral body, with loss of vertebral body height.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nodular infiltrates in the anterior abdominal wall, from prior injections.OTHER: No significant abnormality noted.	1.Stable right apical lung nodule.2.Overall no significant change in retroperitoneal lymphadenopathy.3.Stable appearance of osseous lesions, compatible with metastatic disease.
Generate impression based on findings.	56 year old female with lung cancer on chemotherapy CHEST:LUNGS AND PLEURA: Moderate right pleural effusion, increased from the prior exam. Necrotic right upper lobe mass measures 5.4 x 4.4 cm and previously measured 4.0 x 4.4 cm (image 28, series 3), increased in size. Complete collapse of the right upper and middle lobes due to tumor compression, unchanged. Reference right lower lobe nodule is obscured by the pleural effusion. Upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Reference periaortic lymph node is unchanged, measuring 9 mm and previously measuring 9 mm (image 25, series 3). Additional prominent mediastinal lymph nodes appear similar to the prior exam. Moderate atherosclerotic calcification of the aorta and mild coronary arterial calcification. Aberrant right subclavian artery. Residual high density pericardial fluid is again noted.CHEST WALL: Subcentimeter axillary lymph nodes are unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. No focal hepatic lesions.SPLEEN: Small splenule.ADRENAL GLANDS: Thickening of bilateral adrenal glands is unchanged.KIDNEYS, URETERS: Bilateral hypodense lesions some of which do not measure simple fluid density and are incompletely characterized appearing similar to the prior study.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered prominent retroperitoneal and mesenteric lymph nodes appear similar to the prior exam. Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1. Increased size of necrotic right upper lobe mass with associated collapse of the right upper and middle lobes.2. Increased right pleural effusion.3. Unchanged mediastinal and hilar lymph nodes.
Generate impression based on findings.	T4aN2b laryngeal SCC receiving IC with carbo/taxol. Pt is here for C2D15. There has been interval decrease in size of the infiltrative mass within the right hypopharynx and supraglottic larynx and paraglottic space, with residual tumor tumor that now measures approximately 19 x 22 mm, previously 37 x 44 mm. There is residual partial erosion of the right thyroid cartilage and extension through the thyrohyoid membrane into the prelaryngeal space. In addition, a previously hypermetabolic right level 2 lymph node has decreased in size, now measuring 3 x 6 mm, previously 8 x 12 mm. However, there has been interval increase in size of a cystic right level 4 lymph node that now measures 20 x 23 mm, previously 14 x 17 mm. The major cervical vessels appear to be intact. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is extensive multilevel degenerative spondylosis. There is a mild tree-in-bud opacity in the right upper lobe and scattered pleural calcifications bilaterally. Refer to the separate chest CT report for additional details.	Interval decrease in size of the right hypopharyngeal laryngeal squamous cell carcinoma with residual tumor tumor that now measures approximately 19 x 22 mm, previously 37 x 44 mm, indicating treatment response. In addition a right level 2 lymph node has decreased in size now measuring 3 x 6 mm, previously 8 x 12 mm, but the cystic right level 4 lymph node has increased in size, now measuring 20 x 23 mm, previously 14 x 17 mm.
Generate impression based on findings.	54-year-old female with lung cancer CHEST:LUNGS AND PLEURA: Postradiation changes adjacent to the right mediastinum are again identified. Unchanged 4-mm right pulmonary nodule (image 63, series 5). Additional micronodules are not significantly changed. No new nodules or masses.MEDIASTINUM AND HILA: Reference right paratracheal lymph node measures 10 mm and previously measured 10 mm (image 35, series 3). The heart size is normal. No pericardial effusion. Residual soft tissue about the right hilum appears unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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.	1. Stable 4-mm right pulmonary micronodule.2. Paramediastinal postradiation change and fibrosis.3. Unchanged mediastinal lymph nodes.
Generate impression based on findings.	Male 67 years old; Reason: history of renal cancer with mets to lungs History: metastatic lung cancer CHEST:LUNGS AND PLEURA: Left lower lobe conglomerate of pulmonary nodules measures 1.6 x 1.4cm (image 79, series 4), previously 1.5 x 1.3 cm . Right lower lobe reference nodule has increased in size measuring 3.4 x 3.8cm (image 69, series 4) previously measuring 2.4 x 1.8 cm. Additional scattered pulmonary nodules are unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: Reference right paratracheal lymph node measures 3.3 x 2.0 cm (image 35, series 3) previously2.7 x 2.0 cm. Atherosclerotic calcification of the coronary arteries. Stable non referenced subcarinal lymphadenopathy is stable.CHEST WALL: No significant abnormality notedABDOMEN:Evaluation of visceral organs is limited due to lack of intravenous contrast.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right posterior rib lytic lesion is more sclerotic, compatible with interval treatment (image 97, series 3). The soft tissue component is difficult to measure on this noncontrast exam, but appears decreased in size.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1. Interval increase in the right lower lobe mass. 2. Stable sclerotic lesion in the right posterior rib.3. Other index measurements have not significantly changed.
Generate impression based on findings.	53-year-old female with stage IV gastric cancer. Please compare to all previous scans and provide index lesion measurements for RECIST. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules identified. A focal pleural nodule in the right upper lobe is unchanged in size.MEDIASTINUM AND HILA: Small non-pathologic scattered mediastinal lymph nodes.CHEST WALL: Left-sided central venous catheter terminates in the expected location.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter hypodense lesion in the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild diffuse thickening of the gastric wall is unchanged, most prominent in the gastric antrum. Scattered small mesenteric lymph nodes are unchanged. A reference mid abdominal mesenteric lymph node measures 1.2 x 0.8 cm, unchanged from prior study.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.	Stable exam with no evidence of progression of disease.
Generate impression based on findings.	73-year-old male with lung cancer status post treatment CHEST:LUNGS AND PLEURA: Status post left upper lobectomy without evidence of recurrent disease. Unchanged left basilar scarring. Upper lobe predominant centrilobular emphysema. Focal groundglass opacity in the right middle lobe, most likely post inflammatory/infectious.MEDIASTINUM AND HILA: Reference high paratracheal lymph node measures 5 mm increases to measure 5 mm (image 17, series 3). No mediastinal or hilar lymphadenopathy. Coronary arterial and valvular calcifications are again identified. Extensive atherosclerotic calcifications and noncalcified plaque of the aorta.CHEST WALL: Multiple healed rib fractures are reidentified. Sternotomy wires. No axillary adenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	No signs of localized recurrence. Focal groundglass opacity in the right middle lobe most likely post inflammatory/infectious in etiology, follow-up CT in 3 months is suggested.
Generate impression based on findings.	56-year-old male with cough and dyspnea on exertion, history of lung cancer CHEST:LUNGS AND PLEURA: Status post left pneumonectomy with fluid filled cavity appearing similar to the prior exam. Right paramediastinal scarring consistent with radiation change. No new nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Leftward mediastinal shift is again noted.CHEST WALL: Post surgical rib deformities.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	Status post left pneumonectomy without evidence of recurrent or metastatic disease.
Generate impression based on findings.	65 year old patient with thoracic spine pain. No preceding trauma. There is a diffuse mottled appearance of all bones of the thoracic spine including several relatively focal lytic areas, such as in the left T3 pedicle (sagittal image 70), with possible mild expansion of several pedicles and transverse processes. The vertebral body heights are intact, without evidence of fracture. There are degenerative changes including multilevel facet arthropathy, which results in neural foraminal stenosis at T4-5 and T10-11. There is superimposed ligamentum flavum calcification that results in effacement of the posterior thecal sac at T4-5 and T5-6. There is mild convex right scoliosis centered at T8. There is a 4.7 x 5.2 cm fluid attenuation left renal lesion that most likely representing a cyst, as demonstrated on the CT abdomen. There is mild bilateral dependent atelectasis at the lung bases and mild atherosclerotic calcification of the aortic arch. There is congenital absence of the inferior vena cava with azygous continuation.	Diffuse mottled appearance of the vertebral bone marrow without evidence of pathological fracture. Differential considerations include a marrow infiltrative process, such as multiple myeloma or lymphoma. MRI may be useful for further characterization.
Generate impression based on findings.	Female 57 years old; Reason: eval for SBO / other pathology History: abd pain, h/o multiple abd surgeries incl umb hernia repair, duodenal switch ABDOMEN:LUNGS BASES: Heart size is enlarged. No basilar pleural effusions.LIVER, BILIARY TRACT: Liver has a smooth contour. Stellate scar like lesion in the left hepatic lobe a focal area of calcification of unclear etiology possibly due to prior surgery. Hepatic and portal veins are patent. Mild intrahepatic ductal dilatation.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: Post operative changes in the stomach with a partial gastrectomy. The enteric limb from the stomach to the colon is patent.The biliary limb is obstructed due to a ventral paramedian hernia with a neck measuring 3 cm. The bowel loops proximal to this are dilated up to 3.5cm. There is mild amount of upper abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace upper abdominal ascites.No free intraperitoneal air is evidentPELVIS:UTERUS, ADNEXA: Noncalcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.Post operative changes in the stomach and small bowel - duodenal switch procedure with obstruction of the biliary limb due to an anterior abdominal wall hernia.
Generate impression based on findings.	Female 65 years old; Reason: mets lung cancer, EGFR +, T790M+, s/p 4 cycles of AP26113, pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Right lower lobe mass measures 5.5 x 5.2cm (series 5, image 50), previously 5.4 x 4.8 cm .There is extensive surrounding nodularity which may represent additional tumor, relatively stable. No pleural effusions.MEDIASTINUM AND HILA: Index right hilar lymph node measures 1.1 x 1.3 cm (series 3, image 51), previously 1.6 x 0.8 cm . Heart size is normal without pericardial effusion.Thyroid nodules appear stable.CHEST WALL: Left chest wall Port-A-Cath tip terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter left hepatic lobe hypodensity is unchanged and likely benign.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: Reference gastrohepatic lymph node measures 1.3 x 0.9cm previously 1.4 x 1.0 cm (series 3, image 73), unchanged. Reference paraaortic lymph node measures 0.8 x 0.9cm (series 3, image 97), previously 1.0 x 0.7 cm.Atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: Reference soft tissue density anterior to the esophagus measures2.9 x 1.7 cm (series 3, image 80), previously 2.7 x 1.7 cm .BONES, SOFT TISSUES: Tiny sclerotic lesions throughout the thoracolumbar spine, unchanged.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: Sclerotic lesion in the left superior acetabulum and right ischium are not significantly changed.OTHER: No significant abnormality noted.	1.Right lower lobe mass without significant interval change.2.Mesenteric soft tissue density anterior to the esophagus is unchanged.3.Reference lymph nodes without significant interval change in size.4.Sclerotic osseous lesions are unchanged.
Generate impression based on findings.	History of CVA presenting after a syncopal event. The ventricles, sulci, and cisterns are symmetric and unremarkable. Mild age-appropriate volume loss is present. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. Hypodensities in the periventricular and subcortical white matter are compatible with mild age-indeterminate small vessel disease. A calcification is noted within the left vertebral artery which could be associated with significant stenosis.There is thickening of the left maxillary sinus bone without associated mucosal disease which may have resulted from a prior infection. The paranasal sinuses and mastoid air cells are clear.	1.No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age. However, CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2.Partially visualized left vertebral artery calcification which could be associated with significant stenosis.
Generate impression based on findings.	76-year-old male patient. Reason: h/o HNC and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Moderate interval decrease in mild subpleural fibrosis in the lung periphery. Mild right lower lobe bronchiectasis.Multiple calcified micronodules consistent prior granulomatous disease.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Cardiac size upper limit of normal with unchanged mild pericardial thickening. Minimal coronary artery calcifications. Mild atherosclerotic changes of the thoracic aorta.Left inferior pulmonary ligament lymph node measures 13 x 20 mm (series 3 image 61), previously 17 x 20 mm. High left paratracheal lymph node subjectively decreased in size compared to prior. Right paratracheal and AP lymph nodes minimally decreased in size. Small subcarinal lymph nodes are unchanged.Mildly enlarged bilateral interlobar regional lymph nodes are unchanged. Calcified right hilar lymph node consistent with prior granulomatous disease.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine. T10 superior endplate depression, stable.No axillary lymphadenopathy.Mild interval decrease in size of left lower cervical lymph node. Please refer to CT neck for details.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating lesion adjacent to the falciform ligament is unchanged and likely a cyst. Cholelithiasis without CT evidence of cholecystitis.SPLEEN: Splenic granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.PANCREAS: Atrophic with fatty replacement.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes of the abdominal aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube in place without abnormality.BONES, SOFT TISSUES: Chronic compression fracture of the L2 vertebral body. Moderate to severe degenerative changes in the lumbar spine. Small fat filled umbilical hernia.OTHER: No significant abnormality noted.	Mild interval decrease in left inferior pulmonary ligament lymph node and high left paratracheal lymph node. Otherwise, mediastinal and hilar lymph nodes stable to minimally decreased in size.No new suspicious pulmonary nodules.
Generate impression based on findings.	72-year-old patient. Fall. Rule out intracranial hemorrhage. There is unchanged encephalomalacia within the left superior temporal gyrus underlying the right temporal microcraniotomy for prior intracranial hemorrhage evacuation. There is an unchanged lacunar infarct in the left basal ganglia. The ventricles are stable in size and configuration. There is no evidence of acute intracranial hemorrhage, hydrocephalus, or mass lesion. The orbits, paranasal sinuses, and mastoid air cells appear unchanged.	Unchanged encephalomalacia within the left superior temporal gyrus related to remote hemorrhage and chronic lacunar infarct in the left basal ganglia, but no evidence of acute intracranial hemorrhage. Noncontrast CT is not sensitive for detection of non-hemorrhagic stroke and MRI is recommended, if clinically warranted.
Generate impression based on findings.	CF with fevers and positive bronch cultures. MRSA pneumonia. LUNGS AND PLEURA: Left lower lobe peribronchial thickening and adjacent airspace opacity significantly improved compared to previous but suspicious for residual pneumonia. The left main bronchus stent has been repositioned and the airways are now patent. Small left pleural fluid collection with residual subpleural fluid bilaterally. Dependent pleural thickening on the left versus layering fluid fluid or fluid/debris level in the pleural space.Mild septal thickening and bronchial wall thickening, slightly improved. Residual centrilobular and lobular groundglass opacities and small solid micronodules significantly improved. Tree-in-bud opacities seen in the periphery of the right middle lobe and right lower appears worse in some areas but stable to improved others.MEDIASTINUM AND HILA: Diffuse mediastinal lymphadenopathy and prominent hilar region lymphatic tissue not significantly changed. Cardiomegaly, unchanged. Left VAD tip in the right atrium.CHEST WALL: Sternotomy wire in place. Left intercostal lymphadenopathy minimally improved.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	Interval repositioning of left main bronchus stents with patency of the airways. Significant improvement in a left lung consolidation with residual opacities in the lower lobe suspicious for incompletely treated pneumonia. Slight improvement in interstitial and subpleural edema with unchanged small left pleural fluid collection. Dependent pleural thickening on the left versus layering fluid fluid or fluid/debris level in the pleural space is and the resolution for definitive characterization and could be the result of infection or possibly blood products in the pleural space, unchanged. Ground glass and tree-in-bud opacities are overall improved.
Generate impression based on findings.	Male 54 years old; Reason: patient with a history of adrenal cancer, currently receiving chemotherapy. please assess for disease progression History: adrenal cancer CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary nodules consistent with metastatic disease have progressed. Left lower lobe pulmonary nodule measures 3 x 3.2 cm (image 67, series 5), previously 2.8 x 2.4 cm . Right upper lobe pulmonary nodule measures 1.6 x 1.6 cm (image 26, series 5), previously 1.0 x 0.9 cm.The solid right lower lobe pulmonary mass is larger in size and continues to invade the right lower lobe airways with interval increase in narrowing of the right lower lobe bronchus. Other non referenced nodules have progressed and become more conspicuous. MEDIASTINUM AND HILA: Numerous enlarged mediastinal and hilar lymph nodes unchanged to larger.Reference precarinal node measures 1.4 cm in the short axis (image 37, series 3), previously 1.2 cm in the short axis. Non-index left hilar nodal conglomerate is larger in size measuring 2.7 cm (image 46, series 3), previously 2.4 . This measurement may include incorporated pulmonary nodules and appears more mass like now.Moderate coronary artery calcifications. CHEST WALL: Right chest wall venous access port with catheter terminating at the atriocaval junction. Probable bone island low thoracic spine (3/103).Mild left low cervical adenopathy stable.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy. The left adrenal is normal in morphology.KIDNEYS, URETERS: Status post right nephrectomy. Hypertrophied left kidney with mild hydronephrosis, unchanged. Multiple hypoattenuating lesions in the left kidney are too small to characterize but likely represent benign renal cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic changes of the abdominal aorta and its branches. BOWEL, MESENTERY: Stomach is markedly dilated and filled with fluid and debris.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1. Increase in size of the pulmonary metastases including numerous referenced and non referenced lesion.2. Slight increase in size of prominent mediastinal lymph nodes.
Generate impression based on findings.	Male 65 years old; Reason: evaluate for tumor recurrence sp partial nephrectomy History: renal cell carcinoma ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post operative changes along the anterior aspect of the right kidney from resection of the hypervascular mass. Area of parenchymal scarring. No evident residual mass.Unchanged cyst in the left kidney without evident enhancementRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.Status post resection of the right renal mass without evident residual disease. Follow up study in 12 months is suggested to evaluate for stability.
Generate impression based on findings.	Known arachnoid cyst. New onset numbness/tingling left flank and leg. Asymmetric smile and decreased grip strength in left hand. There is a focus of hypoattenuation adjacent the right peritrigonal white matter that measures up to 10 mm. There is no significant mass effect, hydrocephalus, or herniation. There is an extra-axial CSF attenuating lesion anterior to the right cerebellar hemisphere that measures up to 9 mm in width with mild mass effect. There is no acute intracranial hemorrhage. There is minimal mucosal thickening within the maxillary, ethmoid, and sphenoid sinuses. The skull and extracranial soft tissues are unremarkable.	1. Focal hypoattenuating lesion within the right peritrigonal white matter measures up to 10 mm. Differential considerations could include demyelination/inflammation, infection, ischemia, or neoplasm. Further assessment with MRI is recommended.2. An extra-axial CSF attenuating lesion anterior to the right cerebellar hemisphere that measures up to 9 mm in width likely represents an arachnoid cyst, although this can be further interrogated via MRI as well.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	Reason: h/o recurrent HNC, s/p induction chemo, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Pleural thickening and subpleural calcification prior granulomatous disease unchanged.A new nodular interstitial abnormality primarily in the right lower lobe is present, suggestive of a granulomatous disease, chronic aspiration or mycobacterial infection. There is also new partial atelectasis of the right middle lobe.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are within normal size limits and unchanged.There are severe coronary artery calcifications.CHEST WALL: Degenerative abnormalities affect the thoracic spine with benign-appearing cyst formation.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: Bilateral adrenal nodules are unchanged consistent with benign adenomas.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Vascular calcifications are present. 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.	New right lower lung zone nodular interstitial abnormality with partial atelectasis of the right middle lobe. This could be atypical infection including mycobacterial etiologies, or chronic aspiration. There is no evidence of metastases, however.
Generate impression based on findings.	Right MCA mycotic aneurysm rupture in 2004. CT: There is stable extensive encephalomalacia in the right MCA territory with associated ex vacuo dilatation of the right lateral ventricle. There is a right MCA aneurysm clip that produces streak artifact, which obscures surrounding anatomy. There is no evidence of acute hemorrhage. There is partial resorption of the right craniotomy flap.CTA: There is no definite evidence of recurrence of the treated right MCA aneurysm, although streak artifact from the clip limits assessment for this. No new cerebral aneurysm are identified. There is unchanged deficiency of distal right MCA branches.	1. No definite evidence of recurrence of the treated right MCA aneurysm, although streak artifact from the clip limits assessment for this. 2. Chronic large right MCA territory infarct with unchanged deficiency of distal right MCA branches.3. No evidence of acute intracranial hemorrhage.
Generate impression based on findings.	51 year-old female with lung cancer CHEST:LUNGS AND PLEURA: Increasing consolidation in the right upper lobe adjacent to the resection margin which now measures 10.4 x 2.3 cm and previously measured 6.5 x 3.0 cm (image 24 series 4). Right middle lobe consolidation with central cavitation measures 4.2 x 1.4 cm and previously measured 4.2 x 1 .2 cm, mildly increased in size (image 41 64). Increase in patchy and nodular airspace opacities in the right upper lobe and scattered in the left lung are consistent with disease spread. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic hemangioma appears similar to the prior exam.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.	Increasing right upper and middle lobe consolidation adjacent to the resection margin consistent with disease progression. Additional patchy and nodular opacities in both lungs are consistent with disease spread.
Generate impression based on findings.	T3N2b base-of-tongue squamous cell carcinoma status post-CRT and 10--69 protocol. Also status post left thyroid lobectomy in December, 2011 for colloid nodular disease with hyperplastic nodules. There are stable post-treatment findings with no evidence of locoregional tumor recurrence in the oropharynx. There are also stable postoperative findings related to left thyroid lobectomy without recurrent tumor in the resection bed. There is an unchanged hypoattenuating 4 mm nodule in the remaining right thyroid lobe. Likewise, there is no evidence of significant cervical lymphadenopathy. The airways are patent. The major salivary glands appear unchanged. The major cervical vessels are intact. The partially imaged intracranial structures are unremarkable. There is mild cervical degenerative spondylosis. The imaged portions of the lungs are clear.	No evidence of locoregional tumor recurrence or significant lymphadenopathy.
Generate impression based on findings.	40 year old male with history of follicular non-Hodgkin's lymphoma, status post 3 cycles chemotherapy. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Cardiac size is normal, without pericardial effusion. Interval decrease in size of mediastinal lymph nodes, now with no pathologically enlarged nodes.CHEST WALL: Interval decrease in axillary adenopathy. Reference conglomerate right axillary lymph nodes measure 2.8 x 1.5 cm (image 24, series 401) previously 4.7 x 3.0 cm.ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged and measures 21 cm, unchanged. No focal hepatic lesion.SPLEEN: The spleen measures 12.4 cm in length in craniocaudal dimension, previously 20 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval decrease in diffuse lymphadenopathy, involving portal, celiac, peripancreatic, and retroperitoneal lymph nodes. Reference left periaortic lymph node measures 2.2 x 2.0 cm (image 112, series 41), previously 4.6 x 2.6 cm.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: Interval decrease in diffuse pelvic and inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	Interval decrease in diffuse adenopathy in the chest, abdomen and pelvis.
Generate impression based on findings.	64-year-old female. Reason: mesothelioma s/p right pleurectomy. Now with concern for collapse of lower lobe and/or fluid collection. History: same LUNGS AND PLEURA: Moderately large multiloculated fluid collection in the posterior right lower lobe with near complete atelectasis of the right lower lobe. Right lower lobe airways are patent, however there is significant septal thickening and air space consolidation. A posterior chest tube enters below the 7th rib and an anterior chest tube enters below the 6th rib on the right. The posterior chest tube courses anterior to the large fluid collection. There are two smaller fluid collections in the major fissure and one in the minor fissure.Right upper lobe nodule is unchanged and measures 5 mm (series 4 image 31) and is likely benign. Left upper lobe granuloma is again noted.Right upper lung with septal thickening and dependent groundglass opacities. Small left-sided pleural effusion with compressive atelectasis.MEDIASTINUM AND HILA: Cardiac size within normal limits with small pericardial effusion. Mild atherosclerotic changes of the thoracic aorta.Right cardiophrenic lymph node appears unchanged. Scattered small mediastinal lymph nodes.CHEST WALL: Right lateral chest wall edema and subcutaneous emphysema with possible small intramuscular hematoma. New postsurgical right 5th rib fracture. Mild multilevel degenerative changes in the thoracic spine. No axillary lymphadenopathy. Mild right internal mammary chain lymph node enlargement.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. New numerous surgical clips in the mid abdomen.Abdominal ascites. Mild atherosclerotic changes of the abdominal aorta and its branches. Nonspecific fat stranding is difficult to assess given image noise.	Moderately large loculated right pleural fluid collection with compressive atelectasis of the right lower lobe. Two smaller loculated fluid collections within the major and minor fissures. Chest tubes are not in communication with loculated fluid collections.Septal thickening and scattered ground glass opacities in the right lung may reflect atypical pulmonary edema if the patient is recently postoperative and/or atypical infection.
Generate impression based on findings.	78-year-old female with non-small cell lung cancer, shortness of breath. CHEST:LUNGS AND PLEURA: Postoperative changes of the right lung from right lower lobectomy are redemonstrated with extensive volume loss and fibrosis likely related to radiation treatment. Right lower lobe nodule measures 7 mm, unchanged (image 35, series #5).Scattered foci of emphysema, unchanged.MEDIASTINUM AND HILA: Left-sided port with catheter tip in the mid SVC. Slight interval increase size of some mediastinal lymph nodes. A reference lymph node measures 2.2 x 1.0 cm (image 24, series #3). May represent reactive nodes from chronic inflammatory changes, however, progression of metastatic disease cannot be excluded. Attention on follow-up imaging is warranted. Dense hilar calcifications are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is surgically absent with cholecystectomy clips in the gallbladder fossa. Mild intrahepatic biliary ductal dilatation is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left kidney simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.Stable postoperative and radiation changes of the right lung with extensive volume loss.2.Slight interval increase in mediastinal adenopathy, which may represent reactive lymph nodes though progression of metastatic disease cannot be excluded. Follow-up is advised.
Generate impression based on findings.	73-year-old female with history of lung cancer status post resection/adjuvant chemo RT, compare to prior LUNGS AND PLEURA: Status post right upper lobectomy. Right lower lobe paramediastinal fibrosis and bronchiectasis consistent with prior radiation.Linear opacity adjacent to left major fissure measures 1.6 x 0.5 cm and previously measured 1.6 x 0.5 cm (image 47, series 4), unchanged.Semi-solid nodule at the right lung base measures 1.0 x 0.8 cm and previously measured 1.0 X 0.9 cm, not significantly changed (image 5, series 4). Additional small right lower lobe last nodule is unchanged (image 22, series 4).No new nodules or masses.MEDIASTINUM AND HILA: Reference paratracheal lymph node poorly delineated due to lack of IV contrast measures 1.2 cm and previously measured 1.0 cm (image 31, series 3). No new mediastinal or hilar lymphadenopathy. Coronary arterial and aortic atherosclerotic calcifications.CHEST WALL: No axillary adenopathy. Degenerative changes are again noted in the thoracic spine. Right sixth rib deformity and orthopedic hardware is again seen in the posterior lateral right chest wall.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Thickening of the left adrenal gland appears similar to the prior exam..	Unchanged lung nodules. No evidence of metastatic disease.
Generate impression based on findings.	T2 N0 right lower lobe SCC. RT in 6/13. Post treatment changes. CHEST:LUNGS AND PLEURA: Index lesion right lower lobe measures 2.3 x 1.8 cm (5/1), previously 3.1 x 2.5 cm, smaller. Lesion remains inseparable from the adjacent surface which is thickened. No pleural fluid or pneumothorax. Postsurgical changes in the right lung of right upper lobectomy. Mucoid impaction of a subsegmental right lower lobe bronchus, but no suspicious pulmonary nodules.MEDIASTINUM AND HILA: Unchanged small mediastinal lymph nodes. Coronary artery calcifications. No pericardial fluid.CHEST WALL: Right eighth rib ring-like area of sclerosis unchanged. Healed right-sided rib fracture deformity. Punctate T5 sclerosis unchanged. Endplate degenerative change of the lower thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Interval development of a 2.5 x 3.1 cm mass in the right hepatic lobe, new from prior scans. Distal to lesion in the tip of the right hepatic lobe, there is enhancement of the parenchyma suggesting vascular shunting.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable cyst right kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification involving the aorta and its branches, severe. Probable stenosis of the renal arteries bilaterally. The iliac vasculature is also heavily calcified and appear stenotic.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative change supine with fixation device in L3, L4 and L5.OTHER: No significant abnormality noted.	New 2.5 x 3.1 cm mass in the right hepatic lobe is most consistent with a metastasis. The right lower lobe mass has decreased in size.
Generate impression based on findings.	Altered mental status. The imaged are markedly degraded by patient motion. Within this limitation, there is no gross evidence of acute intracranial hemorrhage or mass. There is nonspecific mild scattered cerebral white matter hypoattenuation. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There may be a small left maxillary sinus retention cyst. The imaged paranasal sinuses and mastoid air cells are otherwise clear. There is a partially imaged enteric tube and mild prominence of the superior ophthalmic veins, which may represent normal variants or indicate increased systemic venous pressure. The skull and extracranial soft tissues are otherwise unremarkable.	The imaged are markedly degraded by patient motion. Within this limitation, there is no gross evidence of acute intracranial hemorrhage or mass. Nonspecific mild scattered cerebral white matter hypoattenuation may represent age-indeterminate small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of acute non-hemorrhagic stroke.
Generate impression based on findings.	63-year-old with history of right lung cancer status post treatment, assess for change CHEST:LUNGS AND PLEURA: Spiculated right upper lobe lung nodule measures 2.3 x 2.1 cm and previously measured 2.4 x 2.1 cm (image 14, series 5), not significantly changed. Increasing surrounding opacity is nonspecific, but may be treatment related. No new lung nodules. Mild centrilobular predominant centrilobular emphysema.Volume loss from severe scoliosis with bilateral basilar atelectasis and scarring is again identified.MEDIASTINUM AND HILA:Multiple enlarged mediastinal lymph nodes with the reference right paratracheal lymph node measuring 1.2 cm and previously measuring 1.3 cm (image 16, series 3).Enlarged main pulmonary artery consistent with pulmonary arterial hypertension. Cardiomegaly and moderate atherosclerotic calcifications of the coronary arteries and aorta.Unchanged enlarged heterogeneous thyroid.CHEST WALL: Severe scoliosis with unchanged orthopedic hardware.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: Bilateral hypoattenuating lesions, likely representing cysts, are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic disease of the abdominal aorta. Infrarenal aortic aneurysm which measures 4.3 x 4.2 cm and previously measured 4.2 x 4.2 cm (image 71, series 3).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Lumbar levoscoliosis and severe thoracic dextroscoliosis.OTHER: No significant abnormality noted.	1. Unchanged size of right upper lobe spiculated mass with increasing surrounding opacity which may be treatment related. 2. Unchanged infrarenal abdominal aortic aneurysm.
Generate impression based on findings.	84-year-old now with pleural plaques and effusion on the right LUNGS AND PLEURA:. Increased right pleural effusion. Multiple unchanged pulmonary micronodules. Left lower lobe pleural thickening, which measures 1.8 cm in depth (image 8, series 4), and previous measured 1.8 cm. Severe centrilobular and paraseptal emphysema. Bilateral pleural calcifications and thickening compatible with prior asbestos exposure.MEDIASTINUM AND HILA: Cardiac leads in expected location. Cardiomegaly.CHEST WALL: Left chest wall ICD. Flowing anterior vertebral body osteophytes. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Flowing anterior vertebral body osteophytes. Hepatic hypodensities are incompletely characterized on this noncontrast exam. Atherosclerotic calcifications of the abdominal aorta and its branches. Splenic granulomata.	1. Unchanged pleural thickening and calcification consistent with prior asbestos exposure.2. Severe centrilobular and paraseptal emphysema. Unchanged pulmonary micronodules.3. Increasing right pleural effusion.
Generate impression based on findings.	Reason: hx H\T\N ca, post CRT, evaluate dx and compare measurements to previous scans History: as above CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Left thyroid lobe resected.No mediastinal or hilar lymphadenopathy noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: Splenic artery embolization coils are present.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.Diverticulosis.BONES, SOFT TISSUES: Mild degenerative changes affect lower lumbar vertebra.OTHER: No significant abnormality noted.	No evidence of metastases, or other significant abnormality.
Generate impression based on findings.	69 years old male with history of tongue cancer. The visualized paranasal sinuses and mastoids are normally pneumatized with the exception of some mild maxillary mucosal thickening. There is minimal opacification of the mastoid air cells. The bones of the calvarium are free of focal destructive lesions. Lens prostheses. Limited view of the intracranial structure is unremarkable. Extensive post therapy changes are redemonstrated in the neck including infiltration of the subcutaneous and fascial planes and thickening of the platysma. There is distortion and volume loss of the tongue, particularly on the left side, with fatty infiltration, all stable findings. No focal soft tissue mass or pathologic enhancement is seen to suggest recurrent disease.No pathologically enlarged lymph nodes are evident. A few scattered subcentimeter submandibular lymph nodes are reidentified on the right, not significantly changed. The index right level Ib lymph node measures approximately 3 mm in short axis dimension (was 3 mm on the prior).Thickening of the epiglottis is likely related to therapy. The vallecula is not effaced. The piriform sinuses are not well seen. The left submandibular gland is absent, but the remaining salivary glands and thyroid are free of focal lesions. The cervical vessels are patent. The bones of the skull base and cervical spine are free of focal lesions.Emphysematous change is redemonstrated in the lung apices.	Stable posttherapy change in the neck with no evidence of recurrent disease or pathologic adenopathy.
Generate impression based on findings.	70 year-old male, with dyspnea LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular and paraseptal emphysema. Mild lower lobe bronchial thickening and bronchiectasis. Resolution of right upper lobe ground glass nodule. Sabre sheath trachea deformity consistent with COPD. Lingular and right middle lobe scarring.MEDIASTINUM AND HILA: Moderate coronary arterial calcifications and atherosclerotic calcifications of the aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	1. Moderate centrilobular and paraseptal emphysema.2. Resolution of right upper lobe ground glass nodule, which may have been inflammatory in etiology or represented AAH.
Generate impression based on findings.	Left lung atelectasis versus effusion. Hypoxia. LUNGS AND PLEURA: Small to moderate layering pleural effusions. Patchy air space opacities at the left apex, right upper lobe along the fissure and dependent aspects of the right upper lobe. Few patchy peribronchial opacities in the right middle lobe also noted. Compressive atelectasis right lower lobe and and the majority of the left lower lobe. No pneumothorax.MEDIASTINUM AND HILA: Moderate anterior mediastinal hematoma. Moderate to large pericardial hematoma; the largest area of the hematoma is adjacent to the output cannula insertion site (3/40-3/44) based on position of the felt pledgets and comparison with prior contrast-enhanced scan, this was discussed with the cardiothoracic ICU resident on call and the patient's attending via speakerphone on 12/6/13, 2:32 p.m. Additional probable pledgets suggest focal repair adjacent to the SVC and right atrial appendage (3/52), correlate with surgical history.LVAD input cannula appears similar in position to the prior cardiac scan on 10/28/13. Smaller volume of layering pericardial blood products below level of the the cannula. Endotracheal tube tip approximately 5-cm above level of carina. The distal left main bronchus is narrowed as are the lingular and left lower lobe airways by extrinsic compression from the heart. For example, the distal left main bronchus measures 4-mm in AP dimension and the lobar airways are intermittently collapsed. The lingular bronchus is not visualized. Where patent the left upper and lower lobe proximal airways measure1-3 mm in transverse dimension. Attenuation of the airways is seen to a lesser extent in the right middle lobe.There is an introducer catheter in the right jugular vein terminating at the level of the right clavicular head. Left subclavian ICD leads terminate in the right right atrial appendage and the mid right ventricle however the severity of streak artifact limits assessment of the distal lead.Interval removal of drive line previously seen in the anterior midline. Looped at the cardiac base, there is a new drive line entering from the left anterior chest wall. No visible fluid collections surround the extrathoracic portion of the line.Mediastinal lymph nodes are upper normal in size. Severe multichamber cardiomegaly.CHEST WALL: Small fluid collection lateral to the right lower chest wall musculature, presumably postoperative. Left chest wall pacemaker. Tracheostomy tube. Median sternotomy with wires and plate/screw devices in place.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Linear bands of hypoattenuation in the spleen suspicious for an infarct. Partially visualized fluid density along the caudal margin of the spleen present previously, incompletely assessed.	1. Moderate anterior mediastinal and pericardial hematoma.2. Extrinsic compression of the left main stem bronchus and lobar airways between the heart and descending thoracic aorta, likely related to posterior mediastinal deviation from hematoma.3. Patchy air space opacities suggestive of aspiration and/or infection.4. Significant compressive atelectasis of the left lower lobe by a combination of pleural fluid and cardiomegaly/mediastinal deviation.5. Small pleural effusions.6. Band-like hypoattenuation in the spleen suspicious for infarct.
Generate impression based on findings.	NHL status post 3 cycles of chemotherapy. There has been marked interval decrease in size of the cervical lymphadenopathy. For example, a left level 3 lymph node now measures 6 x 11 mm, previously 16 x 18 mm and a right level 5 lymph node measures 8 x 10 mm, previously 15 x 15 mm. There has also been interval decrease in size of the axillary lymph nodes bilaterally. The major cervical vessels are patent. The osseous structures are unremarkable. The Waldeyer ring structures are unremarkable. The airways are patent. The paranasal sinuses and mastoid air cells are clear. The partially imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.	Marked interval decrease in size of the cervical lymphadenopathy, indicating treatment response.
Generate impression based on findings.	70 year-old male patient. Reason: h/o HNC, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Pleural calcifications compatible with prior asbestos exposure are stable. Right upper lung micronodule is stable compared to prior examination (series 5 image 33).MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Moderate coronary artery calcifications. Mild atherosclerotic changes of the thoracic aorta. Aortic valve calcifications.Scattered small mediastinal lymph nodes, subjectively minimally smaller compared to prior.CHEST WALL: Mild multiple degenerative changes in the thoracic spine.No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating lesion in the posterior segment of the right hepatic lobe is unchanged and measures 20 x 15 mm (series 3 image 18).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: Infrarenal IVC filter. Moderate atherosclerotic changes of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: Mild to moderate multilevel degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.	No evidence of metastatic disease in the chest or upper abdomen.
Generate impression based on findings.	14 year-old male with headaches. 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 are frothy materials in the right maxillary sinus. There is moderate mucosal thickening in the sphenoid and ethmoid sinuses and right frontoethmoidal recess. There is a small osteoma in the left frontal sinus.	1. No acute intracranial abnormality. 2. Paranasal sinus inflammatory disease and acute right maxillary sinusitis.
Generate impression based on findings.	72-year-old female. Reason: h/o met thyroid ca, compare to previous, measurements pls History: none LUNGS AND PLEURA: Pulmonary nodules are again seen along the right major fissure. Larger reference nodule measures 1.5 x 1.2 cm (series 4 image 27), previously 1.5 x 1.1 cm. Left infrahilar mass demonstrates increase in size and currently measures 2.8 x 4.0 cm (series 4 image 41), previously 2.5 x 2.8 cm. There is also interval increase in narrowing of the adjacent bronchiole and obliteration of the superior segmental bronchus of the left upper lobe.Additional small nodules demonstrate stability or mild increase in size. No new pulmonary lesions identified.Trace dependent atelectasis.MEDIASTINUM AND HILA: Surgical clips again noted in the thyroid bed. Cardiac within normal limits without pericardial effusion. Moderate coronary artery calcifications. Mild adverse chronic changes of the thoracic aorta. No mediastinal lymphadenopathy. Hilar lymph nodes not significantly changed.CHEST WALL: Subcutaneous soft tissue nodule in the right posterior shoulder is unchanged (series 3 image 9).Left breast lesion is unchanged compared to prior study and is increased in size compared to 12/14/2010.Mild multilevel degenerative changes in the thoracic spine.Sclerosis of the right clavicular head, right first rib, and right superior sternum is unchanged from the prior study and may be secondary to radiation treatment. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy.Left renal cyst unchanged.	1.Interval increase in reference pulmonary nodule and lesion with reference measurement provided, consistent with metastatic disease. Additional small nodules are stable to mildly increased in size. No new pulmonary lesions identified.2.Left breast lesion stable compared to most recent prior examination and enlarged compared to examination on 12/14/2010.
Generate impression based on findings.	Female 55 years old; Reason: Please evaluate for portal vein thrombosis History: pt with hx of portal vein thrombosis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. Probable simple cyst in segment two of the liver. No suspicious hepatic lesions.Focal nodular thickening of the gallbladder fundus with cystic changes most suggestive of adenomyomatosis and is unchanged.Hepatic and portal veins are patent. The previously noted portal venous thrombus has resolved the extrahepatic portal vein, superior mesentery vein and splenic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Probable small lipoma in the tail of the pancreas. Other subcentimeter hypodense foci in the pancreas are too small to characterize. No pancreatic inflammation or significant pancreatic ductal dilatation.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: Soft tissue in the expected region of the uterus likely represents the uterus or portion of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Post operative changes in the sigmoid colon.BONES, SOFT TISSUES: Post operative changes in the lower abdominal wall.OTHER: No significant abnormality noted.	1.Portal venous thrombosis.2.Status post partial colon resection without evident obstruction or definite evidence for metastatic disease.
Generate impression based on findings.	56-year-old male with right lung nodule LUNGS AND PLEURA: 5-mm nodule along the right major fissure may represent an intrapulmonary lymph node (image 37, series 5). Additional 3-mm right lower lobe micronodule is nonspecific.Mild apical predominant centrilobular emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal. Hiatal hernia. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral hypoattenuating renal lesions likely represent cysts.	5-mm nodule along the major fissure likely represents an intrapulmonary lymph node, however, if the patient is high risk a 6-12 month follow up may be considered for further evaluation.
Generate impression based on findings.	Male, 82 years old, history of supraglottic cancer. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Again seen is an enhancing soft tissue mass situated predominately in the supraglottic larynx. Since the prior examination, there has been a substantial reduction in size of this mass. For reference, the component which occupied the preepiglottic space measures 1.6 x 1.0 cm (image 39 series 5), previously 3.0 x 2.5 cm.Enhancing soft tissue thickening continues to infiltrate inferiorly at least to the level of the false vocal cords if not to the true vocal cords as well. Tumor is also again seen extending through the anterior margin of the thyroid cartilage. Irregularity and lucency through the thyroid cartilage at this location is unchanged.Since the prior examination, there has been a substantial increase in the degree of treatment related infiltration of the fascial planes as well as supraglottic mucosal edema. Within this background, no definite evidence of new mass lesions is seen.A reference left level 5 lymph node measures 0.7 x 0.5 cm (image 36 series 5) previously 0.5 by 0.5 cm. A right paraesophageal lymph node measures 2.0 x 0.7 cm (image 60 series 5), previously 1.5 x 0.9 cm. Additionally, a left carotid space enhancing mass measures 2.7 x 2.3 cm (image 23 series 5), previously 3.5 x 3.4 cm.A tracheostomy is in place. Cervical vascular structures are unremarkable. With the exception of the left parotid space mass, the salivary glands are unremarkable. The thyroid is free of focal lesions. Emphysema is evident in the visualized upper lungs. No concerning osseous lesions are demonstrated.	1. The interval decrease in size of the patient's previously seen large supraglottic tumor. Tubulated edema and fascial plane infiltration has increased.2. An enhancing tumor within the left parotid space has decreased in size. Scattered additional reference lesions in the neck show slight changes in shape and no definite evidence of progression.3. No evidence of intracranial metastatic disease.
Generate impression based on findings.	Male; 20 years old. Reason: osteosarcoma, off therapy. assess for pulmonary metastases History: osteosarcoma LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy is evident on this noncontrast examination. Residual thymic tissue appears similar to prior study.CHEST WALL: No axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Within limits of this noncontrast exam, the visualized upper abdominal organs are normal.	No evidence of pulmonary metastases.
Generate impression based on findings.	Male; 12 years old. Reason: refractory Neuroblastoma post cycle 5 evaluation; assess for response to therapy CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary micronodules are unchanged. No new pulmonary nodules. No pleural effusion. MEDIASTINUM AND HILA: Right central venous catheter tip in the SVC. No hilar or mediastinal lymphadenopathy. Heart size is normal with no pericardial effusion. A small amount of air noted within the right atrium and main pulmonary trunk likely secondary to injection.CHEST WALL: Sclerotic lesions at T10, T11, and T12 are again noted with endplate changes, similar to prior. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology, size, and enhancement with no focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation. Normal CT appearance of the gallbladder.SPLEEN: Spleen is normal in size, morphology, and enhancement pattern. No focal splenic lesion.PANCREAS: Pancreas morphology and enhancement is normal.ADRENAL GLANDS: No focal right adrenal lesion. Postsurgical changes of a left adrenalectomy. Soft tissue posteromedial to the surgical clip in the left adrenal bed is unchanged in size, measuring 7 x 6 mm.KIDNEYS, URETERS: Corticomedullary differentiation is normal. No pelvicaliceal dilatation.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Sclerotic lesions at T10, T11, and T12 are again noted with endplate changes, similar to prior. OTHER: No significant abnormality noted,PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is contracted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Multiple sclerotic lesions involving L5, sacrum, and iliac and bone marrow biopsy sites, similar to piror. OTHER: Trace amount of pelvic free fluid, similar to prior study.	Unchanged pulmonary micronodules and diffuse osseous lesions.
Generate impression based on findings.	63-year-old male with history of head and neck cancer, evaluate for metastatic disease. Pain in hips. CHEST:LUNGS AND PLEURA: Mild to moderate centrilobular and paraseptal emphysema.Scattered pulmonary micronodules measuring up to 2 mm. Left lower lobe consolidation. Bibasilar mucus plugging. MEDIASTINUM AND HILA: Mildly enlarged mediastinal and hilar lymph nodes. For reference, paratracheal lymph node measures 1.3 x 1.1 cm (image 44, series 4). Right hilar lymph node measures 1.1 x 1.0 cm (image 57, series 4). There is atherosclerotic calcification of the coronary arteries.CHEST WALL: Left chest port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenic granulomas.PANCREAS: Changes status post partial pancreatectomy. The remaining pancreas contains calcifications compatible with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: Gastrostomy tube noted in place.BONES, SOFT TISSUES: Degenerative disease in the spine. Compression deformity of L1-L3 vertebral bodies.OTHER: No significant abnormality notedPELVIS: Metallic streak artifact limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right hip total arthroplasty. Left hip pinning.OTHER: No significant abnormality noted	1.Left lower lobe consolidation, highly suggestive of infection.2.Mildly enlarged mediastinal and hilar lymph nodes.3. Scattered pulmonary micronodules measuring up to 2 mm. Guidelines by the Fleischner society (Radiology 2005: 237:395-400) suggest that patients with a low risk for lung cancer who have nodules less than or equal to 4 mm in diameter require no follow-up. In patients with a higher risk, such as smokers, follow-up is recommended in one year. Patients with a known malignancy are at increased risk for metastasis and should receive three month follow-up.
Generate impression based on findings.	75 year-old female with lung cancer, evaluate for brain metastasis. The ventricles, sulci, and cisterns are symmetric and appropriate for the patient's age. 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 a punctate hyperdensity at the anteromedial left globe, clinical correlation is advised.	No mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. Lack of contrast limits sensitivity of detection of metastasis. Contrast enhanced MRI should be considered if clinical suspicion for metastasis persists.
Generate impression based on findings.	62-year-old male with chronic infection, evaluate emphysema, bronchiectasis LUNGS AND PLEURA: Ill-defined basilar tree in bud and ground glass opacities with bronchiolar wall thickening appear inflammatory/infectious, possibly from prior aspiration. Platelike scarring at the left lung base. No significant emphysema.MEDIASTINUM AND HILA: Multiple prominent subcentimeter mediastinal lymph nodes. Severe atherosclerotic calcification of the coronary arteries. Status post CABG.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	No significant emphysema. Basilar bronchiolitis pattern with platelike scarring at the left base appears post inflammatory/infectious, possibly secondary to aspiration.
Generate impression based on findings.	Male 67 years old; Reason: Pre-kidney transplant evaluation, evaluate vasculature to support transplant History: Pre-kidney transplant evaluation ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesions. Cholelithiasis within a nondistended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Lobular appearance of the kidneys bilaterally. At the lower pole of the right kidney there is a focal hyperdense lesion which is incompletely characterized without contrast. There are other hypodense foci which may represent cysts but are incompletely characterized.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aorta. No aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild to moderate calcific arteriosclerotic disease of the common iliac, mild arteriosclerotic disease of the external iliac arteries.	1.Mild to moderate calcific arteriosclerotic disease of the aorta and branch vessels.2.Lobular appearance of the kidneys with focal hyperdense right renal lesion, incompletely characterized without contrast.3.Cholelithiasis.
Generate impression based on findings.	57-year-old male status post VARDS for pancreatic necrosis, duodenojejunostomy with drains, now with fever and elevated white blood cell count, assess for abscess. Fever. ABDOMEN:LUNG BASES: New small bilateral pleural effusions and bibasilar atelectasis.LIVER, BILIARY TRACT: Metallic common bile duct. Biliary stent is unchanged in position extending into the duodenum. Pneumobilia and air within the gallbladder is again noted.SPLEEN: No significant abnormality notedPANCREAS: Persistent extensive inflammation about the pancreas, with increased edema about the pancreatic head.Interval decrease in size of loculated peripancreatic fluid collection which now measures 2.7 x 1.0 cm (image 61, series 3) previously 3.0 x 1.5 cm.Heterogeneous attenuating collection superior to the drain, abutting the inferior surface of liver is decreased significantly in size and now measures 4.3 x 3.0 cm (image 54, series 3) previously 8.5 x 5.0 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst is again noted. Prominent right renal pelvis appears similar to prior exam. Persistent right perirenal space collections, slightly decreased in size. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes status post duodenojejunostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter is noted in place, containing small foci of air, likely due to catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased ascites.	1.Persistent peripancreatic inflammation, with increased edema about the pancreatic head. Interval decrease in size of peripancreatic fluid collections, however secondary infection cannot be excluded in loculated collections. 2.Persistent but slight interval decrease in right perinephric fluid collections.3.New small bilateral pleural effusions.
Generate impression based on findings.	Diabetes; pre-pancreas transplant evaluation. Evaluate vasculature to support transplant ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal atrophy. 6.6 x 7.6-cm intermediate attenuation cystic focus arising from the lower pole right kidney best seen on image 59 of series 4.RETROPERITONEUM, LYMPH NODES: Mild to moderate aortic calcificationBOWEL, 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: Unremarkable left iliac fossa renal transplant. Mild bilateral common iliac arterial calcification. Minimal right external iliac artery calcification.	Minimal right external iliac artery calcification. Mild bilateral common iliac arterial calcification.Intrinsic intermediate attenuation cystic lesion arising from the right kidney. While a benign complex cyst is favored, this lesion is best considered indeterminate on this noncontrast study. Would recommend correlation with ultrasound. If ultrasound is not diagnostic of a benign etiology, would recommend correlation with dedicated renal CT study.
Generate impression based on findings.	41-year-old female with history of recurrent stage IA ovarian cancer with pelvic bony mets, right acetabular pathologic fracture. Assess for disease progression. CHEST:LUNGS AND PLEURA: Marked interval increase in size and number of innumerable metastatic lung nodules. A reference left lower lobe nodule measures 1.0 x 0.9 cm (image 48, series #5).MEDIASTINUM AND HILA: A reference precarinal lymph node measures 3.0 x 2.5 cm (image 36, series #4).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: New innumerable bilateral renal hypodensities are consistent with metastatic disease.RETROPERITONEUM, LYMPH NODES: Numerous surgical clips possibly from lymph node dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large right-sided pelvic mass involves the right acetabulum, right ischium, right pubic bones, and surrounding soft tissue, with marked interval growth. New right low pelvic pararectal mass (image 214, series #4).Numerous surgical clips in the left hemipelvis.OTHER: No significant abnormality noted.	Dramatic interval progression of metastatic disease, including marked interval increase in pulmonary metastases, numerous new bilateral renal metastases, and growth of right pelvic mass involving the adjacent bones.
Generate impression based on findings.	Female, 76 years old, history of left tongue cancer status post surgery. Evaluate for recurrence. A large part of the oral tongue is obscured by dental amalgam streak artifact. Given this limitation, there appears to be some volume loss and contour irregularity of the left aspect of the oral tongue which may reflect prior surgery, but no definite mass lesion.There is mild deformity of the floor of mouth but without evidence of focal mass or pathologic enhancement. Scarring is evident within both submandibular spaces and the submandibular glands are not clearly visualized suggesting prior bilateral neck dissection.In the background of these changes, no definite focal masses or pathologic lymph nodes are detected. The parotid glands are fatty replaced but free of concerning lesions. The thyroid is small but free of concerning lesions. The cervical vessels are significant for extensive bilateral calcification of the carotid vasculature. No worrisome osseous lesions are demonstrated.	Postsurgical changes are suspected within the oral tongue and floor of mouth and bilateral neck. Without the benefit of a prior exam for comparison, no definite evidence of recurrent tumor or pathologic adenopathy is seen.
Generate impression based on findings.	Female 64 years old; Reason: reassess for metastatic disease History: none CHEST:LUNGS AND PLEURA: Left upper pulmonary nodule measures 1.2 x 0.9 cm (image 46/series 5) , changed. Subcentimeter pulmonary nodule at the superior segment of the left lower lobe is unchanged.No new pulmonary nodules are evident.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion no mediastinal lymphadenopathy. Large hiatal hernia with an intrathoracic stomach.CHEST WALL: Chest wall port terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Cystic lesions in segments 5 and 6 are unchanged. Probable small cysts in segment two.Hepatic and portal veins are patent.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: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal hernia containing loops of small bowel without obstruction. Portion of the transverse colon is contained within this wide mouth hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fracture of L1 and L2 vertebral bodies.OTHER: No significant abnormality noted.	1.No evident change in the left upper lobe pulmonary nodule.
Generate impression based on findings.	43 year-old female with chest pain, a lung nodule follow-up. LUNGS AND PLEURA: Peripheral right middle partially solid nodule measures 7 x 6 mm (image 149, series 5) and previously measured 7 x 5 mm. No additional pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	No significant change in right middle lobe partially solid nodule. 1-2 year follow-up is recommended, low-dose protocol.
Generate impression based on findings.	28 year-old female with HIV/AIDS, disseminated MAC, now with fever. CHEST:LUNGS AND PLEURA: Multiple bilateral ill-defined nodules in as well as focal ill-defined bilateral opacities favoring the lower lobes are not seen on prior chest exam from 12/3/2013, and likely represent new infected foci.Bullous cavitation at the left apex is unchanged without evidence of infection.MEDIASTINUM AND HILA: Right sided central venous catheter terminates in the IVC. Normal heart size. CHEST WALL: Diffuse severe anasarca.ABDOMEN:LIVER, BILIARY TRACT: Multiple diffuse liver hypodensities are stable in number, though appear slightly decreased in size. The gallbladder wall is mildly thickened, likely due to volume overload state/anasarca.SPLEEN: Multiple diffuse splenic hypodensities are stable in number, though appear slightly decreased in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Diffuse confluent retroperitoneal and mesenteric adenopathy is grossly unchanged. Multiple scattered low attenuation nodes are consistent with known MAI.BOWEL, MESENTERY: Small bowel wall thickening and seen on the prior exam is not confidently identified on this exam, though poor opacification of the bowel with enteric contrast significantly limits evaluation of bowel pathology.BONES, SOFT TISSUES: Diffuse severe anasarca. Round, lytic lesions of T9, L2, and L5 are redemonstrated and unchanged from 11/8/2013, not seen on exams prior to this date. A round, lytic lesion of T7 is noted and was not imaged on the prior exam and not seen on the previous chest exam.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: Diffuse severe anasarca. Lytic lesion of the left issue tuberosity demonstrates interval growth, now interrupting the cortex with early pathological fracture.OTHER: No significant abnormality noted.	1.New multiple bilateral ill-defined nodules and focal ill-defined opacities favoring the lower lobes likely represent new infected foci and may explain the patient's fever.2.Stable retroperitoneal and mesenteric confluent adenopathy.3.Growth of lytic bony lesion of the left ischial tuberosity with early pathological fracture. Stable bony lesions of several vertebrae.4.Diffuse severe anasarca.5.Right-sided central venous catheter terminates in the IVC.
Generate impression based on findings.	76-year-old female with tongue cancer, rule out lung METs LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules. No pleural effusions.MEDIASTINUM AND HILA: Enlargement of the main pulmonary artery suggesting pulmonary hypertension. Moderate atherosclerotic calcifications of the aortic arch and coronary arteries. No mediastinal or hilar lymphadenopathy.CHEST WALL: Scattered calcifications within each breast.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Unchanged hepatic cysts, one with peripheral calcification that is only partially visualized.	No evidence of metastatic disease. Probable PA hypertension.
Generate impression based on findings.	Left T3N0Mx Laryngeal SCC s/p CRT completed 1/2013 with new lesion in pyriform sinus concerning for recurrence vs soft tissue necrosis. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is a chronic left basal ganglia lacunar infarct. There is moderate diffuse cerebral white matter hypoattenuation that likely represents microangiopathy. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The imaged paranasal sinuses are clear, although there is opacification of the right conchae bullosa. There is mild opacification of the bilateral mastoid air cells. The skull and extracranial soft tissues are unremarkable, including bilateral lens implants. Neck: There is irregular thickening of the left piriform sinus mucosa and left false and true vocal cords with an air-filled internal laryngocele that measures 9 mm in diameter. There is no subglottic extension. There is diffuse supraglottic edema, particularly involving the right aryepiglottic fold with effacement of the right piriform sinus. There is mild hypopharyngeal airway narrowing. There is asymmetric prominent fatty marrow within the right laryngeal cartilages. The laryngeal cartilages otherwise appear grossly intact. There is no significant cervical lymphadenopathy. The submandibular glands are strophic and hyperemic. The thyroid gland is unremarkable. There is mild to moderate atherosclerotic plaque involving the bilateral carotid bifurcations. There is mild multilevel degenerative spondylosis, but no lytic or blastic lesions are apparent. There is extensive pulmonary emphysema. Refer to the separate chest CT report for additional details.	1. Ill-defined left hypopharyngeal lesion is compatible with squamous cell carcinoma recurrence, as demonstrated on laryngoscopy.2. No evidence of intracranial metastases.
Generate impression based on findings.	69-year-old male with history of tongue cancer, reevaluate and compare to prior exams CHEST:LUNGS AND PLEURA: Unchanged 5-mm left lower lobe pulmonary nodule (image 91, series 4). Upper lobe predominant emphysema and bronchial wall thickening is again noted.MEDIASTINUM AND HILA: Right hilar lymphadenopathy is again noted with reference lymph node measuring 15 mm and previously measuring 18 mm (image 47, series 3). Moderate atherosclerotic calcifications of the coronary arteries. Atherosclerotic calcifications of the aortic arch. Patulous esophagus.CHEST WALL: Degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged hypodense hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged left adrenal mass measuring 3.8 x 2.3 cm and previously measuring 2.8 x 2.4 cm (image 97, series 3).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.	Right hilar lymphadenopathy, mildly decreased in size. No new lesions, and no specific evidence of metastatic disease.
Generate impression based on findings.	Right posterior neck mass. There is a well-defined fat-attenuation mass without significant soft tissue components in the right posterior neck subcutaneous tissues overlying the trapezius and posterior the sternocleidomastoid that measures 51 AP x 35 RL x 31 SI mm. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The airways are patent. There is left tympanomastoid opacification. There appears to be mild anterior subluxation of the bilateral mandibular condyles, which may indicated temporomandibular joint instability. The imaged portions of the intracranial structures are grossly unremarkable.	1. A well defined fat-attenuation mass in the right posterior neck subcutaneous tissues that measures up to 51 mm is compatible with a lipoma.2. Left tympanomastoid opacification may indicate otomastoiditis in the appropriate clinical setting.
Generate impression based on findings.	76-year-old female patient. Reason: super D protocol, lung nodules. compare to previous History: lung nodules, COPD LUNGS AND PLEURA: Moderate centrilobular emphysema.5-mm left lower lobe nodule is unchanged (series 6 image 59).Previously visualized subpleural nodule adjacent to the thoracic spine in the right lower lobe is no longer visualized.Stable scarlike opacity in the right apex with calcifications. Interval decrease in anterior right mid lung scarring with mild residual bronchiectasis.Scattered micronodules, some of which are calcified. No new suspicious appearing pulmonary nodules or masses.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Stable anterior pericardial thickening. Mild coronary artery calcifications. Mild atherosclerotic changes of the thoracic aorta.Stable scattered small mediastinal lymph nodes.CHEST WALL: Superior endplate depression of the T7 vertebral body, stable. Mild multilevel degenerative changes of the thoracic spine.No significant axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mild atherosclerotic changes of the abdominal aorta.Mildly thickened left adrenal gland.	Stable left lower lobe pulmonary nodule and nonspecific micronodules. Resolution of right lower lobe nodule.
Generate impression based on findings.	Shortness of breath. Persistent dyspnea and inability to perform PFTs rule-out lung parenchymal disease. LUNGS AND PLEURA: Bilateral, symmetric subpleural scarring and mild traction bronchiectasis in the upper lung zones is unchanged. The appearance is suggestive of chronic eosinophilic pneumonia or cryptogenic organizing pneumonia.No pleural fluid or pneumothorax. Linear scarring at the lung bases. No signs honeycombing. Scattered 1 to 2-mm calcified and noncalcified micronodules are unchanged, some of which are centrilobular while others are subpleural in location. No suspicious pulmonary nodules or masses.Large lung volumes, but no visible emphysema.MEDIASTINUM AND HILA: Small right paratracheal diverticulum. Normal heart size. Prosthetic aortic valve. Prosthetic mitral annulus. Anterior mediastinal surgical clips.CHEST WALL: Healed median sternotomy with wires in place. Complex cyst or nodule in the left supraclavicular region measures 10 x 14 mm, previously 9 x 14 mm, not significantly changed allowing for skin variability. AUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	Large lung volumes with bilateral subpleural scarring and bronchiectasis unchanged, most consistent with chronic eosinophilic pneumonia (CEP) . Cryptogenic organizing pneumonia may also be included in the differential diagnosis. The appearance is atypical for Churg-Strauss syndrome as no groundglass opacities are appreciated although centrilobular nodules and hyperinflation have been described in this disease, correlate for history of asthma and sinusitis. No acute appearing pulmonary abnormality.
Generate impression based on findings.	Aphasia. Rule out stroke. There is diffuse patchy hypoattenuation within the periventricular and subcortical white matter, including focal encephalomalacia along the left superior frontal gyrus and bilateral foci of hypoattenuation within the basal ganglia likely representing lacunar infarcts. Bilateral ventricles and sulci are slightly prominent. These findings have been stable since the most recent examination, having progressed over multiple previous examinations dating to 2008.There is no acute intracranial hemorrhage, edema, hydrocephalus or mass. The midline is intact. Orbits, paranasal sinuses and mastoids are unremarkable.	1.No acute intracranial hemorrhage mass effect or edema since the most recent examination of 12/4/2013. 2.There is redemonstration of multiple lesions in the deep gray nuclei and internal capsules compatible with lacunar infarcts which were present on prior exams3.There is redemonstration of encephalomalacia involving the left frontal lobe.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.
Generate impression based on findings.	Lung cancer, reevaluate CHEST:LUNGS AND PLEURA: Interval surgical removal of the left upper lobe with partial reexpansion of the lower lobe and retention of an anterior pneumothorax, possibly loculated. No discrete effusion.The humerus underlying and largely ground glass semisolid nodular densities appear grossly unchanged 29/13/13. Reference measurements are as follows:1. right apical lesion which has a centrally solid component and surrounding common glass remains 2.7 cm a right (image 21 series 4).2. the two peripheral mixed groundglass and cystic lesions in the posterior aspect of the right upper lobe are also unchanged in size and density when measured similarly (image 30 series 4). The lateral lesion remains 2.3 cm and the more medial 1.3 cm 3. The peripheral right middle lobe lesion (image 40 series 4) remained 11 mm, unchangedThe left apical scar like lesion remains unchanged although difficult to compare given the postsurgical alteration (image 23 series 4). The remaining lesions are otherwise observed and stable in appearance other than mild basilar streaky densities in the left lung base representing suspected atelectasisMEDIASTINUM AND HILA: No lymphadenopathy.Coronary artery calcifications without additional pericardial or cardiac abnormalityModerate hiatal herniaCHEST WALL: Postsurgical rib changes without additional osseous new abnormality. Scoliosis and scattered moderate degenerative changesABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted. CholelithiasisSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive descending aortic calcifications and branchesBOWEL, 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.	Postsurgical left hemithorax changes in residual moderate pneumothorax. Scattered residual numerous additional bilateral groundglass nodular opacities appear unchanged from 9/13/13
Generate impression based on findings.	Chronic sinusitis and nasal polyps, s/p ESS in April 2013, with recurrent symptoms. There is near complete opacification of the bilateral maxillary sinuses. There is also near complete opacification of the bilateral anterior and left posterior ethmoid sinuses. There is complete opacification of the bilateral frontal sinuses and frontoethmoid junctions. There is mild mucosal thickening within the right posterior ethmoid sinuses and right sphenoid sinus, where there are also bubbly secretions. There is a pneumatized right anterior clinoid process. There is thinning and perhaps dehiscence of the left cribriform plate. The carotid grooves are covered by bone. There is scattered polypoid opacification of the nasal cavity. There is a right conchae bullosa. There is mild mild nasal septal deviation to the left. The imaged dentition appears unremarkable. The mastoid air cells are clear. The orbits are unremarkable. The partially imaged intracranial structures are grossly unremarkable.	1. Extensive pansinus opacification in an osteomeatal unit pattern on the right and combined osteomeatal unit and sphenoethmoid junction pattern on the left.2. Scattered polypoid opacification of the nasal cavity, suggestive of sinonasal polyposis. 3. Thinning and perhaps dehiscence of the left ethmoid roof. Therefore, an underlying encephalocele cannot be excluded and a sinus MRI may be useful to exclude this possibility.
Generate impression based on findings.	75-year-old male patient. Reason: eval parenchyma and effusion History: hypoxia Exam significantly limited by patient motion.LUNGS AND PLEURA: Large right-sided pleural effusion with complete atelectasis of the right lower lobe. Small focus of fibrosis/honeycombing in the anterior right middle lobe may be secondary to radiation changes. Right upper lung with scattered ground glass opacities.Large left pleural effusion with compressive atelectasis of the left lower lobe. Left upper lobe with central groundglass opacities and dependent atelectasisMEDIASTINUM AND HILA: Moderate cardiomegaly without pericardial effusion. Hypoattenuating blood pool consistent with anemia. Moderate atherosclerotic changes of the thoracic aorta. Main pulmonary artery appears mildly enlarged, consistent with pulmonary artery hypertension.CHEST WALL: Multilevel degenerative changes of the thoracic spine. Mild dextroscoliosis. No significant axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate amount of abdominal ascites. Moderate atherosclerotic changes of the abdominal aorta.Cirrhotic appearing liver with nonspecific hypoattenuating foci within the liver parenchyma are too small to characterize and likely represent cysts. Gallbladder filled with sludge/gallstones. There is a small amount of pericholecystic fluid, which is likely secondary to hypervolemia/hypoalbuminemia.Enlarged spleen.	Large bilateral pleural effusions, right greater than left, with compressive atelectasis.Left upper lobe ground glass opacities suggestive of acute pulmonary edema or less likely infection.Cardiomegaly and signs of pulmonary hypertension.
Generate impression based on findings.	61-year-old female with history of head and neck cancer LUNGS AND PLEURA: Severe centrilobular emphysema. Mild diffuse bronchial wall thickening. Multiple scattered micronodules, some of which are calcified consistent with prior granulomatous disease.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease. Central venous catheter tip extends to the SVC. Status post neck dissection. Coronary arterial calcifications. Low right paratracheal lymph node measures 9 mm and previously measured 9 mm (image 41, series 3).CHEST WALL: Left chest wall port. Degenerative changes of the thoracolumbar spine. Unchanged right lateral T8 sclerotic rib lesion.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating splenic lesion, not significantly changed.	1. No specific evidence of metastatic disease.2. Severe centrilobular emphysema.
Generate impression based on findings.	85-year-old male with abdominal and suprapubic pain, likely urosepsis and a suprapubic catheter in place. Acute kidney failure. Hydronephrosis on ultrasound. Rule out stone and emphysematous cystitis. ABDOMEN: Lack of intravenous contrast limits evaluation of abdominal organs.LUNG BASES: Small bilateral pleural effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreatic calcifications, atrophy and ductal dilatation, compatible with chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate to severe right hydronephrosis. Moderate left hydronephrosis. No renal or ureteral calcifications are seen. RETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes are noted. Left periaortic lymph node measures 1.5 x 1.2 cm (image 58 axial series).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Suprapubic catheter in place, with bladder containing multiple foci of air likely due to catheter manipulation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right inguinal hernia containing small foci of air likely due to nonobstructed loop of bowel.OTHER: Body wall anasarca.	1.Moderate to severe bilateral hydronephrosis. No renal or ureteral calcifications.2.Nonspecific mildly enlarged retroperitoneal lymph nodes.3.Right inguinal hernia containing small foci of air likely due to nonobstructive loop of bowel.
Generate impression based on findings.	Lung cancer CHEST:LUNGS AND PLEURA: Lenticular fluid collection with a thick irregular wall decreased in volume. Previously measured portion of the collection did not include the wall measuring 5.3 x 3 .6 cm. Using a similar measurement technique, the lesion now measures 5 x 3.8 cm (3/16). Adjacent consolidated lung with internal traction bronchiectasis and collapse of the upper lobe unchanged. Innumerable irregularly marginated nodules with adjacent ground glass opacity are present in the left lower lobe with some associated septal thickening. Most appear to be airspace in distribution, however there are a few peribronchial distribution nodules present as well.Consolidation in the posteromedial aspect of the right lower lobe superior segment again noted. There is a single 7-mm irregularly marginated nodule which falls outside of the border of this abnormality and could be post therapeutic or metastatic. The proximal right lower lobe bronchus is narrowed. Additional sub-5 mm nodule anterior to the left lower lobe bronchus (5/55).MEDIASTINUM AND HILA: Right hilar lymph node measures 15 mm, previously 17-mm when remeasured in a manner similar to earlier studies. Small subcarinal and right anterior interlobar lymph nodes probably unchanged allowing for differences in scan variability.Normal heart size. Small pericardial fluid collection loculated anteriorly, minimally increased in volume. Enlarged right cardiophrenic lymph node not significantly changed. A single enlarged right internal mammary chain lymph node in the lower chest wall (3/65) is unchanged compared to priors. Left brachiocephalic vein compressed between the left clavicular head and the right innominate; the proximal right common carotid artery is narrowed at its origin.CHEST WALL: Reference right axillary lymph node 10 x 13 mm, previously 9 x 12 mm. Replacement of intercostal fat by soft tissue surrounding the right first rib unchanged. Numerous small axillary lymph nodes elsewhere are unchanged. Sclerosis involving the right first and second ribs. Lytic lesions in the anterior aspect of the right first rib unchanged. Periosteal reaction involving the medial aspects of the superior right ribs unchanged. Lytic lesions in T1, T4 and T8 and faintly sclerotic lesion in the in T3 unchanged. Superior endplate depression of T12 vertebral body. Some of the vertebral bodies have and posterior elements have a moth-eaten appearance which could be due to lytic metastases or myeloma. Chronic left rib deformities.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index lymph node measures 1.6 x 1.2-cm, previously 1.6 x 1.1 cm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: L3 mixed lytic and sclerotic appearance suggestive of vertebral body hemangioma with superimposed metastasis but can be correlated with PET scan or bone scan if clinically warranted..OTHER: No significant abnormality noted.	No significant change in lymphadenopathy or skeletal lesions allowing for differences in technique. Reference right upper lobe measurement unchanged. Interval development of multiple pulmonary nodules which may be infectious or metastatic. Suggest plain film follow-up in 4-6 weeks to assess for resolution. Right lower lobe nodule, nodule anterior to the left lower lobe bronchus and peribronchial nodules are atypical for infectious or inflammatory lesions based on distribution and may be metastatic.
Generate impression based on findings.	56 year old female, with history of liver transplant with nausea and vomiting. Evaluate for abdominal process. ABDOMEN: Lack of intravenous contrast limits evaluation of abdominal organs.LUNG BASES: Right basilar atelectasis/consolidation.LIVER, BILIARY TRACT: Surgical clips and changes status post liver transplant. No hematoma, biloma or perihepatic abscess is seen.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No obstruction.BONES, SOFT TISSUES: Degenerative changes noted in the spine.OTHER: Skin staples, and anterior abdominal incision and stranding due to recent surgery. No ascites.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes noted in the spine.OTHER: No ascites or loculated fluid collections.	Expected postoperative changes without acute abnormality.
Generate impression based on findings.	Reason: 81 year old male with supraglottic cancer, please compare to previous scan 05/02/2013 History: Supraglottic Cancer LUNGS AND PLEURA: Reference left upper lobe nodule is stable and measures 8 mm (series 6 image 44).No significant change in predominantly peripheral lower zone micronodules, likely postinflammatory.Stable apical paraseptal and centrilobular emphysema.10-mm cavitary nodule in the right middle lobe, previously 8mm and solid on the earlier exam of 5/2/13.MEDIASTINUM AND HILA: Cardiac size within normal limits without pericardial effusion. Mild coronary artery calcifications. Minimal atherosclerotic changes of the thoracic aorta.Right-sided chest port with catheter tip at the cavoatrial junction. Tracheostomy stable in position.Moderately enlarged mediastinal lymph nodes are stable to slightly increased in size compared to prior examination. Mild interval enlargement of left aortopulmonary region lymph node, measuring 13 mm (series 4 image 44), previously 11 mm.Stable right hilar lymph node measures 11 mm (series 4 image 46). Other mildly enlarged hilar region lymph nodes are unchanged.CHEST WALL: Moderate multilevel degenerative changes in the thoracic spine with demineralization.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating lesion in the right hepatic lobe is unchanged from prior examination and likely represents a cyst.Stable bilateral renal cysts.	Stable left upper lobe nodule.Stable to mild interval increase in mediastinal lymph nodes.10-mm cavitary nodule in the right middle lobe is compatible with metastatic squamous cell carcinoma.
Generate impression based on findings.	Other benign neoplasm of connective and other soft tissue of head, face, and neckMalignant neoplasm of head, face, and neckSecondary and unspecified malignant neoplasm of lymph nodes, site unspecified(196.9)Radiotherapy follow-up examination Chemotherapy follow-up examination. h/o HNC and CRT, compare to previous measurements CT neck:The patient is status post right neck surgery with evidence for right radical neck dissection. There is an infiltrative appearance present along the soft tissues of the right neck associated with surgical clips. Current infiltration surrounds the carotid sheath on the right side and extends to the right submandibular space and the right parotid space. This appearance has not progressed since the prior exam from July. Previously measured lymph nodes in the right submandibular space currently measure 14 x 5 mm axial dimensions and previously measured 8 x 17 mm axial dimensions. Another right submandibular space node currently measures 8 x 9 mm and is also stableWithin the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the patient is status post right thyroidectomy. The appearance of the thyroid bed remains stableThe airway appears patent.The left parotid and the left submandibular glands appear intact. There is infiltration extending to the right parotid gland and surrounding the right submandibular glandThe visualized lung apices demonstrate emphysema. Calcified nodule is present along the right upper lobeThe carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations. The right jugular vein has been removedThe cervical vertebral bodies in general are intact . There is a disk protrusion at C5-6 and there is suspicion for spinal stenosis. This was also present on the prior exam.	1.No evidence for neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy. 2.There is soft tissue infiltration along the right neck which is suspected to represent post treatment change.3.No evidence for brain metastases.
Generate impression based on findings.	Male, 64 years old, history of floor of mouth cancer, follow up examination. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. Periventricular hypodensity is again seen compatible with age indeterminate small vessel ischemic disease. The bones of the calvarium and skull base are intact. Extensive surgical changes are demonstrated in the neck including evidence of partial left mandibulectomy, myocutaneous flap reconstruction of the left neck, fatty flap reconstruction of the right neck, deformity of the floor of mouth, and bilateral neck dissections.Within this extremely altered background, no definite evidence of tumor recurrence is seen. The left neck flap has decreased in bulkiness probably indicating resolution of surgical edema.The mandibulectomy margins remain relatively sharp allowing for some motion artifact. The residual mandible is heterogeneously sclerotic which may indicate radionecrosis.No pathologic adenopathy is detected by size criteria. The parotid glands are unremarkable. The submandibular glands are not clearly present. The thyroid is unremarkable.The carotid vasculature remains patent. The right internal jugular vein does not opacify similar to prior. The right vertebral artery shows minimal if any opacification similar to prior. Extensive right upper lung abnormalities are seen. Please refer to the separately dictated dedicated chest CT for further details.Erosive change of the right first rib is redemonstrated similar to prior. Adjacent right supra-clavicular scarring/infiltration is also not significantly changed. No new or concerning osseous lesions are detected.	1. Redemonstration of extensive surgical change in the neck. Within this altered background, no definite evidence of recurrent disease or pathologic adenopathy is seen on this exam.2. No evidence of intracranial metastatic disease.
Generate impression based on findings.	Gross hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable bilobar hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst. Otherwise unremarkable kidneys bilaterally without worrisome mass, stone, or hydronephrosis. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enlarged heterogeneous uterus for age.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	No worrisome renal mass lesion, stone, or renal obstruction. Unremarkable collecting systems bilaterally.Heterogeneous enlarged uterus; favor fibroid; however, if clinically indicated, would recommend correlation with GYN ultrasound.
Generate impression based on findings.	Male 55 years old Reason: 55M s/p ileocecal resection with creation of end ileostomy on 11/15 (hx APR for rectal ca c/b prolapsing colostomy) now with purulent drainage around stoma, please assess for peristomal abscess History: leukocytosis, purulent drainage from stoma ABDOMEN:LUNG BASES: Limited evaluation of the lung bases demonstrates a calcified granuloma in the inferior right upper lobe. There is bibasilar dependent atelectasis.LIVER, BILIARY TRACT: The liver is of normal size and without evidence of intra or extra hepatic biliary ductal dilatation. The portal vein is patent. The gallbladder is collapsed.SPLEEN: Hypodensity about the inferior pole of the spleen compatible with splenule.PANCREAS: The pancreas is within normal limits.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys excrete contrast symmetrically and there is no evidence of hydronephrosis or ureteral dilatation.RETROPERITONEUM, LYMPH NODES: Multiple small scattered retroperitoneal lymph nodes are evident; however, none are pathologically enlarged by size criteria. The abdominal aorta is of normal caliber without evidence of aneurysmal dilatation.BOWEL, MESENTERY: A left lower quadrant ileostomy is again noted, thickening in the stomal bowel wall. No evidence of obstruction is evident. There is a loop of bowel within a small ventral hernia, also without evidence of obstruction. The patient is status post total colectomy. The remaining large bowel is of normal caliber.BONES, SOFT TISSUES: Two peristomal fluid collections are evident, not previously seen on the prior examination, the more superior measures 2.9 x 3.1 cm (series 3, image 68), and the more inferior measuring 2.2 x 2.7 cm (image 79, series 3). There is significant fat stranding about the stoma, suggestive of inflammation/phlegmon. This inflammation appears to involve the small bowel wall; however, there is no abnormal enhancement of the stomal bowel wall. These findings are compatible with peristomal abscess formation. Mild degenerative changes affect the thoracolumbar spine and minimal osteoarthritis affects the bilateral hips.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is nondistended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There are bilateral fat-containing inguinal hernias. See abdomen section for bowel findings.BONES, SOFT TISSUES: A presacral hypoattenuating fluid collection is again noted, now measuring 4.8 x 2.4 cm (image 120, series 3), which was previously composed of two distinct fluid collections, which have now amalgamated. This fluid collection is similar in overall size.OTHER: No significant abnormality noted	1.Two peristomal fluid collections with surrounding inflammation, compatible with peristomal abscesses, new since the previous examination2.Previously distinct presacral fluid collections have combined into a single fluid collection, similar in total overall size.
Generate impression based on findings.	Female 90 years old. Reason: abd pain, flank pain History: pain ABDOMEN:LUNG BASES: Limited evaluation of the lung bases reveals right basilar bronchiectasis. The posteroinferior aspect of the right lower lobe appears to be fed by a highly calcified aberrant vessel arising off an aneurysmally dilatated region of the thoracic aorta. There is associated subsegmental atelectasis without evidence of consolidation. Round soft tissue density in the most superior aspect of the visualized right lower lobe is most likely vascular in origin. Multiple pulmonary nodules are seen scattered throughout the bilateral lung bases. The thoracic aorta is aneurysmally dilated measuring 7.8 x 4.7 cm (image one, series 3), and extending below the diaphragm, where it takes on a more normal caliber, before becoming aneurysmally dilated again just proximal to the bifurcation of the common iliacs. There is no evidence of hematoma or leak. There are severe atherosclerotic calcifications of the thoracic aorta.There is cardiomegaly without evidence of pericardial effusion. An artificial mitral valve is in place. LIVER, BILIARY TRACT: The parenchyma the liver demonstrates abnormal hyperattenuation perhaps related to amiodarone administration. There is cholelithiasis without evidence of cholecystitis. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are hypoattenuating lesions in the parenchyma of both kidneys most compatible with simple renal cysts. Both kidneys appear slightly atrophic. There is no evidence of hydronephrosis or ureteral dilatation. There is atherosclerotic calcifications of the bilateral renal arteries.RETROPERITONEUM, LYMPH NODES: There is aneurysmal dilatation of the abdominal aorta just proximal to the level of the bifurcation measuring 4.5 x 4.4 cm (image 48, series 3). There is no evidence of retroperitoneal hematoma or leak. There is severe atherosclerotic calcification of the abdominal aorta and its branches. There is no significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel is of normal caliber without evidence of obstruction.BONES, SOFT TISSUES: Focal sclerosis in the superior aspect of the L2 vertebral body likely represents a benign enostosis. There are mild/moderate degenerative changes of the thoracolumbar spine and moderate osteoarthritis affects the bilateral hips.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are two calcified uterine masses, compatible with leiomyomatous uterus.BLADDER: The bladder is nondistended.LYMPH NODES: There is no pelvic lymphadenopathy evident.BOWEL, MESENTERY: See abdominal section.BONES, SOFT TISSUES: See abdominal section.OTHER: No significant abnormality noted	1.Aneurysmal dilatation of the thoracic and abdominal aorta without evidence of leak.2.Anomalous highly calcified vessel arising off the aneurysmally dilated descending thoracic aorta and coursing into the posterior-inferior aspect of the right lobe.3.Cardiomegaly.4.Multiple pulmonary nodules likely infectious/inflammatory in etiology; however, continued CT surveillance is recommended.5.Cholelithiasis without evidence of cholecystitis.6.Leiomyomatous uterus.
Generate impression based on findings.	Evaluate for PE PULMONARY ARTERIES: Segmental and subsegmental right descending pulmonary emboli, likely acute.LUNGS AND PLEURA: 1.3 x 1.1 cm nodule seen in the left lower lobe, unchanged in size when compared with the prior CT. This nodule measures up to 200 Hounsfield units compatible with calcification and may represent a granuloma. Dependent atelectasis is present, however no consolidation or pleural effusion is seen.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post right nephrectomy and right adrenalectomy. Accessory spleen is seen medial to the spleen. Posterior spinal fixation device of the lumbar spine is partially visualized.	1.Acute right descending pulmonary artery emboli.2.Calcified left lower lobe nodule unchanged when compared with the prior CT. Follow-up CT is recommended in one to two years to establish stability.
Generate impression based on findings.	10-year-old female with persistent left hand pain and swelling.EXAMINATION: Noncontrast CT of the left hand and wrist 12/6/13 Healed fracture of the base of the thumb metacarpal. No acute fracture or dislocation is identified. Soft tissues are unremarkable. The visualized tendons appear intact.	No acute fracture or dislocation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	Shortness of breath, evaluate for PE PULMONARY ARTERIES: No significant abnormality noted.LUNGS AND PLEURA: The right main stem bronchus is occluded with atelectasis of the right upper and middle lobes. This has progressed from the prior study where an underlying upper lobe mass is seen. This is compatible with the patient's known adenocarcinoma. A tracheal diverticulum is now present measuring up to 1.3 x 1.0 cm (image 31, series 11). Mild centrilobular emphysema predominantly affects the upper lobes.MEDIASTINUM AND HILA: Pneumomediastinum is present. Confluent right hilar and subcarinal lymphadenopathy appears similar to the prior study, however is difficult to measure. Small pericardial effusion is unchanged.CHEST WALL: Subcutaneous emphysema is seen, predominately in the right chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Colonic diverticulosis is partially visualized. Incidental note of a replaced left hepatic artery is present, a normal variant.	1.No pulmonary embolus.2.Occlusion of the right mainstem bronchus with atelectasis of the right upper and middle lobes, likely due to the patient's known underlying adenocarcinoma in the right upper lobe.3.Pneumomediastinum and subcutaneous emphysema in the chest wall.
Generate impression based on findings.	Male 44 years old Reason: 44 yo M with AML and recent dx colitis/diverticulitis at OSH, now with worsening abd discomfort. History: abd pain ABDOMEN:LUNG BASES: Limited evaluation of the lung fields reveal dependent bibasilar atelectasis.LIVER, BILIARY TRACT: No focal masses are seen in the hepatic parenchyma and there is no intrahepatic or extrahepatic biliary ductal dilatation. The portal vein is patent. Multiple low density foci are seen within the gallbladder lumen, compatible with gallstones. There is no evidence of cholecystitis or pneumobilia.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Low-density lesion in the inferior pole of the right kidney compatible with simple renal cyst.RETROPERITONEUM, LYMPH NODES: The abdominal aorta is of normal caliber without evidence of aneurysmal dilatation. There is no retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: There is sigmoid diverticulosis without evidence of diverticulitis. There is a short focal segment of sigmoid bowel wall thickening without evidence of surrounding inflammation or abnormal enhancement, which is likely postinflammatory in etiology. The large and small bowel is of normal caliber without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgical clips in the left inguinal canal likely related to prior vasectomy.BLADDER: The bladder is nondistended.LYMPH NODES: There are several slightly prominent pelvic lymph nodes, not pathologically enlarged by size criteria.BOWEL, MESENTERY: See abdominal sectionBONES, SOFT TISSUES: Mild degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted	1. Cholelithiasis without evidence of cholecystitis.2. Diverticulosis without evidence of active diverticulitis.3. Focal bowel wall thickening of the sigmoid colon without evidence of surrounding inflammation, likely postinflammatory in etiology.
Generate impression based on findings.	Tachycardic, needing oxygen, chest pain, evaluate for pulmonary embolus PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: No consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	No pulmonary embolus or other significant abnormality.
Generate impression based on findings.	80 year-old with syncope and collapse. There are a few hypodense foci within the ventricular and subcortical white matter consistent with minimal chronic small vessel ischemic disease, and correlating with the appearance of the recent MR exam. There is no acute intracranial pathology including hemorrhage, edema, mass, or hydrocephalus. The midline is intact. Visualized portions of the skull, paranasal sinuses and mastoid air cells are unremarkable.	Examination stable since recent MRI with minimal chronic small vessel ischemic changes. No acute intracranial pathology.
Generate impression based on findings.	24 year old patient with headache, nausea, vomiting and nystagmus. There is a right frontal burr hole with a ventriculostomy catheter extending into the right frontal horn with its tip at the midline in the third ventricle, unchanged. The ventricles again demonstrate a parallel configuration and the corpus callosum is thinned. There has been interval increase in size of the lateral and third ventricles since the prior examination -- the frontal horns are visualized bilaterally where they were previously slitlike. The fourth ventricle is stable.There is no acute intracranial hemorrhage, mass or edema. Stable findings include a focus of encephalomalacia within the right frontal lobe as well as dural calcification most prominent over the right hemisphere. Bones are stable. Mastoids are clear.	Slight interval increase in size of the lateral and third ventricles. Stable ventriculostomy catheter.
Generate impression based on findings.	Female 24 years old Reason: eval pathology History: abdominal pain, N/V, hemoptysis ABDOMEN:LUNG BASES: Motion artifact degrades evaluation of the lung bases.LIVER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation and the portal vein is patent. There is biliary sludge without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A punctate calcification in the right renal pelvis likely represents a non obstructing renal calculus. The kidneys secrete contrast symmetrically and there is no evidence of hydronephrosis or ureteral dilatation.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The large and small bowel are of normal caliber without evidence of obstruction.BONES, SOFT TISSUES: There is a small fat containing umbilical hernia.OTHER: There is a ventriculoperitoneal shunt catheter noted coursing through the anterior chest wall into the abdomen, with its tip seen just left of midline, without evidence of complication or fluid collection. PELVIS:UTERUS, ADNEXA: There is fluid within the uterine cavity, likely physiologic in nature. There is a small amount of free fluid in the pelvis, likely related to the shunt catheter.BLADDER: The bladder is nondistended.LYMPH NODES: There is no pelvic lymphadenopathy.BOWEL, MESENTERY: See abdominal sectionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.Biliary sludge without evidence of cholecystitis.2.Ventricular peritoneal shunt catheter without evidence of complication.
Generate impression based on findings.	Altered mental status. Rule out stroke. There is moderate ill-defined patchy hypoattenuation within the periventricular and subcortical white matter in keeping with sequela of age-indeterminate small vessel ischemic disease. Ventricles and sulci are prominent, though to a degree which is in keeping with the patient's age. There is no acute intracranial abnormality including hemorrhage, mass, edema or hydrocephalus. Visualized portions of the orbits and paranasal sinuses are unremarkable. Mastoids are clear.	Age-indeterminate small vessel ischemic disease without acute intracranial pathology. If there is persistent concern regarding acute ischemia, MRI could be considered.
Generate impression based on findings.	Male 21 years old Reason: eval for pancreatitis/ appy History: abdominal pain and vomiting ABDOMEN:LUNG BASES: Respiratory motion degrades evaluation of the lung bases. No focal airspace opacities identified.LIVER, BILIARY TRACT: A focal hypodense lesion in the right hepatic lobe is too small to characterize on this examination. There is no evidence of intrahepatic or extrahepatic biliary ductal dilatation and there is no evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys excrete contrast symmetrically and there is no evidence of hydronephrosis or ureteral dilatation.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes are evident.BOWEL, MESENTERY: Poor distribution of the oral contrast limits evaluation of the small and large bowel; however, given this limitation, the large and small bowel are of normal caliber without evidence of obstruction. A tubular structure arising off the cecum is indistinct, but may represent the appendix, but the lack of oral contrast in the distal bowel severely limits the sensitivity/specificity. There is free fluid within the pelvis. These findings are concerning for possible appendicitis given the clinical history. There is no enhancement of the peritoneum to suggest peritonitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Free fluid in the pelvisPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is nondistendedLYMPH NODES: No significant lymphadenopathy is evidentBOWEL, MESENTERY: Lack of oral contrast distribution limits the sensitivity of this examination. See abdominal section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is dependent and nondependent fluid within the pelvis.	The appendix is not definitely identified, but given the pelvic ascites and clinical history, appendicitis is a significant possibility. Gastroenteritis is another possibility; however, this is felt to be less likely.These findings were discussed with the primary clinical service at the time of dictation.
Generate impression based on findings.	Headache. There is mild diffuse volume loss. There is no intracranial hemorrhage, mass, edema or hydrocephalus. The midline is intact. Orbits, paranasal sinuses and mastoid air cells are unremarkable. There are no visualized bony abnormalities.	No acute intracranial pathology demonstrated.
Generate impression based on findings.	History of Barrett and circumflex restaging scans status post oral and schedule agent CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules compatible with metastases are again seen. The previously referenced left lower lobe nodule now measures 18 x 14 mm (image 63, series 5), previously 19 x 14 mm. The previously referenced right lower lobe nodule now measures 11 x 8 mm (image 68, series 5), previously 10 x 9 mm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in size and there is no pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hyperattenuating focus along the posterior wall of the gallbladder likely represents a gallstone. No evidence of cholecystitis. Hypodense focus in the liver dome is too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodularity of the left adrenal gland is unchanged when compared with the prior study.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged. The previously referenced periportal lymph node again measures 11 mm in short axis (image 104, series 3).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.	1.Innumerable pulmonary metastases without significant change from prior study.2.No change in the index periportal lymph node.
Generate impression based on findings.	Fall. Rule out intracranial hemorrhage. There is a better defined focus of encephalomalacia within the left lentiform nucleus corresponding with a focal infarct demonstrated on prior CTs. There is subtle ex vacuo dilatation of the adjacent left lateral ventricle. There is dural calcification and a benign hyperostosis frontalis. There is no acute intracranial pathology including mass, edema, hemorrhage or hydrocephalus. The midline is intact. The portions of the orbits, paranasal sinuses and mastoid air cells are unremarkable.	Focus of encephalomalacia related to evolution of a prior infarct in the left basal ganglia, without acute intracranial pathology.
Generate impression based on findings.	Female 45 years old Reason: patient w/ recent diagnosis of diverticulitis, continued pain. r/o abscess History: LLQ pain ABDOMEN:LUNG BASES: There is mild dependent bibasilar atelectasis right greater than left.LIVER, BILIARY TRACT: There is no intrahepatic or extrahepatic biliary ductal dilatation. The portal vein is patent. There are peripherally calcified gallstones without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys secrete contrast symmetrically and there is no evidence of hydronephrosis or ureteral dilatation. Punctate calcification in the left renal collecting system are compatible with a non-obstructing renal calculus.RETROPERITONEUM, LYMPH NODES: There are multiple slightly prominent retroperitoneal lymph nodes, not pathologically enlarged by size criteria.BOWEL, MESENTERY: There has been interval improvement in the inflammatory changes affecting the sigmoid colon compared to the prior examination, compatible with resolving diverticulitis. Again noted is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is a small amount of fluid within the uterine cavity, likely physiologic in etiology. There is a 2.2 x 2.8 cm (series 8020, image 57) low-density lesion in the left ovary compatible with an ovarian cyst, incompletely characterized on this examination.BLADDER: The bladder is nondistended.LYMPH NODES: There is no pelvic lymphadenopathy.BOWEL, MESENTERY: See abdominal sectionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.Resolving inflammatory changes about the sigmoid colon compatible with resolving diverticulitis, without evidence of complication such as abscess or fistulous formation.2.Left ovarian cyst incompletely characterized on this examination.
Generate impression based on findings.	Male 62 years old; Reason: Stage IV pancreas cancer please provide index lesion measurements for pancreas and up to lesions for liver for RECIST enrolled on study that requires distant measurable disease History: As above CHEST:LUNGS AND PLEURA: New subtle nodularity of the pleural surface and interlobular septal thickening highly suspicious for lymphangitic tumor.New trace bilateral pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Hyperenhancing small mediastinal lymph nodes with a right paratracheal lymph node measuring 1.0 x 0.9 cm (image 32/series 3). CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: There are at least 4 hypodense hepatic metastases. The previously sampled right hepatic lobe lesion measures 2.7 x 2.7 cm (image 113/series 3), previously, 2.3 x 2.3SPLEEN: No significant abnormality notedPANCREAS: Hypodense pancreatic tail mass measures 5.4 x 2.5 cm on image 108/series 3 previously, 5.1 x 2.1 cm. The splenic vein is thrombosed. Extensive perigastric varices.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes. Left para-aortic node measures 1.6 x 1.4 cm (image 120/series 4) previously, 1.4 x 1.0 cm.BOWEL, MESENTERY: New nodularity of the mesentery with trace upper abdominal ascites highly suspicious for peritoneal carcinomatosisBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: New peritoneal nodularity and hyperenhancement of the peritoneum most suggestive of peritoneal carcinomatosisBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.Increase in the size of the hepatic lesion.2.New pleural nodularity, peritoneal nodularity and retroperitoneal lymphadenopathy. The findings are most suggestive of lymphangitic carcinomatosis in the lung and peritoneal carcinomatosis.

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