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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.	Female 90 years old; Reason: obstruction History: leaking stool, protuberant abd, decreased bowel sounds ABDOMEN:LUNGS BASES: Calcified right lower lobe pulmonary granuloma.LIVER, BILIARY TRACT: Cholelithiasis with hyperdense material within the gallbladder and perihepatic ascites.SPLEEN: Splenic calcifications with hypodense sub-capsular areas possibly due to prior infarctions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Adrenal glands are nodular.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large midline nearly fluid attenuating mass that occupies most of the abdomen. It measures at least 25 x 16 x 31 cm.PELVIS:UTERUS, ADNEXA: The abdominal mass possibly originates from the adnexa or uterusBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As aboveOTHER: Ascites	1.Large midline hypodense mass. Measuring over 31 cm in span. The lesion may originate from the adnexa, uterus or peritoneum. The study is limited without contrast. Further evaluation with a contrast enhanced MRI of the abdomen pelvis is suggested.2.Cholelithiasis.3.Abdominal and pelvic small amount of ascites.
Generate impression based on findings.	Female 64 years old; Reason: Persistent sepsis with Staph bacteremia and C.Diff infection. Also has signs of pneumonia on CXR. Eval for source, abscess, etc. History: Hypotension requiring pressors CHEST:LUNGS AND PLEURA: There are biapical cavitary lesions. Right apical posterior cavitary lesion measures4.3 x 5.5 cm (image 32/series 4).Smaller left apical cavitary lesionThere is a ground-glass nodule in the right middle lobe and a few other scattered right lower lobe pulmonary nodules.No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Calcified hilar lymph nodes.Left neck catheter terminates at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis in either kidney. Probable left renal cysts. The right kidney is slightly malrotated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectal tube.BONES, SOFT TISSUES: Left femoral vascular catheter.OTHER: No significant abnormality noted.	1.Biapical pulmonary cavitary lesions most suggestive of an infectious process and may be the source of the patient's sepsis. This is most likely due to a infectious process possibly from staph aureus. Fungal and atypical infections can also cause cavitations. Pulmonary embolic disease is considered less likely.
Generate impression based on findings.	Male 44 years old; Reason: history testes cancer, s/p chemotherapy, assess for recurrence History: none ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes. No aortocaval lymphadenopathy.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 pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post operative changes in the left inguinal canal.OTHER: No significant abnormality noted.	1.Post operative changes in the left inguinal canal without evident retroperitoneal lymphadenopathy.
Generate impression based on findings.	Female 25 years old; Reason: Stage IV NLPHL with bone, spleen, skeletal, liver involvement, s/p 6 cycles of R-CHOP in 12/2012 History: NLPH Lymphoma CHEST:LUNGS AND PLEURA: No new pulmonary lesions. Subcentimeter micronodule along the right minor fissure on image 47/series 5 is unchanged. The pleural spaces are clear.MEDIASTINUM AND HILA: Index lymph node the left thoracic inlet measures 1.0 x 0.8 cm (image 7/series 3) previously, 1.4 x 1.0 cm.Subpectoral lymph nodes. Less subpectoral node measures 1.5 x 0.9 cm (image 19/series 3) previously, 1.7 x 0.8 cm.Left axillary lymph node measures 0.8 x 0.7 cm (image 24/series 3) previously, 0.9 x 0.8 cm.CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions have developed. Hepatic and portal veins are patent..SPLEEN: Spleen is normal in size ; no diagnostic abnormality.PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No retroperitoneal, mesenteric or porta caval lymphadenopathy..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Contraceptive device and tampon in place..BLADDER: No significant abnormality noted..LYMPH NODES: Right external iliac lymph node measures 1.7 x 1.0 cm (image 157/series 3) previously, 2.2 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..	Decrease in the size of the existing lymph nodes with no new pathologic nodes.
Generate impression based on findings.	Chronic sinusitis. The maxillary sinuses are congenitally diminutive. There are no abnormal contents including secretions, air-fluid levels or mucosal thickening. The frontal, maxillary, ethmoid and sphenoid sinuses are each aerated. Ostiomeatal units are patent bilaterally. There is minimal rightward nasal septal deviation. There is a solitary benign-appearing sclerotic focus representing osteitis condensans within the left maxillary alveolar ridge.Limited assessment of the orbits and partially visualized intracranial contents is unremarkable.	No significant sinus abnormality. Minimal rightward nasal septal deviation.
Generate impression based on findings.	New AML. Please evaluate for infection. There is a small amount of nonspecific soft tissue density demonstrated at the dependent/inferior aspect of the maxillary sinuses bilaterally, more so on the left. There is lucency and irregularity of the posterior wall of the left maxillary sinus both at this level and more superiorly (series 5 image 30) with some associated subtle nodular soft tissue density and ill-defined haziness within the left retromaxillary fat pad as compared to the contralateral side. This does not extend to the level of the pterygopalatine fossa superiorly. The right retromaxillary fat pad is clear. There is no orbital stranding or intracranial mass on the limited provided images. There is no other significant sinus findings. Mastoid air cells are clear.There appears to irregularity of the left orbital floor, likely relating to a chronic fracture.	1. Lucency and irregularity of the posterior wall of the left maxillary sinus associated with a small amount of mural increased density within the sinus and ill-defined soft tissue density/haziness of the fat within the left retromaxillary fat pad. The finding is subtle, although in the context of new AML this raises the possibility of an infection such as invasive fungal sinusitis, or focal involvement by AML. Please correlate clinically.2. Probable chronic left orbital floor fracture.A report is issued to Dr. Dabbouseh (Medicine) via telephone at the time of reporting: 5:35 PM on 12/07/2013 by Dr. Michael Mayich.
Generate impression based on findings.	Weakness malaise and fatigue. Rule out stroke. There is diffuse prominence of CSF spaces which is in keeping with the patient's age. There is atherosclerotic calcification of the basilar and bilateral cavernous carotid arteries. There is no intracranial mass, edema, hydrocephalus or hemorrhage. The midline is intact. Orbits, paranasal sinuses, mastoid air cells and visualized bony structures are unremarkable.	Age-related changes without acute intracranial pathology. If there is persistent concern regarding CVA, MRI could be considered.
Generate impression based on findings.	46 your old patient with history of metastatic cancer and syncope/collapse. Evaluate for intracranial hemorrhage. There are no visualized intracranial masses, edema, hemorrhage or hydrocephalus. The midline is intact. Orbits, bones, mastoids and visualized paranasal sinuses are unremarkable.There is soft tissue density nodule apparently exophytic from the left posterior parietal scalp. This could represent an external object abutting and indenting the skin surface or a skin tag,	1.No visualized acute intracranial pathology. Unenhanced CT is a relatively insensitive method for assessing for the presence of subtle intracranial masses, and if there is concern regarding intracranial metastatic disease MRI could be considered. 2.Apparent possible prominent exophytic soft tissue nodule associated with the left parietal scalp which could be assessed clinically.
Generate impression based on findings.	Female 63 years old; Reason: r/o intra-abdominal fluid collection, pneumonia in patient with septic shock History: septic shock, fever, tachycardia, hypotension Suboptimal evaluation of the solid and hollow abdominal viscera do the lack of intravenous contrast.CHEST:LUNGS AND PLEURA: Diffuse bilateral ground-glass pulmonary opacities with mild areas of consolidation at the lung apices. Trace bilateral pleural effusion. No pneumothorax or cavitary lesions.MEDIASTINUM AND HILA: Heart size is mildly enlarged. Trace pericardial effusion. No mediastinal lymphadenopathy.Right neck central venous catheter terminates about the right atrium. its exact position is hard to determine due to motion.Endotracheal tube terminates at the thoracic inlet. CHEST WALL: No significant abnormality noted.Low attenuation area superficial to the right posterior shoulder.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodense hepatic lesions. Trace perihepatic ascites. Gallbladder is not distended.SPLEEN: Spleen is normal in size. Fluid around the spleen that impresses upon the splenic contour may represent a pseudocyst.PANCREAS: Fatty atrophy of the pancreas. Infiltration of fat planes surrounding the pancreas possibly due to acute pancreatitis. Hyperdense mass in the lesser sac measures at least 5.3 x 2.8 cm (image 84/series 3) and has imaging features suggestive of a hematoma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: Mixed attenuation mass at the level of the gastric antrum/pylorus measures 5.5 x 4.1 cm (image 76/series 3). No bowel obstruction. The portions of the bowel are suboptimal opacified with intervening soft tissue or fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Upper abdominal ascites some of which is mildly hyperdense.PELVIS:UTERUS, ADNEXA: Atrophic or resectedBLADDER: Decompressed by Foley catheterLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse body wall anasarca.OTHER: Ascites with layering hyperdense component.	1.Bilateral ground-glass opacities with areas of consolidation differential considerations include an infectious process, pulmonary edema.2.Mixed attenuation lesion in the stomach suggests a hematoma, a neoplastic mass is also the differential.3.Hyperdense mass in the lesser sac suggests a hematoma.4.Layering hyperdense material in the pelvis suggests hematoma.5.Given the history this may represent a hemorrhagic pancreatitis.6.Suboptimal evaluation of the abdomen due to the lack of intravenous contrast.7.Pockets of fluid in the upper abdomen may represent pseudocysts.
Generate impression based on findings.	Headache and speech disturbance. Rule out aneurysm. Unenhanced CT head: There is patchy hypoattenuation of the periventricular distribution without significant volume loss. No intracranial hemorrhage, hydrocephalus or obvious mass. The midline is intact. There is no pathological enhancement. There is an air-fluid level within left maxillary sinus suggestive of acute sinusitis as well as mild mucosal thickening with minimal secretions in the right maxillary and bilateral ethmoid sinuses. Frontal and sphenoid sinuses are clear. Mastoid air cells are clear.CTA neck: There is variant aortic arch anatomy where in the left vertebral artery branches directly from the aorta distal to the left common carotid. There is significant tortuosity without stenosis at the origin of each of the 4 arterial branches. There is irregularity associated with atherosclerotic plaque at the proximal right external carotid artery. There is no hemodynamically significant stenosis of the internal carotid arteries bilaterally according to NASCET criteria. The vertebral arteries demonstrate normal cervical course and morphology without steno-occlusive lesion or aneurysm.CTA head: There is atherosclerotic plaque including calcification within the cavernous portions of the ICAs bilaterally with normal distal ICAs, MCAs and ACAs. The intracranial vertebral, basilar and posterior cerebral arteries are unremarkable. There is no steno-occlusive lesion or aneurysm within the anterior or posterior circulation.Other findings: There is a heterogeneity including a questionable left thyroid nodule which is obscured by significant artifact. Sonographic assessment be considered if clinically warranted.	1.Patchy hypoattenuation of the periventricular distribution. This is a nonspecific finding but could represent sequela of age indeterminate small vessel ischemia. 2.Mild atherosclerotic disease with calcification in the cavernous ICAs bilaterally without significant steno-occlusive lesion or aneurysm.3.Air-fluid level within left maxillary sinus suggestive of acute sinusitis. Please correlate clinically.
Generate impression based on findings.	Female 52 years old; Reason: re evaluate fluid collections History: persistent abd tenderness CHEST:LUNGS AND PLEURA: Pleural-based pulmonary nodule in the right lung base is nonspecific (image 51/series 4). The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: Healed right rib fractures. Scar from prior port in the right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Mild hypertrophy of the caudate with mild hepatic enlargement suggests chronic liver disease. Probable simple cyst in segment 7 of the lesion liver.Hepatic and portal veins are patent. Status post cholecystectomy; no biliary ductal dilatationSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small nodule which is indeterminate in the left adrenal gland . Right adrenal gland is unremarkable.KIDNEYS, URETERS: No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes in the small bowel with a surgical anastomotic line.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall with soft tissue gas on the fluid veins. There is a surgical drain superficial to the sagittal plane. A percutaneous drainage catheter terminates within a small pocket of fluid adjacent to the expected location of the cecum in the right lower abdomen. Exact fascial planes fluid pocket size is not easy to determine but measures at least 3.8 x 2.0 cm.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: Post traumatic changes in the right ilium with multiple surgical plates and screws. Extensive infiltration of the soft tissue in the anterior abdominal wall.OTHER: No significant abnormality noted.	1.Infiltration of the soft tissues in the right lower abdomen with slight decrease in the size of the fluid pocket following percutaneous catheter drainage. No new collections.2.Extensive infiltration of the soft tissues in the anterior abdominal wall with gas along the fascial planes and a surgical drain.
Generate impression based on findings.	Male 38 years old; Reason: r/o renal tumor History: renal mass in ultrasound ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys have a lobular contour. No focal renal mass. The collecting system is normal in caliber. No nephrolithiasis in either kidney. No perinephric fluid collections. The renal vasculature are patent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.No focal renal mass. Abnormality seen on the ultrasound corresponds to a lobulation of the renal contour.
Generate impression based on findings.	74 year old female with history of shortness of breath and history of multiple myeloma. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Small bilateral pleural effusions with associated atelectasis. Multiple scattered subcentimeter pulmonary nodules are noted, with one of the largest being seen in the right lower lobe measuring approximately 8 mm (series 9 image 83). This is of uncertain etiology, and should be followed up with CT when clinically appropriate to ensure resolution. Scattered tree in bud and ground glass opacities suggest an infectious/inflammatory component. Bilateral septal thickening is seen particularly in the lower lobes which could be related to mild pulmonary edema although this is nonspecific.MEDIASTINUM AND HILA: Mild cardiac enlargement no appreciable pericardial effusion. Small hiatal hernia.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	1.No pulmonary embolus.2.Small bilateral pleural effusions with associated atelectasis.3.Multiple scattered subcentimeter pulmonary nodules of uncertain etiology. Recommend follow-up with CT from clinically appropriate to ensure resolution.
Generate impression based on findings.	67 year old patient with dysphagia, weight loss. Assess for mass/obstructing lesion. The proximal esophagus is patulous containing an air-fluid level related to obstruction more distally. Please refer to the CT chest report for further detail.There are lymph nodes measuring up to 10 mm at the IA nodal station without significant adenopathy elsewhere including at the IB and II levels. The nasopharynx, oropharynx and hypopharynx each have normal morphology with no mucosal irregularity or mass visualized. The epiglottis, piriform region, larynx and proximal trachea are also unremarkable. Thyroid, submandibular and parotid glands are unremarkable.There is variant arch anatomy wherein the left common carotid is the first branch of the right brachiocephalic. There is significant atherosclerotic calcification at the carotid bifurcations bilaterally resulting in bilateral mild-moderate stenosis. A punctate focus of air within the left internal jugular vein is iatrogenic and related to power injection. There is multifocal calcification associated with spiculation and volume loss within the right pulmonary apex. Refer to the CT report for further detail.There are multilevel degenerative changes of the cervical spine including intervertebral disk loss with disk osteophyte complexes at the C3-4 through C6-7 levels (most prominent at the C5-6 level). There is mixed sclerotic/lucency within the inferior endplate of C4.	1.Patulous proximal esophagus with air-fluid level related to more distal obstruction. Please refer to the CT chest report for further detail.2.Lymph nodes measuring up to 10 mm at the IA level without significant adenopathy elsewhere. These are nonspecific and may be reactive.3.Spiculation/calcification in the right pulmonary apex likely relating to scarring. Refer to CT chest report for further detail.4.Vascular calcification involving the carotid bifurcations resulting in bilateral mild-moderate stenosis.5.Degenerative changes of the cervical spine. Lucency in the inferior endplate of C4 is most likely degenerative, although if there is concern for osseous metastatic disease, a bone scan could be obtained.
Generate impression based on findings.	Female 66 years old; Reason: s/p chole with GB injury History: s/p chole with GB injury ABDOMEN:LUNGS BASES: Healing left posterior medial rib fractures.LIVER, BILIARY TRACT: Liver has a smooth contour. Hepatic and portal veins are patent. There is minimal intrahepatic biliary ductal dilatation. Surgical drains terminate in the area of the gallbladder fossa. Trace amount of residual fluid measures 2.3 x 2.3 cm.Percutaneous catheter traverses the gallbladder fossa and terminates within the duodenum.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is fatty atrophic. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Calcifications in the hila of both kidneys may represent either non obstructing calculi or small vascular calcifications. Left lower pole renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. Infrarenal abdominal IVC filter.BOWEL, MESENTERY: Percutaneous gastrojejunal catheter with a balloon within the stomach lumen and the catheter tip at the level of the duodenum. No bowel obstruction is evident.BONES, SOFT TISSUES: Large ventral abdominal wall defect with probable packing material that contacts the fascial plane. Mild infiltrative changes in the omental fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post total left hip arthroplasty. Degenerative changes affect the right hip.Degenerative changes affect the lower lumbar spine.OTHER: No drainable collections in the pelvis.	1.Drainage catheter in the gallbladder fossa with small residual fluid.2.Percutaneous gastrojejunostomy catheter terminates within the duodenum.3.No new loculated fluid collections in the upper abdomen.4.Percutaneous catheter that traverses the gallbladder fossa terminates in the duodenum 5.No bowel obstruction.6.Large ventral abdominal wall defect.
Generate impression based on findings.	71 year old female with history of known pulmonary embolus status post trauma lysis at outside hospital. PULMONARY ARTERIES: Massive thrombus is noted in the main pulmonary artery, extending only superficially into the left pulmonary artery but extensively into the right pulmonary artery and its proximal branches. The pulmonary trunk measures approximately 3.8 cm in diameter, suggesting increased pulmonary pressures.LUNGS AND PLEURA: Multiple bilateral pulmonary nodules are scattered throughout the lung parenchyma, nonspecific but are suspicious for metastatic disease. Reference right lower lobe pulmonary nodule (series 8 image 79) measures approximately 9 mm in diameter.MEDIASTINUM AND HILA: Flattening of the intraventricular septum with the suggestion of slight bowing leftward suggests increased right-sided pressures.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis and arterial calcifications.	1.Massive thrombus in the main pulmonary artery extending into the right pulmonary artery and its branches, with only slight extension to the left pulmonary artery.2.Abnormally increased main pulmonary artery diameter, as well as flattening of the interventricular septum is suggestive of elevated right-sided pressures.3.Scattered bilateral lung nodules, nonspecific but suggestive of metastatic disease.
Generate impression based on findings.	Female 26 years old; Reason: r/o appy History: abdominal pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The appendix fills with contrast without periappendiceal inflammatory changes. It is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No pericolonic inflammatory changes.BONES, SOFT TISSUES: Bilateral pars defects of the L5 vertebral body with grade 1 anterolisthesis of L5 on S1.OTHER: No free fluid in the pelvis.	1.No CT findings of acute appendicitis, bowel obstruction or drainable fluid collections.
Generate impression based on findings.	Male 58 years old; Reason: r/o pancreatitis, pseudocyst History: abdominal pain, epigastric pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas enhances homogeneously. No definite CT findings of acute pancreatitis. No peripancreatic fluid collections. The splenic vein is patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance homogeneously. Mild hyperenhancement of the mid ureters.RETROPERITONEUM, LYMPH NODES: IVC filter. Mild infiltration of the fat planes in the retroperitoneum.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.No CT findings of acute pancreatitis (patient has elevated lipase)2.No pseudocyst formation.3.Infiltration of fat planes in the retroperitoneum with mild hyperenhancement of the ureters in their mid course.
Generate impression based on findings.	Female 76 years old; Reason: r/o intra-abdominal fluid collection and lung source as cause of sepsis History: hypotension, fever, tachycardia, complicated surgical history requiring washout at last admission CHEST:LUNGS AND PLEURA: Increasing consolidation in the left lung base with finding suspicious for a small cavitary lesion in the left lung base measuring approximately 2 centimeters. (Image 41 /series 4)Postradiation changes in the anterior aspect of the right chest. Small left pleural effusion, no pneumothorax.MEDIASTINUM AND HILA: Heart size is enlarged with a trace pericardial effusion. Endotracheal tube terminates about the thoracic inlet.Right central venous catheter terminates at the right atrium. Left central venous catheter terminates in the SVC.Mediastinal lymphadenopathy with enlarged right paratracheal lymph nodes.CHEST WALL: Post operative changes in the right breast wall with a small pocket of fluid possibly a seroma following mastectomy.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged. Infiltration of the fat planes surrounding the gallbladder with mild pericholecystic fluid. The imaging findings are most suggestive of cholecystitis.The intrahepatic portal veins are diminutive. The left portal vein is suboptimally imaged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Cystic changes in the left kidney, suboptimally evaluated.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta.BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates within the stomach lumen. There is a loop of bowel traversing adjacent to the inserted percutaneous catheter (image 105).No surrounding collections.Right lower abdominal ostomy. Status post colectomy.BONES, SOFT TISSUES: Infiltrative changes in the lower anterior abdominal wall with a large ventral defect.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus has been resected.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectum containing fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.Mild gallbladder wall thickening with infiltration of the fat planes suggestive of acalculous cholecystitis given no stones were seen on the recent ultrasound.2.Enlarged liver suggestive of liver disease.3.Percutaneous gastrostomy catheter terminates in the stomach lumen. A loop of bowel traverses between the anterior wall of the stomach and the body wall. It is difficult to determine if the catheter traverses through the loop of small bowel.4.Finding suspicious for a cavitary changes involving the pneumonia of the left lower lobe.5.Findings discussed with Dr. Elliott via telephone at the time of dictation.
Generate impression based on findings.	Male 55 years old; Reason: RUQ pain, blood in biliary drainage from percutaneous tube. Please eval for tube placement History: bleeding in biliary drainage, RUQ pain ABDOMEN:LUNGS BASES: Pulmonary nodule in the right upper lobe adjacent to the major fissure is unchanged. No basilar pleural effusions.LIVER, BILIARY TRACT: Status post right hepatectomy. There is compensatory hypertrophy of the left hepatic lobe.The left hepatic portal venous branches are patent.The hepatic lesion measures 4.6 x 2.9 cm (image 25/series 4) previously, 4.3 x 2.9 cm.There are other hypodense hepatic lesions.A metallic biliary stent is present within the liver. A percutaneous catheter traverses the stent and terminates within the duodenum. A fluid collection along the lateral aspect of the liver is not significantly changed. No biliary ductal dilatation.No intrahepatic hematoma. Proximal aspect of the stent abuts the left portal venous branch and may be the source of the patient's bleeding (image 32/series 4).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: Extensive calcified retroperitoneal and upper abdominal lymph nodes.BOWEL, MESENTERY: Small bowel is normal in caliber. No bowel obstruction. Extensive abdominal wall laxityBONES, 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: Postoperative changes in the rectosigmoid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	Percutaneous delivery catheter abuts the left portal venous branch as it traverses through the stent. This may be the source of the bleed although there is no intrahepatic hematoma, perihepatic hematoma or intra-abdominal hematoma.Findings discussed with Dr. Polite at the time of dictation
Generate impression based on findings.	Female 43 years old; Reason: patient with abdominal pain mostly in RLQ, r/o torsion or GI pathology that may account for symptoms History: patient with abdominal pain mostly in RLQ, r/o torsion or GI pathology that may account for symptoms ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal location.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large fluid filled uterus. Fluid extends into to dilated fallopian tubes about the adnexa. There is hyperenhancement of the myometrium. There is a small enhancing fundal fibroid. No ovarian enlargement is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Appendix is normal in caliber without surrounding inflammatory changes.BONES, SOFT TISSUES: No intra-pelvic fluid collections.OTHER: No significant abnormality noted.	1.Fluid within the endometrial cavity extending into dilated fallopian tubes. Differential considerations include endometritis and hematometra, hydrosalpinx or pyosalpinx, malignancy considered less likely.2.Pelvic sonography is recommended for further evaluation.
Generate impression based on findings.	Headache. Evaluate for obstructive hydrocephalus. The patient is status post right hemispherectomy with stable postoperative findings including fragmentation of the right calvarium and dural calcification related to prior craniotomies as well as bilateral ventriculostomy catheters which are demonstrated in stable position since the examination earlier in the day, and in approximately stable position (accounting for change in CSF space configuration) since their placement 10/29/2013. Ventricular size including the more focal oval cystic structure which could represent the third ventricle or possibly a periventricular cyst is unchanged.The dimensions of the CSF collection underlying the right craniotomy defect are unchanged since earlier in the day. There is no visualized intracranial hemorrhage, herniation, or pathologic enhancement. Orbits, paranasal sinuses and mastoids are unremarkable.	1. Unchanged configuration of the extraaxial collection related to right hemispherectomy since an examination earlier in the day.2. Unchanged position of ventriculostomy catheters and ventricular size.
Generate impression based on findings.	Female 56 years old; Reason: Rectal Cancer: Restaging History: none CHEST:LUNGS AND PLEURA: There are multiple pulmonary nodules. The right lower lobe reference pulmonary nodule measures 1.8 x 1.3 cm (image 69/series 4) previously, 1.8 x 1.2 cm. Lesion is more solid.Some of the lesions show central calcification. Some of the lesions have cavitation. No definite new pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port terminates at the cavoatrial junctionABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy.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: Right abdominal ileostomy.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: Post operative changes about the rectosigmoid. Stable presacral soft tissue thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.No evident change in the size of the pulmonary lesions.
Generate impression based on findings.	Male 71 years old; Reason: HCC screening History: Cirrhosis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. The fissures are widened..Multiple layering gallstones within a nondistended gallbladder. No biliary ductal dilatation Features of portal hypertension: Spleen is top normal in size. No ascites. Portal vein: Main portal vein and intrahepatic portal venous branches are patent. Hepatic veins: Hepatic veins are patent.Hepatic artery: Hepatic artery is patent.No focal hypervascular lesion is evident.SPLEEN: Spleen is top normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Calcific or sclerotic disease of the renal vasculature with focal artery dilatation about the right renal hilum possibly due to positive remodeling or a small aneurysm.RETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	Cirrhotic liver without focal hepatic lesion to suggest HCC.Cholelithiasis.
Generate impression based on findings.	Female 25 years old; Reason: evaluate MRSA abscess History: pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal fluid collections are evident.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: The left iliac fossa fluid collection has resolved. No catheter is present. Mild skin thickening in the superior facial tissues.OTHER: No significant abnormality noted.	1.Resolution of the left iliac fossa fluid collection.2.If there is high clinical suspicion for a persistent fluid collection which cannot be detectable by CT MRI should be considered.
Generate impression based on findings.	Male 49 years old; Reason: Re-evaluate disease status following adjuvant therapy for progression; compare to previous scan History: Stage III melanoma CHEST:LUNGS AND PLEURA: Left upper lobe pulmonary nodule measures 8 mm (image 87 series 5) previously, 5 mm.No new lesions. Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Index left axillary lymph node measures 6-mm (image 19 series 3), unchanged.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Stable segment two hypodense probable cyst . No new hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: 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: Right inguinal node measures 9-mm (image 213/series 3), unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postoperative changes from hernia repair in the left inguinal canalOTHER: No significant abnormality noted	1.Increase in the size of the left upper lobe pulmonary nodule. The remainder of the reference lymph node measurements are unchanged.
Generate impression based on findings.	Female 37 years old; Reason: 37yo female with history of ovarian CA, evaluate disease status History: as above CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter ground glass nodule adjacent to the pleural and the superior segment of the right lower lobe (image 40/series 4). The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Poorly defined hypodense lesion in segment 6 of the liver is unchanged. Hepatic and portal veins are patent. No new lesions.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: Post operative changes in the retroperitoneum. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: 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 exam without evident of metastatic disease.2.Nonspecific subcentimeter ground-glass nodule in the right lower lobe
Generate impression based on findings.	History of cough. Rule out lung abscess. LUNGS AND PLEURA: Consolidation of the inferior right lower lobe with air bronchograms, as well as the inferior right middle lobe. There is a small focus of consolidation in left lower lobe posteriorly as well as ground glass and nodular opacities distributed throughout the inferior right upper lobe and left upper lobe. No discrete pulmonary parenchymal cavitation or abscess is seen. MEDIASTINUM AND HILA: Postoperative findings consistent with gastric pull-up. There is an anterior mediastinum fluid collection with air-fluid level and slight enhancement of the rim. This collection tracks superiorly from at least the level of the diaphragm to anterior to the left thyroid lobe. Although this collection may simply be postoperative in nature, cannot exclude infection.CHEST WALL: Postoperative findings consistent with gastric pull-up, including multiple surgical clips in the anterior chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postoperative findings consistent with history of gastric pull-up.	1.Extensive multifocal consolidation in the lungs as described above. Given the patient's history and there is geographic distribution, this could be aspiration related or infectious. 2.Anterior mediastinum fluid collection with internal air-fluid level and slight rim enhancement. This finding could be post operative, although cannot exclude infection of this collection.
Generate impression based on findings.	Male 78 years old; Reason: evaluate for HCC History: cirrhosis ABDOMEN:LUNGS BASES: There is a leads terminate within the heart.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Fissures are widened.Multiple gallstones within a nondistended gallbladder. Minimal intrahepatic ductal location in the left lobe. Features of portal hypertension: The spleen is enlarged. Portal vein: Portal vein is patent. Hepatic veins: Hepatic veins are patentHepatic artery: Hepatic artery is patentLesions: Scattered hypervascular foci in the liver which do not washout and not the criteria for HCC.SPLEEN: The spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Focal dissection of the left renal artery, unchanged.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mixed sclerotic and lucent foci in the right ilium, unchanged.OTHER: No significant abnormality noted.	1.Cirrhotic liver without suspicious hepatic lesion.2.Splenomegaly.3.Cholelithiasis.4.Focal dissection of the left renal artery.
Generate impression based on findings.	67-year-old male with history of shortness of breath and dysphagia. Assess for mass. LUNGS AND PLEURA: Numerous bilateral calcified lung nodules, suggesting prior granulomatous infection. Few of these smaller nodules are not fully calcified, warranting follow-up to ensure stability. Right upper lobe nodular opacity with internal coarse calcifications and surrounding scar/emphysema. This is nonspecific but could be related to prior granulomatous infection. Right posterior lung base pleural calcification/plaque.MEDIASTINUM AND HILA: The esophagus is patulous with internal air fluid level extending from the level of the thyroid inferiorly to a complex, lobulated masslike thickening of the esophagus at approximately the level of the AP window. This masslike process extends inferiorly to approximately the GE junction, and has adjacent low attenuation lesions which may represent necrotic lymph nodes. An additional likely necrotic lymph node is seen anterior to the SVC and the right side at the level of the carina (series 3 image 50).CHEST WALL: T10 vertebral body demonstrates age indeterminate compression fracture. Multiple right sided rib fractures with callus formation.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple subcentimeter hypoattenuating lesions within the liver, nonspecific and may be simple cysts although evaluation with dedicated liver imaging would add specificity if clinically warranted.	1.Masslike thickening of the mid/distal esophagus with likely adjacent necrotic lymph nodes and superior esophageal dilatation, suspicious for malignancy which could be further violated with endoscopy. 2.Right apical scar like opacity with adjacent emphysema and internal coarse calcifications. Numerous bilateral calcified lung nodules, suggesting prior granulomatous infection. Few of these smaller nodules are not fully calcified, warranting follow-up to ensure stability. 3.Multiple hypoattenuating hepatic lesions, nonspecific.
Generate impression based on findings.	Slurred speech. Rule out stroke. There is patchy white matter hypoattenuation in a periventricular distribution without significant volume loss. No intracranial hemorrhage, hydrocephalus or obvious mass. The midline is intact. There is an air-fluid level within the left maxillary sinus suggestive of acute sinusitis as well as mild mucosal thickening with minimal secretions in the right maxillary and bilateral ethmoid sinuses. Frontal and sphenoid sinuses are clear. Mastoid air cells are clear. There are no aggressive bone lesions demonstrated.	1.Patchy white matter hypoattenuation which is nonspecific, but could possibly represent age indeterminate sequela of small vessel ischemic disease. If there remains clinical concern for an acute ischemic event, MRI brain recommended.2.Air-fluid levels in left maxillary sinus suggestive of acute sinusitis. Please correlate clinically.
Generate impression based on findings.	Female 63 years old; Reason: hx of lap RYBG, now with nausea/vomiting and LUQ abdominal pain History: above ABDOMEN:LUNGS BASES: No basilar atelectasis. Small amount of gas noted in the mediastinum, possibly postoperative.LIVER, BILIARY TRACT: Liver has a smooth contour. Nonspecific hypodense segment 6 lesion. Cholelithiasis within a nondistended gallbladder. No biliary ductal dilatation. Trace perihepatic ascites.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 of gastric bypass. The enteric limb is dilated with multiple air-fluid levels up to the distal anastomosis. The bowel loops are dilated up to 3.8-cm. Distal to the anastomosis, the bowel loops are collapsed.BONES, SOFT TISSUES: Soft tissue infiltration of the intra-abdominal fatOTHER: No drainable intra-abdominal fluid collections.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: Trace abdominal ascites.	1.Findings of a bowel obstruction with a transition at the distal anastomosis.2.Small foci of gas in the anterior mediastinum of unclear etiology but may be postoperative.
Generate impression based on findings.	Male 57 years old; Reason: Pt is a 57 y/o male with met rcc, evaluate for progression during off-cycle of pazopanib History: met rcc, lung nodules CHEST:LUNGS AND PLEURA: Reference right lower lobe pulmonary nodule measures 1.0 x 0.9 cm (image 46/series 4) previously, 0.9 x 0.7 cm.The nodule adjacent to the major fissure measures 0.9 x 0.8 cm (image 43/series 4) previously, 0.6 x 0.6 cm.There are other scattered subcentimeter nodules. No definite new pulmonary lesions.Mild upper lobe predominant emphysematous changes and anterior pleural calcified plaquing.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN: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. No focal mass is evident in the right renal fossa. The left kidney is normal morphology without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.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: Scattered pelvic sclerotic foci likely represent small bone islands.OTHER: No significant abnormality noted	1.Minimal increase in the size of the right lobe pulmonary nodules. No evident new lesions.
Generate impression based on findings.	Severe headache. Unenhanced CT head: There is no intracranial mass, edema, hemorrhage, or hydrocephalus. The midline is intact. There is no pathological enhancement. The orbits, mastoid air cells and bones of the calvarium are unremarkable. The sinuses are clear.CTA head: There is a developmentally smaller left ICA due to a hypoplastic left A1 segment with the left A2 fed by right A1 and patent anterior communicating complex. Bilateral MCAs are normal. There is a patent right posterior communicating artery with no visualized left. Intracranial vertebral arteries are normal. There is variant anatomy of the AICA -- PICA systems bilaterally with a single dominant vessel on each side. Basilar artery and PCAs are unremarkable. There are no steno-occlusive lesions or aneurysms demonstrated in the intracranial vasculature.	1.No acute intracranial abnormality.2.Unremarkable CTA of the head.
Generate impression based on findings.	Female 34 years old; Reason: 34F with persistent abdominal bloating, dyspepsia and frequent BM x 3 months History: dyspepsia, bloating, LUQ pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small calcifications in both adrenal glands.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No mesenteric or retroperitoneal adenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Terminal ileum is unremarkable. Appendix is normal. No bowel obstruction or inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fluid within the endometrial cavity and probable right corpus luteal cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	1.No evident inflammatory bowel changes or bowel obstruction.2.Calcified adrenal glands bilaterally. The findings are nonspecific and include old infection, trauma. No focal mass is evident. Pediatric neoplastic adrenal lesions can also calcify.
Generate impression based on findings.	Patient with history of ALL with neutropenia, fever and right cheek swelling. There is asymmetric fluid/soft tissue attenuation with associated stranding of fat overlying the right superior alveolar ridge superficial to cortical breakthrough of the buccal cortex associated with a periapical focal lucency at the root of the right maxillary second bicuspid (ADA #4). This lucency is larger than on the examination dated 2/12/2013. The inferior maxillary wall is intact. There is lobulated soft tissue density within the maxillary sinuses bilaterally. Sphenoid, ethmoid and frontal sinuses are clear. There is no other periapical lucency within limits of artifact imposed by dental hardware. There are no aggressive bony lesions. Orbits are unremarkable.	Findings suggestive of cellulitis overlying the right maxillary region related to a probable periapical abscess of the right second maxillary bicuspid.
Generate impression based on findings.	55-year-old with left ear/neck pain. Evaluate for acute abnormalities. There are surgical clips related to prior thyroidectomy. There are an overall increased number of prominent lymph nodes demonstrated throughout the examined field. Many were visualized on the previous examination, with slight interval increased size since 2005. There are slightly enlarged submental nodes and a right supraclavicular node each measuring up to 1.1 cm, while the remaining visualized nodes are not enlarged by CT size criteria. There is two nonenlarged left retroauricular nodes demonstrated. The nasopharynx, oropharynx and hypopharynx each demonstrate normal mucosal contour without any visualized mass. The epiglottis, piriform sinus, larynx and trachea are unremarkable. Submandibular and parotid glands are unremarkable. There are no aggressive appearing bony lesions, however there are multilevel degenerative changes including disk-osteophyte complexes at C4-5 and C6-7 in addition to bilateral facet degenerative changes at C7-T1.There is significant limitation by beam hardening artifact and lack of contrast, however there is questionable prominence of soft tissue within the left hilum.	1.Sequela of prior thyroidectomy. 2.Multiple lymph nodes demonstrated throughout the neck. Many were demonstrated on the exam in 2005, with slight interval increased size. Two submental and a single right supraclavicular node are enlarged, while the remainder are within normal limits by CT size criteria. Two small nodes are incidentally noted in the left post-auricular region.3.Prominence of soft tissue density within the left hilum which is only partially visualized on this unenhanced exam, which may represent normal vascular structures. Further assessment with designated chest CT may be obtained as clinically indicated.
Generate impression based on findings.	53 year old female, evaluate for pneumonia, fluid overload. Persistent hypoxia and respiratory distress. History of breast cancer currently on chemotherapy. LUNGS AND PLEURA: Symmetric Bibasilar dependent consolidations are noted within the lower lobes as well as the left upper lobe lingula, with small underlying pleural effusions. Minor scattered focal predominantly peripheral air space opacities are also noted, which makes it difficult to exclude underlying pulmonary nodules although no large discrete pulmonary nodules are identified. The constellation of findings are nonspecific, but could represent pneumonia versus aspiration. The remainder of the aerated lung is unremarkable without significant diffuse ground-glass opacities. MEDIASTINUM AND HILA: Heart size is normal with trace pericardial effusion. Coarse left thyroid calcification is noted. Left IJ line is noted. Numerous nonenlarged nodes are noted scattered throughout the mediastinum and hila, which are nonspecific. CHEST WALL: Just below the level of the sternoclavicular joint, there is a focal fluid collection with an air-fluid level in the right anterior chest wall/superior breast, presumably related to prior Mediport surgical defect but an abscess is not excluded. No significant axillary adenopathy is identified. Mild focal vertebral degenerative changes are noted.UPPER ABDOMEN: Trace amount of hyperdense material within the stomach is noted. Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	1.Bibasilar consolidations and small pleural effusions with scattered focal opacities which are nonspecific, but these findings could represent pneumonia versus aspiration. Pulmonary edema is considered less likely as heart size is normal with trace pericardial effusion.2.Air-fluid level in the right anterior chest wall presumably related to prior Mediport surgical defect, but an abscess is not excluded.
Generate impression based on findings.	33 year old patient status post fusion for lumbosacral spondylolisthesis. There are postoperative changes related to decompression and L5-S1 fusion. Rods connect the transpedicular screws which traverse the pedicles of L5 and S1. There has been L5 laminectomy. There is a JP drain entering the skin at L1 extending inferiorly along the midline to the S1 level. There is subcutaneous air dorsal to the erector spinae musculature in the region of the operative field.There are chronic bilateral pars defects at L5 with grade 3 spondylolisthesis L5 on S1 (55%). There are sclerotic endplate changes and irregularity of L5 and S1 including rounding of the anterior aspect of S1, loss of vertebral body height at the posterior aspect of L5, and uncovering of the L5-S1 disk. The disk space is nearly completely obliterated. There is moderate-severe bilateral foraminal narrowing, without any central spinal canal stenosis.Elsewhere, there is trace retrolisthesis of L4 on L5. Vertebral body and intervertebral disk heights are maintained from T12 through L4. There is spina bifida occulta at T12-L2 and S1-S2. Between T12 and L4 there is no disk bulge or facet arthropathy. There is no canal or neural foraminal compromise.There is a partially visualized fluid attenuation associated with a blind ended air-filled tubular structure most likely representing the appendix in the right lower quadrant.	1.Postoperative changes related to fixation of L5-S1.2.Grade 3 spondylolisthesis of L5 on S1 on the basis of bilateral L5 pars interarticularis defect. Significant resultant degenerative change at L5-S1 with moderate-severe foraminal narrowing.3.Spina bifida occulta at T12-L2 and S1-L2.4.Incompletely visualized fluid within the right lower quadrant closely associated with what is most likely the air filled appendix, and therefore unlikely to represent appendicitis. However, please correlate clinically.
Generate impression based on findings.	57 year-old patient with a history of squamous cell carcinoma of unknown primary status post left neck dissection and CRT. Please reevaluate and compare to prior exams. There are stable postoperative changes within the left neck including effacement of fat planes and asymmetry of the sternocleidomastoid musculature. The oral cavity, oropharynx, nasopharynx, and hypopharynx are unremarkable. The epiglottis, piriform sinus, larynx and proximal trachea are unremarkable. There is no lymphadenopathy demonstrated. The thyroid, submandibular, and parotid glands are unremarkable. With exception of an eccentric noncalcified plaque within the mid left common carotid artery, the vascular structures are grossly normal. Visualized portions of the orbits and sphenoid sinuses are normal. There is stable soft tissue density within the maxillary sinuses bilaterally. There is rightward deviation of the nasal septum. There are multilevel degenerative changes of the cervical spine including intervertebral disk height loss at C5-6 and C6-7 with disk-osteophyte complexes resulting in neural foraminal stenoses bilaterally. There is multifocal lucency within the lung apices consistent with emphysema.	1.Postoperative changes related to left neck dissection.2.No evidence of residual or recurrent disease or lymphadenopathy on today's examination.3.Degenerative changes of the cervical spine.4.Stable soft tissue density associated with the maxillary sinuses bilaterally.
Generate impression based on findings.	63 year-old status post fall striking head. Now with jaw pain. Rule out fracture. CT head: There is a small amount of swelling at the right posterior parietal/occipital scalp without underlying fracture. There is no intracranial hemorrhage, edema, mass or hydrocephalus. The midline is intact. Mastoids are clear.Maxillofacial CT: There is incomplete fusion of the anterior C1 arch as well as the bilateral retrosomatic clefts which is normal variant anatomy. There are no visualized fractures. There are two foci of benign-appearing sclerosis within the right mandible likely representing osteitis condensans. Orbits and sinuses are normal. There is calcification at the carotid bifurcations bilaterally. There are significant multilevel degenerative changes within the visualized portion of the lumbar spine resulting in reversal of physiologic lordosis. There is grade 1 anterolisthesis of C2 on 3 with disk height loss and disk osteophyte complexes from C3-4 through C5-6. The remaining levels are not visualized.	1.No fracture. A small amount of swelling within the scalp likely related to the patient's fall without intracranial abnormality including hemorrhage.2.Significant multilevel degenerative change of the cervical spine. Designated imaging could be performed as clinically indicated.3.Variant anatomy of the C1 vertebral body.
Generate impression based on findings.	Headache, vomiting. Pancytopenia. Rule out intracranial hemorrhage. There is no intracranial mass, edema, hemorrhage or hydrocephalus. Gray-white differentiation has a normal appearance and the midline is intact. There are no visualized fractures. Orbits and mastoids are unremarkable. There is soft tissue density within the left sphenoid sinus and an adjacent air fluid level.	No intracranial hemorrhage demonstrated. Air-fluid level potentially representing acute sinusitis.
Generate impression based on findings.	58 year-old female with unexplained weight loss. ABDOMEN:LUNG BASES: Small left and trace right pleural effusions.LIVER, BILIARY TRACT: Status post cholecystectomy. Calcific density adjacent to gallbladder fossa was not present on prior exam but may represent dropped gallstone which was previously obscured by cholecystectomy clips (series 3, image 48).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating lesions in both kidneys, most likely benign cysts. Nonobstructing stones in the inferior calyces of both kidneys, largest on the right measuring 4 mm (series 3, image 60). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormalityBOWEL, MESENTERY: Postsurgical changes around the stomach and in left upper quadrant. No evidence of bowel obstruction. Large amount of stool throughout the colon.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large amount of stool is present in the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.No specific findings of malignancy.2.Status-post cholecystectomy; calcific density adjacent to the gallbladder fossa was not seen on prior exam but may represent dropped gallstone which was obscured by metallic clips on prior exam. Alternatively, this could represent prior focus of inflammation which subsequently calcified. No evidence of surrounding stranding to suggest active inflammation.3.Small left pleural effusion and diffuse anasarca, of unclear etiology.4.Nonobstructing stones in inferior calyces of both kidneys.
Generate impression based on findings.	78-year-old female with history of left carotid body paraganglioma with complaints of neck swelling and pain. There is redemonstration of a soft tissue mass in the left carotid space immediately superior to the carotid bifurcation which splays the internal and external carotid arteries without encasing these structures. This is compatible with a carotid body paraganglioma and measures 2.4 x 2.6 x 3.4 cm, previously 2.4 x 2.7 x 3.1 cm. There is minimal mass effect upon the aerodigestive tract appearing similar to the prior exam. No lymphadenopathy is identified. A right total shoulder arthroplasty device and left-sided pacemaker limits evaluation of the lower neck, including a large multinodular goiter, which is grossly similar in size but obscured by significant streak artifact. This goiter displaces the esophagus and trachea rightward with mild compression, however the trachea remains patent. There are small bilateral maxillary mucous retention cysts and mild mucosal thickening of the anterior ethmoid air cells. The parotid and submandibular glands are fatty replaced. There are calcifications at the left bifurcation. There is moderate degenerative spondylosis and incomplete fusion o f the posterior arch of C1. There is a punctate hyperattenuating focus within the right pons, which appears to be unchanged, but of indeterminate significance. The partially imaged intracranial structures are otherwise grossly unremarkable. The imaged portions of the upper lungs are clear.	1.The left carotid bifurcation mass compatible with a carotid body paraganglioma appears minimally increased in size, measuring up to 3.4 cm, although assessment is limited by lack of intravenous contrast.2.Limited evaluation of the multinodular goiter with unchanged mass effect upon the trachea and esophagus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	54-year-old female with fever, hypoxia, dyspnea. Rule out abscess, fluid collection. Postop day 3 status post pancreaticoduodenectomy with pancreaticojejunostomy for duodenal adenocarcinoma. ABDOMEN:LUNGS BASES: Moderate bilateral pleural effusions with associated compressive atelectasis.LIVER, BILIARY TRACT: Periportal edema in association with dilated IVC and ascites most likely relates to fluid overload. Trace pneumobilia, likely related to recent biliary surgery. The gallbladder is absent. No liver metastases or other lesions seen.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: Postoperative changes in the right upper quadrant from recent pancreaticoduodenectomy with moderate amount of scattered nonloculated ascites and trace free air. No loculated fluid collection is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous uterus.BLADDER: Foley catheter with some free air in the bladder, likely due to recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis of the sigmoid and descending colon without evidence of diverticulitis. Scattered moderate ascites without loculation.BONES, SOFT TISSUES: Small amount of free fluid in the pelvis compatible with recent abdominal surgery.OTHER: No significant abnormality noted.	Expected postoperative changes from recent pancreaticoduodenectomy without evidence of loculated fluid collection.
Generate impression based on findings.	47 year old female status post bedside replacement of G-tube, now with abdominal bloating. Assess placement. ABDOMEN:LUNG BASES: Small right pleural effusion and overlying right base consolidation/atelectasis. Subsegmental atelectasis/consolidation also present in the left base.LIVER, BILIARY TRACT: Small amount of ascites fluid around liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodular thickening unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Jejunostomy tube enters through anterior abdominal wall and terminates in jejunum. Moderate amount of free intraperitoneal air is present. No evidence of bowel obstruction. No evidence of extraluminal contrast to suggest a leak. Moderate amount of ascites fluid without evidence of loculation. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of ascites fluid without loculation. No evidence of obstruction. Rectal tube is in place. Percutaneous right lower quadrant drain terminates in upper pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.Jejunostomy tube in place. Moderate amount of free air is present, which may be due to recent manipulation of tube. However, if recent manipulation was not performed, this raises suspicion for leakage. 2.Moderate amount of ascites fluid without loculation.3.Bilateral basilar, right more than left, lung consolidation.Pager 8467 paged without callback. Findings text paged to pager 8467 (covered by Aimee Kennedy) at 9am on 12/9/2013.
Generate impression based on findings.	59 year-old female with persistent diarrhea. Evaluate for colitis. ABDOMEN:LUNG BASES: Small bilateral pleural effusions and bilateral basilar atelectasis/consolidation. Small pericardial effusion.LIVER, BILIARY TRACT: Status post cholecystectomy. Focal area of hypoattenuation in segment 4 most compatible with focal fatty deposition due to inflow of chest wall collaterals. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys bilaterally, with multiple hypodensities too small characterize but most compatible with cysts.RETROPERITONEUM, LYMPH NODES: Multiple small lymph nodes in upper abdomen. BOWEL, MESENTERY: Large ventral hernia containing stomach and multiple loops of small and large bowel, without evidence of obstruction.BONES, SOFT TISSUES: Multiple collateral vessels are seen in the upper abdominal wall. Mixed sclerotic and lucent changes in the bones are most compatible with renal osteodystrophy.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis affects the distal colon, without evidence of diverticulitis. There is minimal wall thickening in a short segment of the sigmoid colon, which is suspected to be due to lumen collapse although minimal colitis is also a possibility (series 5, image 96).BONES, SOFT TISSUES: Mixed sclerotic and lucent changes in the bones are most compatible with renal osteodystrophy.OTHER: No significant abnormality noted	1.Minimal wall thickening in sigmoid colon is likely due to under distention, however, very mild colitis is also a possibility.2.Diverticulosis without evidence of diverticulitis.3.Large ventral hernia containing stomach and bowel without obstruction.
Generate impression based on findings.	28 year-old female with right-sided abdominal pain. Evaluate for stone. Lack of intravenous contrast limits evaluation of solid organs. Lack of enteric contrast limits evaluation of bowel.ABDOMEN:LUNG BASES: Note is made of scattered pulmonary micronodules which are nonspecific but may be post infectious or postinflammatory. There is bibasilar scarring/atelectasis. No pleural effusion, pneumothorax, or focal consolidation.LIVER, BILIARY TRACT: Subcentimeter hypodensities in the liver are too small to characterize, but likely represent simple cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral calculi are identified. There is no evidence of perinephric fat stranding, hydronephrosis, or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A moderate amount of stool is noted throughout the colon. The appendix is normal in size and appearance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic focus in the S1 vertebral body, likely represents a benign bone island.OTHER: No significant abnormality noted	No acute intra-abdominal process. No findings to account for the patient's pain.
Generate impression based on findings.	46 year old female with recurrent pneumothorax, assess for loculation LUNGS AND PLEURA: Large right pneumothorax with multiple pleural adhesions. The right lung is mostly collapsed. Left streaky perihilar and basilar linear opacities indicate scarring and atelectasis.MEDIASTINUM AND HILA: Extensive pneumomediastinum. The mediastinum is shifted to the left. The heart size is normal. No lymphadenopathy.CHEST WALL: Extensive subcutaneous emphysema extends from the right chest wall superiorly into the neck and beyond the field of view.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	Large right pneumothorax with multiple pleural adhesions and collapse of the right lung as well as leftward mediastinal shift. Extensive subcutaneous emphysema and pneumomediastinum.
Generate impression based on findings.	52-year-old female with a history of follicular lymphoma. CHEST:LUNGS AND PLEURA: There is biapical scarring/atelectasis. Note is made of bilateral pulmonary micronodules some of which are calcified suggestive of prior granulomatous disease. There is no pleural effusion, pneumothorax, or focal consolidation.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: There is extensive bilateral axillary lymphadenopathy. Left axillary lymphadenopathy measures 2.1 x 1.5 cm (29; series 3). Note is made of supraclavicular lymphadenopathy.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: There is cardiophrenic lymphadenopathy. Note is made of extensive gastrohepatic and porta hepatus lymphadenopathy. Confluent gastrohepatic lymphadenopathy measures 7.5 x 5.1 cm (97; series 3). There is associated mild attenuation of the common hepatic artery which appears patent. There is extensive retroperitoneal lymphadenopathy. Periaortic lymphadenopathy measures 3.3 x 2.7 cm (120; series 3). There is bilateral inguinal lymphadenopathy. Right external iliac lymphadenopathy measures 3.8 x 2.2 cm (172; series 3).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: There is cardiophrenic lymphadenopathy. Note is made of extensive gastrohepatic and porta hepatus lymphadenopathy. Confluent gastrohepatic lymphadenopathy measures 7.5 x 5.1 cm (97; series 3).There is extensive retroperitoneal lymphadenopathy. Periaortic lymphadenopathy measures 3.3 x 2.7 cm (120; series 3). There is bilateral inguinal lymphadenopathy. Right external iliac lymphadenopathy measures 3.8 x 2.2 cm (172; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	Extensive lymphadenopathy involving the chest, abdomen and pelvis, consistent with the stated history of lymphoma, with reference measurements provided above.
Generate impression based on findings.	history of relapsing Ewing sarcoma. Rule out metastatic disease versus infection. CHEST:LUNGS AND PLEURA: Bilateral right greater than left pleural effusions with underlying compressive atelectasis/consolidation. The central airways are clear.MEDIASTINUM AND HILA: Left central venous catheter tip in right atrium. No mediastinal or hilar lymphadenopathy. No pericardial effusion. CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous hepatic parenchymal enhancement. No focal hepatic lesions are identified. The portal vein and its branches appear patent. No intrahepatic or extrahepatic biliary ductal dilatation is seen. Mucosal enhancement of the gallbladder with a small amount of pericholecystic fluid is noted. This finding is nonspecific and may be related to associated ascites in the abdomen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.BOWEL, MESENTERY: A moderate amount of abdominal and pelvic ascites is present. The colon is decompressed, limiting evaluation. However, there is mild mural thickening involving the ascending and transverse colon, compatible with nonspecific colitis. There is no evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality noted. Metallic density is again noted superior to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A moderate amount of abdominal and pelvic ascites is present. The colon is decompressed, limiting evaluation. However, there is mild mural thickening involving the ascending and transverse colon, compatible with nonspecific colitis. There is no evidence of bowel obstruction.BONES, SOFT TISSUES: Sclerotic and lytic foci involving the bilateral iliac wings and sacrum are again noted, compatible with known history of Ewing sarcoma.OTHER: No significant abnormality noted	Mild wall thickening of the ascending and transverse colon, compatible with a nonspecific colitis. Potential etiologies include infectious or inflammatory causes. Bilateral pleural effusions with underlying atelectasis/consolidation. Moderate amount of abdominal and pelvic ascites. Redemonstration of findings in the pelvis compatible with known Ewing's sarcoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	54-year-old female with hypoxia, rule out PE PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Moderate bilateral pleural effusions with associated compressive atelectasis. Mild interstitial thickening consistent with edema.MEDIASTINUM AND HILA: Moderately enlarged paratracheal and prevascular lymph nodes. The heart size is normal.CHEST WALL: Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Pneumobilia and foci of free intraperitoneal gas and ascites consistent with recent abdominal surgery.	1. Technically adequate exam without evidence of pulmonary embolus2. Moderate bilateral pleural effusions with compressive atelectasis.
Generate impression based on findings.	38-year-old female with abdominal pain, distention. Evaluate for obstruction, biliary disease. ABDOMEN:LUNGS BASES: Partially imaged filling defect in likely the right pulmonary artery (image 1, series #3) with associated moderate wedge-shaped area of consolidation opacity of the right lower lobe. While contrast timing is not optimal for evaluation of pulmonary arteries and the extent of the filling defect is not imaged, findings are suggestive of PE with infarction.Mild left basilar atelectasis is also noted. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 5-mm hypoattenuating right lower pole lesion is too small to further characterize.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: Myomatous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Trace free fluid in the pelvis, likely be physiologic.OTHER: No significant abnormality noted.	Findings suggestive of pulmonary embolism of the right pulmonary artery with infarction in the right lower lobe. Notably, this study is not optimal in detecting or characterizing extent of pulmonary embolism, and if clinically warranted, a dedicated chest CT pulmonary embolism protocol may be utilized.
Generate impression based on findings.	Cardiac arrest with altered mental status. There is diffuse bilateral hypoattenuation with loss of gray-white differentiation within the cerebral hemispheres. Mass-effect including complete sulcal effacement and cisternal effacement with crowding of the foramen magnum by cerebellar tonsils has increased since the prior examination (12/6/2013). Ventricles are ventricles are not dilated and the midline is intact. There is no intracranial hemorrhage.Orbits are unremarkable. There is complete opacification of left maxillary sinus which was demonstrated previously.	Diffuse loss of gray-white differentiation consistent with anoxic injury. Significant mass effect including cisternal effacement and crowding of foramen magnum by cerebellar tonsils in keeping with early herniation.
Generate impression based on findings.	29 year-old female with shortness of breath, rule out pulmonary embolism PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Multiple clusters of irregular cysts of varying sizes with thickened septa are present bilaterally in the upper and lower lobes. Adjacent scarlike opacities and few small groundglass nodules are also present. No pleural effusions.MEDIASTINUM AND HILA: The heart size is normal. Moderately enlarged prevascular and high paratracheal lymph nodes. The thyroid is diffusely enlarged.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	1. Technically adequate exam without evidence of pulmonary embolus2. Multiple clusters of cysts in both upper and lower lobes, the appearance and distribution of which is atypical for LAM, LCH and LIP. However, an atypical presentation of LCH is a leading possibility. Postinfectious etiologies might also be considered in the appropriate clinical setting.
Generate impression based on findings.	R/o obstruction vs other acute abdomen vs constipation; x-ray with gas-filled bowel loops History: hx CP/MR, chronic constipation ABDOMEN:LUNG BASES: The lung bases are clear without evidence of effusion or consolidation. No pericardial effusion is seen.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A gastrostomy tube is in place. A VP shunt catheter is noted with its tip in the right lower quadrant. There is moderate gaseous distention of the colon without evidence of obstruction. Moderate amount of stool is also noted. Colonic interposition between the liver and anterior abdominal wall is noted. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in place with a small amount of air within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A gastrostomy tube is in place. A VP shunt catheter is noted with its tip in the right lower quadrant. There is moderate gaseous distention of the colon without evidence of obstruction. Moderate amount of stool is also noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid is present in the pelvis.	No evidence of bowel obstruction. Moderate amount of stool is present within the rectum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	50 year-old male with difficulty moving tongue, tongue numbness and speech difficulty with mass seen on outside CT. There is mild asymmetry at the base of the tongue, although no discrete mass lesion is apparent. No significant lymphadenopathy is identified. The paranasal sinuses and mastoid air cells are clear. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are unremarkable. The parotid, submandibular, and thyroid glands are unremarkable. The major salivary glands are unremarkable and there is no evidence of sialolithiasis. There are atherosclerotic calcifications at the carotid bifurcations and a small crescentic intramural thrombosis on the right with approximately moderate stenosis. There is mild degenerative spondylosis. There is absence of ADA 20 and a large cavity affecting ADA 15 with associated partially imaged periodontal lucency. The partially imaged intracranial structures are grossly unremarkable.	1.Mild asymmetry at the base of the tongue, although no discrete mass lesion is apparent.2.Large cavity affecting ADA 15 with associated partially imaged periodontal lucency.
Generate impression based on findings.	52-year-old female with follicular lymphoma, never treated, evaluate Limited intracranial and orbital views are unremarkable. The visualized mastoid air cells and paranasal sinuses are clear.Diffuse bilateral cervical lymphadenopathy at all nodal stations. Reference right level IIa lymph node measures 1.5 x 1.6 cm (series 6 image 25). Reference left supraclavicular lymph node measures 1.5 x 1.0 cm (series 6 image 38). Bilateral axillary and retropectoral lymphadenopathy. Prominence of the adenoids and tonsillar lymphoid tissue.No exophytic mass or focal effacement of the aerodigestive tract. The thyroid gland, submandibular glands and parotid glands are free of focal lesions.The major cervical vasculature is patent. No suspicious osseous lesions are present. Scattered pulmonary micronodules in the visualized lung apices and mediastinal lymphadenopathy. Please see dedicated chest CT report from today's date further details.	Diffuse bilateral cervical lymphadenopathy at all nodal stations. Bilateral axillary and retropectoral lymphadenopathy.
Generate impression based on findings.	H/o intracranial bleed 2/2 HLH, coagulopathy. Now, loss of function in BUE, hands CT head: There are no new intracranial findings. Recently documented intraparenchymal hemorrhage is not visualized on today's examination. There is no intracranial mass, edema, or hydrocephalus. The midline is intact.CT C-spine: There is a right sided central venous catheter. There is diffuse stranding within subcutaneous fat including a hematoma layering along the right sternocleidomastoid. There straightening of the physiologic lordosis which is likely positional without loss of vertebral body or intervertebral disk height. There is no significant degenerative change are suspected spinal canal stenosis.	1.No acute intracranial abnormality including new hemorrhage. Sequela of prior intraparenchymal hemorrhages are not demonstrated due to evolution of blood products.2.Anasarca within neck soft tissues as well as a hematoma overlying the right sternocleidomastoid muscle.
Generate impression based on findings.	Reason: possible honeycombing seen on CXR History: hypoxic respiratory failure LUNGS AND PLEURA: Bilateral lower lobe predominant subpleural reticulation and basilar honeycombing. Patchy groundglass nodular opacities, especially on the right (image 52/94). Calcified granuloma left lower lobe.MEDIASTINUM AND HILA: Right venous catheter tip at RA/SVC junction. Left venous catheter tip at SVC azygous confluence. Coronary calcification. Calcified nodes consistent with healed granulomatous disease. Borderline cardiomegaly. Trace pericardial fluid.CHEST WALL: Degenerative change involving the spine. Small bilateral axillary lymph nodes. Nonspecific coarse calcifications involving the breasts bilaterally. Correlate with results of result dedicated breast imaging.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nasogastric tube extends beyond the field of view.	1. Bilateral and lower lobe predominant subpleural reticulation and basilar honeycombing, most consistent with UIP. Superimposed groundglass nodular opacities are nonspecific but can be due to infection, among extensive alternative considerations. Continued follow-up is recommended.2. Other findings as above.
Generate impression based on findings.	26-year-old female status post cesarean section with persistent tachycardia and hypoxia PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Small pleural effusions with bilateral basilar atelectasis. Mild bronchial wall thickening may reflect underlying reactive airway disease.MEDIASTINUM AND HILA: The heart size is normal. No mediastinal or hilar lymphadenopathy.CHEST WALL: Severe rotary scoliosis and kyphosis, with fusion of the posterior elements and disk spaces.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	1. Technically adequate exam without evidence of pulmonary embolus.2. Basilar atelectasis and small pleural effusions.
Generate impression based on findings.	Male 73 years old; Reason: 73 yo male with HCC with chronic etoh abuse. Please evalaute extent of disease prior to surgical resction. History: none CHEST:LUNGS AND PLEURA: Scattered micronodules are noted throughout the lung fields. No dominant mass lesion detected. Subpleural cystic and atelectasis is seen.MEDIASTINUM AND HILA: Small indeterminate hypoattenuating left-sided thyroid nodule.Mild cardiomegaly with pulmonary vascular congestion. Coronary artery and aortic calcifications noted.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..Cholelithiasis is noted in the gallbladder. There is mild intrahepatic and extrahepatic biliary ductal dilation. Portal vein: Patent Hepatic veins: PatentHepatic artery: Patent with conventional anatomyLesions: 2.6 x 2.6 cm lesion (image 34, series 11) in segment two, arterial enhancement yes, washout yes. This has decreased in size but has become more nodular than previous. SPLEEN: Mild splenomegaly.PANCREAS: Stable hypodense nonenhancing lesion with a few septations in the body of the pancreas, measuring 3.5 X 1.1 cm (image 55, 11) previously 3 x 1.1cm. No evidence of calcifications within it. Differential includes a mucinous cystadenoma versus IPMN vs. pseudocyst. Pancreatic duct is nondilated. No other focal lesions noted. No evidence of peripancreatic fat stranding.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple right renal cysts are noted.RETROPERITONEUM, LYMPH NODES: Small periportal lymph nodes in the setting of cirrhosis.Atherosclerotic disease of the aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVISPROSTATE, SEMINAL VESICLES: No significant abnormality noted.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	1. Cirrhotic morphology liver with mild splenomegaly with a lesion in segment 2 that meets the AASLD criteria for HCC. Hepatic vessels are patent.2. Stable predominantly cystic, septated lesion in the body of the pancreas. Differential includes a mucinous cystadenoma versus IPMN vs. pseudocyst. MRCP is recommended for further evaluation.
Generate impression based on findings.	57 year-old male with history of cheek mucosa cancer. Follow-up. CT head: There is no evidence of enhancing cerebral lesions to indicate metastasis. Ventricles and sulci are normal size. Gray-white matter differentiation is preserved. No evidence of extra-axial fluid collection. The orbits and mastoid air cells are unremarkable. Mucosal thickening is noted in the maxillary sinuses with mild mucosal thickening of the ethmoid air cells.CT neck:Status post right neck and right submandibular gland dissection. Mild thickening of the platysma underlying the right mandibular ramus with reticulation of the adjacent fat, likely due to postradiation changes. Stable appearance of asymmetry of the piriform sinuses. There is no evidence of enhancing mass within the neck or lymphadenopathy by CT criteria.The visualized aerodigestive tract is unremarkable without evidence of focal effacement or exophytic mass. Cervical vascular structures are intact. The right vertebral artery is small in caliber. Retropharyngeal course of the left internal carotid artery. The right submandibular gland is surgically absent. The right parotid gland appears atrophic. The left parotid, thyroid and left submandibular glands are unremarkable. The lung apices are clear. Dedicated CT chest is dictated separately.No focal osseous lesions identified. Redemonstrated degenerative changes in the cervical spine with mild retrolisthesis of C5 on C6 and associated degenerative endplate changes.	No evidence of intracranial metastasis. Posttreatment changes of the neck without evidence of mass or lymphadenopathy.
Generate impression based on findings.	57 year-old female with chest pain, epigastric pain and difficulty swallowing LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Patulous fluid filled esophagus with distal debris. Note is made of a right-sided aortic arch with aberrant left subclavian artery. No lymphadenopathy in the mediastinum or hila.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic hypodensities likely represent cysts.	1. Patulous fluid filled esophagus most consistent with achalasia, although an underlying obstructing mass or stricture cannot be excluded. 2. Right-sided aortic arch with aberrant left subclavian artery.
Generate impression based on findings.	52-year-old female with newly diagnosed tonsil squamous cell carcinoma, baseline scan. Status post right tonsillectomy. No enhancing intracranial lesions to suggest metastatic disease. No mass effect, edema, hydrocephalus or midline shift. No gross intracranial hemorrhage or intra-/extra axial fluid collections. The mastoid air cells and paranasal sinuses are clear. The orbits are unremarkable.Postsurgical changes of a right neck dissection. Hyperplastic, fairly symmetric tonsillar tissue without a focally enhancing measurable lesion. No exophytic mass or focal effacement of the aerodigestive tract. No soft tissue masses are present in the neck. No cervical lymphadenopathy by CT size criteria.Hypoattenuating thyroid nodules. The submandibular glands and parotid glands are free of focal lesions.Multilevel degenerative changes of the visualized cervicothoracic spine most pronounced at C6-C7 including endplate degenerative changes. No suspicious osseous lesions are present.The major cervical vasculature is patent. The lung apices are unremarkable. Please see dedicated chest CT from today's date for further details.	1. Hyperplastic, fairly symmetric tonsillar tissue without a focally enhancing measurable lesion.2. No cervical lymphadenopathy.3. No evidence of intracranial metastases.
Generate impression based on findings.	12 y/o F with relapsing Ewing sarcoma s/p SCT p/w new pleural effusion and persistent fevers. There has been interval resolution of bubbly secretions within the bilateral maxillary and sphenoid sinuses. However, there has been interval retention cyst formation within the right maxillary sinus and a residual retention cyst within the left maxillary sinus. There is also a small retention cyst within the left posterior ethmoid sinus. The frontal sinuses are clear. The nasal cavity is clear. The mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. There is no evidence of rim-enhancing fluid collections.	Interval resolution of bubbly secretions within the maxillary and sphenoid sinuses with residual retention cysts, but no evidence of acute sinusitis or abscess.
Generate impression based on findings.	83-year-old male status post large pelvic sarcoma resection, now with fever. ABDOMEN:LUNGS BASES: Small bilateral pleural effusions with associated compressive atelectasis. Small pericardial effusion.LIVER, BILIARY TRACT: Large solitary gallstone in the gallbladder without evidence of biliary obstruction. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney. Bilateral nephroureterostomy tubes are in place with left-sided proximal ureteral dilatation. Two right-sided exophytic simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric stranding adjacent to fluid collections. Described in detail below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is surgically absent. A Foley catheter is in place in a neobladder in the low pelvis.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical clips in the low abdomen and pelvis, presumably from recent resection. There are multiple fluid collections, largest left of the mid rectum adjacent to the suture line measuring approximately 9.1 by 5.0 cm containing debris, air, and an air-fluid level (image 128, series #3). Multiple satellite collections superiorly contain gas, debris and fluid with associated mesenteric stranding, and are likely tracking from the main large pararectal collection. Findings are concerning for a rectal leak and infection.BONES, SOFT TISSUES: Left inguinal hernia containing only mesenteric fat.OTHER: No significant abnormality noted.	1.Multiple gas containing fluid collections appearing to arise from the suture line in the mid rectum, concerning for infection from rectal leak. 2.Bilateral nephroureteral stents. Atrophic left kidney, with proximal ureteral dilatation.
Generate impression based on findings.	Reason: h/o HNC, RTC, com pare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Centrilobular and tree in bud nodular opacities, predominantly in the right middle lobe, highly suggestive of aspiration, are slightly improved. Scattered punctate micronodules, some of which are calcified, are unchanged. Emphysema and apical scarring. No suspicious pulmonary nodules. Calcified pleural plaques consistent with history of asbestosis exposure.MEDIASTINUM AND HILA: Coronary calcification. Debris in central airways consistent with aspiration.CHEST WALL: Right chest wall port has been removed. Degenerative change involving the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hypodensity in right lobe, too small to characterize (image 102/162)SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Presumed left adrenal adenoma is unchanged.KIDNEYS, URETERS: Scattered punctate calcifications presumably nonobstructive stones. Scattered subcentimeter hypodensities are too small to characterize but stable and presumably cysts.PANCREAS: Mild pancreatic ductal dilatation is unchanged.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: Degenerative change involving the lumbar spine.	No evidence of metastatic disease.
Generate impression based on findings.	Evaluate for abdominal pseudocyst. Patient is status post VP shunt. ABDOMEN:LUNG BASES: The lung bases are clear without evidence of consolidation or effusion. No pericardial effusion is seen.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild amount of abdominal and pelvic ascites is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: VP shunt catheter tip terminates in the right upper quadrant. There is no evidence of a CSF pseudocyst.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild amount of abdominal and pelvic ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	VP shunt catheter without evidence of CSF pseudocyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
Generate impression based on findings.	81 year-old female with abdominal pain, nausea, and vomiting. ABDOMEN:LUNG BASES: Right-sided predominant cardiomegaly.LIVER, BILIARY TRACT: Mild hepatomegaly with small amount of surrounding ascites fluid. Prominence of hepatic veins and intrahepatic IVC.SPLEEN: No significant abnormality notedPANCREAS: Minimal dilation of the pancreatic duct, without evidence of obstructing mass; this may be due to pancreatic divisum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cyst in right kidney measures 3.5 cm and contains thin septation without calcification, most compatible with Bosniak type II cyst (series 4, image 58). No hydronephrosis or perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites fluid. Scattered areas of mild bowel dilation without evidence of obstruction, which may be due to focal adhesions. No bowel wall thickening. No free intraperitoneal air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites fluid. Scattered areas of mild bowel distention without evidence of obstruction or wall thickening, which may be related to nonobstructing adhesions.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.No acute abnormality to account for patient's symptoms.2.Small amount of ascites fluid, distention of hepatic veins, and right-sided cardiomegaly, raising suspicion for right-sided heart failure.3.Right kidney cyst containing thin septation, most compatible with benign Bosniak type II cyst.4.Mild dilation of pancreatic duct without evidence of obstructing lesion. There is possibility of pancreatic divisum, which could be further evaluated with M.R.C.P. if clinically indicated.
Generate impression based on findings.	Reason: 56 y/o female with h/o LAD s/p bx c/f histo with previous CT with RUL nodule, check for progression of disease History: LAD LUNGS AND PLEURA: Small subcentimeter scarlike nodular opacity in the periphery of the right upper lobe (image 33/114) is unchanged. Punctate micronodules, some of which are calcified (especially in the left upper lobe) are unchanged. Apical scarring is unchanged. No significant new pulmonary nodules. MEDIASTINUM AND HILA: Scattered small subcentimeter nodesCHEST WALL: Small bilateral axillary lymph nodes.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.	Small subcentimeter nodular opacity in the periphery of the right upper lobe is unchanged and more suggestive of scarring than active infection. There are no new nodules or significantly enlarged intrathoracic lymph nodes.
Generate impression based on findings.	25-year-old male with RSV epiglottitis now with fever and hoarse voice, evaluate for abscess. There has been interval extubation. There is interval decrease in the degree of diffuse mucosal edema involving the supraglottic larynx and hypopharynx with relative sparring of the epiglottis. However, there is a more discrete areas of hypoattenuation that extends from the right aryepiglottic fold to the posterior hypopharyngeal wall that measure up to 6 mm in diameter, although this is difficult to delineate from the lumen of the aerodigestive track, which is effaced in this region. There is also a small retropharyngeal effusion without extension into the mediastinum. There are scattered mildly enlarged cervical lymph nodes, which are likely reactive. The orbits are unremarkable. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. There is scattered paranasal sinus opacification. The mastoid air cells are clear. The partially imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear.	Residual supraglottic an hypopharyngeal edema with a more discrete areas of hypoattenuation that extends from the right aryepiglottic fold to the posterior hypopharyngeal wall that measure up to 6 mm in diameter that may represent phlegmon or early abscess formation, although it is difficult to delineate this from possible intraluminal aerodigestive track secretions. Followup CT with regional oral contrast administration or ultrasound may be useful, if clinically warranted.
Generate impression based on findings.	57-year-old male with generalized abdominal pain, constipation. ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: Subcentimeter hypodensity in the inferior edge of right lobe, most compatible with cyst (series 80352, image 48). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is stranding and thickening of short segment of the sigmoid colon, as well as multiple diverticula in affected colon, most consistent with diverticulitis. Several foci of free intraperitoneal air present in the colon, consistent with microperforation (series 80352, image 104). Small amount of free fluid is present in the pelvis but no loculated fluid collection to suggest abscess. No obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	Diverticulitis of short segment of the sigmoid. Several foci of extraluminal gas in pelvis are consistent with microperforation, but no gross intraperitoneal free air is present. No evidence of drainable fluid collection.
Generate impression based on findings.	78 year-old male with metastatic thyroid cancer. CHEST:LUNGS AND PLEURA: Multiple nodules not significantly changed. Reference left lower lobe nodule measures 6 mm, previously measured 6 mm (series 5, image 73).MEDIASTINUM AND HILA: Reference pretracheal lymph node is stable, measuring 10 x 13 mm, previously measured 9 x 11 mm (series 3, image 25). However, a more inferiorly located none reference pretracheal node is increased in size, measuring 10 mm in short axis, previously measured 5 mm (series 3, image 34).Moderate coronary artery calcifications. The heart is normal in size without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Stable right lobe hypodensities most compatible with cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland nodule not significantly changed, measuring 4.5 x 1.8 cm, previously measured 4.4 x 1.4 cm (series 3, image 108). Again noted calcified left adrenal nodule.KIDNEYS, URETERS: Bilateral hypoattenuating lesions are not significantly changed, most compatible with cysts. Some of these lesions have attenuation higher than expected for simple cysts, and may be proteinaceous or hemorrhagic in nature, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Enlarged right external iliac nodes not significantly changed (series 3, image 189, 186).BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Expansile lesion arising from right acetabulum/ileum not significantly changed, measuring 5.2 x 4.9 cm, previously measured 5.1 x 4.8 cm (series 3, image 193).Multiple surgical clips in the pelvis.OTHER: No significant abnormality noted	1.No significant change in the innumerable pulmonary nodules.2.Mild increase in mediastinal lymphadenopathy.3.No significant change in expansile right pelvic lesion, right pelvic lymphadenopathy, and right adrenal lesion.
Generate impression based on findings.	Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Interval increase in size of left upper lobe multi-lobulated nodule abutting the mediastinum, measuring 18 x 10 mm on image 35/119. It was roughly 9 x 4 mm on prior image 31/130 in retrospect. Punctate micro-nodule in right middle lobe (image 72/119) is stable. No new pulmonary nodules.MEDIASTINUM AND HILA: Coronary calcification. Scattered small subcentimeter lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed subcentimeter right renal cyst.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: Degenerative change involving spine.OTHER: No significant abnormality noted.	Interval increase in left upper lobe pulmonary nodule suggestive of metastatic disease.
Generate impression based on findings.	Reason: Pt s/p alloSCT evaluate PNA. History: Evaluate PNA. LUNGS AND PLEURA: Right lower lobe groundglass opacity with slight centrilobular nodular component suggestive of infection. Aspiration may appear similarly.MEDIASTINUM AND HILA: Venous catheter tip at RA/SVC junction. Scattered small subcentimeter lymph nodes. Trace pericardial fluid.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.	Right lower lobe opacity suggestive of infection.
Generate impression based on findings.	21-year-old female with abdominal pain common generalized. Rule-out ovarian pathology versus appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal stomach, small bowel to the right lower quadrant. The colon is feces filled without abnormality seen. Appendix is well visualized and normal without periappendiceal inflammatory changes. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Normal uterus, and normal, adnexa without abnormal masses. Small amount of fluid in the endometrial cavity is seen, presumably physiologic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal stomach, small bowel to the right lower quadrant. The colon is feces filled without abnormality seen. Appendix is well visualized and normal without periappendiceal inflammatory changes. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	No abnormality seen in the abdomen or pelvis and no findings seen to account for patient's symptomatology.
Generate impression based on findings.	Reason: please eval pulmonary mucor and liver abscesses History: serial imaging, recently febrile CHEST:LUNGS AND PLEURA: Widespread consolidation with areas of cystic change and multiple nodules, worst in the right lower lobe but also present in the right middle and upper lobes is slightly increased in density though the overall distribution appears similar. Very small right pleural effusion. Left upper lobe pulmonary nodule (image 44/99) is unchanged. Background emphysema.MEDIASTINUM AND HILA: Venous catheter tip in SVC. Enlarged mediastinal nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Two hypodense lesions in the dome of the liver are stable given differences in technique. A subcentimeter hypodensity in the anterior aspect of the left lobe (image 99/155) is also stable given differences in technique. A fourth lesion in the inferior right lobe (image 134/155) was not within the field of view of the prior study.SPLEEN: A hypodense lesion in the spleen (image 83/155) likely also represents an abscess and was much better seen on current study due to IV contrast. It is grossly stable.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. Widespread consolidation with areas of cystic change and multiple nodules, worst in the right lower lobe but also present in the right middle and upper lobes is slightly increased in density though the overall distribution appears similar. Very small right pleural effusion. 2. Liver lesions are stable given difference in technique.3. Splenic lesion better seen on current study given presence of contrast. It is grossly stable and also likely represent an abscess.
Generate impression based on findings.	Male 85 years old; Reason: Pt is an 85 y/o male with prostate cancer, hematuria with foley in place, evaluate for upper tract lesion, CT urogram, 3D reconstruction, DELAYED VIEWS History: hematuria, prostate cancer ABDOMEN:LUNGS BASES: Large right pleural effusion noted. Smaller left pleural effusion. Bilateral compressive atelectasis. Heart is moderately enlarged in size with coronary artery calcifications.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..Cholelithiasis without cholecystitis. No intrahepatic or extrahepatic biliary ductal dilation Portal vein: Attenuated but patent Hepatic veins: PatentHepatic artery: Conventional anatomy and patentLesions: No definite lesions to suggest HCC are noted. Moderate to severe ascites is seen throughout the abdomen extending into the pelvis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic cyst noted off of the right kidney. Bilateral kidneys are atrophic. No stones or mass lesion detected. No hydronephrosis.Other too small to characterize lesions are noted in the right and left kidney.RETROPERITONEUM, LYMPH NODES: Moderate to severe atherosclerotic disease of the aorta and branch vessels are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive degenerative disease with surgical instrumentation of the lower lumbar vertebral bodies.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality notedBLADDER: The catheter seen within the bladder. Mild right nodular thickening of the bladder mucosa is seen, however including characterized given lack of full distention.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: Lytic lesion in the right iliac bone, worrisome for metastatic diseaseOTHER: No significant abnormality noted.	1.Cirrhotic morphology with ascites, and no evidence of HCC.2.Lytic lesion in the right iliac bone concerning for metastatic disease.3.Nonspecific indeterminate right nodular thickening of the bladder.
Generate impression based on findings.	27 year-old female with abdominal pain with peritoneal signs, rule-out appendicitis, free fluid. Diarrhea and bright red blood per rectum. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver is of diffusely homogeneously low attenuation, most likely representing diffuse steatosis. No focal lesions are seen in the liver, however, the presence of fat can obscure the presence of focal lesions. No abnormalities are seen in the, gallbladder or biliary tract.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel, and through the colon. No intrinsic bowel abnormalities are seen and no evidence of obstruction. Appendix is well visualized without wall thickening or peri-appendiceal inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Marked distention of the bladder without other abnormality seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel, and through the colon. No intrinsic bowel abnormalities are seen and no evidence of obstruction. Appendix is well visualized without wall thickening or peri-appendiceal inflammatory changes. No evidence of diverticulitis. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1. Diffuse hepatic steatosis. 2. No other significant abnormalities and no findings seen to account for patient's symptomatology.
Generate impression based on findings.	78-year-old male with metastatic thyroid cancer, reevaluate No mass effect, focal edema or suspicious enhancement is present to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact.Postsurgical changes of a thyroidectomy are again present. No significant change within the thyroid bed to suggest recurrent disease. Partially calcified nodule on the left side of the thyroid bed is unchanged. Reference small left level 4 nodule is difficult to distinguish and has not significantly changed in size measuring 0.4 x 0.4 cm (series 7 image 50), previously measured 0.4 x 0.4 cm. Reference right supraclavicular nonenhancing nodule is unchanged measuring 1.6 x 1.6 cm (series 7 image 62), previously measured 1.7 x 1.6 cm.Effacement of the fascial planes of the neck is unchanged and likely related to prior therapy. The aerodigestive mucosa is within normal limits. The parotid glands are small. The submandibular glands are unremarkable. The cervical vessels remain patent. Bilateral atherosclerotic vascular calcifications at the carotid bifurcations. The visualized lung apices are clear. Mediastinal lymphadenopathy. Please see dedicated chest CT from today's date for further details.Multi-level degenerative changes of the cervical spine most pronounced from C5 through C7 including neuroforaminal compromise without identification of suspicious osseous lesions.	1. Stable postsurgical and posttreatment changes without evidence of progressive disease in the neck or intracranial metastatic disease.2. Incompletely visualized superior mediastinal lymphadenopathy. Please see dedicated chest CT from today's date for further details.
Generate impression based on findings.	36-year-old male with abdominal pain, right lower quadrant; nausea, vomiting, and diarrhea.? Appendicitis. ABDOMEN:LUNG BASES: Bibasilar atelectasis, right greater than left. No pleural disease seen.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small benign cysts without other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal. Stomach and small bowel to the right lower quadrant. Colon is feces filled without diagnostic abnormality. Appendix is well-visualized and normal without periappendiceal inflammatory changes. No evidence of diverticulitis. No free mesenteric fluid seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal. Stomach and small bowel to the right lower quadrant. Colon is feces filled without diagnostic abnormality. Appendix is well-visualized and normal without periappendiceal inflammatory changes. No evidence of diverticulitis. No free mesenteric fluid seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1. No significant findings seen in the abdomen or pelvis. No findings seen to account for patient's symptomatology.
Generate impression based on findings.	70 year-old male with metastatic RCC. Evaluate for progression. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary metastases range in size from a few millimeters to largest lesion in the left lower lobe measuring 2.3 x 1.9 cm. Metastases exhibit progression in number and size from the previous exam.Moderate bilateral pleural effusions, right greater than left, with associated compressive atelectasis.MEDIASTINUM AND HILA: A 2.0-cm cystic left thyroid nodule is identified (image 7, series #3).An enlarged pretracheal lymph node measures 2.2 x 1.3 cm.New large filling defects in the right atrium and right ventricle may represent metastatic disease (image 68, series #3).Small pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple right lobe subcentimeter hypodensities are too small to further characterize. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: A new hypodense pancreatic lesion measuring 2.1 x 1.9 cm is concerning for new metastasis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. At least two heterogeneous, hypodense, ill-defined lesions of the left kidney, larger in the upper pole, measuring approximately 4.6 cm. These lesions were not seen on prior MRI dated 9/26/2013. Rapid progression is concerning for metastatic disease versus infection, favoring metastases in light of progression of disease in other sites.A left lower pole nonobstructing renal stone is unchanged.RETROPERITONEUM, LYMPH NODES: A retrocrural lymph node is slightly increased in size, measuring 1.9 x 1.7 cm (image 92, series #3). An aortocaval lymph node is also slightly increased in size, measuring 1.5 x 1.4 cm (image 120, series #3).BOWEL, MESENTERY: A solitary 2.5 x 1.3 cm peritoneal implant adjacent to the right lobe of the liver is identified.BONES, SOFT TISSUES: A new subcutaneous enhancing lesion within the right paraspinal muscles measures 2.1 x 2.0 cm (image 136, series #3). No lucent skeletal lesions to suggest bone metastases.OTHER: Mild ascites is noted.PELVIS:Streak artifact from orthopedic left hip prosthesis significantly limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place. A dependent bladder stone is noted, not previously seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip orthopedic prosthesis. Sclerotic bony lesion of the right ischium is unchanged. No lucent lesions to suggest bone metastases.OTHER: No significant abnormality noted	1.Significant interval progression of metastatic disease, including increase in size and number of pulmonary metastases, new peritoneal, pancreas, right atrium and ventricle, right paraspinal muscle, and likely left kidney involvement, and worsening adenopathy.2.New left renal lesions likely represent metastases, though infection remains a differential consideration. Recommend clinical correlation.3.Left renal and bladder calculi.
Generate impression based on findings.	Reason: 70 male with AML, neutropenic fever. r/o infiltrate History: Neutropenic fever LUNGS AND PLEURA: Linear scarring and atelectasis in left lower lobe. No evidence of consolidation. Scattered punctate calcified granulomas.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Degenerative change involving thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granulomas.	No evidence of pneumonia.
Generate impression based on findings.	Reason: assessment of lesion History: dka LUNGS AND PLEURA: Bilateral basilar subsegmental atelectasis.No suspicious nodules.MEDIASTINUM AND HILA: Large inhomogeneous thyroid goiter, predominantly involving the right lobe, which accounts for the peritracheal opacity described on the chest radiograph. The enlarged right lobe produces some degree of compression and deviation of the trachea.No significant lymphadenopathy. Calcified right hilar lymph nodes compatible with previous infection.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Probably defined hepatic hypodensities which are incompletely characterized, but most likely cysts.	Large goiter which accounts for the abnormality described on the chest radiograph. Basilar subsegmental atelectasis.
Generate impression based on findings.	Reason: eval for infection given worsening cough History: cough, leukemia LUNGS AND PLEURA: Very mild nonspecific bronchial wall thickening but no evidence of pneumonia.MEDIASTINUM AND HILA: Right PICC tip in right subclavian vein.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.	Very mild nonspecific bronchial wall thickening but no evidence of pneumonia.
Generate impression based on findings.	Reason: Pt with hx of HNC s/p CRT; please re-eval and compare to prior exams History: as above CHEST:LUNGS AND PLEURA: Moderate to severe centrilobular emphysema. Scattered pulmonary micronodules/intrapulmonary lymph nodes are unchanged. No new pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size normal without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic hypodense lesion in the right lobe is unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral, nonobstructive renal calculi noted. Multiple hypodense renal lesions noted on the left are unchanged versus 2012 though, again comparison to index scan (10/3/2005) shows slight growth involving the left lower pole (image 127/153). Though this may represent a complex cyst, a very slowly growing renal cell carcinoma cannot be excluded. Left renal cortical scarring, unchanged.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: Mild to moderate multilevel degenerative changes are noted.OTHER: No significant abnormality noted.	1. No evidence of metastases.2. Nonspecific left renal lesion unchanged. See above.
Generate impression based on findings.	Reason: substernal goiter History: substernal goiter LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Large heterogeneous thyroid goiter as previously described.The goiter extends retrosternally for a distance of approximately 5 cm, to the level of the main pulmonary artery and it produces marked compression and some inferior displacement of the left innominate vein. It is incompletely visualized in its superior extent.CHEST WALL: The goiter extends superiorly into the neck and is incompletely visualized on the current scan.No significant lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter water density hepatic lesion compatible with a cyst.	Large retrosternal thyroid goiter.
Generate impression based on findings.	72-year-old male with history of cholangiocarcinoma. Restaging. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules are identified. Stable right basilar linear scarring.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a right hepatic lobectomy and hepaticojejunostomy. Resolving pneumobilia. Stable hypodense left hepatic lobe lesion approximating water density is unchanged and likely represents a simple cyst. No intrahepatic biliary ductal dilatation. The portal vein and its branches are patent.An unopacified Roux limb approaches the resection margin and likely represents the ill-defined soft tissue density at the hepatic hilum noted on previous studies.Evolution of scarring at the dome in the area of previously seen postoperative fluid collection is identified and unchanged (image 85, series #5).SPLEEN: No significant abnormality notedPANCREAS: Atrophic, fatty replaced pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Redemonstrated soft tissue density surrounding the celiac axis and SMA, stable since at least 12/7/2011. Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic enlargement is noted, unchanged from prior study.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	1.Stable postsurgical changes of right hepatectomy and hepaticojejunostomy.2.Prostatic enlargement.
Generate impression based on findings.	62 year-old male with prostate cancer after 6 cycles of investigational therapy. ABDOMEN:LUNG BASES: Bilateral basilar pleural calcifications in subsegmental atelectasis/consolidation in right base, likely related to prior asbestos exposure.LIVER, BILIARY TRACT: Hypoattenuating, fluid density lesion in right lobe consistent with cyst (series 3, image 28). No suspicious liver lesions identified. Diffuse hypoattenuation of the liver parenchyma compatible with hepatic steatosis. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter renal hypodensities bilaterally too small to characterize but most likely represent benign cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Mild atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate sclerotic focus in L3 vertebral body not entirely specific but most consistent with bone island (series 3, image 64).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Focal hypodensity along right UVJ is most consistent with bladder diverticulum, not significantly changed (series 3, image 109).LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted	1.No definite evidence of metastatic disease.2.Punctate sclerotic focus in L3 vertebral body not entirely specific but most consistent with bone island; consider bone scan for better evaluation of bone metastases.
Generate impression based on findings.	Reason: baseline scan in patient with newly diagnosed tonsil SCC History: see above CHEST:LUNGS AND PLEURA: Linear scarring or atelectasis at the lung base. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral breast implants. Scoliosis.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate subcentimeter hypodensities in the dome and left lobe, too small to characterize.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.	No evidence of metastatic disease.
Generate impression based on findings.	79-year-old female with history of breast cancer presenting with pain at the hip joint, pelvic region and thigh, evaluate for right hip fracture There is a mixed sclerotic and lytic, cortically-based lesion in located at the lesser trochanter. Provided the patient's history of breast cancer, this is highly suspicious for a metastatic lesion. There is a break in the cortex at the medial aspect of the femur, inferior to the lesser trochanter that may represent a nondisplaced pathologic fracture. Degenerative arthritic changes affect the lower lumbar spine and sacroiliac joints. A sclerotic lesion in the left ilium adjacent to the sacroiliac joint.	Mixed sclerotic and lytic lesion in the right lesser trochanter is highly suspicious for a site of metastatic breast cancer with associated nondisplaced pathologic fracture.
Generate impression based on findings.	Reason: history of esophageal cancer, s/p chemoRT and surgery History: none CHEST:LUNGS AND PLEURA: Mild scarring at the right base.Large surgical clips in the right major fissure, unchanged.No suspicious nodules.MEDIASTINUM AND HILA: Status post esophagectomy and gastric interposition with no sign of recurrence.Interval herniation of the transverse colon into the mediastinum, extending within approximately 4 cm of the carina.No significant lymphadenopathy.Moderate coronary artery calcification.Interval resolution of a small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hepatic cysts.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: Previously described inhomogeneous soft tissue mass suggestive of an enlarged lymph node, now 29 x 23 mm, slightly increased from 24 x 21 mm previously. The rate of growth is unusually indolent for metastatic disease and other etiologies are possible.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.Status post esophagectomy and gastric interposition with interval herniation of the transverse colon into the mediastinum.2. Enlarged abdominal mediastinal lymph node with central necrosis, slightly increased since the previous scan.
Generate impression based on findings.	71 year-old female status post catheter guided embolectomy PULMONARY ARTERIES: Massive right filling defect within the right main pulmonary artery extending distally with slight extension into the left main pulmonary artery appears similar to the prior exam. Enlargement of the main pulmonary artery is consistent with pulmonary hypertension.LUNGS AND PLEURA: Multiple pulmonary bilateral nodules, suspicious for underlying metastatic disease. Small right pleural effusion. Multiple pleural based nodules are also identified.MEDIASTINUM AND HILA: No significant lymphadenopathy. Straightening of the intraventricular septumCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis.	1. Unchanged massive filling defect within the right main pulmonary artery with associated enlargement of the main pulmonary artery and bowing of the interventricular septum.2. Multiple pulmonary nodules suggesting underlying metastatic disease.
Generate impression based on findings.	Reason: Pt with CA of the cheek mucosa. please re-eval . S/p CRT 2011. History: as above CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary micronodules, many of which are calcified, probably benign and unchanged. No new suspicious pulmonary nodules. Mild basilar atelectasis. Nodular calcified pleural plaques, likely asbestos related.MEDIASTINUM AND HILA: Coronary calcification. Scattered small mediastinal and hilar lymph nodes are 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: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Degenerative change involving the spine.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.	No evidence of metastatic disease.
Generate impression based on findings.	Basal cell carcinoma s/p maxillectomy and orbital rim resection. There are interval recent postoperative findings findings related to left maxillectomy and inferior orbital rim and floor resection with reconstruction of the orbital rim and floor with bone graft and reconstruction of the maxillectomy defect with soft tissue graft. A drainage catheter courses into the surgical bed and a left nasal stent is in position. There is diffuse edema within the soft tissue graft, as well as areas of possible mild hematoma formation medially. The orbital floor bone graft is displaced superiorly, impinging upon the inferior rectus muscle and globe. There is also mild stranding of the left orbital fat that may represent hemorrhage. There is no definite evidence of residual tumor, although assessment is limited by lack of intravenous contrast. The imaged intracranial structures are grossly unremarkable.	Interval left maxillectomy and orbital rim and floor resection with reconstruction, in which the orbital floor bone graft is displaced superiorly where it impinges upon the inferior rectus muscle and globe. Mild left orbital hemorrhage is also present.
Generate impression based on findings.	68 year-old female with shortness of breath on dialysis, rule out pulmonary nodules LUNGS AND PLEURA: Moderate centrilobular emphysema and scattered cysts. Right lower lobe nodules, the largest measuring 12 x 10 mm (image 51, series 5) with spiculation, suspicious for lung cancer. An additional 7 x 4 mm nodule is present in the right lower lobe (image 54, series 5). Scattered nonspecific micronodules. Scarring along the fissure on the right. Mosaic attenuation pattern.MEDIASTINUM AND HILA: Cardiomegaly. Moderate atherosclerotic calcifications of the coronary arteries and aortic arch. Multiple enlarged mediastinal lymph nodes, the largest in the superior mediastinum measuring 1.7 cm (image 67, series 3). Nonspecific left thyroid hypoattenuating lesion.CHEST WALL: No axillary adenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left hepatic hypodensity is partially visualized, incompletely characterized, but likely representing a cyst. Coarse left adrenal calcification.	1. 12-mm right lower lobe spiculated nodule suspicious for primary carcinoma. Additional 7-mm nodule and scattered micronodules are also noted.2. Moderate centrilobular emphysema.
Generate impression based on findings.	Reason: lung cancer, s/p chest RT. Pls c/w previous study and evaluate dz status and tx response. History: lung ca CHEST:LUNGS AND PLEURA: Severe upper lobe predominant centrilobular paraseptal emphysema. No new pulmonary nodules.Reference left hilar mass has decreased to 15 mm (image 47/153). Endobronchial extension of tumor and mucus plugging is less severe on current study. Aspirated debris is seen in the central airways.MEDIASTINUM AND HILA: AP window mass has decreased to 19 mm on image 42/153. Other smaller lymph nodes are grossly stable.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.	Interval decrease in reference measurements with no new sites of disease.
Generate impression based on findings.	59 year old patient status post L5-S1 decompression and fusion with pain and abnormal sensation to exclude cord compression. Postoperative changes are demonstrated including bilateral transpedicular screws at L5 and S1 and an interbody cage in the disk space with partial fusion related to the implanted bone graft. There is irregularity of the inferior L5 and superior S1 endplates with endplate sclerosis of S1. Alignment and vertebral body height is normal. Intervertebral disk space is normal at each level rostral to L5-S1. The conus medullaris is demonstrated at the L1 level.L1-2: There is no significant disk bulge or degenerative change. Spinal canal and neural foramen are patent bilaterally.L2-3: There is no significant disk bulge or degenerative change. Spinal canal and neural foramen are patent bilaterally.L3-4: There are degenerative facet changes and ligamentum flavum hypertrophy which do not result in significant canal or neural foraminal stenosis.L4-5: There is a diffuse disk bulge with degenerative facet changes and ossific material related to the decompression/fusion procedure. There is moderate-severe canal stenosis (6 mm AP) due to effacement from both anterior and posterior aspects. The L4 nerve roots exit above the most severe level of central stenosis though there is complete effacement of contrast along the nerve root sleeves as is visualized at other levels. The L5 descending nerve roots are impinged within the lateral recesses at this level as well.L5-S1: Laminectomy, screws and interbody cage are each demonstrated. There is no stenosis of the canal at this level. Nerve roots demonstrate a normal appearance as they exit the neural foramina bilaterally.	1.Postoperative changes related to decompression and fusion of L5-S1.2.Moderate-severe stenosis of the spinal canal at the L4-5 level where it measures 6 mm with severe bilateral foraminal narrowing and presumed impingement of the exiting L4 and descending L5 nerve roots bilaterally.
Generate impression based on findings.	70 year-old female with lung cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged. Moderate centrilobular emphysema. Apical and right basilar scarring.MEDIASTINUM AND HILA:. Marked interval decrease in size of necrotic mediastinal masses. Reference low right paratracheal mass measures 1.5 x 2.1 cm and previously measured 3.2 x 4.3 cm (image 29, series 3). Reference prevascular lymph node appears linear and scarlike, no longer discretely measurable (image 23, series 3). Moderate coronary arterial calcifications.Port catheter tip extends to the right atriumCHEST WALL: Right chest wall port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuation, likely focal fat infiltration, adjacent to the falciform ligament.SPLEEN: Splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple unchanged bilateral small hypodensities, likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged sclerosis in the left ilium.OTHER: No significant abnormality noted.	1. Marked interval decrease in mediastinal lymphadenopathy. No new lesions.

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