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Generate impression based on findings.
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Reason: history of head and neck cancer History: pulmonary opacities concerning for aspiration on last CT CHEST:LUNGS AND PLEURA: Left lower lobe opacities have improved, likely resolving aspirate or infection. However, there is new patchy interstitial and air space opacity in the right lower lobe with associated bronchial wall thickening as well as ground glass and solid nodular opacities in the right upper lobe (image 55/113 and 48/113). This is associated with debris in the right bronchus and more suggestive of aspiration than metastatic disease though continued follow-up is recommended.MEDIASTINUM AND HILA: Metallic fragments in the area of the anterior right ventricular wall and left chest wall.CHEST WALL: Small bilateral axillary lymph nodes not significantly changed. Metallic fragment possibly from a bullet, in the left anterior chest wall.ABDOMEN: Absence of IV and 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: Small upper abdominal lymph nodes unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube tip in stomach. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Left lower lobe opacities have improved, likely resolving aspirate or infection. However, there is new patchy interstitial and air space opacity in the right lower lobe with associated bronchial wall thickening as well as ground glass and solid nodular opacities in the right upper lobe. This is associated with debris in the right bronchus and more suggestive of aspiration than metastatic disease though continued follow-up is recommended to exclude metastases.
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Generate impression based on findings.
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Reason: Follow up scan for disseminated aspergillus History: none LUNGS AND PLEURA: Upper lobe cavitary nodule with an internal solid component, unchanged.A new small solid nodule in the left lower lobe adjacent to the major fissure (series 4/27).New small solid nodule in the right lower lobe (series 4,45).Small nodules in the right middle lobe, unchanged.Right lower lobe subpleural nodule, previously cavitary (series 4/57), not significantly changed in size.Moderate bilateral pleural effusions, slightly decreased on the left.Mild groundglass opacity of the lung bases suggestive of edema, not significantly changed.MEDIASTINUM AND HILA: Interval increase in an anterior mediastinal lymph node (series 3/57) now 14 mm in diameter.Soft tissue opacity in the pericardial fat anteriorly, unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Right renal cyst. Small left Bochdalek hernia.
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1. Several nodules are stable but some new small nodules have developed, compatible with fungal infection.2. Slightly decreased pleural effusions.
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Generate impression based on findings.
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84-year-old female with ataxia, rule out CVA There is a slightly hyperdense focus in the extra-axial space of the left frontal lobe measuring 0.8 x 0.5 cm (5/18) which is best seen on coronal images and was present on the prior MRI. There is no definitive acute intracranial hemorrhage or extra-axial fluid collection. The ventricles and sulci fall within normal limits for age. There is no midline shift or basal cistern effacement. There is moderate periventricular and subcortical hypodensities which is nonspecific but may represent small vessel ischemic disease, age indeterminate.The visualized portions of the paranasal sinuses and mastoid air cells are clear. The orbital contents are unremarkable. The osseous structures are unremarkable.
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1.Moderate periventricular and subcortical hypodensity is nonspecific but may represent small vessel ischemic disease, age indeterminate. Please note that CT is not sensitive for the early detection of nonhemorrhagic stroke and if there is strong clinical concern, a MRI may be obtained.2.Hyperdense focus in the extra-axial space of the left frontal lobe was present on the prior MRI 1/21/2013 and likely represents an extra axial lesion, which is nonspecific and could represent a small meningioma, or an engorged/chronically thrombosed cortical vein. 3.No definitive acute intracranial hemorrhage.
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Generate impression based on findings.
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Altered mental status Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.At C5-6 there is loss of disk space height and endplate and uncovertebral osteophytes. There is a disk bulge at this levelThe internal carotid arteries are deviated medially at the level of C2 and located immediately behind the nasopharynx at the midlineThe left common carotid artery originates from the innominate arteryBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery is identified and is intact. There is a large amount of a posterior cerebral arteries bilaterally with the hypoplastic P1 segmentsCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the distal internal carotid arteries.There is redemonstration of a hyperdense focus centered in the right centrum semiovale measuring 23 x 10 mm in axial dimensions which is unchanged when compared to the previous exam. There is mild asymmetry in the size of the frontal horns of the lateral ventricles right slightly larger than leftNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for aneurysm.2.No evidence for cervicocerebral occlusive disease3.there is redemonstration of a small lesion in the right centrum semiovale which is unchanged since prior exam which is suspected to represent an old focus of infarction
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Generate impression based on findings.
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84-year-old male with history of cystic mass in the head of pancreas. History of recurrent skin cancer. CHEST:LUNGS AND PLEURA: Status post right wedge resection. No significant change in mild soft tissue thickening and nodularity adjacent to suture material, likely representing scarring (series 13, image 33).Multiple lung nodules are mildly increased in size, largest in the right upper lobe measuring 6 mm, previously measured 5 mm (series 13, image 22). Increasing size of nodules can also be appreciated in more inferiorly located right upper lobe nodule (series 13, image 27), and pleural based left upper lobe nodule (series 13, image 33).Bilateral basilar scarring/atelectasis.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Stable moderate pericardial effusion and mild ectasia of the ascending aorta. No significant lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating liver lesions compatible with cysts, not significantly changed. No biliary ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: Since 2011, there has been development pancreatic duct stone in mid pancreas, with increase in dilation of upstream pancreatic duct, currently measuring 11 mm in maximal diameter (series 11, image 92). Innumerable cystic lesions are mildly increased in size; largest lesion in the head of the pancreas measures 2.1 x 2.2 cm, previously measured 1.8 x 2.0 cm (series 9, image 46).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple subcentimeter hypoattenuating lesions in both kidneys, most compatible with cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large heterogeneous prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical clips in right inguinal region. Right hydrocele.OTHER: No significant abnormality noted
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1.Since 2011, development of stone in mid pancreatic duct with associated increase in upstream pancreatic duct dilation up to 11mm in diameter. The development of stone in this location is of unclear etiology, and may be due to underlying stricture although small neoplasm cannot be excluded. 2.Multiple hypoattenuating lesions arising from pancreatic parenchyma, largest in head, are mildly increased in size may represent IPMNs.3.Mild increase in size of lung nodules.
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Generate impression based on findings.
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Airway narrowing due to multinodular goiter. There is enlargement of the left thyroid lobe and isthmus, which collectively measures up to 5.4 AP x 4.7 RL x 7.7 cm. In addition, the left thyroid lobe is heterogenous, with a dominant nodule that measures up to 3.1 cm. The right thyroid lobe is mildly enlarged as well, although no discrete nodules are identified. There is mild shift of the trachea and esophagus to the right with mild airway narrowing, in which the trachea measures a minimum of 13 mm transversely. There is mild nonspecific diffuse prominence of the adenoids and lingual tonsils, which also contain tonsilloliths. The major salivary glands are unremarkable. There is no significant lymphadenopathy. There is mild multilevel degenerative spondylosis. The partially imaged intracranial structures are grossly unremarkable. There is a groundglass opacity in the right lung apex that measures up to 18 mm.
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1. Enlarged thyroid gland, particularly the left lobe and isthmus with multiple nodules, the largest of which measure up to 3.1 cm and mild associated tracheal narrowing and deviation. Thyroid ultrasound and FNA may be useful for further characterization of the thyroid nodules.2. A ground-glass opacity in the right lung apex that measures up to 18 mm, which may be neoplastic or inflammatory. A dedicated baseline chest CT is recommended for further characterization.Discussed with DR. Sarne at 11:30 AM.
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Generate impression based on findings.
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Reason: metastatic renal cancer, s/p 2 cycles of VEGF inhibitor History: s/s associated with metastatic renal cancer LUNGS AND PLEURA: Widespread micronodules, the vast majority are calcified. These are more suggestive of healed granulomatous disease than metastases. The largest noncalcifed nodule is 5 mm in the medial right upper lobe (image 15/96) Roughly 1 cm groundglass subsolid nodule in the right upper lobe (image 29/96) more suggestive of an indolent adenocarcinoma (primary lung) than metastatic disease. Continued follow-up is recommended.MEDIASTINUM AND HILA: Small lipoma adjacent to the left inferior pulmonary vein. Coronary calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status-post left nephrectomy with multiple upper abdominal nodules incompletely visualized but consistent with residual/recurrent disease. Please see recent MR for further details.
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1. Widespread micronodules, the vast majority are calcified. These are more suggestive of healed granulomatous disease than metastases though continued follow up is recommended. 2. Roughly 1 cm groundglass subsolid nodule in the right upper lobe suggestive of an indolent adenocarcinoma (primary lung).3. Status-post left nephrectomy with multiple upper abdominal nodules incompletely visualized but consistent with residual/recurrent disease.
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Generate impression based on findings.
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5-year-old male with history of T-cell lymphoma. End therapy evaluation. LUNGS AND PLEURA: No pulmonary nodule or mass is identified. No pleural effusion is seen. The central airways are clear.MEDIASTINUM AND HILA: Left central venous catheter tip in the distal SVC. Mild interval increase in size of anterior mediastinal soft tissue, likely indicating thymic rebound or hyperplasia.No hilar lymphadenopathy is identified. No pericardial effusion is seen.CHEST WALL: Prominent right axillary lymph node is unchanged in size. UPPER ABDOMEN: No significant abnormality noted.
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Increasing anterior mediastinal soft tissue, most consistent with thymic rebound/hyperplasia. Otherwise, no evidence of significant lymphadenopathy.
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Generate impression based on findings.
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Reason: h/o HNC, compare to previous, measurements pls, s/p CRT History: none CHEST:LUNGS AND PLEURA: Scattered micronodules predominantly within the subpleural regions and are unchanged. Reference nodule in in the right upper lobe measures 5 x 3 mm (image 51/108); previously measured 5 x 3 mm. Other micronodules are also stable.MEDIASTINUM AND HILA: Coronary calcification. Atherosclerotic calcification of the aorta and its branches. Punctate hypodense nodule in thyroid unchanged.CHEST WALL: Right chest wall port has been removed. Healed right sided rib fractures.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 small renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative change involving the spine.OTHER: No significant abnormality noted.
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Stable small pulmonary micronodules which are presumably postinflammatory. No definitive evidence of metastases.
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Generate impression based on findings.
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62-year-old male with fall and altered mental status Head:There is asymmetric enlargement of the extra-axial spaces on the left measuring up to 4 mm with CSF density fluid. No acute intracranial hemorrhage is evident. There are scattered periventricular hypodensities which are nonspecific but likely represent mild small vessel ischemic disease, age indeterminate. Hypoattenuating foci in the right parietal and right occipital lobes likely represent age indeterminate strokes. A hypodensity in the right basal ganglia may represent perivascular space or old lacunar infarct. The ventricles and sulci fall within normal limits for age. There are no intracranial masses, midline shift, or basal cistern effacement. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is right periorbital soft tissue swelling. There is no retrobulbar hematoma. The osseous structures of the head are unremarkable. Extensive vascular calcifications are noted throughout the carotid arteries.Cervical spine:There is no evidence of acute fracture or malalignment. There is a retroflexion of the odontoid without underlying fracture. Calcification of the longus coli tendon is evident. There are multilevel degenerative changes, most prominent at C5-C6 and C6-C7 with degenerative changes and endplate erosions. There is mild loss of vertebral body height at C5-C6, likely chronic. Extensive carotid and vertebral artery calcifications are noted. The apex of the right lung is opacified with volume loss. There is no prevertebral soft tissue swelling. The airway appears patent. The thyroid gland is unremarkable.
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1.No acute intracranial hemorrhage.2.Hypoattenuation in the right parietal and right occipital lobes likely represent age indeterminant infarcts. Hypodensity in the right basal ganglia represents either an old lacunar infarct or perivascular space. Mild age indeterminant small vessel ischemic disease. 3.Minimal asymmetry of the extra-axial spaces with enlargement of the left extra-axial space.4.Degenerative changes of the cervical spine without fracture. If there is clinical suspicion for cord or ligamentous injury, an MRI is recommended.5.Volume loss and opacification of the partially visualized right lung apex.6.Right periorbital soft tissue swelling.
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Generate impression based on findings.
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5 year-old male with T-cell lymphoma. End therapy evaluation. The orbits are unremarkable. The mastoid air cells are clear. A small pocket of air seen in the pre-medullary cistern on the prior exam is no longer seen.There are frothy materials in the maxillary and ethmoid sinuses. There is no mass or adenopathy in the neck. Small lymph nodes in bilateral neck remain stable, and are within normal limits based on size criteria.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Limited view of the chest is unremarkable. Again noted is a left subclavian venous catheter.
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1. Stable small lymph nodes in bilateral neck. No evidence of neck mass or lymphadenopathy.2. Evidence suggestive of acute sinusitis.
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Generate impression based on findings.
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75-year-old female with malignant neoplasm of the mouth, status post CRT, reevaluate Redemonstration of surgical changes from a left neck dissection with lymph node dissection. No evidence of residual or recurrent disease.No exophytic mass lesions or mucosal enhancement is present in the aerodigestive tract. Again seen are extensive postoperative changes in the left floor of the mouth with loss of fascial planes and nonspecific infiltration of subcutaneous fat. No enhancing mass lesion is identified in the surgical bed. Irregular contour of the laryngeal folds is similar to the prior.No cervical lymphadenopathy by CT size criteria. The airway is patent. The thyroid gland is nodular which is unchanged. The right submandibular gland is atrophic due to posttreatment changes. The left submandibular gland is absent, likely postsurgical.Moderate multilevel degenerative changes are again present in the cervical spine worst at C4-C5 and C5-C6. Postsurgical changes of a partial left mandibular resection with bone graft and plate reconstruction appearing similar to the prior. The cervical vasculature is patent.Limited intracranial and orbital views are unremarkable. Limited views of the paranasal sinuses and mastoid air cells are clear. The visualized lung apices are clear.
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Stable postoperative changes of a left neck dissection. No definite evidence of residual or recurrent tumor. No evidence of cervical lymphadenopathy.
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Generate impression based on findings.
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8 year-old female with hearing loss. CT RIGHT TEMPORAL BONEThe pinna is normal. The mastoid is well developed with clear air cells and intact trabeculae. The external auditory canal is normal. The middle ear cavity is aerated. The malleus, incus, and stapes are normal. The oval and round windows are normal. The inner ear structures (cochlea, vestibule, and semicircular canals) are normal. The cochlear and vestibular aqueducts are normal. The tegmen tympani appears intact. The facial nerve canal is normal. The carotid canal, sigmoid sinus plate, and jugular fossa are normal. There appears mild increase in height at the midportion of the internal auditory canal. The porus and aperture are normal in size. CT LEFT TEMPORAL BONEThe pinna is normal. The mastoid is well developed with clear air cells and intact trabeculae. The external auditory canal is normal. The middle ear cavity is aerated. The malleus, incus, and stapes are normal. The oval and round windows are normal. The inner ear structures (cochlea, vestibule, and semicircular canals) are normal. The cochlear and vestibular aqueducts are normal. The tegmen tympani appears intact. The internal auditory canal including porus and aperture is normal in size. The facial nerve canal is normal. The carotid canal, sigmoid sinus plate, and jugular fossa are normal. There appears mild increase in height at the midportion of the internal auditory canal. The porus and aperture are normal in size. There is minimal mucosal thickening and fluids in the right sphenoid sinus.
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1. Normal CT appearance of the otic capsule, labyrinthine windows, and internal auditory canals apart from somewhat patulous appearance of the bilateral internal auditory canals.2. No CT evidence for abnormality of the ossicles and middle ear cavity.
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Generate impression based on findings.
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32 male with history of metastatic adenoid cystic carcinoma. LUNGS AND PLEURA: Multiple bilateral pulmonary masses consistent with metastatic disease are mildly increased in size since the prior exam. For reference one right middle lobe nodule measures 1.9 x 1.4 cm and previously measured 1.6 x 1.2 cm (image 42, series 4). A left upper lobe nodule adjacent to the major fissure measures 1.9 x 1.8 cm and previously measured 1.5 x 1.8 cm (image 34, series 4), also increased in size. No new lesions or pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Small hiatal hernia.CHEST WALL: No axillary lymphadenopathy. A shunt catheter extends inferiorly within the soft tissues of the right chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Multiple pulmonary metastases, mildly increased in size from the prior exam.
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Generate impression based on findings.
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Basal cell carcinoma. Neck: There are postoperative findings related to partial left anterior maxillectomy, left turbinectomy, and left orbital floor reconstruction. There is a lytic defect with associated soft tissue along the medial aspect of the left maxillary alveolus that measures 8 AP x 9 RL x 8 SI mm, which may represent residual tumor, although it is not significantly changed. More confluent soft tissue attenuation in the reconstructed left check extending superiorly to the inferior aspect of the left orbit is unchanged and may be post-treatment in nature. There is persistent soft tissue effacement of the left pterygopalatine fossa, which is also likely post-treatment in nature. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands appear unchanged. The major cervical vessels appear unchanged. The partially imaged intracranial structures are grossly unremarkable. There has been interval increase in size of multiple pulmonary nodules that are consistent with metastases, but are better delineated on the concurrent chest CT.Orbits: There is mild unchanged post-operative stranding in the inferior left orbital fat, but no evidence of discrete intraorbital mass lesions. There has been interval decrease in the degree of left lacrimal sac distention. There are bilateral lens implants.
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1. Extensive postoperative findings related to left maxillectomy with a lytic defect with associated soft tissue along the medial aspect of the left maxillary alveolus that measures up to 9 mm, which may represent residual tumor, although it is not significantly changed. No evidence of intraorbital tumor involvement and interval decrease in left lacrimal sac distention.2. Interval increase in size of multiple pulmonary nodules that are consistent with metastases, but are better delineated on the concurrent chest CT.
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Generate impression based on findings.
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Reason: restaging scans History: hx of head and neck cancer CHEST:LUNGS AND PLEURA: Scattered micronodules, many of which are calcified, are unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: Calcified left hilar lymph nodes. Aberrant right subclavian artery, normal variant.Nodule in right thyroid bed (image 8/136) please see dedicated neck CT report for further details.CHEST WALL: T10 vertebral body metastasis not significantly changed (image 69/136).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Surgical clips in region of right adrenal gland.KIDNEYS, URETERS: Stable renal hypodensities, presumably cysts.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.Small ventral hernia.BONES, SOFT TISSUES: L5 metastasis not significantly changed. Other smaller sclerotic foci in lumbar vertebral bodies unchanged.OTHER: No significant abnormality noted.
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1. Osseous metastases stable.2. See neck CT regarding measurements of tracheoesophageal groove mass in the neck.3. No new sites of disease.
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Generate impression based on findings.
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Female 34 years old; Reason: Assess vasculature prior to listing for kidney transplant History: Diminished peripheral pulses ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is unremarkable for unenhanced technique.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic area near the tail of pancreas likely represents fluid in the lesser sac or possibly an IPMN. Peri-splenic ascites.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal parenchyma is hyperdense. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild calcific chest carotid disease of the abdominal aorta. No aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Abdominal ascites.PELVIS:UTERUS, ADNEXA: Calcified soft tissue mass in the right adnexa measures 4.9 x 3.7 cm (image 87/series 3) is unchanged. There is additional soft tissue soft superior to this adjacent to the vessels which is new. Some of the lesions have imaging features suggestive of fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild calcific arteriosclerotic disease of the iliac vessels. Pelvic ascites.
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1.Mild calcific arteriosclerotic disease of the aorta and branch vessels.2.Partially calcified and noncalcified soft tissue mass arises from the uterus, further evaluation with ultrasonography is recommended.3.Upper abdominal and pelvic ascites.4.Nonspecific cystic area either in or around the tail of the pancreas, follow up is suggested
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Generate impression based on findings.
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Male 63 years old; Reason: Please evaluate degree of bowel obstruction and location of possible transition point in pt s/p cystectomy with neobladder History: Continued distention ABDOMEN:LUNG BASES: Coronary artery calcifications. Distal tip of the central venous catheter in the cavoatrial junction.LIVER, BILIARY TRACT: Numerous hepatic cysts. Calcified hepatic granulomata. SPLEEN: Calcified splenic granulomata. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Air in both renal collecting systems / pelves. Bilateral percutaneous small diameter ureteral stents, one extends from the right distal ureter and another from the left proximal ureter. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous fluid filled proximal loops are dilated with an abrupt transition in the distal ileum. Small bowel obstruction with transition point near the anastomosis in the right pelvis again is the summary of findings. The degree of proximal bowel dilatation appears slightly greater than previously. NG tube tip in the gastric body decompressing the stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy. BLADDER: Status post cystoprostatectomy. Foley catheter in a decompressed neobladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colon and rectum are decompressed from proximal small bowel obstruction. See abdomen above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Surgical drains in pelvis exit in both lower quadrants. Midline surgical skin staples. Left fat-containing umbilical hernia.
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1. Stable small bowel obstruction at or near the anastomosis in the pelvis, right lower quadrant. No interval change noted.2. Post-op changes of cystoprostatectomy and neobladder formation.
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Generate impression based on findings.
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Female 54 years old; Reason: history of breast cancer, pt receiving treatment - please eval for response/progression using measurements and compare with previous History: see above CHEST:LUNGS AND PLEURA: Moderately severe upper lobe emphysema.Reference left upper lobe pulmonary nodule measures 4-mm previously, 6 mm on image 46 series 6. Partially calcified soft tissue in the right anterior lung /chest wall adjacent to the middle lobe measures 5.9 x 2.4 cm (image 59/series 6) previously, 5.7 x 2.5 cm.Few other scattered nodules are not significantly changed..MEDIASTINUM AND HILA: Left chest wall port terminates at the cavoatrial junction.CHEST WALL: Sclerotic changes given the sternum compatible with metastatic disease. There is soft tissue mass posterior to the sternum that abuts the pericardium. Transverse lucency through the sternum most likely represent a pathologic fracture.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Decrease in the size of the left upper lobe pulmonary nodule.2.Stable size of the soft tissue in the right anterior chest wall with destruction of the sternum.
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Generate impression based on findings.
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Male 57 years old; Reason: history small cell prostate cancer on chemotherapy; assess for response History: none CHEST:LUNGS AND PLEURA: The right lower lobe pulmonary nodule measures 0.6 x 0.5 cm (image 78/series 5) previously, 0.8 x 0.6 cm. The pleural effusions have resolved.Additional pulmonary lesions are now evident for example on image 65 in the right lower lobe and image 64 in the left lower lobe.MEDIASTINUM AND HILA: Right paratracheal lymph node measures 2.0 x 1.4 cm (image 36/series 3) previously, 2.1 x 1.4 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There are least 7 hepatic lesions. A reference right hepatic lobe lesion measures 2.3 x 2.0 cm (image 99/series 3). These lesions were not evident on the prior noncontrast study. The lesion is not present on the study dated 7/24/2013.Status post cholecystectomySPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral percutaneous nephrostomy catheters. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Decrease in the retroperitoneal lymphadenopathy.. The reference aortocaval lymph node measures 1.4 x 1.1 cm (image 145/series 3) previously, 2.1 x 1.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Small foci gas within the urinary bladder.LYMPH NODES: Right obturator lymphadenopathy measures 3.5 x 2.1 cm (image 207/series 3) previously, 3.8 x 2.4 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable soft tissue nodularity in the right posterior lateral body wall. Degenerative changes affect the lumbar spine. Subtle sclerotic changes involving the superior and plate of the L2 vertebral body suspicious for possible metastatic disease.OTHER: Small amount of pelvic ascites that appears loculated in the right lower abdomen.
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1.Decrease in the size of the pulmonary, retroperitoneal and pelvic nodes.2.Multiple hepatic lesions highly suspicious for metastatic disease.3.Finding suspicious for metastatic disease to the superior endplate of the L2 vertebral body. Correlation with bone scan suggested.
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Generate impression based on findings.
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Female 43 years old; Reason: 43 yr old patient with ovarian cancer s/p recent surgery of the liver and additional chemotherapy post. eval disease process compare to scan prior to surgery 8-12-13 History: none CHEST:LUNGS AND PLEURA: Stable micronodules identified bilaterally. For example, 4-mm right middle lobe nodule is stable in size. No new nodules. No pleural effusion.MEDIASTINUM AND HILA: Referenced right paratracheal lymph node measures 10 x 0 .7 cm, previously measured in the same (image 36, 3). The Port-A-Cath at the junction of right atrium and SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion in the right lobe of liver is best seen on (image 93 , series 3), has increased in size measuring 2.9 x 1 .4 cm, previously 1.5 x 1.0 Cm. The attenuation has reduced to near water density, possibly suggesting response or necrosis.Referenced hypodense caudate lobe soft tissue lesion has markedly decreased in size now not measurable, previously measuring 3.2 x 1.6 cm (image 133). SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodensities in both kidneys are too small to be characterized.RETROPERITONEUM, LYMPH NODES: Multiple surgical clips are identified along the bilateral para-aortic regions.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Increase in size of the right lobe liver lesion, although now measures near water density which may represent positive response.2. Interval reduction/near resolution of the caudate lobe hypodense lesion.
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Generate impression based on findings.
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54-year-old female with metastatic breast cancer experiencing retro-orbital pain Redemonstrated is stable mild orbital proptosis. The orbits are otherwise unremarkable. The mastoids are clear. Limited view of the intracranial structures is unremarkable. The maxilla, mandible, sphenoid boned, nasal bones, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. Other than scattered small foci of mucosal thickening, the frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. Note is made of bilateral Haller cells. The nasal septum is deviated rightward with a right-sided septal spur. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Redemonstrated is stable mild orbital proptosis. The orbits are otherwise unremarkable. Specifically, there are no CT findings to explain the patient's new retro-orbital pain.
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Generate impression based on findings.
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Metastatic thyroid on treatment. Evaluate for disease progression. Head: There is no mass effect, edema, or abnormal enhancement to suggest intracranial metastases. The osseous structures are intact. The ventricles are stable in size and configuration. There is an unchanged partially opacified under-developed right mastoid. There are bilateral temporomandibular joint degenerative changes.Neck: There are postoperative findings related to total thyroidectomy. There is an unchanged heterogeneously enhancing mass within the right tracheoesophageal groove that measures 14 x 9 mm, previously 14 x 9 mm. No new lesions are identified within the thyroidectomy bed. There is no evidence of lymphadenopathy by size criteria. For example, a right level 1B reference lymph node measures 5 x 5 mm, which is unchanged. The aerodigestive track is unremarkable. The major salivary glands appear unchanged. The carotid and jugular vessels are grossly patent. There is an aberrant right subclavian artery. The osseous structures are unchanged. Refer to the separate chest CT for additional details.
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1.No significant interval change in the right tracheoesophageal groove recurrent tumor that measures up to 14 mm.2.No significant cervical lymphadenopathy. 3.No evidence of intracranial metastatic disease.
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Generate impression based on findings.
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Male 59 years old; Reason: squamous cell esoph ca, s/p chemo and RT. pls c/w previous study and evaluate dz status. History: esoph ca CHEST:LUNGS AND PLEURA: Mild scarring along the right major fissure in the right upper lobe is unchanged.No suspicious pulmonary lesions.Pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Trace pericardial effusion. Small mediastinal lymph nodes are unchanged.CHEST WALL: Right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has smooth contour. Hepatic and portal veins are patent. No suspicious hepatic lesions. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymph node measures 2.4 x 2.2 cm (image 84/series 3) previously, 2.5 x 2.1 cm.BOWEL, MESENTERY: Distal esophageal thickening is unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Near stable size measurements of the gastrohepatic lymph node. No definite new sites of disease.
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Generate impression based on findings.
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Severe asthma, worsened by sinus infections. There is mild left ands mild to moderate left maxillary sinus mucosal thickening that extends into the infundibula. There is near complete opacification of the bilateral ethmoid sinuses, with relative sparring of the left posterior ethmoid sinus. There is near complete opacification of the left sphenoid sinus and mild to moderate mucosal thickening of the right sphenoid sinuses. There is minimal mucosal thickening within the frontal sinuses. Many of the paranasal sinuses contain hyperdense secretions (measuring up to ~110 HU). The ethmoid roofs are nearly symmetric and grossly intact. The carotid grooves and optic canals are covered by bone. The lower nasal cavity is clear. There is minimal nasal septal deviation to the left. The mastoid air cells are clear. The partially imaged intracranial structures and orbits are grossly unremarkable.
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Pansinus opacification in a sporadic pattern.
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Generate impression based on findings.
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75-year-old male with a history of malignant neoplasm of bladder. Assess for upper tract urothelial cancer and/or metastatic disease. 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: Scarring at lateral midpole region of right kidney, with associated adjacent benign largest cyst, unchanged since 11/19/12. Remainder of right kidney parenchyma appears normal.Left kidney shows scattered and diffuse foci of poor opacification of the cortex in a striated pattern. This is nonspecific and usually not associated with malignancy and most commonly seen with either infection, vascular disease or obstruction. This finding is new since 11/19/12 No evidence of hydronephrosis is seen to suggest obstruction.Prompt and symmetric excretion of contrast material is seen on the 10 minute excretory sequence with normal-appearing pyelocalyceal systems bilaterally and no evidence of mass lesion. The ureters are moderately well opacified throughout their course without abnormality seen.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes seen in the aorta without evidence of aneurysm. Normal. Bifurcation is seen. No adenopathy or masses.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, adenopathy or other abnormality seenBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse degenerative changes without significant abnormality notedOTHER: No significant abnormality noted
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1. Scarring in right kidney and large benign right renal cyst without other parenchymal right renal abnormality. 2. Striated appearance to left kidney with foci of poor perfusion enhancement -- this is nonspecific, but not associated with urothelial cancer. Most often this relates to pyelonephritis, vascular disease and obstruction. No evidence of obstruction is seen. 3. No evidence for metastatic disease.
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Generate impression based on findings.
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T0N1 SCC of unknown primary completed CRT 52013. There are postsurgical findings related to bilateral selective neck dissection and tonsillectomy. There is no significant cervical lymphopathy by size criteria. No mass lesion is identified. There apparent closure of the laryngeal airway, which is likely physiologic in nature in combination with radiation-induced edema. There is an air-filled 6 mm diameter left laryngocele. The thyroid gland and major salivary glands are unremarkable. The major cervical vessels are grossly patent. The osseous structures are unchanged. The partially imaged intracranial structures are unremarkable. The partially imaged upper lungs are clear.
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No definite evidence of mass lesions or significant lymphadenopathy in the neck.
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Generate impression based on findings.
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Male 30 years old; Reason: r/o adenopathy; possible testicular cancer History: none ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter too small to characterize low-attenuation focus within segment 7 of the right lobe of liver best seen in image 24, series 3; favor benign etiology. No ductal dilatation. Hepatic vessels patent.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: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence for acute or metastatic process. No other abnormalities seen.
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Generate impression based on findings.
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Left-sided headache and facial pain with memory loss. There is focal area of white matter hypoattenuation extending from the left superior temporal gyrus through the supramarginal/angular gyri to the level of the inferior parietal lobule. There is subtle mass effect on the left ventricular trigone with no associated hydrocephalus, hemorrhage or calcification. There is no midline shift. There are no visualized contralateral lesions or midline shift. Orbits and mastoid air cells are unremarkable. There are no aggressive appearing bony lesions. Scalp soft tissues are unremarkable.
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Focal hypoattenuation within the left posterior temporal and parietal lobes associated with subtle mass effect. This finding is nonspecific, though further investigation with contrast-enhanced MRI is recommended as this could potentially represent a neoplastic lesion. Less likely differential possibilities include include inflammatory or infectious etiology.A note was made in the STATconsult program at the time of initial reporting (1:17 pm December 09, 2013)
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Generate impression based on findings.
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76-year-old secondary malignant neoplasm of other specified type melanoma of skin, examination of participant in clinical trial. IRB-10-666 re-evaluate disease status following discontinuation or drug due to intolerance CHEST:LUNGS AND PLEURA: Few micronodules are unchanged bilaterally. Referenced left lower lobe nodule measuring 5 mm (image 71, 4) is unchanged from prior study.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Reference AP window lymph node measures 0.8 x 0.6 cm (image 33, series 4) previously 0.8 x 0.6 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable left adrenal nodule measuring 1.7 x 1 .5 cm, previously measured 1.7 x 1.5 cm (image 106, series 3).KIDNEYS, URETERS: Stable hyperdense exophytic lesion arising from the left kidney (image 131, 3), most likely representing proteinaceous cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Few small retroperitoneal lymph nodes, not enlarged by CT criteria clenching from prior study.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: Stable bone island in the left femoral neckOTHER: No significant abnormality noted
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No interval change in pulmonary micro-nodules.No evidence of mediastinal or retroperitoneal lymphadenopathy.Stable left adrenal nodule.
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Generate impression based on findings.
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61-year-old female with metastatic cholangiocarcinoma -- restaging CHEST:LUNGS AND PLEURA: No change in scattered left lower lobe micronodules (for example, series 8022, image 36). No evidence for lesions, worrisome for metastasis. No pleural abnormality seen.MEDIASTINUM AND HILA: No adenopathy or masses. No significant abnormality noted.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of catheterABDOMEN:LIVER, BILIARY TRACT: The prior index lesion in segment 4 (series 3, image 84) now measures 5.0 x 4 .0 cm, previously 4.1 x 3.9 cm. there are numerous other small lesions throughout. The liver of varying appearances, some with faint enhancement and some with ill-defined low density appearance. All in location seen on prior examinations and most likely represent smaller foci of metastatic disease. These subjectively appear unchanged in size allowing for differences in contrast technique.Left breast stent remains in place in the common bile duct. Pneumobilia is present, indicating patency of the stent.Confluent density in the porta hepatis abutting the stent and extending into the hepatic hilum is again seen and represents progression of metastatic disease seen in the hilum. On series 3, image 84. This confluence measures 4.9 x 3 .6 cm, previously 4.3 x 2 .8 cm, but substantially increased when compared with 6/18/13 when this confluence mass measured 3.3 x 3.0 cm. due to this progression, the portal vein has progressively been narrowed and now on today's examination appears to be occluded as it courses through this mass with reconstitution or a thin channel persisting through to the intrahepatic portions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing right mid calyceal calculus, unchanged -- no other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental nodule in the right anterior abdomen (series 3, image 100) measures 1.9 by 1.6 cm, previously 1.4 x 1.0 cm. Additional omental nodule are seen. Deep in the pelvis as described in pelvis below.Orally administered contrast progresses through normal appearing stomach, small bowel to the colon without intrinsic abnormality or obstruction. Colon is feces filled without other abnormality. Scattered ascites is seen of a small amount.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: An enhancing mass with central low attenuation is seen in the peritoneum posterior to the uterus (series 3, image 163) measuring 3.4 x 1.9 cm. This represents a peritoneal metastasis which is increased in size when compared with prior 8/20/13 exam when this measured 2.1 x 1.5 cm and smaller on more remote scans.Orally administered contrast progresses through normal appearing stomach, small bowel to the colon without intrinsic abnormality or obstruction. Colon is feces filled without other abnormality. Scattered ascites is seen of a small amount..BONES, SOFT TISSUES: There is new mixed, sclerotic/lytic changes in the superior aspect of the sacrum (series 3, image 138), most consistent with a metastasis with some soft tissue extension into the sacral spinal canal. OTHER: No significant abnormality noted..
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1. No evidence of metastatic disease in the thorax. 2. Slight increase in size of index lesion in the liver with numerous other abnormal lesions most likely unchanged, but difficult to evaluate due to different contrast enhancement characteristics. 3. Increasing size of multiple peritoneal metastatic nodules. 4. Increasing aggregate confluence of masses in the porta hepatis which now markedly narrows and probably obstructs the portal vein. 5. New mixed sclerotic/lytic lesion in S1 indicative of new metastatic disease.
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Generate impression based on findings.
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Unspecified disorder of conduct. There is no intracranial mass, hemorrhage, hydrocephalus or edema. The midline is intact. Orbits and bones are unremarkable. Mastoids are aerated. There is mucosal thickening or secretions within the left maxillary and right posterior ethmoid sinuses.
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No intracranial abnormality demonstrated.
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Generate impression based on findings.
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Reason: history of NSCLC, s/p LUL lobectomy, now with new LLL nodule to be evaluated for change in size History: previous cough with sputum now resolved LUNGS AND PLEURA: Reference mass in the left lower lobe is slightly decreased and is now cavitary. It measures 35 x 23 mm on image 65/100. It has a thick wall. There is surrounding satellite nodularity with slight extension superolaterally (image 56/100) versus prior scan. Extensive emphysema is present. Multiple scattered subcentimeter nodules, unchanged. Emphysema.MEDIASTINUM AND HILA: Coronary calcification. Hiatal hernia. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Postop change on the left. Multilevel degenerative change with extension of calcified portion of a disk into the canal (image 95/103).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Adrenal nodules unchanged.
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Left lower lobe mass slightly smaller, though much of the change is size is likely attributable to the fact that the lesion is now cavitary; the wall of the mass is unchanged. It is not possible to differentiate between a lung abscess and malignancy in this instance as many of the imaging features can be seen in both. Close imaging follow up is recommended; the nodule would be amenable to transthoracic needle biopsy.
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Generate impression based on findings.
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Reason: History of metastatic breast cancer, evaluate for extent of disease History: History of metastatic breast cancer, evaluate for extent of disease CHEST:LUNGS AND PLEURA: Radiation reaction of the right apex.Increased size of a nodule posteriorly at the right apex (series 5/23) suspicious for a metastasis.Markedly increased right pleural metastases (arrows).Moderate right pleural effusion.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.Catheter tip in the right atrium.Tracheostomy tube in place.CHEST WALL: Necrotic right chest wall mass (series 3/70) measures 7.0 x 4.2 cm, not significantly changed.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: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Metastasis posterior to and compressing the IVC at its junction with the right atrium (series 3 /76) now measures 39 mm in transverse dimension, increased from 25 mm previously.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval increase in pulmonary, pleural and abdominal metastases.
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Generate impression based on findings.
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53-year-old female, status post liver resection for HCC and 22 -- evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Prior right hepatectomy and cholecystectomy with appearance unchanged from series of postoperative examinations. No evidence of recurrent liver mass is seen. No intrahepatic or extrahepatic biliary duct dilatation is seen. Portal venous, and hepatic venous branches all appear patent and normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left benign parapelvic, renal cysts, unchanged. No other abnormality seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No inherent abnormality seen in the stomach, small bowel, or large bowel. No free mesenteric fluid. Small anteroventral well hernia seen unchanged containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Status post right hepatectomy without evidence of recurrent or metastatic disease. 2. Removal of the prior noted gastric laparoscopic band.
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Generate impression based on findings.
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58 year-old male with pancreatic cancer. CHEST:LUNGS AND PLEURA: Stable left lower lobe nodule measuring 4 mm, previously measured 4 mm (series 4, image 79). Several other scattered nodules unchanged. No new suspicious nodules.MEDIASTINUM AND HILA: Subcentimeter hypodensity in left thyroid lobe unchanged. Stable prominent mediastinal lymph nodes. Right chest wall port catheter tip in distal SVC. Heart is normal size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: New thrombosis of intrahepatic portions of the right portal vein branches (series 3, image 100, 108). Increasing size of thrombus in main portal vein (series 3, image 109).Multiple subcentimeter hypodensities in the liver suspicious for metastases, not significantly changed.Hepatic veins patent.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple surgery. Ill-defined soft tissue lesion adjacent splenic vein and SMV confluence, not significantly changed, measuring 1.8 x 1.7 cm, previously measured 1.8 x 1.9 cm (series 3, image 111). Infiltrating soft tissue is also seen expanding inferiorly along the retroperitoneum and root of mesentery and encasing the superior mesenteric artery (series 3, image 122).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: As noted above, ill-defined soft tissues as well as enlarged lymph nodes are seen in retroperitoneum, not significantly changed. Multiple surgical clips are noted thereBOWEL, MESENTERY: Ill-defined soft tissue is seen extending along the root of mesentery, compatible with involvement by tumor and appearing not significantly changed. The superior mesenteric vein is encased by abnormal soft tissue and appears completely occluded, with multiple collateral vessels in the mesentery which reconstitute flow in the main portal vein.Haziness and subtle nodularity in mesentery suspicious for peritoneal carcinomatosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Complete occlusion of superior mesenteric vein, increased thrombus in main portal vein, as well as distal intrahepatic portal vein branches. 2.Infiltrative soft tissue around SMV and SMA origin, with extension along the root of mesentery and retroperitoneum, compatible with involvement by tumor and not significantly changed.3.Multiple ill-defined hypodensities in the liver most consistent with metastases, not significantly changed.4.Stable lung nodules.
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Generate impression based on findings.
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primary HPT, s/p parathyroidectomy in 10/2012 with persistently elevated Calciums, persistent primary HPT. Thyroid cancer There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):Right thyroid (image 9390: 125.3HU, 138.0HU, 146.9HU, 124.5HURight Carotid artery (image # 274 ):: 31.6HU, 361.0HU, 169.3HU, 146.8HURight Jugular vein (image # 274 ):: 43.7HU, 166.4HU, 191.7HU, 147.7HURight submandibular gland (image # 247 ): 9HU, 71.2HU, 106.4HU, 94.9HURight sternocleidomastoid muscle: (image # 274 ):35.4HU, 86.6HU, 84.1HU, 79.0HULymph node (image # 247 ): 29.8HU, 90.6HU, 190.9HU, 114.5HUNodule behind sternal notch image 462: (72.1HU, 97.1HU, 93.6HU. 87.3HU) - variable density due to artifactCT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The patient is status post thyroidectomy with some residual tissue at the thyroid bed suspected to represent thyroid tissue.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The mastoid air cells are clear. There is mucosal thickening in the right maxillary sinus. The ethmoid air cells and frontal sinuses and the upper parts of the maxillary sinuses are not included on this exam.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There degenerative changes present with uncovertebral osteophytes at the C3-4 where there is a narrowing of the right neural foramen.Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 480SUPERIOR VENA CAVA: 173INNOMINATE VEIN JUNCTION: 313LEFT INNOMINATE VEIN: 253LEFT INTERNAL JUGULAR VEIN, LOWER: 158LEFT INTERNAL JUGULAR VEIN,MID: 182LEFT INTERNAL JUGULAR VEIN, UPPER: 161RIGHT INTERNAL JUGULAR VEIN, LOWER: 204RIGHT INTERNAL JUGULAR VEIN, MID: 179RIGHT INTERNAL JUGULAR VEIN, UPPER: 198
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1.There is an equivocal lesion located at the sternal notch eccentric to the right which is indeterminate for parathyroid adenoma due to artifact.2.Status post thyroidectomy. Some thyroid like tissue is present in the thyroid bed.
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Generate impression based on findings.
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84-year-old female with history of SIADH. Rule out malignancy. Image reconstructions are distorted due to patient positioning, severe kyphosis.CHEST:LUNGS AND PLEURA: Unchanged right upper lobe micronodule. No suspicious nodules identified.MEDIASTINUM AND HILA: Bilateral previously noted thyroid nodules.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: Left adrenal nodule measures 2.8 x 2.0 cm, grossly unchanged from 3/11/2006.KIDNEYS, URETERS: Multiple bilateral simple cysts are noted. Other subcentimeter hypodensities are too small to further characterize.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Small ventral hernia containing only omental fat without evidence of complication (image 125, series 80324). BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Distended bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis of the sigmoid and descending colon, without evidence of diverticulitis. Rectal prolapse is noted causing thickened appearance of the rectal wall. Correlation with visual inspection or anoscopy may be utilized to exclude underlying neoplasm if clinically indicated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Stable nonspecific left adrenal nodule.2.Rectal prolapse.
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Generate impression based on findings.
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58-year-old female with history of metastatic breast cancer, evaluate extent CHEST:LUNGS AND PLEURA: Persistent right lower lobe collapse secondary to obstruction of the proximal bronchus intermedius by perihilar soft tissue encroachment. Right paramediastinal postradiation bronchiectasis and fibrosis.Reference right middle lobe nodule measures 2.0 x 1.7 cm and previously measured 2.1 x 1.4 cm (image 40, series 5).Reference left lower lobe nodule adjacent to the fissure measures 1.2 x 1.9 cm and previously measured 1.1 x 1.7 cm (image 35, series 5).Reference paramediastinal nodularity in the left upper lobe measures 2.4 cm and previously measured 1.3 cm (image 21, series 5). Additional nodule abutting the left mediastinum adjacent to the aortic arch measures 1.0 cm and previously measured 0.9 cm (image 26, series 5).MEDIASTINUM AND HILA: Port catheter tip extends to the cavoatrial junction.Reference, right lower paratracheal lymph node measures 10 mm and previously measured 7 mm (image 32 series 3).Right inferior mediastinal mass encasing the right inferior pulmonary vein and descending pulmonary artery also appears unchanged. Mild coronary arterial calcifications.CHEST WALL: Right chest wall port. Bilateral breast implants. Right axillary dissection. No axillary lymphadenopathy. Faint sclerotic focus in the T1 vertebral body is again noted. Right rib deformity compatible with prior fracture.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Reference right hepatic metastasis measures 1.3 x 1.8 cm and previously measured 2.6 x 1.7 cm (image 92, series 3). An additional hepatic lesion is stable to marginally smaller (image 87/151).SPLEEN: Small nonspecific splenic hypodensity is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic lymph node measures 1.8 x 0.8 cm and previously measured 1.9 x 1.2 cm (image 83, series 3).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Widespread metastases grossly stable (see above for measurements). No new sites of disease.
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Generate impression based on findings.
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Reason: metastatic breast CA to lung. evaluate for changes. History: none LUNGS AND PLEURA: Reference left upper lobe pulmonary nodule measures 10 x 7 mm on image 31/103, unchanged.Reference right lower lobe pulmonary nodule measures 8 x 6 mm on image 71/103, unchanged.Cluster of partially calcified nodules in perifissural left lower lobe (image 39/103) unchanged and consistent with healed granulomatous disease. Apical scarring and fibrosis unchanged. Mild emphysema. No new pulmonary nodules.MEDIASTINUM AND HILA: Hypodense right thyroid nodule unchanged. Venous catheter tip at RA/SVC junction. Coronary calcification. Small 10-mm precarinal lymph node (image 36/151) unchanged.CHEST WALL: Ill-defined lytic lesions within T2 and T12, unchanged. Stable minimal left chest wall loculated fluid collection, likely a seroma. Postsurgical changes from bilateral mastectomy with right breast prosthesis and right axillary lymph node dissection. No axillary lymphadenopathy. Right-sided chest wall port.Small subcentimeter nodule in subcutaneous tissues of right posterior back (image 37/151) unchanged over multiple previous. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left cortical scarring, unchanged.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.Hiatal hernia.BONES, SOFT TISSUES: Degenerative change and ill-defined lucency in L2, unchanged.OTHER: No significant abnormality noted.
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Stable pulmonary nodules. No new sites of disease.
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Generate impression based on findings.
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Right parotidectomy for metastatic melanoma with PET positive lung nodule and periauricular neck nodules concerning for metastatic disease, on a clinical trial with a response measured by PET. There are postoperative findings related to right parotidectomy with unchanged diffuse skin thickening at the operative site. There is no evidence of discrete mass lesion within the parotidectomy bed. There is no significant cervical lymphadenopathy by size criteria. The remaining salivary glands and thyroid are unremarkable. The osseous structures are unremarkable. There is an unchanged soft tissue structure in the right premalar fat pad that measures 8 x 17 mm. The major cervical flow voids are grossly intact. The partially imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear.
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No evidence of locoregional tumor recurrence of significant lymphadenopathy.
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Generate impression based on findings.
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Reason: T0N1 SCC of unknown primary completed CRT 52013. please re-eval and compare to prior scans History: as above CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are unchanged. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Previously noted supraclavicular lymph node is not in the field of view. Please see neck CT report for further details.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: Multilevel degenerative change involving the spine. The nonspecific sclerotic focus in L2 is unchanged.OTHER: No significant abnormality noted.
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Stable CT with no evidence of metastatic disease.
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Generate impression based on findings.
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48 year-old female with left flank pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Stranding around tail of the pancreas suggestive of pancreatitis. No fluid collection identified.ADRENAL GLANDS: Nonspecific thickening of adrenal glands bilaterally.KIDNEYS, URETERS: No evidence of hydronephrosis or renal stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the upper abdomen, most compatible with gastric bypass surgery. No evidence of bowel obstruction. Small amount of fluid is seen extending from left upper quadrant down left paracolic gutter.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis affects distal colon, without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stranding around pancreatic tail most compatible with pancreatitis, of unclear etiology. No fluid collections.
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Generate impression based on findings.
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50 year-old male with constant lower abdominal pain for one year. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver, 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 material rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant without intrinsic abnormality seen. Colon is feces filled and without diagnostic abnormality. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast material rapidly progresses through normal appearing stomach and small bowel to the right lower quadrant without intrinsic abnormality seen. Colon is feces filled and without diagnostic abnormality. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No diagnostic abnormality seen in abdomen or pelvis. No findings seen to account for patient's symptomatology.
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Generate impression based on findings.
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41 years old male with history of nasopharynx cancer, status post CRT. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Very mild right lateral nasopharyngeal soft tissue prominence is a stable finding and likely related to prior therapy. No focal mass or pathologic enhancement is seen to suggest recurrent disease. No pathologic adenopathy is identified in the neck.The aerodigestive tract is free of suspicious focal masses and enhancement. Edema of the pre-epiglottic space, epiglottis and aryepiglottic folds is stable and likely related to therapy. The glottis is unremarkable and the airway is patent throughout. The salivary glands and thyroid are unremarkable. The right internal jugular vein does not opacify below the level of the carotid bifurcation, a stable finding. Apical scarring and two right apical micronodules do not appear significantly changed. As noted on multiple prior exams, enlargement of the right foramen ovale relative to the left is stable. The medial right petrous air cells are also stably opacified. No suspicious bony lesions are seen.
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1.No evidence of recurrent disease or pathologic adenopathy in the neck.2.No intracranial metastatic disease.
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Generate impression based on findings.
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2-year-old male with history of pelvic sarcoma and left eye, please assess chemotherapy response. ABDOMEN:LUNG BASES: Minimal basilar dependent atelectasis. No pleural effusions. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Displacement of the bowel loops secondary to the known sarcoma without evidence of obstruction.BONES, SOFT TISSUES: Again identified is a mixed cystic and solid predominately right sided pelvic mass with heterogeneous enhancement. The size of this mass has significantly decreased from the prior study. In greatest dimension, and now measures 8.2 x 5 cm (image 72, series 3), previously measuring 9 x 9.9 cm. There is associated mass effect with cranial displacement of bowel loops. The mass continues to be inseparable from the right psoas and obturator internus muscles. The component invading the right obturator internus muscle and involving the right ischiorectal fossa appears to have increased in size from the prior study. The underlying bones do not appear to be involved.OTHER: No significant abnormality noted
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Overall significant interval decrease in size of pelvic mass consistent with history of sarcoma as discussed above. Involvement of the right obturator internus muscle has however increased.
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Generate impression based on findings.
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Metastatic left breast cancer to lung on treatment, need re- evaluation and compare to prior CHEST:LUNGS AND PLEURA: Multiple sub pleural bilateral pulmonary nodules. Referenced left upper lobe pulmonary nodule measures 7 x 5 mm on image 21, 4, unchanged from prior study, when it measured 7 x 5 mm. A right lower lobe pulmonary nodule measures 6 x 4 mm, previously measured 7 x 5 mm on image 53, 4, grossly unchanged from prior study. Centrilobar emphysema noted. No new lesions noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The morphology of the breast discontinuous enhancing masses appears slightly different from prior study, probably due to the difference in position of the breast however, overall appears unchanged from prior study.Enlarged conglomerate left axillary lymph node measures 2.8 x 1 .8 cm, previously measured 2.8 x 2 cm (image 21, 3), mostly unchanged from prior studyABDOMEN:LIVER, BILIARY TRACT: A few subcentimeter hypodense lesions in both lobes of liver are mostly unchanged from prior study. These most likely represent small cysts.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: Markedly distended stomach without evidence of any gastric outlet obstruction probably could be transient.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic changes of the abdominal aorta and its branches.PELVIS:UTERUS, ADNEXA: Few calcified fibroids noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Benign bone island with central lucency in the right iliumOTHER: No significant abnormality noted.
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1. Stable pulmonary nodules and left axillary lymphadenopathy.2. Markedly distended stomach without evidence of any gastric outlet obstruction, this probably could be transient, at the time of ingestion of oral contrast.
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Generate impression based on findings.
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49-year-old female with abdominal distention for 6 months. CHEST:LUNGS AND PLEURA: Paraseptal and centrilobular mild emphysema. Mild basilar atelectasis/scarring. Nonspecific micronodule in right lower lobe measuring 3 mm, likely benign in nature (series 6, image 43).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No suspicious liver lesions identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multi-loculated hypoattenuating material is present throughout the abdominal cavity, causing significant abdominal distention and consistent with pseudomyxoma peritonei.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiloculated hypoattenuating material is present throughout the abdominal cavity and pelvis, consistent with pseudomyxoma peritonei; while source is unclear, origin is likely from right ovary (series 4, image 164).Enlarged heterogeneous uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Multiloculated hypoattenuating material present throughout the abdominal cavity and pelvis, suggestive of pseudomyxoma peritoneum likely due to ovarian malignancy such as mucinous cystadenoma/cystadenocarcinoma of the right ovary.
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Generate impression based on findings.
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76-year-old male with hematuria. History of prostate cancer. Status post XRT. Evaluate upper tracts and bladder for tumor, also evaluate for kidney stones. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Two homogeneous, hypodense, unilocular lesions in the pancreatic head involving the head, larger, measuring 1.2 cm (image 71, series #6), likely representing IPMNs. Multiple punctate calcifications in the body and tail are also noted.ADRENAL GLANDS: Homogeneous, solid right adrenal nodule measures 1.6 x 0.9 cm approaches water density and meets criteria for benign adrenal adenoma.KIDNEYS, URETERS: Multiple bilateral simple cysts. In addition, multiple bilateral subcentimeter hypodensities are too small to further characterize. Right inferior pole 8mm nonobstructing renal calculus. No filling defect within the entire course of the ureters to suggest ureteral stone or other ureteral pathology.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:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis of the sigmoid colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.8mm right inferior pole nonobstructing renal calculus.2.Two pancreatic head hypodensities likely represent IPMNs.
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Generate impression based on findings.
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Reason: Pt with NPX Ca. s/p CRT; please re-eval and compare to prior scans History: as above CHEST:LUNGS AND PLEURA: Scattered benign appearing micronodules, but no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Small accessory splenules are present.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cystlike hypodensities.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases. Cholelithiasis is present.
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Generate impression based on findings.
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Reason: f/u aspergillosis, on posaconazole History: cough, lung abnormalities LUNGS AND PLEURA: Previously seen pulmonary nodules have decreased in size, and cavities have also diminished in size with decreased wall thickness.No new pulmonary or pleural abnormalities. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.A very small pericardial effusion has improved.Low attenuation of the circulating blood pool is consistent with anemia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. A hepatic cyst like hypodensities are unchanged.
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Interval improvement in pulmonary nodules and cavities.
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Generate impression based on findings.
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Reason: extensive stage small cell lung cancer with liver metastases s/p 6 cycles of chemotherapy, post-treatment scan History: none CHEST:LUNGS AND PLEURA: Right upper lobe mass measures 73 x 63 mm on image 20/128, grossly stable. On previous study a craniocaudal measurement was given; on current study this is 55 mm (image 44/71). Right upper lobe atelectasis is similar.Satellite nodules in the right lower lobe (image 36/99) are marginally increased, the reference nodule now measuring 6 mm. Other scattered micronodules are unchanged. No new pulmonary nodules.MEDIASTINUM AND HILA: Reference paratracheal lymph node measures 28 x 20 mm on image 29/128, slightly increased from prior of 18 x 17 mm.Atherosclerotic calcification of the aorta and branches. Coronary calcification.CHEST WALL: Degenerative change involving right shoulder. Degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Widespread hepatic metastases are stable in number though appear slightly increased in size, even when accounting for differences in the phase of contrast enhancement. For reference a mass in the left lobe measures 28 mm on image 93/128 and was 18 mm on prior study/image 94/132.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference nonspecific left renal lesion is stable a 12 x 9 mm on image 89/128. The right kidney is not imaged in its entirety. Other nonspecific renal lesions are stable.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic stent graft partially visualized.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Grossly stable right lung mass.2.Minimal interval increase in size of right upper lobe nodule.3.Slight increase in mediastinal lymphadenopathy.4.Increase in size of liver metastases.5. Stable reference left renal lesion.
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Generate impression based on findings.
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55 year old female with question of tracheomalacia LUNGS AND PLEURA: Bilateral reticular interstitial opacities with architectural distortion and traction bronchiectasis consistent with sarcoidosis are unchanged.The upper airway was rapidly scanned during forced expiration and the AP diameter of the airway compared with inspiratory images decreased from 19 to 14 mm, within normal limits. The remainder of the airways appeared within normal limits as well.MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes and small calcified hilar lymph nodes. ICD leads in expected location. Cardiomegaly.CHEST WALL: Left chest wall generator. Unchanged T7 vertebral body compression deformity.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Prominent lymph nodes in the upper abdomen, unchanged.
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No evidence of tracheomalacia. Chronic findings of sarcoidosis are unchanged.
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Generate impression based on findings.
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25 year-old female, 36 weeks pregnant, shortness of breath PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Pleural effusions, greater on the left. Widespread consolidation and ground glass opacities on the left. Mild bronchial wall thickening.MEDIASTINUM AND HILA: The heart size is normal. Prominent mediastinal and hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Technically adequate exam without evidence of pulmonary embolus.2. Extensive left pulmonary opacities consistent with pneumonia. Pleural effusions, larger on the left, and mild associated pulmonary edema.
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Generate impression based on findings.
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23-year-old female with abdominal pain -- assess for small bowel abnormality. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Benign perfusion defect in anterior left lobe of liver -- no other significant parenchymal liver abnormality seen. Portal and hepatic venous structures appear normal.Patient is status post cholecystectomy. No intrahepatic or extra hepatic biliary duct dilatation is seen to suggest biliary obstruction.SPLEEN: No significant abnormality notedPANCREAS: Punctate calcifications from prior granulomatous disease -- No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Low density near water contrast maximally distends the stomach and adequately distends the mid and distal jejunum and ileum. The proximal jejunum is only minimally distended. No evidence of any smaller large bowel abnormalities seen with no areas of focal wall thickening or abnormal enhancement. No areas of stricture or narrowing are seen and no evidence of dilatation to suggest obstruction.The appendix is not discretely seen, however, no evidence of any inflammation in the right lower quadrant or abnormal fluid collections are seen. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Low density near water contrast maximally distends the stomach and adequately distends the mid and distal jejunum and ileum. The proximal jejunum is only minimally distended. No evidence of any smaller large bowel abnormalities seen with no areas of focal wall thickening or abnormal enhancement. No areas of stricture or narrowing are seen and no evidence of dilatation to suggest obstruction.The appendix is not discretely seen, however, no evidence of any inflammation in the right lower quadrant or abnormal fluid collections are seen. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No abnormality seen in the abdomen or pelvis. Specifically, no small bowel. Abnormality identified.
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Generate impression based on findings.
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92 year-old female with abdominal pain. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions and basilar scarring/atelectasis. Severe coronary artery calcifications and calcification of mitral valve annulus.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Multiple granulomas compatible with prior granulomatous infection.PANCREAS: Calcification in pancreatic tail. Atrophy pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate hydronephrosis and hydroureter bilaterally. Hypoattenuating lesions in both kidneys, most likely benign cysts. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications throughout the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate compression deformity of T10 vertebral body. Severe degenerative changes affect lumbar spine, worst at L1-2.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Severe distention of rectum with large amount of fecal material, measuring 11 cm in maximal diameter. There is small amount of wall thickening of the rectum as well as small amount of presacral fluid, suggestive of stercoral colitis. Colon more proximally appears normal caliber.BONES, SOFT TISSUES: Orthopedic screws noted in proximal femur.OTHER: No significant abnormality noted
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1.Severe distention of rectum with large amount of fecal material and mild associated presacral fluid, most consistent with chronic impaction/stercoral colitis. 2.Severe degenerative changes affect the spine, including compression deformity of T10 vertebral body.
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Generate impression based on findings.
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Reason: 71 y/o male with met prostate cancer, lung nodules History: met prostate cancer, lung nodules LUNGS AND PLEURA: Multiple bilateral pulmonary nodules measuring from a few millimeters up to 17 mm in diameter, new since the previous scan, highly suspicious for metastasis.A reference right lower lobe nodule measures 10 mm in diameter (series 4/64).A reference left lower lobe nodule measures 17 mm in diameter (series 4/77).MEDIASTINUM AND HILA: Extensive mediastinal lymphadenopathy, increased compared to previous.A right paratracheal lymph node measures 12 mm in short axis diameter (series 3/36) compared to 11 mm previously.However a reference anterior mediastinal lymph node (series 3/30) has decreased from 11 mm to 8 mm in short axis diameter.Moderately severe coronary artery calcification.CHEST WALL: Multiple sclerotic metastases have developed throughout the spine, sternum and ribs.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited evaluation but no gross abnormalities.
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Interval progression of pulmonary, mediastinal and skeletal metastases.
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Generate impression based on findings.
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Acute myeloid leukemia in remission, s/p consolidation I chemotherapy per AML08, with persisting pancytopenia febrile despite improving neutropenia and broad spectrum antibiotics. The paranasal sinuses, nasal cavity, and mastoid air are clear. The facial soft tissues are unremarkable. The imaged intracranial structures and orbits are grossly unremarkable. The imaged dentition is unremarkable.
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No evidence of sinusitis.
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Generate impression based on findings.
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Reason: lung nodule History: lung nodule LUNGS AND PLEURA: Persistent right upper lobe consolidation which completely obscures the known right upper lobe nodule. Stable small loculated pleural air collection/pneumothorax just posterior to the suture line (image 30/112).Severe emphysema, grossly stable, with wall thickening and opacity surrounding a left posterior bleb or bullae (images 61/112). Underlying chronic interstitial abnormality is also unchanged. Postop change right middle lobe.MEDIASTINUM AND HILA: Multiple small roughly 1 cm mediastinal nodes are unchanged. Coronary calcification. Heterogeneous thyroidCHEST WALL: Postop change on the right.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Persistent right upper lobe consolidation obscures the known right upper lobe nodule and is not significantly changed.
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Generate impression based on findings.
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46 year old female with history of breast cancer, evaluate for PE PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Bilateral pleural effusions with adjacent compressive atelectasis. Bronchial wall thickening. Mild apical predominant emphysema. Aspirated debris in central airways.MEDIASTINUM AND HILA: The heart size is normal. No mediastinal or hilar lymph adenopathy. Venous catheter tip in SVC.CHEST WALL: Extensive postoperative changes of the anterior chest wall with clips and adjacent foci of gas and fluid, extending to the internal mammary chain. Bilateral surgical drains. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Technically adequate exam without evidence of pulmonary embolus.2. Bilateral pleural effusions and compressive atelectasis. Aspirated debris in central airways.3. Extensive postoperative changes of the chest wall.
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Generate impression based on findings.
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73 year old female with lung cancer CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema. Consolidation and atelectasis of the left upper lobe with peripheral cavity or loculated pleural air is unchanged. Small unchanged pleural effusion.Interval increase in size of multiple right pulmonary metastases. Reference lesion measures 2.6 x 2.3 cm and previously measured 2.4 x 2.0 cm (image 38, series 4).MEDIASTINUM AND HILA: Previously reported left subclavian vein thrombus is not appreciated on current study. Some of the imaging findings may have been secondary to mixing. Mildly enlarged mediastinal lymph nodes are not significantly changed. Coronary calcification.CHEST WALL: T8 compression deformity and left seventh rib fracture deformity, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Splenomegaly with multiple unchanged hypodensities.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged renal hypodensities, likely representing cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification of the abdominal aorta and its branches. Aneurysm at the origin of the SMA is again noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval increase in size of lung metastases.
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Generate impression based on findings.
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Reason: Apical lesions? History: Left Horner's syndrome LUNGS AND PLEURA: Benign-appearing micronodules, at least one calcified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered hepatic hypodensities too small to characterize but likely benign.
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No significant abnormality. Specifically, there are no findings to correlate with the patient's Horner's syndrome.
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Generate impression based on findings.
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7 year-old female with history of acute myeloid leukemia. CHEST:LUNGS AND PLEURA: Scattered upper bilateral upper lobe nodules are again noted. No new focal lung opacities identified. No pleural effusion. Minimal basilar dependent atelectasis is present.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is identified. Bilateral central venous catheter tips are in the SVC and right atrium.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously seen hypoattenuating foci in the peripheral aspect of the bilateral kidneys is not well visualized on today's exam, likely secondary to timing of contrast administration.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is focal short segment mural thickening of the descending colon. The remainder of the visualized colon is within normal limits. Mild amount of pelvic ascites is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Focal short segment mural thickening of the descending colon, likely representing a focal colitis.
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Generate impression based on findings.
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Unspecified cerebral artery occlusion with cerebral infarctionUnspecified disorders of arteries and arterioles. acute stroke, left side weak. eval for clot Neck CTA: There is opacification of the great vessels, carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The patient is status post bilateral endarterectomy in which the right one has a recent. Irregular surface of the right internal carotid artery is presumably related to recent surgery On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There is high-grade stenosis at the origin of the right subclavian artery from the innominate artery.There is interstitial emphysema present in the right neck status post recent right carotid endarterectomy with a drain in placeThere are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at C4-5, C5-6 and C6-7 associated with neural foraminal narrowing spinal canal narrowing.There is emphysema present in the upper lung fields. There is a large air filled cavity in the right upper lung field associated with the an air-fluid level there is associated pleural thickening in the bilateral lung fields there is interstitial lung disease present There is a left-sided pleural effusion presentThe patient is status post recent endotracheal intubationBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The anterior communicating artery is tiny. The right posterior communicating artery is small to medium sizedAtherosclerotic calcifications are present along the distal internal carotid arteries. .There is extracranial origin of the right posterior inferior cerebellar artery there the right vertebral artery is smaller than the left vertebral arteryCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. No early stigmata of cerebral infarction are appreciatedThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
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1.No evidence for acute intracranial cerebrovascular occlusion2.no evidence for acute intracranial hemorrhage mass effect or edema3.High grade stenosis at the origin of the right subclavian artery.4.Status post endarterectomy bilaterally without evidence for carotid stenosis. The irregular surface of the right internal carotid artery at the endarterectomy site is presumably related to the fact that the procedure was recently performed. Please correlate with surgical findings5.interstitial lung disease and emphysema6.findings are suspicious for a localized a pneumothorax with air fluid level. If clinically appropriate CT of the chest may be of further benefit7.pleural effusion on the left side8.the aortic arch was not included on this exam9.findings were discussed with Dr. Frank it in the procedure
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Generate impression based on findings.
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54 year-old female with dizziness, evaluate Evaluation of the supratentorial and infratentorial brain is limited by extensive streak artifact.Head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No gross abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No convincing evidence of edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:Straightening of the cervical spine. The vertebral body heights and disk spaces are relatively maintained without evidence of fracture or malalignment. There is no prevertebral soft tissue swelling. Within limits of CT, no findings to suggest significant central canal compromise.Heterogeneous left thyroid lobe goiter with calcifications. Several nonspecific prominent left level two cervical lymph nodes. The visualized lung apices are clear.
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1.Limited examination of the supratentorial and infratentorial brain secondary to artifact. Within these limitations, no gross acute intracranial abnormalities.2.No evidence of cervical spine fracture or malalignment.3.Heterogeneous left thyroid lobe goiter with calcifications. Ultrasound may be obtained for further characterization if clinically desired.
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Generate impression based on findings.
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Female 50 years old; Reason: 50 yr old patient with fallopian tube cancer s/p 6 cycles of IP chemo. eval for new baseline post treatment History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heterogeneous hypodensity in the left thyroid lobe is noted, incompletely characterized on the CT examination.Small pericardiac node of dubious clinical concern.CHEST WALL: Right Port-A-Cath noted with its tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Small cyst in the right lobe of the liver. No other lesion detected. Cholelithiasis without ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Incidentally noted are bilateral extrarenal pelvises.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Drain noted in the pelvis. No ascites or free fluid.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. Surgical staples seen along the lymphatic distribution.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sutures noted in the sigmoid.OTHER: No significant abnormality noted.
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1.No evidence of metastatic disease detected.
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Generate impression based on findings.
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64-year-old female with cholangiocarcinoma -- restaging CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Again noted is mild dilatation of the mid descending thoracic aorta with an AP dimension of 4.6-cm (series 3, image 37). Right anterior chest wall Port-A-Cath tip catheter in the distal superior vena cava, unchanged. No adenopathy or other masses.CHEST WALL: No significant abnormality noted with right chest wall port stable in appearance.ABDOMEN:LIVER, BILIARY TRACT: Biliary stents are unchanged in location. There is, however, no pneumobilia seen in the left lobe of the liver as seen on prior examination and slightly more prominent dilatation of the left lobe ducts -- patency of the stent cannot be ascertained. Right lobe does not appear to show dilatation of the intrahepatic ducts.No mass lesions in the liver parenchyma are seen to suggest metastatic disease. Portal vein is normal with the right branches appearing normal, however, poor visualization of the left branches are seen and most likely there is occlusion proximally with reconstitution of vessels distally similar to appearance on prior examination. There is increased soft tissue density along the medial posterior aspect of the two biliary stents in the porta hepatis (series 3, image 87, and this extends medially as well to what appears to be an enlarging lymph node (series 3, image 89) measuring 1.6 x 1 .7 cm, which previously measured 1.1 x 1.3 cm. This was described on prior report as soft tissue in the region of the porta hepatis being prominent.SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Left kidney has been removed. Right kidney again shows well-circumscribed lesion, unchanged in size and may represent a hyperdense cyst (series 3, image 122). No other abnormalities are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the colon without intrinsic abnormality. The sigmoid colon shows extensive diverticular changes with a muscular hypertrophy pattern, but without further complication. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Status post hysterectomy without other abnormality.BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the colon without intrinsic abnormality. The sigmoid colon shows extensive diverticular changes with a muscular hypertrophy pattern, but without further complication. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..
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1. Slight increase in soft tissue density and probable lymph node enlargement adjacent to biliary stents worrisome for increasing residual or metastatic tumor. 2. Increasing left hepatic lobe, biliary duct dilatation with no pneumobilia seen -- patency of the left stent is questioned. 3. No parenchymal liver lesions worrisome for tumor are seen on this examination although only one portal venous phases obtained unlike prior examination that included multiple phases..
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Generate impression based on findings.
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48-year-old male with lung cancer. Status post 4 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Multiple bilateral small micronodules predominantly subpleural and peripheral, are not changed from prior studies. Stable postsurgical changes in right middle lobe. No new nodules or areas of consolidation seen. No pleural disease identified.MEDIASTINUM AND HILA: No significant abnormality noted -- no adenopathy or change is noted.CHEST WALL: Left chest wall Port-A-Cath again seen with tip of catheter at the superior vena cava -- right atrial junction. Compression deformity with marked collapse of T6 vertebral body, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Reference right lobe parenchymal lesion (series 3 image 99.) Has decreased in size, measuring 2.8 x 2 .0 cm, 2.9 x 2.7 cm on 10/14/13. No other lesions worrisome for metastasis are seen with small scattered subcentimeter hypodensities, too small to characterize, but unchanged since May, 2012, and, most likely small cysts. Gallbladder and biliary tract appear normal.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 enlarged lymph nodes seen -- scattered small subcentimeter lymph nodes again noted unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable appearance to the sclerotic S1 midline lesion. No new lesions or abnormalities are seen elsewhere.OTHER: No significant abnormality noted
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1. Stable appearance of small, subcentimeter pulmonary nodules. 2. Decreased size of right hepatic lobe index lesion. 3. Stable appearance to T6 vertebral body compression deformity and sclerotic lesion S1.
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Generate impression based on findings.
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56-year-old man with metastatic renal cell carcinoma, hematuria, and abdominal pain. Evaluate for progression. CHEST:LUNGS AND PLEURA: Stable pulmonary micronodules. No areas of airspace consolidation or parenchymal lung masses. New bilateral pleural effusions, right greater than left.MEDIASTINUM AND HILA: New adenopathy is seen within enlarged left aortopulmonary window lymph node (series 8, image 41), which now measures 2.5 x 1.2 cm, previously 1.3 x 0.8 cm. Probably increased subcarinal adenopathy, although the pleural effusion makes this difficult to assess.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver shows marked heterogeneity with diffuse infiltration. Space-occupying lesions are difficult to measure. It is very difficult to compare to an MR exam of 9/19/13 due to technique differences, but the liver metastatic involvement has increased in extent diffusely. The prior reference lesion in the anterior aspect of the right lobe is difficult to isolate outwith the numerous adjacent lesions now. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass, predominantly enhancing with foci of necrosis within it measures 4.4 x 4.2-cm (series 8, image 116) unchanged from the MR examination 9/19/13. Right adrenal gland is normal.KIDNEYS, URETERS: Large left renal mass again seen and measures 6.3 x 7.4 cm (series 8, image 119). While this is larger than on prior examinations, it has markedly decreased. Its enhancement and vascularity, suggesting necrosis.The right renal mass previously described now measures 2.1 x 2.0 cm (series 8, image 139) reduced in size from 4/29/13 when it measured 3.1 x 3.2 cm, but slightly increased in size from the MR exam of 9/19/13 when it measured 1.9 x 1.6 cm.RETROPERITONEUM, LYMPH NODES: No change in the mildly enlarged retroperitoneal lymph nodes are seen with the largest in the aortocaval space (series 8, image 157) measuring 1.9 x 0.9 cm.. This is unchanged from MR exam, measuring 1.8 x 0.8 cm.Inferior vena cava does not show evidence of tumor thrombus as demonstrated on prior CT and MR. There is thrombus in the left renal vein to the distal left renal vein, but not into the inferior vena cava.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: Mildly enlarged inguinal lymph nodes are again identified. Minimally changed. The reference right inguinal lymph node (series 8, image 218) measures 1.2 x 1 .4 cm. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Bilateral renal cell carcinoma, which without increased in size has decreased its vascularity with tumor necrosis. 2. No change in size of large left adrenal mass. 3. No change in extent of left renal vein tumor thrombus, with no evidence of thrombus in the inferior vena cava. 4. No significant change in retroperitoneal reference, lymph nodes. 5. Increasing mediastinal (aortopulmonary) lymph node worrisome for metastasis. 6. Diffuse liver metastases difficult to compare with prior MR, but appears to have increased in its distribution.
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Generate impression based on findings.
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Male 39 years old; Reason: eval for kidney stone History: left flank 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: Numerous calcifications in the pelvis are likely phleboliths, although cannot entirely rule out a stone given inability to trace the ureters without IV contrast. No proximal dilation, hydronephrosis, perinephric stranding, or inflammation to suggest obstructing calculus.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: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: Left femoral plate and screws noted. Degenerative disease of the spine and hips are noted.OTHER: No significant abnormality noted.
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1.No kidney stones, hydronephrosis or perinephric stranding as clinically questioned.
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Generate impression based on findings.
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86 old male with chest pain. Evaluate for dissection. The lack of appropriate contrast timing limits evaluation of the solid organs. The lack of oral contrast limits evaluation of the bowel. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Mild coronary artery calcifications. Normal heart size. Mild atherosclerotic calcification of the thoracic aorta. There is no aortic enlargement nor displacement of intimal calcifications, which suggest against aortic dissection. However, given the technical limitations as described above, a small dissecting channel cannot be excluded.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Two simple cysts are noted in the left lobe of the liver. Cholelithiasis without evidence of cholecystitis. A 9-mm homogeneous, hyperdense structure in the territory of the head of the pancreas and adjacent descending duodenum. Differential includes a common bile duct stone in the ampulla, duodenal diverticulum with high-density debris or pill, or nonspecific pancreatic calcification. There is no intra-or extrahepatic biliary ductal dilatation, and lack of common duct dilatation with a stone of this size would be atypical. No other evidence of cholangitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches without focal ectasia. There is no aortic enlargement nor displacement of intimal calcifications, which suggest against aortic dissection. However, given the technical limitations as described above, a small dissecting channel cannot be excluded.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Findings suggest against aortic dissection, though limitations in technique compromise detection of a small dissection.2.Cholelithiasis.3.High-density focus in the area of the pancreatic head and adjacent descending duodenum may represent a common duct stone, duodenal diverticulum, or pancreatic calcification. No common duct dilatation or other evidence of cholangitis.
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Generate impression based on findings.
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Clinical question: Evaluate for mass. Signs and symptoms: Seizure. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is mild ectopia of cerebellar tonsils.Unremarkable cerebral cortex, cortical sulci, ventricular system and disuse of the spaces otherwise. The gray -- white matter differentiation is preserved.
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Minimally ectopic cerebellar tonsils and unremarkable head CT otherwise.
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Generate impression based on findings.
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Clinical question: Intracranial hemorrhage. Signs and symptoms: Fall, hit head. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Minimal periventricular and subcortical nonspecific low-attenuation white matter is noted. Although nonspecific findings are often result of age indeterminate small vessel ischemic strokes. Possibility of demyelinating process as well should be considered.Unremarkable sagittal cortex, cortical sulci, ventricular system and CSF spaces are.Unremarkable calvarium, scalp, orbits, paranasal sinuses and mastoid air cells.
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1.No acute posttraumatic findings.2.Nonspecific periventricular and subcortical low attenuation white matter as detailed above.
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Generate impression based on findings.
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56-year-old female with tachycardia, fallopian tube cancer, status post lysis of adhesions, rule out PE PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus.LUNGS AND PLEURA: Underinflated lungs. New moderate right pleural effusion with associated compressive atelectasis. Small left pleural effusion and left lower lobe atelectasis.MEDIASTINUM AND HILA: Multiple prominent mediastinal lymph nodes. Central venous catheter extends to the right atrium. Enteric tube extends to the stomach.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Evaluation of the liver is limited due to contrast phase. The liver appears diffusely enlarged and edematous. Low density lesion in the posterior right hepatic lobe is nonspecific, but may represent liquefaction or necrosis. Abdominal ascites.
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1. No pulmonary embolus.2. New pleural effusions, larger on the right, with associated lower lobe atelectasis.3. Diffuse hepatic enlargement and hypoattenuation with focal hypoattenuation in the posterior right hepatic lobe, which could represent liquefaction or necrosis. Recommend further clinical correlation and dedicated cross-sectional imaging if clinically warranted. Findings discussed with Dr. Brown (pager 9876) at the time of dictation.
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Generate impression based on findings.
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38-year-old male with left costovertebral angle tenderness, recurrent UTIs and history of kidney stones. Evaluate for renal stones. ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits evaluation of solid parenchymal organs and vasculature are as, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney appears normal. Two punctate calcifications are seen in the kidney, most consistent with nonobstructing calyceal calculus. Lack of IV contrast limits ability the tectum, renal masses. No hydronephrosis is seen. Ureters are not dilated and no calculus is seen in the course of the ureters. Left perinephric linear density is seen, most consistent with probable procedure, related to kidney stone disease with scarring. No perinephric fluid collections are seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterior, ventral hernia seen containing large and small bowel, without complication. The bowel shows no other intrinsic abnormalities and no free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder superpubic catheter. Collapsed bladder without other abnormality seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Anterior, ventral hernia seen containing large and small bowel, without complication. The bowel shows no other intrinsic abnormalities and no free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Two punctate left renal calculus without obstruction. 2. Large intra-abdominal wall ventral hernia without complication.
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Generate impression based on findings.
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Male 70 years old; Reason: hx small cell cancer of bladder, sp neoadj chemo and resction History: small cell bladder Lack of intravenous and enteric contrast limits evaluation of the solid organs and bowels. Given these limitations, the following findings were made:CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules are unchanged from the prior study. For example, 4-mm right middle lobe nodule is stable in size. No discrete new nodules or masses detected. Mild central lobular emphysema is again noted. No pleural effusion or consolidation.MEDIASTINUM AND HILA: Right port catheter in place with tip at the cavoatrial junction. Previously referenced precarinal lymph node measures 1.4 x 0.6 cm (image 43, series 3), not significantly changed from the prior study. The heart is normal in size and there is no pericardial effusion. Coronary artery calcifications are again noted.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right perinephric stranding is unchanged from the prior study.RETROPERITONEUM, LYMPH NODES: Extensive moderate to severe atherosclerotic disease of aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Superior endplate deformities of T12, L2, and L3 are unchanged from prior study.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post creation of neobladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of complication. Surgical sutures noted in the right lower quadrant along the cecum.BONES, SOFT TISSUES: Degenerative changes are again seen in the lumbosacral spine. Fluid collection at the superior portion of the right inguinal canal is unchanged from the prior study.
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No evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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43 year-old female with abdominal pain. Rule out diverticulitis. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The gallbladder is surgically absent with cholecystectomy clips in the gallbladder fossa. Stable small right hepatic lobe simple cyst.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: Nonspecific infiltration of mesenteric fat adjacent to a short segment of the distal descending colon is noted with a small moderate fluid in the left paracolic gutter. Fluid is also noted in the mid right pelvis tracking adjacent to the bladder. A diverticulum in the affected colonic segment is questioned, raising the possibility of a mild or early acute diverticulitis versus colitis. While these findings are not confidently differentiated from old scarring, scattered, diffusely enlarged mesenteric lymph nodes also support an acute inflammatory etiology. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A large 7.9 x 6.6 cm round, homogeneous, low density lesion arises from the right adnexa (image 125, series #3).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: Small amount of free fluid in the left paracolic gutter.
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1.Nonspecific infiltrative changes adjacent to a short segment of distal descending colon. While findings cannot be differentiated from old scarring, a mild or early acute inflammatory component of diverticulitis or colitis is favored.2.7.9-cm cystic lesion of the right adnexa. Follow up with pelvic ultrasound would be recommended if there is clinical suspicion for ovarian mass and/or torsion.
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Generate impression based on findings.
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72-year-old female with shortness of breath, chest pain, history of ILD PULMONARY ARTERIES: Large filling defect in the proximal left descending pulmonary artery propagating distally, organizing against the vessel wall. Additional eccentric filling defect in the right lower lobe pulmonary artery.LUNGS AND PLEURA: Bilateral basilar predominant, architectural distortion, interstitial fibrosis and traction bronchiectasis with minimal honeycombing.MEDIASTINUM AND HILA: Intrathoracic stomach. Prominent mediastinal lymph nodes. Enlargement of the main pulmonary artery with straightening of the intraventricular septum suggests pulmonary arterial hypertension with right heart dysfunction. Cardiomegaly.CHEST WALL: Status post right mastectomy. Multifocal sclerotic osseous lesions. T6-7 posterior osteophyte extends within the spinal canal.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Extensive atherosclerotic calcifications of the abdominal aorta.
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1. Bilateral lobar pulmonary emboli, likely chronic, with PA hypertension.2. Unchanged fibrotic interstitial lung disease may represent fibrosing NSIP or possible UIP pattern.3. Multifocal sclerotic osseous lesions suggestive of metastatic disease.
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Generate impression based on findings.
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35 year old female with right supraclavicular and chest wall swelling. SVC protocol. LUNGS AND PLEURA: Trace bibasilar dependent atelectasis. Small right pleural effusion. MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. There is a mildly enlarged right paratracheal lymph node measuring 9 mm (image 35, series 3). No hilar adenopathy. There is narrowing of the right subclavian vein at the thoracic inlet (image 28, series 3), probably not clinically significant. The right internal jugular vein and SVC are patent without thrombus or occlusion. There is loss of fat planes in the mediastinum, compatible with edema of the mediastinal fat. CHEST WALL: Soft tissue stranding in the right neck and right axilla, with mildly enlarged right axillary, and right chest wall lymph nodes. Focal soft tissue opacity in the superior chest which could represent fluid collection or mass. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Right neck and right axillary soft tissue stranding, with mildly enlarged lymph nodes, of unclear etiology, but could be secondary to soft tissue infection.2.Focal soft tissue opacity in the superior chest, which could represent fluid collection or mass. 3.No evidence of significant venous obstruction. 4.Small right pleural effusion. Findings discussed with Dr. Beiser via phone at 9:25 AM on 12/10/13.
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Generate impression based on findings.
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Male, 29 years old, brain tumor, intraoperative evaluation. Imaging was obtained portably in the operating room at various time points before and during tumor resection.Images obtained preoperatively redemonstrate a hypodense lesion situated in the left insula/basal ganglia region. There is moderate regional mass effect with effacement of the frontal horn of the left lateral ventricle.Images obtained intraoperatively demonstrate a left craniotomy with wide exposure of the left cerebral hemisphere. Images are provided at 3 time points during surgery which show progressive debulking of the left insular tumor. On the final set of images, there are a few foci of hyperdense material within the operative bed compatible with expected surgical blood product. Two foci of more intensely hyperdense material are also seen within the operative bed of uncertain etiology perhaps representing surgical material.
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Preoperative and intraoperative imaging demonstrates expected surgical change during resection of the patient's left insular/basal ganglia tumor.
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Generate impression based on findings.
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61-year-old female with acute lymphoid leukemia. Evidence of ileus/obstruction on abdominal x-ray. Copious diarrhea. ABDOMEN: The limits of a non-IV contrast-enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma. Multiple gallstones again seen without gallbladder wall thickening. Pericholecystic fluid is seen. The most likely relates to ascites seen elsewhere as well. No intrahepatic or extrahepatic biliary duct dilatation seen to suggest obstruction.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: Since prior examination apparent intestinal tube is in position in distal esophagus at the esophagogastric junction but does not extend into the stomach. Stomach appears normal and is not distended. Small bowel diffusely shows fluid-filled contents, but without distention beyond expected from normal and no inherent abnormality or wall thickening. Colon similarly is fluid-filled and air-filled with no evidence of wall thickening or pericolonic inflammation. Large amount of fluid in the colon to the rectum, consistent with the history of diarrhea. Rectal balloon is in expected position.Scattered ascites is seen about the liver, spleen, and free in the mesenteric, and pooling in dependent pelvis without loculations.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: Since prior examination apparent intestinal tube is in position in distal esophagus at the esophagogastric junction but does not extend into the stomach. Stomach appears normal and is not distended. Small bowel diffusely shows fluid-filled contents, but without distention beyond expected from normal and no inherent abnormality or wall thickening. Colon similarly is fluid-filled and air-filled with no evidence of wall thickening or pericolonic inflammation. Large amount of fluid in the colon to the rectum, consistent with the history of diarrhea. Rectal balloon is in expected position.Scattered ascites is seen about the liver, spleen, and free in the mesenteric, and pooling in dependent pelvis without loculations.BONES, SOFT TISSUES: Diffuse soft tissue and subcutaneous edema. Degenerative changes seen throughout. The bony spine and pelvis.OTHER: No significant abnormality noted
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1. No evidence of significant intestinal ileus or obstruction with fluid-filled colon consistent with diarrhea, but without other diagnostic findings. 2. Ascites. 3. Gallstones without evidence complication.
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Generate impression based on findings.
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51 year old with dry cough, evaluate for fungal pneumonia. LUNGS AND PLEURA: Patchy airspace opacities in the right upper lobe and superior segment of the right lower lobe compatible with infection. Moderate bronchiectasis in both lung bases. Small focal opacities in the left lower lobe, compatible with infection. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Severe atherosclerotic calcification of the coronary arteries. No mediastinal or hilar lymphadenopathy is seen.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Patchy airspace opacities in the right upper, superior segment of right lower and left lower lobes compatible with acute infection. 2.Moderate bronchiectasis in both lower lobes suggestive of chronic aspiration or infection.
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Generate impression based on findings.
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12-year-old female with chronic myelogenous leukemia in lymphoblastic crisis. Pre-transplant evaluation. CHEST:LUNGS AND PLEURA: Small groundglass airspace opacity of the posterior segment of the left upper lobe as well as subsegmental atelectasis of the superior and posterior segment of the left lower lobe. No effusions or pneumothorax.MEDIASTINUM AND HILA: No enlarged mediastinum lymph nodes or pericardial effusion.CHEST WALL: Bilateral central lines are terminating in the SVC. No evidence of sclerotic or erosive lesions of the bones.ABDOMEN:LIVER, BILIARY TRACT: Normal liver parenchymal attenuation with no evidence of intra-or extra hepatic biliary duct dilatation.SPLEEN: Minimal splenomegaly of 12 cm. Normal splenic enhancement.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Normal bilateral and symmetric kidney enhancement with no evidence of pelvocaliectasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Minimal multifocal patchy airspace opacities of the left upper lobe as described, most likely dependent atelectasis in nature rather than infectious.
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Generate impression based on findings.
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73-year-old male with COPD, dyspnea, sepsis, right upper lobe opacity Exam limited due to motion artifact.LUNGS AND PLEURA: Severe diffuse centrilobular emphysema. Right upper lobe consolidation. No pleural effusions. Calcified subpleural nodule in the anterior right lower lobe.MEDIASTINUM AND HILA: No lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Severe emphysema with right upper lobe consolidation consistent with pneumonia.
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Generate impression based on findings.
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Female 40 years old; Reason: 40 y/o f with peripheral eosinophilia and diffuse rashes, RUQ u/s with multiple hepatic and splenic lesions of mixed echogenicity and increased vascularity, please eval for occult malignancy. History: see above CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified nodules in the lung are noted. Reference right middle lobe nodule measures 7 x 5 mm. Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral prominent axillary adenopathy is noted with reference right axillary lymph node measuring 1.9 x 2 cm.ABDOMEN:LIVER, BILIARY TRACT: Two hypoattenuating lesions in the liver are noted. Reference inferior right lobe lesion measures 1.9 x 4.3 cm (series 7 image 110).The superior lesion near the hepatic dome is more difficult to measure and blends into the surrounding liver parenchyma. These are compatible with the previously seen ultrasonographic lesions.SPLEEN: Numerous hypoattenuating lesions are noted with a reference lesion measuring 1.8 x 1.8 cm in the superior aspect of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion in the midpole right kidney likely a cyst. No perinephric fluid collections, or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline retroperitoneal adenopathy.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: Enhancing inguinal adenopathy is noted bilaterally, with reference node measuring up to 12 mm in short axis (series 7 image 196).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Nonspecific hypoattenuating lesions in the liver and spleen with adenopathy. Findings are nonspecific, however are suspicious for infection/abscess given patient's increased eosinophilia. Although less likely, metastatic disease cannot entirely be ruled out.2.Pulmonary nodules measuring up to 7mm, follow up suggested.
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Generate impression based on findings.
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Male, 29 years old, headache status post surgery. Post surgical change is demonstrated status post left frontoparietotemporal craniotomy. Scalp swelling, pneumocephalus and a small amount of fluid along the craniotomy are within expected postsurgical limits.The patient is status post resection of a previously demonstrated left insular/basal ganglia tumor. The resection bed contains foci of air and a small amount of hyperdense blood product felt to be within expected postoperative limits. It appears that a majority of the tumor has been resected, though MRI would be required for better assessment of residual disease.There is generalized left cerebral mass effect in the form of sulcal effacement, partial effacement of the left lateral ventricle and a midline shift to the right of approximately 8 mm.No unexpected or large intracranial hemorrhage is seen. The right cerebral hemisphere is unremarkable allowing for shift to the right. The ventricles are not dilated. No frank brain herniation is detected. There is mild medialization of the left uncus.
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Expected postoperative findings status post tumor resection. Quantity of blood product within the left insular/basal ganglia resection bed is within expected limits. There is generalized mass effect in the form of left cerebral sulcal effacement and a midline shift to the right.
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Generate impression based on findings.
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63 year-old female with abdominal pain, fever, leukocytosis, 4 days after colonoscopy. Rule out appendicitis or free air. ABDOMEN:LUNGS BASES: Two hypoattenuating lesions in the liver in segments 2 and 8 (images 28 and 36, series #3) demonstrate nodular peripheral enhancement, are stable and size and appearance, and likely represent hemangiomas. Multiple other subcentimeter hepatic hypodensities are too small to further characterize though are unchanged and likely of benign etiology.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: An approximately 12 cm segment of ascending colon demonstrates low-density, edematous wall thickening and mucosal enhancement, with mild pericolonic fluid and fat stranding and mildly engorged adjacent vasculature. These are typical findings of colitis. Appendix is normal. No evidence of obstruction, pneumatosis, free air, or abscess. The distal colon is unaffected. No other abnormalities in intestinal tract. 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: An approximately 12 cm segment of ascending colon demonstrates low-density, edematous wall thickening and mucosal enhancement, with mild pericolonic fluid and fat stranding and mildly engorged adjacent vasculature. These are typical findings of colitis. Appendix is normal. No evidence of obstruction, pneumatosis, free air, or abscess. The distal colon is unaffected. No other abnormalities in intestinal tract. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Colitis of the ascending colon without evidence of complication.
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Generate impression based on findings.
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Vascular syncope, seizure. Stroke versus brain tumor versus hematoma. Changes demonstrated on the prior exam are now chronic including the region of temporoparietal encephalomalacia associated with ex vacuo dilatation of the right lateral ventricle. The temporal horn and trigone have increased in size on the basis of encephalomalacia related to the temporal lesion/infarct while encephalomalacia within the frontal lobe relates to the previously placed EVD catheter. There are no new masses, hemorrhage, edema or hydrocephalus. The midline is intact. Orbits, visualized portions of paranasal sinuses and mastoids are unremarkable.
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Changes described previously are now chronic which including right temporoparietal encephalomalacia and volume loss resulting in increased size of the right lateral ventricle. CT is relatively insensitive for the detection of acute ischemia and if there is concern, MRI could be considered.
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Generate impression based on findings.
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53 year-old male with palate cancer and status post palate resection. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for mild maxillary sinus mucosal thickening. Limited view of the intracranial structure is unremarkable. Redemonstration of postsurgical changes of a partial resection of the right hard palate and alveolar ridge, unchanged. Previously noted enhancing focus of soft tissue in the resection bed has decreased in enhancement and size and likely represents scarring. No new focus of enhancement to suggest recurrence. Redemonstration of postsurgical changes of bilateral lymph node dissection. unchanged. Reference right level 2 lymph node measures 1.0 x 0.6 cm, unchanged (series 4 image 79). Reference right level 5 lymph node measures 0.6 x 0.4 cm, unchanged (series 4 image 127). No new or enlarging lymph nodes. The submandibular and parotid as well as thyroid glands are unremarkable. The carotid and vertebral arteries and jugular veins are patent. No destructive osseous lesions are evident. Reversal of the normal cervical spine lordosis is unchanged. Degenerative changes greatest at C5-C6, unchanged. Limited views of the chest demonstrates a normal variant azygous lobe and nonenlarged mediastinal lymph nodes. Please see separately dictated CT chest also performed on the same day.
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1.Postsurgical changes of the right hard palate and alveolar ridge with no evidence of recurrence. 2.Stable cervical lymph nodes with no new or enlarging lymph nodes. 3.Please see separate dictation for CT Chest also performed on the same day.
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Generate impression based on findings.
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Male 62 years old; Reason: 62 yo M admitted with STEMI s/p PCI now with severe back pain, eval for retroperitoneal bleed History: pain ABDOMEN:LUNGS BASES: Moderate cardiomegaly with atheromatous calcifications of the aorta and vessels. Vascular congestion in the lung bases with atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Fat stranding in the peripancreatic space without evidence of necrosis, drainable fluid collections, or mass lesions. No ductal dilation or stone seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive fat stranding in the upper retroperitoneum extending from the root of the mesentery, to the iliac bifurcation is of unclear etiology. The inflammatory change extends to the bilateral perirenal spaces without drainable fluid collection or nodules detected. Numerous borderline nodules in the retroperitoneum are noted including a right retrocrural node measuring 1.6 cm in short axis (series 3 image 43).Moderate to severe atherosclerotic disease.Left iliac stent noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Soft tissue inflammation and thickening is noted in the bilateral inguinal regions adjacent to the surgical clips, without evidence of drainable fluid collection or mass. Tissue induration in the expected location of the left groin catheter is noted.Bilateral femoral arterial stents noted.
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1.No evidence of hematoma detected.2.Extensive inflammatory change in the retroperitoneum extending from the root of the mesentery to the pelvis of unclear etiology. A differential considerations include pancreatitis versus sclerosing mesenteritis.
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Generate impression based on findings.
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Altered mental status. Check EVD and assess bleed. The EVD is in stable position, traversing the right frontal lobe with its tip resting in stable position in the third ventricle. Residual intraventricular hemorrhage is demonstrated in a stable configuration from the most recent exam on 12/8/2013. This primarily involves right lateral ventricle with a smaller amount amount of blood product in the left occipital horn. There is additional blood product within the right parieto-occipital fissure which has demonstrated minimal interval redistribution and likely extending from the posterior parietal lobe where there is visualized edema. There has been interval stability in ventricular size since the examination 12/8/2013 with decrease in size since the exam 12/6/2013.There are no new foci of intracranial hemorrhage. There is no new edema, herniation or midline shift. Orbits, paranasal sinuses and mastoid air cells are unremarkable.
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There has been no change in ventricular size or in the amount of intraventricular blood products since the exam 12/8/2013 with slight interval decrease in ventricular size since 12/6/2013. Minimal interval redistribution of blood products within the parieto-occipital fissure which likely extend from the adjacent aspect of the posterior parietal lobe where there is stable edema.
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Generate impression based on findings.
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Metastatic melanoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes. A representative precarinal lymph node best seen on image 35 of series 3 measures 1.5 x 1.1 cm.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: Left renal cystRETROPERITONEUM, LYMPH NODES: Mild abdominal aortic aneurysmal dilatation; maximal AP diameter 2.5 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable fibroid uterusBLADDER: No significant abnormality noted.LYMPH NODES: Abnormally large right femoral lymph node best seen on image 155 of series 3 measuring 4.6 x 4 cm. Associated with right common iliac and external iliac metastatic adenopathy. A representative right common iliac lymph node best seen on image 125 of series 3 measures 1.5 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative changes involving right inguinal region.OTHER: No significant abnormality noted.
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Right femoral, external iliac, and common iliac metastatic adenopathy. Indeterminate mildly enlarged mediastinal lymph nodes.
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Generate impression based on findings.
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Female, 12 years old, history of CML in lymphoid blast crisis, pretransplant evaluation. The frontal sinuses and frontoethmoidal recesses are clear. There may be a small osteoma at the level of the right frontoethmoidal recess. The sphenoid sinuses are clear. The sphenoethmoidal recesses are somewhat obscured by minimal mucosal thickening. Mild patchy mucosal thickening is seen through the ethmoid air cells, more so on the right.There is moderate peripheral mucosal thickening as well as a fluid level in the right maxillary sinus with evidence of some bubbly debris. The right maxillary outflow pathway is obscured. Minimal peripheral mucosal thickening is seen within the left maxillary sinus. The left maxillary outflow pathway is narrowed but probably patent.Mild scattered debris is evident within the nasal cavity. The nasal septum is intact. The nasal turbinates are within normal limits.
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Findings to suggest active sinus inflammatory disease at least in the right maxillary sinus.
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Generate impression based on findings.
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67-year-old male with lung cancer status post two cycles of chemotherapy CHEST:LUNGS AND PLEURA: Interval decrease in size of right perihilar mass encasing the right lower and middle lobe pulmonary arteries and obliterating the right pulmonary veins, now measuring 7.6 x 4.6 cm and previously measuring 9.5 x 7.8 cm (image 71, series 3). Post obstructive atelectasis and consolidation of the right lower lobe is improved from the prior exam. Severe diffuse emphysema.Decreased pleural effusion and thickening in the right lower lobe. Chest tube extends medially within the right lower lobe pleura.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 10 mm in short axis and previously measured 11 mm (image 44, series 3). Interval decrease in mediastinal and supraclavicular lymphadenopathy. Coronary arterial calcifications and atherosclerotic calcification of the aortic arch.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: Unchanged renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Sclerotic metastasis in the right ilium is partially visualized, seen on prior PET/CT, not imaged on more recent PE protocol CT.OTHER: No significant abnormality noted.
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1. Interval decrease in size of right perihilar mass encasing the pulmonary arteries and veins with improved postobstructive atelectasis and consolidation. 2. Sclerotic lesion in the right ilium seen on prior PET/CT consistent with metastasis.
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Generate impression based on findings.
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47 year old female with shortness of breath, compare progression of diagnosis and infiltrate. Additional history of COPD. LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema. There is a focal nodular opacity in the left upper lobe, measuring 16 x 7 mm (image 59, series 5), not seen on previous exam. No pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal, without pericardial effusion. No mediastinal or hilar lymphadenopathy is present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There is a mildly enlarged right retrocrural lymph node measuring 9 mm in short axis (image 3 series 3). Otherwise the visualized upper abdomen is unremarkable.
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1.New upper lobe nodular opacity measuring 16 x 7 mm. PET CT may be helpful for further evaluation vs. short term follow-up in 3-6 months.2.Severe centrilobular and paraseptal emphysema.
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Generate impression based on findings.
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Metastatic prostate carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: New sclerotic bony metastasesABDOMEN:LIVER, BILIARY TRACT: Dramatic interval appearance of innumerable low attenuation bilobar lesions consistent with extensive metastatic foci. No ductal dilatation. Hepatic vessels patent.Stable cholelithiasis without acute inflammation.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: New sclerotic bony metastasesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: New trace ascitesBONES, SOFT TISSUES: New sclerotic bony metastasesOTHER: No significant abnormality noted
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Interval appearance of innumerable bilobar metastatic hepatic foci. New sclerotic bony metastases
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Generate impression based on findings.
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62 year old male with valvular heart disease, restrictive lung disease with hypoxemia after orthopedic surgery. LUNGS AND PLEURA: There is bibasilar subsegmental atelectasis. No pleural effusion.MEDIASTINUM AND HILA: Cardiomegaly, unchanged from prior exam. Small amount of pericardial fluid. Calcification of the aortic valve leaflets and severe coronary artery calcification. Ectasia of the descending aorta, similar to prior exam. The pulmonary artery is enlarged, consistent with pulmonary artery hypertension.CHEST WALL: Complex fracture of the manubrium, with interval healing noted. Fractures of the left clavicle, left 3 through 7 ribs, and left scapular body are again noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Lumbar spinal hardware with resulting artifact limits evaluation. Within limitations no significant abnormality is seen.
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1.Bibasilar subsegmental atelectasis.2.PA hypertension.
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Generate impression based on findings.
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17-year-old male with paralytic strabismus and partial encephali with a -- looking for malignancy and/or lymph nodes. CNS demyelination suggestive for paraneoplastic process. CHEST:LUNGS AND PLEURA: Right bronchiectasis, bronchial thickening and tree in, but opacities most compatible with recurrent infection/aspiration. Other than this, the remainder of the lung parenchyma is free of infiltrates, nodules or masses. Small amount of right pleural effusion is present, but no pleural disease is seen on the left. MEDIASTINUM AND HILA: Calcified lymph nodes from prior granulomatous disease -- no significant adenopathy seen.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcified granuloma without other abnormality.PANCREAS: 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, small bowel, and colon without intrinsic abnormality or evidence of obstruction. A small amount of free scattered mesenteric fluid is seen of uncertain etiology.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 appearing stomach, small bowel, and colon without intrinsic abnormality or evidence of obstruction. A small amount of free scattered mesenteric fluid is seen of uncertain etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Right lower lobe pulmonary changes, most consistent with prior infection/aspiration. No evidence of thoracic malignancy seen. 2. Trace amount of free mesenteric fluid seen of uncertain significance. No evidence of other significant abdominal abnormality.
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Generate impression based on findings.
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46-year-old male with malignant penile cancer. Restaging. Also, a possible abscess in right groin with right groin discharge, pain, and erythema. CHEST:LUNGS AND PLEURA: New right lower lobe airspace consolidation with air bronchograms with some tree in bud pattern most consistent with infection/aspiration. The left lung shows a new micro-nodule (series 8, image 34) which was not present on 9/23/1307/24/13. Follow-up imaging if clinically indicated, could help clarify and characterize this nodule.No pleural diseaseMEDIASTINUM AND HILA: No, adenopathy or other masses.CHEST WALL: Right chest wall Port-A-Cath with catheter tip in right superior vena cava with double SVC as demonstrated previously.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right pelvic kidney with mild hydronephrosis and dilated ureter. Again seen and a stent in the mid and distal ureter into the bladder. The right ureter and the stent are in a right inguinal hernia unchanged as described on prior examinations.Left kidney shows punctate left upper pole nonobstructing calculus unchanged. No other significant abnormalities. RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy or other 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: Marked increase in the right obturator reference lymph node (series 6, image 191) which now measures 10.5 x 7 .8 cm, previously 6.2 x 4.7 cm. left external iliac lymph node, unchanged. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral large necrotic inguinal masses are again seen. These were incompletely imaged in their entirety in the prior exam and, thus comparison of size is not possible. Right inguinal mass has maximal dimension of 14.2 x 6.3 cm and now has foci of air within it along with low density necrosis and infection. There cannot be excluded. The left inguinal mass has maximal dimension of 17.2 x 8.6 cm and is predominantly low density and, presumably necrotic although there are enhancing foci within this.Bilateral inguinal hernias on the left containing only mesenteric fat, and on the right containing the right ureter.OTHER: No significant abnormality noted
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1. Increasing size of right internal obturator. Reference lymph node mass with necrosis. 2. Large bilateral inguinal soft tissue masses with necrosis and a -- infection. There cannot be excluded. 3. Bilateral inguinal hernias, unchanged, the right hernia contains the right ureter. 4. Right lower lobe lung air space consolidation with air bronchograms consistent with infection/aspiration.
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Generate impression based on findings.
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Metastatic prostate cancer status post 12 cycles of investigational therapy CHEST:LUNGS AND PLEURA: Scattered micronodules, similar to prior. No new suspicious nodules or masses. Unchanged bibasilar scarring.MEDIASTINUM AND HILA: Index right hilar lymph node measures 2.4 x 1.7 cm (series 3, image 76), previously 2.5 x 1.7 cm. Index subcarinal lymph node measures 3.0 x 1.8 cm (series 3, image 63), previously 3.2 x 2.0 cm. Normal sized heart without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Unchanged sclerotic T3 and T9 vertebral body lesions. Healing right 4th and 5th rib fractures.ABDOMEN: LIVER, BILIARY TRACT: Scattered unchanged hypoattenuating hepatic lesions, likely representing cysts. No new focal hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple unchanged bilateral hypodense renal foci, likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Increased size of the left periaortic lymph node, measuring 3.5 x 3.3 cm (series 3, image 148), previously 3.3 x 2.9 cm. No new enlarged lymph nodes identified.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: The confluence left common iliac mass measures 6.4 x 4.5 cm (series 3, image 180), previously 6.3 x 4.2 cm. The left common iliac artery reference lymph node measures 2.2 x 2.0 cm (series 3, image 200), previously 2.8 x 2.0 cm. The right external iliac reference lymph node measures 2.5 x 2.3 cm (series 3, image 208), previously 2.0 x 2.0 cm. No new enlarged lymph nodes identified.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged sclerotic lesions in the sacrum and right pubic rami. Surgical hardware in the right hip.
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1. Mild interval increase in size of the abdominopelvic lymphadenopathy.2. Minimal change in the thoracic lymph nodes.
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