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Generate impression based on findings.
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78-year-old female with hypoxia PULMONARY ARTERIES: The main pulmonary artery is large consistent with pulmonary hypertension. Right heart strain with marked intraventricular septum deviation.Technically adequate study demonstrating multiple pulmonary emboli in the proximal segmental branches of the right upper lobe and distal right descending pulmonary artery. Small filling defects in the distal subsegmental branches of the left lower lobe are also identified. In some regions, thrombi are eccentric in location raising a question of chronic and acute PE.LUNGS AND PLEURA: Examination limited by motion artifact. Faint bilateral upper lobe groundglass opacities.MEDIASTINUM AND HILA: Scattered normal-sized mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small bilateral renal hypodensities, likely representing cysts.
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Multiple bilateral segmental and subsegmental pulmonary emboli with right heart strain.
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Generate impression based on findings.
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72 year-old male with abdominal pain, right lower quadrant. ABDOMEN:LUNG BASES: Calcified granuloma in right lower lobe.LIVER, BILIARY TRACT: Extensive wall thickening and surrounding inflammatory change around the gallbladder consistent with acute cholecystitis. Mild intra-hepatic ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: The cystic lesion in uncinate process measures 1.0 x 1.3 cm (series 3, image 46); this is most consistent with a cystic pancreatic neoplasm such as IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple cysts in kidneys bilaterally, largest in right upper pole. Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the aorta and its branches. Mildly enlarged lymph nodes in upper retroperitoneum.BOWEL, MESENTERY: No bowel obstruction. Diverticulosis without diverticulitis. G-tube in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Acute cholecystitis.2.Cystic lesion in uncinate process nonspecific but likely IPMN; consider MRCP for better characterization.
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Generate impression based on findings.
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Male, 72 years old, history of recurrent parotid cancer with brain invasion, presenting with increased ptosis on the left. Enhancing tumor is partially visualized within the left masticator space. Tumor extends from here through the floor of the left middle cranial fossa to invade the intracranial space. The overlying left temporal lobe is displaced superiorly and is edematous similar to the prior MRI. The size of the enhancing tumor is similar to that seen on the prior MRI, though accurate comparison is difficult secondary to differences in technique. As before, invasion of the left cavernous sinus, left Meckel's cave, and extension along the cisternal portion of the left fifth cranial nerve are seen.The remainder of the brain is free of mass effect and pathologic enhancement. No abnormal extra-axial fluid collections or acute intracranial hemorrhage is demonstrated. The ventricular system is patent and within normal limits for size. Mild periventricular hypodensity is seen which may reflect age indeterminate small vessel ischemic disease.
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Redemonstration of tumor invading the left middle cranial fossa with resultant superior displacement and edema within the left temporal lobe. Findings are similar to those seen on the prior MRI, though accurate comparison is limited secondary to differences in technique.
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Generate impression based on findings.
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53-year-old female with history breast cancer, tachycardia, hypoxia, fevers PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Interval increase in size of bilateral pleural effusions with associated compressive atelectasis. Additional small scattered air space opacities are unchanged, possibly infectious/inflammatory.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Enteric tube extends to the stomach.CHEST WALL: Site of prior right anterior chest wall port contains granulation tissue. Anterior inferior endplate sclerosis of T7, nonspecific.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No pulmonary embolus. Increased bilateral pleural effusions and compressive atelectasis.
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Generate impression based on findings.
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Male 51 years old; Reason: sbo History: pain and nausea ABDOMEN:LUNGS BASES: Numerous nodules are noted in the lung bases, with a reference a by 8mm pleural-based nodule in the left lower lobe.LIVER, BILIARY TRACT: Small hemangioma noted in the lateral segment left lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nonobstructing nephrolith right kidney. Otherwise, no hydronephrosis, perinephric fluid collections, or fat stranding. Small hypoattenuating lesion too small to characterize right midpole.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: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Numerous pulmonary nodules partially visualized on this CT abdomen. CT chest advised for full characterization2. No acute inflammatory process detected.3.Dr. Ward notified of the findings at 9:21 on 12/11/13
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Generate impression based on findings.
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62 year-old female with hip pain status post fall, evaluate for hip fracture Osteophytosis of the acetabulum and joint space narrowing indicating moderate osteoarthritis. No specific evidence of acute fracture or malalignment.Note is made of extensive atherosclerotic vascular calcifications.
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Degenerative changes of the hip without evidence of fractures or dislocation.
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Generate impression based on findings.
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17 year-old female with thyroid cancer LUNGS AND PLEURA: 5-mm left lower lobe nodule. No additional nodules or masses within the limitations of motion artifact. No pleural effusions.MEDIASTINUM AND HILA: Heterogeneous enlarged right thyroid mass is only partially visualized and extends across the midline, inferiorly to the level of the innominate artery and partially surrounds the trachea, which remains patent. See dedicated neck CT for further detail. No conclusive mediastinal or hilar lymphadenopathy, though tumor would be difficult to differentiate from lymphadenopathy within the superior mediastinum. Anterior mediastinal soft tissue is consistent with thymus; indeterminate in appearance and may be assessed on subsequent nuclear scintigraphy.CHEST WALL: No axillary lymphadenopathy. The mass grows into the soft tissues of the right lateral neck and displaces the jugular vein. The mass extends posteriorly to the spine but the vertebral body cortices appear intact.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Large heterogeneous right thyroid mass, partially visualized, see dedicated neck CT for further detail. 2. Nonspecific 5 mm left lower lobe nodule. Recommend 3-month CT follow-up to exclude metastasis or correlation with nuclear scintigraphy.3. No visible skeletal metastases.
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Generate impression based on findings.
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Female 86 years old; Reason: h/o Crohn's with c/f fistula/malignancy History: see above ABDOMEN:LUNGS BASES: Bilateral atelectasis and scarring in the left lung base noted. Mild cardiomegaly with vascular congestion.LIVER, BILIARY TRACT: No liver lesion detected. Normal morphology. Cholelithiasis without evidence of cholecystitis seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality detected.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cysts noted in the right kidney. Largest measuring approximately 3.5 cm. No Hydronephrosis, calcifications, or Perinephric Fluid Collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is loss of haustration with parity colonic inflammatory stranding and mild wall thickening in the sigmoid colon and extending into the proximal descending colon. This is compatible with the patient's known history of Crohn's disease.Small suggestion of a colocolonic fistula is seen (series 3 image 75) between the sigmoid and descending colon. No abscess or drainable fluid collections identified.No obstruction or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Heterogeneous 2.9 x 2.5 cm lesion with dystrophic calcifications just inferior to the active area of inflammation is noted. It appears to abut an adjacent small bowel loop.PELVIS:UTERUS, ADNEXA: Atrophic or surgically resected. Heterogeneous 2.9 x 2.5 cm lesion with dystrophic calcifications just inferior to the active area of inflammation is noted. It appears to abut an adjacent small bowel loop. This also may be continuous with left broad ligament. The right ovary also contains a calcification, and measures 1.3 x 1.9 cm.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.Active inflammatory Crohn's disease in the left lower quadrant that likely colocolonic fistula.2.Heterogeneous partially calcified mass in the left lower quadrant. Differential considerations include ovarian neoplasm, neoplasm of small bowel origin, or omental sarcoma. Pelvic MRI or ultrasound advised for full characterizationDr. Marmi Shah notified of the findings at 9:43 on 12/11/13
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Generate impression based on findings.
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43 year-old male. Locally advanced pancreatic cancer. Evaluate for progression. Wilm's tumor status post right nephrectomy. ?peritoneal mets at OSH CT scan, admitted with RUQ pain, eval for metastatic disease. History: pancreatic Ca, RUQ pain ABDOMEN:LUNG BASES: Right middle lobe calcified granuloma. Stable scattered calcified and noncalcified micronodules. No hilar or mediastinal lymphadenopathy.LIVER, BILIARY TRACT: No focal hepatic lesion is evident. No biliary ductal dilatation. CBD stent is unchanged in position.SPLEEN: No significant abnormality notedPANCREAS: Lesion at the junction of the pancreatic head and neck measures 1.1 x 1.6 cm (coronal image 57). Upstream pancreatic dilatation measuring up to 0.5 cm and distal pancreatic atrophy is unchanged. Narrowing of the extrahepatic portal vein at the confluence of the SMV and splenic vein is unchanged. Soft tissue density adjacent to the celiac artery origin, probably a lymph node is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy with no abnormal soft tissue in the surgical bed. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Stable postsurgical changes of the descending and transverse colon. No ascites or discrete peritoneal nodularity.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites persists without change. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.
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1. Stable pancreatic head/neck lesion compatible with the patient's known adenocarcinoma.2. No new lesions are identified in the abdomen, or pelvis. Small amount of ascites persists.3. No definite peritoneal lesions. The peritoneal nodularity seen on the 11/30/2013 outside CT exam is less prominent, and no definite change since 8/27/2013 was identified. No specific acute abnormality to explain RUQ pain.
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Generate impression based on findings.
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Female, 27 years old, status post assault. Evaluate for facial fracture. No maxillofacial fractures are detected. Mucosal thickening within the paranasal sinuses, particularly the ethmoid air cells, likely reflect an inflammatory process. Multiple dental findings are seen including several missing and or carious teeth and impacted wisdom teeth.The soft tissues of the orbits are within normal limits allowing for mild bilateral proptosis. The soft tissues of the neck are remarkable for scattered nonspecific lymph nodes and tonsillar prominence. Extensive intracranial calcifications are partially visualized involving the bilateral basal ganglia and scattered areas of the gray-white junction in symmetric fashion.
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1. No maxillofacial fracture or other definite acute post traumatic findings.2. Dental findings including missing/carious teeth are likely chronic however correlation with history and exam is suggested.3. Extensive intracranial calcification is partially visualized on this examination involving the deep gray nuclei and gray-white junction bilaterally. The pattern is highly suggestive of a metabolic derangement or perhaps Fahr's disease.
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Generate impression based on findings.
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Male 66 years old; Reason: Stage IV adenocarcinoma of the lung. Metastatic lung cancer, s/p chemo x 8 cycles, pls c/w previous study and evaluate tx response. CHEST:LUNGS AND PLEURA: Small increase in moderate sized right pleural effusion and right basilar atelectasis obscuring right lower lobe nodule . Volume loss in the right middle lobe with right middle lobe nodule contiguous with the right pericardium are similar to the prior exam. The subpleural right middle lobe nodule seen on the prior exam is obscured by increased pleural effusion. MEDIASTINUM AND HILA: Mediastinal lymphadenopathy with ill-defined reference precarinal lymph node is stable (image 40 series 4) and measures 1.7 x 2.7 cm. Epicardial lymph nodes are stable. Heart size is normal.CHEST WALL: Dextroscoliosis of the thoracic spine with accompanying degenerative changes.Stable rib metastases with right 10th rib associated soft tissue mass effacing the right liver capsule and extending into the right lateral chest wall. New right sided percutaneous drain in the pleural effusion at the right lung base. ABDOMEN:LIVER, BILIARY TRACT: No focal parenchymal lesion. Gallstones are noted in the gallbladder without evidence of cholecystitis. No intra- or extra-hepatic biliary ductal dilationSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Several too small to characterize lesions in the kidneys bilaterally. Hyperdense foci noted in the kidneys bilaterally are nonobstructing nephroliths. There is no hydronephrosis or hydroureter. No perinephric stranding or fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a stable right lateral chest wall mass indenting into the liver that arises from the 10th rib metastasis. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval increase in right pleural effusion. Interval placement of drainage catheter in the effusion at the right lung base. Otherwise stable metastatic disease.
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Generate impression based on findings.
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79-year-old female with follicular non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Scattered punctate calcified and noncalcified micronodules are nonspecific but likely due to prior granulomatous infection.Cluster of peripheral nodules in right lower lobe is likely result of mild aspiration or bronchiolitis (series 4, image 16).MEDIASTINUM AND HILA: No significant lymphadenopathy. Moderate coronary artery calcifications. Heart is normal in size without pericardial effusion. Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Several round hypodensities in the spleen are nonspecific but may represent lymphomatous deposits; for reference, lesion in the medial aspect of spleen measures 9 mm (series 3, image 94).PANCREAS: Diffuse mild dilation of pancreatic duct with diameter measuring up to 4 mm. Several hypodense lesions are present in the head of the pancreas, uncinate process and tail; largest of these located in the uncinate process is a multiloculated cystic lesion measuring 1.7 x 2.8 cm (coronal series 80256, image 64). These may represent a combination of IPMNs and serous cystadenoma. There is suggestion of a pancreatic divisum, although this is equivocal (coronal series 80256, image 65).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate hypodense foci in both kidneys too small to characterize but most consistent with benign cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No lymphadenopathy.2.Hypodense lesions in the spleen may represent lymphomatous deposits.3.Multiple calcified and noncalcified lung nodules nonspecific but likely result of prior granulomatous infection.4.Multiple cystic lesions in the pancreas, incompletely characterized on this study but likely representing IPMNs and/or serous cystadenoma. There is also suggestion of pancreatic divisum. These can be better characterized with M.R.C.P.
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Generate impression based on findings.
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69 year-old female with right flank pain. Evaluate for retroperitoneal abscess. ABDOMEN:LUNGS BASES: Calcified left lower lobe granuloma is unchanged. Minimal bilateral basilar atelectasis.LIVER, BILIARY TRACT: Unchanged left hepatic lobe simple cyst. Gallbladder surgically absent with cholecystectomy clips in the gallbladder fossa.SPLEEN: Multiple calcified splenic granulomas are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged left adrenal adenoma.KIDNEYS, URETERS: Unchanged right angiomyolipoma. Enlarged right kidney. A left simple cyst and bilateral subcentimeter hypodensities, too small to characterize, are unchanged. Unchanged right lower pole nonobstructing renal calculi.Soft tissue mass along the right ureter measures approximately 1.1 x 0.9 cm (image 96, series #3), previously 1.5 x 1 .0 cm, though is not optimally evaluated due to lack of opacification of the ureters, and therefore direct comparison is difficult.RETROPERITONEUM, LYMPH NODES: Interval growth of enhancing complex right retroperitoneal lesion, now invading the posterior body wall through the adjacent posterior musculature and subcutaneous fat. Fluid density centrally is suggestive of necrosis. The lesion also now anteriorly displaces the right kidney and extends approximately 21 cm in its craniocaudal dimension to the mid pelvis. Greatest axial dimensions measure 11.2 x 6.8 cm (image 77, series #3), from 5.9 x 5.8 cm measured previously.Reference left para-aortic lymph node measures 1.1 x 0.9 cm (image 60, series #3), unchanged. Scattered small retroperitoneal lymph nodes are unchanged.Moderate atherosclerotic calcification of the abdominal aorta and its branches with multiple ulcerated plaques, unchanged. BOWEL, MESENTERY: Left lower quadrant ostomy. Scattered small mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Redemonstrated left-sided lymphocele, grossly unchanged.
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1.Marked interval growth of right retroperitoneal complex cystic mass with invasion of the posterior body wall.2.Soft tissue mass along the right ureter is not significantly increased in size.3.Atherosclerotic calcification of the abdominal aorta with multiple ulcerated plaques, grossly unchanged.
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Generate impression based on findings.
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25-year-old male with history of persistent fevers and epiglottitis with concern for abscess Edema involving the epiglottis and right aryepiglottic fold is improved, however there remains a small hypodense collection at the base of the right aryepiglottic fold. This measures 6 x 5 mm and is slightly smaller and better defined on the present exam. A small retropharyngeal effusion seen previously has resolved. Scattered enlarged cervical lymph nodes appear similar to the prior exam and are likely reactive.The orbits are unremarkable. There is mild mucosal thickening of the right sphenoid sinus. The mastoid air cells are clear. The oral cavity, oro/nasopharynx and subglottic airways are patent. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. The partially visualized intracranial structures are grossly unremarkable. The partially visualized lung apices are clear. A PICC is seen with its tip in the left brachiocephalic vein
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Continued improvement in supraglottic and laryngeal edema. However, there is a persistent small hypodense focus at the base of the right aryepiglottic fold which could represent phlegmon or a small abscess.
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Generate impression based on findings.
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Male, 18 years old, history of malignant peripheral nerve sheath tumor of the left hypopharynx status post non-oncologic resection with multiple positive margins. Preoperative MRI showed a lateral level 2 lymphadenopathy right side more than left. The left level 2 nodes have been removed and were negative. Postop PET scan showing positive retropharynx and right level 2 adenopathy. 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. Mucosal thickening seen on the prior examination involving the base of tongue and bilateral, left more than right, pharyngeal walls has decreased in prominence. The vallecula is somewhat better expanded though does remain partially effaced by this tissue. The pharyngeal walls remain slightly thickened bilaterally.The oral tongue and floor of mouth are unremarkable. The epiglottis and the aryepiglottic folds are unremarkable. The piriform sinuses are better aerated than on the prior exam. The glottis and subglottic airway are unremarkable.No pathologic adenopathy is detected by size criteria. A right level IIa node which was hypermetabolic on prior PET is probably identified on image 25 of series 5 where it measures 1.4 x 0.7 cm (previously 1.8 x 1.0 cm). Scattered additional nodes through the right neck have also diminished in size relative to the prior CT. A focus of moderate hypermetabolism on prior PET at level IIb on the right just below the mastoid correlates to several very small nodes on the present study. Scarring and infiltration through the fascial planes is evident within the left neck compatible with prior dissection.The salivary glands and thyroid are free of focal lesions. The cervical vessels are patent and unremarkable. No concerning osseous lesions are demonstrated. A left chest port catheter is in place.
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1. Interval decrease in the size of mucosal thickening which on the prior CT involved the base of the tongue and vallecula as well as the bilateral, left more than right, pharyngeal walls.2. General interval decrease in the size of neck lymph nodes including level 2 nodes on the right which were hypermetabolic on prior PET. No frankly pathologic nodes are identified by size criteria.3. No intracranial metastatic disease.
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Generate impression based on findings.
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44-year-old female, evaluate NSIP LUNGS AND PLEURA: Unchanged mild basilar predominant subpleural groundglass and reticular opacities. The disease affects predominately the posterior lung fields in a bandlike subpleural distribution. Scattered unchanged micronodules.No calcified pleural plaques are appreciated.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal.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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Unchanged mild basilar interstitial abnormality. The bandlike appearance is somewhat atypical, query history of asbestos exposure as pulmonary asbestosis can produce a similar appearance.
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Generate impression based on findings.
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Breast cancer and posterior neck spindle cell neoplasm, s/p surgery. There is a heterogeneously enhancing, lobulated mass within the midline of the posterior neck, centered within the superior fibers of the trapezius muscles, adjacent to the occipital bone. The tumor is ill-defined and measures approximately 30 AP x 30 RL x 26 SI mm with a small component that projects posteriorly along the surgical incision site. There is no evidence of involvement of the underlying bone. However, there is a diffuse mildly heterogeneous appearance of the vertebral bone marrow. There is also a left upper lobe pulmonary nodule with ill-defined margins that measures up to 20 mm, within a background of moderate pulmonary emphysema. There is no significant cervical lymphadenopathy. There is evidence of rhinoplasty and bilateral breast implants, which are partially imaged. The thyroid gland and major salivary glands are unremarkable. The airways are patent. There is mild atherosclerotic plaque involving the bilateral carotid bifurcations. The imaged portions of the orbits and intracranial structures are grossly unremarkable.
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1. A heterogeneously enhancing, lobulated mass within the midline of the posterior neck, centered within the superior fibers of the trapezius muscles measuring up to 30 mm is compatible with recurrence spindle cell neoplasm. No evidence of significant cervical lymphadenopathy.2. A left upper lobe pulmonary nodule with ill-defined margins that measures up to 20 mm likely represents a metastasis. A dedicated chest CT is recommended for further evaluation.3. Diffuse mildly heterogeneous appearance of the vertebral bone marrow may represent metastatic disease. A bone scan may be useful for further evaluation.
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Generate impression based on findings.
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69-year-old male, reevaluate left apical lesion, concern for fungal infection LUNGS AND PLEURA: Decreased size of left apical opacity. Near resolution of left basilar ground glass opacities which were likely due to aspiration. Unchanged 6-mm left lower lobe nodule (image 15, series 4). Calcified right upper lobe nodule compatible with prior granulomatous disease.MEDIASTINUM AND HILA: Mild coronary arterial calcification. Calcified mediastinal lymph nodes, compatible with prior granulomatous disease. Right PICC tip extends to the cavoatrial junction.CHEST WALL: Degenerative changes of the thoracolumbar spine and unchanged compressive deformity of the T4 vertebral body as well as lower thoracic Schmorl's node.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Splenic granulomata.
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Decreased size of left apical opacity, most likely infectious or inflammatory in etiology.
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Generate impression based on findings.
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65 year-old male with history of metastatic head and neck cancer. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. A partially calcified left level 2/3 reference lymph node is unchanged measuring 10 x 9 mm (image 98, series 5). No new or suspicious adenopathy is detected in the neck. No exophytic mass lesions. Mucosal thickening in the upper aerodigestive tract may be treatment-related changes. The airway is patent. There is redemonstration of a sialolith likely situated within the proximal left submandibular gland duct, unchanged in appearance. The thyroid and parotid glands are unremarkable. The bilateral internal jugular veins are partially occluded. The carotid and vertebral arteries are patent.Degenerative changes are seen in the cervical spine.
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No evidence of tumor recurrence in the neck. Stable reference lymph node.
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Generate impression based on findings.
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62-year-old female with left hemidiaphragm paralysis, evaluate for cardiac compromise due to elevated diaphragm. LUNGS AND PLEURA: Elevation of the left hemidiaphragm. No suspicious nodules or masses. No air space opacities or pleural effusions..MEDIASTINUM AND HILA: Heart size is normal. Mild coronary arterial calcifications. No mediastinal or hilar lymphadenopathy or mass lesions in the distribution of the phrenic nerve. Nonspecific hypodense lesion in the left thyroid gland.CHEST WALL: Degenerative changes of the thoracolumbar spine. Partially visualized hardware in the lower cervical spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense left renal lesion likely represents a cyst. High density focus in the gastric lumen likely ingested material.
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Elevation of the left hemidiaphragm, most compatible with phrenic nerve injury. No evidence of extrinsic cardiac compression by the diaphragm.
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Generate impression based on findings.
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Thyroid cancer. There is a soft tissue attenuation right thyroid nodule that measures up to 17 mm with a course calcification. There are numerous enlarged right level 2 through 4 and bilateral level 6 and 7. The lymph nodes are heterogeneous and many of these contain coarse calcifications and areas of necrosis. In addition, many of the lymph nodes display ill-defined margins that may represent extracapsular spread. The largest lymph node on the right is a level 4 lymph node that measures 31 x 40 mm. The largest lymph node on the left is a lower level 6 lymph node that measures 25 x 29 mm. There compression of the right internal jugular vein at the level of the level 4 lymph nodes. The trachea is deviated to the left, but remains patent. The major cervical arteries are patent. The osseous structures are unremarkable. The imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear.
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1. A right thyroid mass measuring up to 16 mm is compatible with thyroid carcinoma.2. Extensive metastatic cervical lymphadenopathy, including right level 2 through 4 and bilateral level 6 and 7 lymphadenopathy, the largest of which measures up to 40 mm on the left and 30 mm on the right, with signs of extracapsular spread.
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Generate impression based on findings.
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Female 53 years old; Reason: r/o intra-abdominal abscess. R/o signs of enterocolitis. eval lumbar spine for abscess, mets. History: fever, ileus, recent MSSA bacteremia, breast cancer, LE weakness ABDOMEN:LUNGS BASES: Bilateral pleural effusions, left greater than right. Associated compressive atelectasisLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Dilation of the main pancreatic duct which is more focally dilated in a cystic fashion, and continues into the pancreatic body. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis or perinephric fluid collections. Two small to characterize lesions in the kidneys bilaterally. One large lesion likely a cyst noted midpole left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube in stomach.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: Dilation of the fluid-filled distal rectosigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Prominent left inguinal varices of dubious clinical etiology. Trace free fluid.
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1. Cystic lesion in the pancreas contiguous with the main duct suspicious for an IPMN main duct type but further characterization with MRCP advised2. Nonspecific right inguinal varices of dubious etiology. 3. No obstruction
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Generate impression based on findings.
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59-year-old male with diffuse large B-cell lymphoma involving posterior left thigh. CHEST:LUNGS AND PLEURA: Stable punctate micronodules. No new suspicious nodules. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Stable hypodensities too small to characterize, likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable subcentimeter hypodensities, likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable exam without evidence of lymphadenopathy.
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Generate impression based on findings.
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27 year-old female with blunt head trauma. Examination shows extensive calcification symmetrically in the bilateral basal ganglia, thalami and dentate nuclei as well as in the subcortical white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for opacification of the ethmoid sinuses.
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1. No acute intracranial abnormality. 2. Extensive calcification symmetrically in the bilateral deep gray matter nuclei and subcortical white matter. Differential may include Fahr disease, metabolic disorders and sequela of prior infections.
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Generate impression based on findings.
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42 year old female with right lower quadrant pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Multiple heterogeneous lesions in the uterus compatible with fibroids.Enlarged right adnexa measures 4.9 x 3.4 cm, incompletely characterized but likely representing combination of right ovary and physiologic cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of free fluid likely physiologic in nature.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Enlarged right adnexa may represent combination of right ovary and physiologic cyst, however, given patient's right lower quadrant pain and lack of other pathology to account for symptoms, adnexal pathology such as torsion is also a consideration. This may be better evaluated with pelvic ultrasound.2.Multiple heterogeneous lesions arising from uterus compatible with fibroids.
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Generate impression based on findings.
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Newly diagnosed follicular lymphoma of the conjunctivae. The orbits are not included in the filed of view. Nevertheless, there is no significant cervical lymphadenopathy. The Waldeyer ring structures are not enlarged. The thyroid and major salivary glands are unremarkable, The major cervical vessels are patent, although the carotid arteries are tortuous. The airways are patent. There is mild multilevel degenerative spondylosis, but no lytic or blastic lesions. The imaged portions of the lungs are clear.
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The orbits are not included in the filed of view. Nevertheless, there is no significant cervical lymphadenopathy.
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Generate impression based on findings.
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31-year-old female with new onset right-sided abdominal pain. Rule out appendicitis. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: A mildly inhomogeneous, hypoattenuating round mass is seen in segment 4 of the liver near the hepatic hilum measuring 3.9 x 2.9 cm. May represent a hemangioma, though is incompletely characterized on single phase imaging.Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is dilated to 14 mm with moderate periappendiceal stranding and no loculated fluid collection. A small appendicolith is questioned near the insertion to the cecum (image 84, series #3). No intraperitoneal free air.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.Acute appendicitis without evidence of perforation or abscess.2.3.9-cm liver mass near the hepatic hilum may represent hemangioma, though dedicated triple phase imaging is recommended for complete characterization.3.Cholelithiasis.
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Generate impression based on findings.
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3-year-old female with history of neuroblastoma. Assess for progression of disease comment 3 months off therapy. CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis. No suspicious pulmonary nodule or mass. No pleural effusion. The central airways are clear.MEDIASTINUM AND HILA: No hilar lymphadenopathy is seen. No pericardial effusion is identified. Confluent anterior mediastinal soft tissue is unchanged measuring 4.4 x 2.4 cm (image 16, series 4).CHEST WALL: Scattered sclerotic lesions within the thoracic spine are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. No intrahepatic or extrahepatic biliary ductal dilatation. The portal vein and its branches are patent.SPLEEN: Ill-defined region of hypoattenuation within the mid spleen may represent a splenic infarct or be secondary to contrast timing administration.PANCREAS: The pancreas is normal in morphology and enhancement.ADRENAL GLANDS: Adrenal glands are normal in appearance without evidence of a focal lesion.KIDNEYS, URETERS: The kidneys enhance symmetrically without evidence of focal lesion. Cortical medullary differentiation is preserved.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic lesions are similar to the prior study.OTHER: Soft tissue density adjacent to celiac axis and portal vein is unchanged measuring 1.5 x 1.2 cm (image 55, series 4), previously measuring the same.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered sclerotic vertebral lesions are again noted and unchanged.OTHER: No significant abnormality noted
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1. No interval change in soft tissue in the anterior mediastinum, likely representing benign thymic hyperplasia. 2. No interval change in soft tissue density adjacent the celiac axis.3. New ill-defined region of hypoattenuation within the spleen is felt to be related to contrast timing, however may alternatively represent an infarct.
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Generate impression based on findings.
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Morbid obesity. Bronchial neoplasm and mesothelioma. CHEST:LUNGS AND PLEURA: Persistent small pleural fluid collections greater on the right unchanged. Mild interval enlargement of the reference left lower lobe nodule, currently 13 mm, previously 9 mm (image 63 series 5). Scattered additional micronodules are otherwise not significantly changed. No new additional masses or nodules.Stable unchanged mild minimal septal thickening and ground glass opacity possibly representing mild edema. Old postsurgical changes the left lower lobe with suture line.The reference pleural thickening at the level of the brachial cephalic vein is also unchanged measuring 12 mm in the 4 o'clock position (image 24 series 3).MEDIASTINUM AND HILA: Mediastinal lipomatosis and stable scattered multiple lymph nodes. The low right paratracheal lymph node (image 37 series 3) remains 13 mm. The reference subcarinal lymph node remains 18 mm unchanged (image 49 series 3).Coronary artery calcifications the cardiac and pericardial appearance otherwise within limits.Small right cardiophrenic lymph nodes are unchangedCHEST WALL: The index right retrocrural lymph node is similar in appearance remaining 17 mm in short axis (image 86 series 3). The right diaphragmatic cruise remains thickened and irregular, although similar in appearance it remains suspicious for tumor involvement (image 105 series 3).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: Similar thickening along the retroperitoneal fascia. No new abnormality.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Similar unchanged sclerotic focus in the right 11th rib. No new suspicious abnormalitiesOTHER: No significant abnormality noted.
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Interval stability in overall appearance other than mild interval enlargement of the small pulmonary nodule in the left lung base. This slight change may be partially due to differences in volume averaging and breathing although disease progression must also be considered. Reference measurements provided
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Generate impression based on findings.
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35 year old female with Langerhans cell histiocytosis, presumed remission after chemotherapy. CHEST:LUNGS AND PLEURA: Bilateral upper lobe ground glass opacities and micronodules not significantly changed. No new or suspicious lesions or opacities.MEDIASTINUM AND HILA: Multiple mildly enlarged mediastinal lymph nodes not significantly changed, may be reactive. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No significant change in upper lobe ground glass opacities and micronodules.
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Generate impression based on findings.
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66-year-old male with history of AML, immunocompromised with bilateral pleural effusions, and positive CMV. LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Extensive calcified pleural plaques, consistent with the history of asbestos exposure.Persistent focus of left upper lobe consolidation is mildly increased in size with subtle convex borders, and measures 1.6 x 2.4 cm (image 43 series 4) and previously measured 1.3 x 2.3 cm. Continued clearing of additional airspace opacities. Mild diffuse bronchial wall thickening is again noted.MEDIASTINUM AND HILA: Central venous catheter tip extends to the SVC. Moderate coronary arterial calcifications. Small pericardial effusion. Multiple small mediastinal lymph nodes not enlarged by CT criteria.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the abdominal aorta and its branches.
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1. Mild increase in size of 2.4 cm left upper lobe opacity for which close follow up is warranted. Additional previously identified airspace opacities are nearly resolved.2. Bilateral pleural effusions and compressive atelectasis as well as small pericardial effusion.
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Generate impression based on findings.
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Adenocarcinoma, follow-up CHEST:LUNGS AND PLEURA: Right middle lobectomy or partial lobectomy with postsurgical changes similar in appearance. No evidence of localized recurrence. The multiple small scattered micronodules are without significant change. No suspicious nodules or masses. No effusions.The irregular density observed in the right upper lobe extending to the posterior margin remains 1.8 x 0.9 cm (image 29 series 4) with a distinct decrease in overall density and concave margins. The reference peripheral hazy nodule in the right lower lobe (image 44 series 4) has also decreased in overall density and appearance; currently measuring 6 x 4 mm, previously 7 x 6 mmMEDIASTINUM AND HILA: The reference left paratracheal reference lymph node remains 11 mm (image 33 series 3). The precarinal reference lymph node remains 12 mm (image 38 series 3).Mild nonspecific cardiomegaly with a prominent main pulmonary artery unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Extensive hepatic cysts appear unchanged and remain well-demarcated and homogeneous in low density. No new suspicious abnormalitiesSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mildly nodular left adrenal gland unchangedKIDNEYS, URETERS: Limited evaluation given lack of contrast, however nephrolithiasis is observed on the left with additional bilateral multiple nodular low density suggesting numerous cysts. Dedicated imaging may be indicatedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes of the descending aorta and branchesBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive postsurgical suture observed in the midline and throughout the upper abdomen bilaterallyOTHER: No significant abnormality noted.
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Interval gross stability in overall reference measurements, however the pulmonary lesions appear less dense and demonstrate more concave margins suggesting continued improvement. Reference measurements provided
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Generate impression based on findings.
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Reason: Patient with Multiple Myeloma, s/p auto stem cell transplant. H/O aspergillus infection. History: cough, wheezing LUNGS AND PLEURA: 3.7-cm right lower lobe lobulated mass with adjacent nodules remains compatible with infection, and has not significantly changed.Severe emphysema.Prior wedge resection right upper lung zone.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are unchanged.Status post sternotomy for CABG, with densely calcified native coronary arteries.Catheter tip in SVC.CHEST WALL: Left chest wall subclavian port.Median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Pancreatic calcifications consistent with chronic pancreatitis.
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No change in right lower lobe mass consistent with ongoing fungal infection.
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Generate impression based on findings.
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Reason: pt with h/o lung ca s/p chemo/rt (PCI) History: Lung ca CHEST:LUNGS AND PLEURA: Left peri-hilar and paramediastinal radiation fibrosis with volume loss are unchanged.Stable right lower lung zone micronodules.No evidence of pulmonary or pleural tumor. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Calcified nodes from prior granulomatous disease or treated tumor are stable, specifically the previously measured 11-mm AP window node.Moderate sized pericardial effusion is unchanged.Moderate coronary calcification is present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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: Previously noted L5 lucent lesion not included on this study. OTHER: No significant abnormality noted.
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No change, and no reliable evidence of recurrent tumor, or other significant abnormality.
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Generate impression based on findings.
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65-year-old male with history of head and neck cancer, compare with prior CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: The heart size is normal. No mediastinal or hilar lymphadenopathy. Moderate coronary arterial calcification. Small hiatal hernia. Small right Bochdalek hernia.CHEST WALL: Few punctate sclerotic foci in the ribs and vertebral bodies, likely bone islands.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Unchanged hypoattenuating hepatic lesions, likely represent cysts. Calcified hepatic granulomataSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetrically small left kidney is unchanged. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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Unchanged exam without evidence of metastatic disease.
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Generate impression based on findings.
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Lung cancer, non-small cell. Follow-up CHEST:LUNGS AND PLEURA: Overall gross stability of the lungs bilaterally with the moderate right pleural effusion and associated volume loss. Apical changes remain consistent with post radiation scarring and pneumonitis.The numerous small pulmonary and pleural nodules appear similar in appearance and size. Of particular note is a left upper lobe nodular density (image 30 series 4) which although remains a 7 x 8 mm in dimension, appears mildly denser which may be partially due to volume averaging. The reference right basilar lesion along the medial wall remains 12 mm (image 54 series 4) and 2.1 x 1.0 cm (image 64 series 4). MEDIASTINUM AND HILA: The reference high left paratracheal lymph node remains a 7 mm (image 10 series 3). No additional new lymphadenopathy.Mild pericardial effusion unchanged. The cardiac appearance other than mild coronary calcifications remains unremarkable.CHEST WALL: Extensive sclerosis and compression of T5 is unchanged. Mild scattered sclerotic foci in multiple ribs are also unchanged.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Persistent exophytic lesion arising from the right upper pole, currently measuring 2.3 cm, previously 2.1 cm (image 94 series 3). This may be also partially due to breathing differences although enlargement cannot be excluded and dedicated imaging may be indicatedPANCREAS: 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: Stable L3 lucent lesion, unchanged and nonspecificOTHER: No significant abnormality noted.
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1. Stable thoracic and intrapulmonary reference lesions and appearance2. Questionable mild enlargement of the right upper pole nodular density, consider dedicated imaging. See description provided
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Generate impression based on findings.
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68 year-old male with history of head and neck cancer and status post CRT. 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. There is redemonstration of posttreatment changes, including diffuse edematous change of the pharyngeal mucosa, hyperemia of the submandibular glands, and obscuration of the fat planes. The previously referenced conglomerate of right level 2 lymph nodes is now indistinguishable from fat infiltration of the right carotid space. Overall, this appears unchanged from the prior study. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. There is no clinically significant adenopathy. The parotid glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. The carotid and vertebral arteries are patent. The right vertebral artery is hypoplastic. The internal jugular veins are patent.The vertebral body heights are maintained. Reversal of the cervical spine is again noted with anterolisthesis of C3 on C4 and retrolisthesis of C4 on C5. Bilateral neuroforaminal narrowing is seen at C4-C5 and C5-C6. Degenerative disk disease is unchanged from the prior study.Several periapical lucencies are again noted. The lung apices are clear. Please see dedicated CT chest/abdomen/pelvis report for further details.
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Stable posttreatment changes without local tumor recurrence or cervical lymphadenopathy.
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Generate impression based on findings.
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64-year-old male with lung cancer, compare with prior CHEST:LUNGS AND PLEURA: Unchanged 8-mm nodule along the right major fissure, probably an intrapulmonary lymph node (image 48, series 4). Left upper lobe and paramediastinal consolidation and atelectasis consistent with radiation reaction, unchanged.No new suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No new mediastinal or hilar lymphadenopathy. Reference left hilar lymph node measures 8 mm and previously measured 8 mm (image 26, series 3). Moderate coronary arterial calcification and atherosclerotic calcification of the aorta..CHEST WALL: Radiation change of the upper thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small, nonspecific hypodensities are unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodensities are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Bullet in the anterior right abdominal wall again noted.OTHER: No significant abnormality noted.
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Stable postradiation changes in the left upper lobe without evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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68-year-old male with history of head and neck cancer, CRT, bone lesion. Compared to previous with measurements. CHEST:LUNGS AND PLEURA: Mild atherosclerotic consultation of the thoracic aorta and coronary arteries.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged left adrenal nodule (image 104, series #3) since at least 5/22/2012.KIDNEYS, URETERS: Multiple subcentimeter left renal hypodensities are too small to characterize though unchanged from prior exam.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical tacks in the low anterior abdominal wall. Right abdominal wall intramuscular lipoma is grossly unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged, heterogeneous prostate.BLADDER: Redemonstrated wall thickening of an incompletely distended bladder suggests chronic outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis of the sigmoid colon.BONES, SOFT TISSUES: Small sclerotic focus in the right iliac bone is unchanged.OTHER: No significant abnormality noted
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No CT evidence of metastatic disease.
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Generate impression based on findings.
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Skull fracture over 8 weeks ago with continued headaches. There is a persistent nondisplaced left occipital fracture. There is no evidence of acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is partial opacification of the left maxillary sinus. The imaged mastoid air cells are clear. There is an incidental persistent craniopharyngeal canal. The extracranial soft tissues are unremarkable.
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Persistent nondisplaced left occipital fracture. No evidence of acute intracranial hemorrhage, mass, or cerebral edema.
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Generate impression based on findings.
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62 year old female with metastatic ovarian cancer. CHEST:LUNGS AND PLEURA: Cyst in the inferior aspect of right upper lobe unchanged. Scattered linear opacities most compatible with scarring. No evidence of suspicious nodules. Trace effusions bilaterally.MEDIASTINUM AND HILA: Pre-carinal node measures 1.1 x 1.7 cm (series 3, image 26). Mild coronary artery calcifications. Heart size normal. Subcentimeter thyroid nodules.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver compatible with metastases, some of which are increased in size. Reference right lobe lesion not significantly changed and measures 1.1 cm, previously measured 1.1 cm. Increase in size is best appreciated in several left lobe lesions, such as segment 2 lesion which currently measures 1.6 cm, previously measured 0.6 mm (series 3, image 61).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild hydronephrosis on the right unchanged.RETROPERITONEUM, LYMPH NODES: No significant change in borderline enlarged retroperitoneal nodes; reference aortocaval node measures 7 x 12 mm, producing measured 6 x 10 mm (series 3, image 113).BOWEL, MESENTERY: Moderate ascites fluid and omental/mesenteric nodularity consistent with peritoneal carcinomatosis; most omental lesions appear decreased in size and more cystic/necrotic compared to prior exam. Decrease in size is best appreciated along left hemi-abdomen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous lesions, some of which contain fat and calcification, likely represent combination of leiomyomas arising from uterus as well as adnexal lesions. The most superiorly located uterine lesion appears more cystic since the prior exam.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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Mixed response with increase in size of several liver lesions but decrease in size of many omental lesions.
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Generate impression based on findings.
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Chest pain unspecified. Effusion on CXR. Evaluate for PE. PULMONARY ARTERIES: Technically adequate infusion quality to the level of the interlobar pulmonary arteries. Segmental and subsegmental emboli may not be visible in the lower lobes. Aa minimal eccentric recanalized chronic thrombus in the left descending pulmonary artery (5/117). No acute appearing pulmonary emboli are appreciated. Motion artifact degrades image quality through the lung bases, also limiting evaluation.LUNGS AND PLEURA: Small bilateral pleural fluid collections, increased compared to previous.Dependent changes and compressive atelectasis of the posterior lung fields. Subsegmental atelectasis left lower lobe.No pneumothorax.MEDIASTINUM AND HILA: Mild prevascular lymphadenopathy measuring up to 11-mm, not significantly changed. Mild para-aortic, subcarinal and paratracheal lymphadenopathy, unchanged. Mild cardiophrenic lymphadenopathy bilaterally.Small pericardial fluid collection, increased in volume from previous. In some areas, this measures higher than simple fluid, suspicious for a complex collection either due to blood products or possibly infectious pericarditis. Retained epicardial pacing wires versus small-caliber drains within the anterior and basilar pericardial spaces unchanged. Moderate cardiomegaly or, about the same. Mitral prosthesis. Right cardiac chamber enlargement with straightening of the intraventricular septum suggesting right heart strain. Main pulmonary artery difficult to measure due to motion but probably normal in caliber. CHEST WALL: Mild internal mammary chain lymphadenopathy, left greater than right. Osseous nonunion of the sternum with areas of cortical resorption involving the manubrium and superior sternum which could indicate osteomyelitis.. Sternal closure wires again noted. No drainable substernal fluid collections. Soft tissue density nodule in the anterior mediastinum seen on series 5 image 78 may reflect confluent lymphadenopathy ; a hematoma may have a similar appearance but is considered less likely.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No acute abnormality.
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1. No evidence of acute pulmonary embolus to the lobar level. Minimal nonocclusive chronic recanalized thrombus in the left descending pulmonary artery and evidence of right heart strain.2. Small circumferential pericardial fluid collection has increased in volume compared to the previous examination and measures higher Hounsfield units than simple fluid, suspicious for complex collection due to infectious pericarditis or less likely blood products. Retained wires in the pericardial space, correlate with surgical history.3. Diffuse anterior and middle mediastinal lymphadenopathy as well as internal mammary chain lymphadenopathy, about the same.4. Osseous nonunion of the sternotomy fracture with cortical resorption; this may be an early sign of osteomyelitis.5. Small pleural effusions. Nonspecific left lower lobe subsegmental atelectasis.
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Generate impression based on findings.
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22-year-old male with Hodgkin lymphoma status post ABVD and RT. CHEST:LUNGS AND PLEURA: Few scattered micronodules are stable.MEDIASTINUM AND HILA: Two calcified right mediastinal lymph nodes are unchanged. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Remains prominent in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.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 CT evidence of suspicious adenopathy or recurrent disease.
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Generate impression based on findings.
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76-year-old male. Metastatic prostate cancer. Reason: Evaluation after 25 weeks on enzalutamide. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Hypodense nodule in the right thyroid lobe is unchanged. Calcified right paratracheal node. No mediastinal or hilar lymphadenopathy.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Gallstones. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 3 cm left adrenal mass demonstrated to be a myelolipoma on prior MRI (series 3, image 101).KIDNEYS, 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: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: Pelvic nodal mass is stable and measures 2.2 x 2.3 cm (series 3, image 166). BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion in the left femoral neck, consistent with a metastases, unchanged. Four functional lumbar segments. L5 is sacralized bilaterally. OTHER: No significant abnormality noted
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Stable examination.
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Generate impression based on findings.
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Right upper lobectomy for lung cancer LUNGS AND PLEURA: Persistent numerous groundglass nodules bilaterally unchanged. The reference lesions are all similar in appearance (image 21, 22 and 26 series 4), however multiple lesions were evaluated and compared directly. No suspicious new additional nodules or new semisolid components.Postsurgical changes of the right upper lobectomy unchanged. No effusions.MEDIASTINUM AND HILA: Calcified right hilar lymph nodes. No additional lymphadenopathy.Mild coronary calcifications.CHEST WALL: Scattered mild degenerative changes throughout the thoracic spine unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Large left renal cyst. No additional upper abdominal abnormalities within this limited evaluation
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Numerous scattered bilateral groundglass nodules without evidence of interval change. Serial CT follow-up imaging is again required to continue monitoring for indolent primary neoplasm versus atypical adenomatous hypoplasia
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Generate impression based on findings.
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20 year-old male with history of refractory neuroblastoma. Rule out pathologic fracture. Presented with pain.EXAMINATION: CT pelvis without IV contrast 12/11/13 Again seen are mixed sclerotic and lytic lesions diffusely throughout the pelvis, compatible with history of metastatic neuroblastoma. No discrete fracture or dislocation is identified. Probable chronic avulsion of the left lesser trochanter is again noted.Adjacent to the inferior aspect of the right femoral head in the space of the right obturator externus, there is a hypoattenuating lesion measuring 5.1 x 3.7 cm (image 68, series 5). There are also probable bilateral joint effusions.Baclofen pump is noted. The visualized bowel is normal in caliber. Diffuse skeletal metastases in the lower lumbar spine are noted, including end plate changes at the superior and inferior endplates of L5.
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Hypoattenuating lesion in the region of the right operator externus as discussed above. This likely represents a metastatic lesion or hematoma. Probable bilateral joint effusions are noted. There is no evidence of an acute pathologic fracture.
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Generate impression based on findings.
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Esophageal cancer status post 6 cycles of chemo evaluate for disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Left chest port tip at the SVC/RA junction. Normal heart size. No pericardial fluid. Previously measured periesophageal mass inseparable from the right lateral wall of the descending thoracic aorta at the level of the left atrium measures 1.5 x 1.2 cm, previously 1.9 x 1.4 cm (axial series image 50). Small surrounding periesophageal lymph nodes are unchanged. There is mild distal esophageal wall thickening to the level of the GE junction which is unchanged. Poor contrast enhancement of the stomach precludes measurement of gastric component of mass, though gastric wall thickening is appreciated consistent with known tumor.CHEST WALL: Left chest port. Mild spinal stenosis due to ligamentous ossification in some areas of the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Majority of the hepatic metastases appear smaller with reference right hepatic lobe lesion measuring 10 x 10 mm, previously 14 x 14 mm (axial series image 94).SPLEEN: Splenic lesion better defined on today's examination but appears similar in size, indeterminate. Although this could be an occult metastasis, a splenic cyst, hemangioma or lymphangioma are also possibilities.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild retroperitoneal lymphadenopathy. Reference gastrohepatic lymph node measures 20 x 15 mm, previously 21 x 16 mm (axial image 88). The diaphragm posterior to the lesion appears irregularly thickened and abnormally enhancing which could indicate localized invasion however this is poorly seen. Reference aortocaval lymph node measures 6 x 6 mm, previously 9 x 9 mm, smaller (axial image 126).BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastric wall thickening involving the GE junction extends into the fundus and body of the stomach, about the same. Extend is unclear given lack of oral contrast and under distention of the stomach which may mimic wall thickening. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Improvement reference measurements of esophageal mass, hepatic metastases and lymphadenopathy.
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Generate impression based on findings.
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77 year-old male with mesothelioma status post-pleurectomy and decortication LUNGS AND PLEURA: Status post interval pleurectomy and decortication with trace peripheral fluid and scarring. Peripheral soft tissue nodularity at the left lung base which measures 11 mm in depth deserves close follow-up (image 16, series 3). Volume loss on the left. No pneumothorax.CHEST WALL: Subcutaneous emphysema tracks along the chest wall, presumably from recent surgery. Left chest wall generator. Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Right renal cyst is partially visualized.
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Status post interval pleurectomy and decortication with peripheral scarring and fluid as well as soft tissue nodularity at the left base which deserves close follow-up.
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Generate impression based on findings.
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Male 71 years old Reason: eval for progression History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Multiple nodular lung opacities, some of which are increased in size. The right upper lobe lesion is not significantly changed, measuring 1.0 x 1.8 cm, previously measured 1.1 x 1.8 cm (series 5, image 27). Reference right middle lobe nodular focus is increased in size measuring 1.1 x 2.5 cm, previously measured 0.5 x 1.7 cm (series 5, image 41).Increase in size and ill-defined right base opacity with associated bronchiectasis, measuring approximately 1.8 x 3.6 cm (series 5, image 69).Linear left upper lobe reference nodule not significant changed measuring 5 x 10 mm, previously measured 5 x 9 mm (series 5, image 16).Increase in size of left lower lobe nodule (series 5, image 70).MEDIASTINUM AND HILA: Interval increase in mediastinal and hilar lymphadenopathy. In reference right hilar soft tissue measures 3.5 x 2.7 cm, previously measured 3.3 x 1.3 cm (series 3, image 46). The lesion narrows the right lower lobe bronchus. In significant increase in size is also noted in multiple upper mediastinal nodes (series 3, image 26).CHEST WALL: Interval increase in size of multiple sclerotic lesions in the osseous structures.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating focus in pancreatic head is not significant changed, measuring approximately 1.9 x 1.2 cm, previously measured 1.9 x 1.4 cm (series 3, image 104).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable punctate nonobstructing stones in both kidneys. Hypodensities in the kidneys unchanged, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy. Extensive atherosclerotic calcifications in the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Right external iliac node unchanged and measures 7 x 6 mm, previously measured 6 x 5 mm (series 3, image 165).BOWEL, MESENTERY: Penile prosthesis reservoir unchanged.BONES, SOFT TISSUES: Sclerotic focus in right sacrum unchanged.OTHER: No significant abnormality noted
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1.Increase in size of multiple liver nodules and lesions.2.Significant increase in mediastinal lymphadenopathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Left upper lobectomy for adenocarcinoma LUNGS AND PLEURA: Left upper lobectomy with postsurgical changes and a scar-like abnormality in the posterior aspect of the left apex not conclusively changed measuring approximately 12 mm in craniocaudal dimension when measured in a similar fashion ( image 39 series 80268).The right upper lobe small ground glass nodular density also remains unchanged measuring 9 mm (image 40 series 5). The mild central density again unchanged, warranting continued serial imaging to exclude indolent adenocarcinoma.MEDIASTINUM AND HILA: Marked heterogeneous enlargement of the thyroid gland, unchanged. Probable goiter.No lymphadenopathyAtherosclerotic calcifications of the aorta and coronary. The cardiac and pericardium otherwise remain within limits.Small hiatal herniaCHEST WALL: Surgical clips in the left axilla. Questionable asymmetric breast density, greater on the left, consider follow up and dedicated imaging.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. No additional abnormalities observed in this limited view of the upper abdomen
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1. Stable appearing right upper lobe ground glass nodular density, however serial imaging is again recommended to exclude an indolent adenocarcinoma.2. left apical scar like abnormality and postsurgical changes unchanged3. Questionable left breast mass, please correlate with physical exam and consider additional dedicated imaging
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Generate impression based on findings.
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Osteomyelitis of skull, sp craniotomy, 4 month follow up. There is a left hemicraniotomy flap. There has been interval partial remineralization of the small lucent foci within the anterior portion of the flap. The remainder of the flap appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable.
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Interval partial remineralization of the small lucent foci within the anterior portion of the left hemicraniotomy flap.
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Generate impression based on findings.
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T4N2b supraglottic carcinoma s/p completion of 5/5 cycles of CRT on 3/1/12. There are post-treatment findings in the neck with persistent extensive mucosal edema in the glottic and supraglottic regions with severe narrowing of the airway at this level. There is no discrete mass lesion identified, however. Likewise, there is significant cervical lymphadenopathy by size criteria. For example, a left level 1B lymph node measures 8 x 6 mm, previously 7 x 6 mm, and a left level 2A lymph node measures 10 x 5 mm, previously 9 x 5 mm. These lymph nodes appear hyperemic and are likely reactive. There is unchanged hyperemia of the bilateral submandibular glands, also likely related to treatment. A tracheostomy tube is in position and the airway inferior to the tube is patent. There is unchanged irregularity and sclerosis of the right thyroid cartilage, which likely represents osteoradionecrosis. The osseous structures are otherwise unremarkable. There is an apparent air-fluid level within the right maxillary sinus. There are unchanged bilateral cheek skin lesions, which likely represent sebaceous cysts or related processes. The partially imaged intracranial structure are grossly unremarkable.
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1. Post-treatment findings for a supraglottic squamous cell carcinoma with persistent edema in this region, but no evidence of discrete mass lesions or significant cervical lymphadenopathy.2. An apparent air-fluid level within the right maxillary sinus may indicated acute sinusitis.
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Generate impression based on findings.
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Adenocarcinoma, follow-up LUNGS AND PLEURA: The reference left upper lobe pleural based nodule has improved and diminished in size, currently measuring 1.0 x 0.9 cm (image 22 series 5) from a prior measurement of 1.7 x 1.4 cm. Associated pleural involvement remains suspected.Associated subpleural reticulation, moderate traction bronchiectasis and honeycombing is again observed, most pronounced in the lung bases. This fibrotic UIP pattern is similar but currently demonstrates mildly increased changes in the upper lung, greater on the left possibly representing superimposed radiation change. No new superimposed suspicious nodules or masses. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy, specifically the conglomerate nodal mass anterior to the carina and is diminished in size and currently below the threshold and demonstrates fatty centers. The previously measured 2.0 cm currently measures 1.2 cm. (Image 44 series 4). The reference left hilar lymph node is also diminished in size and currently borderline in its dimension and at 10 mm from 14 mm (image 54 series 4).Small hiatal hernia.Cardiac and pericardial appearance unchangedCHEST WALL: Right chest wall port. Interval progression and increased from pressure defect of lower thoracic vertebrae, suspected T10 and T11. Questionable faint new lytic lesion in the manubrium.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Presumed cyst in the left lobe of the liver. No additional new abnormalities in the upper abdomen
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1. Interval improvement with decreased size of the left upper lobe pleural-based mass following treatment, reference measurements provided. Associated decrease in lymph node measurements.2. Mildly increasing fibrotic changes and questionable post radiation change of the left upper lobe.3. Progression of multiple compressed lower thoracic vertebrae with lytic lesions suspicious for metastatic disease
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Generate impression based on findings.
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Pleural mesothelioma, completed chemotherapy, please restage. CHEST:LUNGS AND PLEURA: Right hemithorax volume loss with circumferential pleural thickening and fluid consistent with provided history of mesothelioma. Reference measurements on the right as follows:Level of the origin of the great vessels (3/28): Three o'clock position 12 mm, previously 17-mm. Six o'clock position 9 mm, previously 14-mm.Level of the hepatic dome (3/70) 5 o'clock position 17 mm, unchanged.Tumor on the right involves the visceral pleural surfaces of the fissures, not significantly changed.No pleural fluid.No conclusive contralateral pleural disease.MEDIASTINUM AND HILA: Index right paratracheal lymph node unchanged at 11-mm (3/27). Tumor is inseparable from the right posterior lateral wall of the trachea at the level of the top of the aortic arch, unchanged (3/28). Additional numerous mildly enlarged mediastinal lymph nodes bilaterally in all compartments are stable to slightly decreased in size.Tumor extends into the pericardial fat pad on the right.Focal pericardial thickening or fluid adjacent to the pulmonary outflow tract (on the left). Nodular pericardial thickening on the right could reflect mediastinal pleural tumor in part however a thin focal areas obliterates the epicardial fat plane such as adjacent to the SVC (3/56), and is suspicious for pericardial involvement despite lack of significant volume of the pericardial fluid.CHEST WALL: Mild right internal mammary chain lymphadenopathy, unchanged. Numerous small lymph nodes are in the paravertebral fat. The tumor obliterates the right prevertebral/paravertebral fat locally (3/71) in the lower thorax, but there is no evidence of cortical erosion to suggest osseous invasion.Small right supraclavicular lymph nodes (3/3) are unchanged. No areas of extension beyond the bony thorax are identified.ABDOMEN: Absence of enteric contrast material markedly limits 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: Mildly enlarged lymph node in the gastrohepatic ligament unchanged (3/97).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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Improvement reference pleural measurements on the right. Thoracic lymphadenopathy unchanged. Tumor involves the mediastinum and probably the pericardium, despite the lack of pericardial effusion. Visceral pleural involvement on the right. No signs of extension outside of the bony thorax or of conclusive intra-abdominal spread of disease. Please refer to prior outside PET report regarding right low neck and gastrohepatic ligament lymph node significance.
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Generate impression based on findings.
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Nonalcoholic liver disease. Evaluate for intracranial bleed. Limited portable CT that exclude the majority of the posterior fossa structures. Within this limitation there is no evidence of acute intracranial hemorrhage or cerebral edema. There is a fat attenuation lesion within the superior vermian cistern that is incompletely imaged, but is compatible with a lipoma. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are air fluid levels in the maxillary sinuses, likely replated to intubation. There a nodular skin lesions in the occipital region that may represent sebaceous cysts.
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Limited portable CT that exclude the majority of the posterior fossa structures. Within this limitation there is no evidence of acute intracranial hemorrhage.
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Generate impression based on findings.
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Male 63 years old; Reason: NHL, re-eval and compare to previous History: NHL CHEST:LUNGS AND PLEURA: There are multiple bilateral pulmonary nodules. AP window nodule measures 1.7 x 1.1 cm (image 36/series 5) previously, 1.8 x 1.4 cm.Right hilar nodule measures 0.9 x 0.9 cm (image 50/series 5) previously, 1.3 x 1.2 cm.Right lower lobe peripherally located nodule measures 1.3 x 1.0 cm (image 78/series 5) previously, 1.6 x 1.4 cm.Left lower lobe peripherally located nodule has nearly resolved measuring 1.3 x 0.6 cm (image 77/series 5) previously, 2.0 x 1.4 cm.Ground glass changes in the right upper lobe (image 37/series 5) have slightly improved.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive coronary calcifications.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple well marginated hypoechoic and cystic areas in liver are unchanged and compatible with cysts.No suspicious hepatic lesions.Calcified gallstones layer within a nondistended gallbladder. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple cystic lesions in both kidneys. At the lower pole of the right kidney, there is a complex cystic lesion with internal septations extending at least a Bosniak 2F. lesion. It is not significantly changed in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel adjacent to the transplant kidney is suboptimally distended but has a mildly thickened wall.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right iliac fossa renal allograft without hydronephrosis, nephrolithiasis or perinephric fluid collections.
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1.Decrease in the size of the pulmonary lesions.2.Bosniak 2F cystic lesion in the right kidney.3.Nonspecific bowel wall thickening in the pelvis adjacent to the transplant renal allograft
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Generate impression based on findings.
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Throat cancer CHEST:LUNGS AND PLEURA: Mild emphysema with multiple scattered solid and ground glass micronodules all measuring under 5 mm. Essentially unchanged in size and number. No suspicious new focal air space abnormality (Image 41 series 4).Focal septal thickening in the right lung base resolves, presumably postinfectious. No effusionsMEDIASTINUM AND HILA: Tracheostomy tube unchanged.Reference right pretracheal lymph node (image 21 series 3) remained 8 mm. In the low right paratracheal lymph node when measured similarly currently measures 1.4 cm from a prior measurement of 2.0 cm (image 36 series 3).Coronary calcifications.CHEST WALL: Right chest portABDOMEN: 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: Cortical scarring of the left kidney unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes. No lymphadenopathyBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No significant abnormality noted.BONES, SOFT TISSUES: Old G-tube trackOTHER: No significant abnormality noted.
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No significant interval change or findings to suggest recurrence. Mild changes in reference lymph node measurements may be partially due to positioning and volume averaging.
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Generate impression based on findings.
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Male 64 years old; Reason: 64 y/o M w/ metastatic urothelial carcinoma, please restage prior to initiation of chemotherapy History: none CHEST:LUNGS AND PLEURA: Severe left upper lobe emphysema and mild right upper lobe emphysema. Scarring in the left upper lobe. Left upper lobe pulmonary nodule measures 4 x 4 mm on image 35/series 4.MEDIASTINUM AND HILA: Small mediastinal lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is diffusely hypoattenuating compatible with fatty infiltration. No suspicious hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral renal cysts. Phase of imaging is suboptimal to evaluate for small renal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta.No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged with heterogeneous enhancement of the left peripheral zone.BLADDER: No significant abnormality notedLYMPH NODES: Left pelvic iliac node measures 2.1 x 1.9 cm (image 183/series 3) previously, 2.7 x 2.0 cm.Left external iliac lymph node measures 2.1 x 1.6 cm (image 172/series 3), previously, 1.5 x 0.8 cmBOWEL, MESENTERY: Scattered chronic diverticula.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Significant pelvic lymphadenopathy. Enlargement of some of the lymph nodes in the pelvis.
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Generate impression based on findings.
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Malignant neoplasm of prostate. There is multilevel degenerative spondylosis, particularly at C4-5 and C6-7, but no discrete lytic or blastic lesions are identified in the spine. There is a lucency in the left mandibular body, which likely represents an extraction cavity. There are no soft tissue mass lesions in the neck. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are intact. The partially imaged intracranial structures are grossly unremarkable. The airways are patent. There is biapical scarring with associated calcifications.
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Multilevel degenerative spondylosis, particularly at C4-5 and C6-7, which may account for the abnormal activity on the prior bone scan. Otherwise, no evidence of metastatic disease to the neck.
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Generate impression based on findings.
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Face and neck cancer squamous cell. CHEST:LUNGS AND PLEURA: Interval removal of the tracheostomy tubeEnlarging bilateral pleural effusions far more pronounced on the left and with underlying compression atelectasis.Multiple metastatic lesions to the lungs and pleura have increased in size. The reference left lung base lesion currently measures 4.9 x 4.1 cm, previously 4.4 x 3.1 cm (image 54 series 4). The right lung base parenchymal and subpleural nodules also increased in size it difficult to measure secondary to compression and/or partial consolidation of the right lower lobe.Particular attention is made of multiple bilateral diaphragmatic lesions demonstrating significant interval increase in size, greater on the left.MEDIASTINUM AND HILA: Previously described right hilar lymphadenopathy is difficult to discern given collapse and or consolidation. The previous reference right hilar node remains approximately 1.2 cm (image 51 series 3).Unchanged mild cardiomegaly and small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Extensive cholelithiasis. Liver otherwise unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal poorly visualized and potentially engulfed in a large renal mass. Right adrenal unremarkableKIDNEYS, URETERS: Infiltrative left renal and metastatic lesion extending from the apex of the kidney towards the hilum. When measured similarly, this lesion or multiple conglomerate lesions measure 7.4 x 4.1 cm (image 85 series 3) from a prior measurement of 5.6 x 4.1 cm. Right kidney unremarkable other than a simple cystPANCREAS: No significant abnormality noted but the overall organ appears small and atrophic.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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Interval increasing number and size of multiple metastatic lesions. Reference measurements above. Please note particular involvement of the left kidney and both diaphragms/pleura.
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Generate impression based on findings.
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Peritoneal mesothelioma LUNGS AND PLEURA: Mild diaphragmatic thickening on the left is not distinguishable from pleural surface in that location. Lack of pleural fluid favors that the pleura is not involved. No additional finding suggests pleural involvement by tumor. No suspicious pulmonary nodules or masses. No pneumothorax.MEDIASTINUM AND HILA: Last VAD tip at the level of the superior vena cava. Moderate coronary artery calcification. No pericardial fluid. No intrathoracic lymphadenopathy.CHEST WALL: A small left the low cervical region lymph node in is unchanged compared to 2011 and likely benign. No axillary lymphadenopathy.Small sclerotic foci in the right humeral head and left scapula are unchanged compared to 2011 and likely represent benign bone islands.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. CT abdomen and pelvis will be reported separately. Subtle peritoneal thickening, nodularity and soft tissues stranding predominantly on the left is consistent with known peritoneal mesothelioma.
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No evidence of intrathoracic spread of disease. Peritoneal mesothelioma involving the left hemidiaphragm with without conclusive spread to the diaphragmatic pleural surface as no ipsilateral pleural fluid is present.
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Generate impression based on findings.
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Malignant neoplasm of the renal pelvis, follow-up LUNGS AND PLEURA: Persistent unchanged left basilar scarring with a small subcentimeter nodular density (image 76 series 4).Mild centrilobular emphysema without additional focal abnormality. No effusionsMEDIASTINUM AND HILA: A persistent mild anterior mediastinal soft tissue compatible with residual recurrent thymus, unchanged. No lymphadenopathyThe cardiac and pericardium other than moderate coronary calcifications remains unchangedCHEST WALL: Minimal gynecomastiaUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Pancreatic fullness in the mid body again observed without a discrete lesion or significant change. The appearance of uncertain significance and dedicated imaging may be clinically indicated. Again no additional subdiaphragmatic abnormalities are observed in this limited upper abdominal exam
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No pulmonary metastatic disease identified
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Generate impression based on findings.
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52-year-old male. History of mesothelioma, peritoneal, status post resection on observation. Evaluate evidence of disease compare to previous ABDOMEN:LUNG BASES: No effusions. Micronodules unchanged. Please refer to chest CT report.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Peritoneal disease noted adjacent to the left hemidiaphragm, spleen, and stomach is unchanged compared to prior. For reference purposes, a focus adjacent to the stomach and spleen (image 29; series 9) currently measures 2.2 x 1.1 cm (1.1 cm in thickness); this same focus also measured 2.2 x 1.1 cm previously (image 105; series 3; 8/14/2013 study).PELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Unchanged peritoneal disease adjacent to the left hemidiaphragm, stomach and spleen with reference measurements given above.
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Generate impression based on findings.
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Post inflammatory pulmonary fibrosis with shortness of breath on exertion. LUNGS AND PLEURA: Subpleural distribution reticulation and nodularity with traction bronchiolectasis, but no discrete areas of honeycombing identified. Abnormality appears to spare the extreme lung apices but otherwise appears fairly symmetric and without zonal predilection. No pleural fluid or pneumothorax. A single subpleural cyst is noted in the right lower lobe near the costophrenic angle.MEDIASTINUM AND HILA: The esophagus is dilated and has retained fluid in its proximal and mid segments. Mild cardiomegaly. No pericardial fluid. Mild mediastinal lymphadenopathy bilaterally. Mild hilar lymphadenopathy bilaterally. For future reference a low right paratracheal region lymph node measures 14-mm (3/49). The main pulmonary artery is enlarged, measuring 33-mm in transverse dimension, consistent with pulmonary arterial hypertension.CHEST WALL: Small enhancing lymph nodes in the low cervical region bilaterally. Mild axillary and subpectoral lymphadenopathy, right greater than left. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range is unremarkable.
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1. Moderate subpleural pulmonary fibrosis and traction bronchiectasis without evidence of honeycombing. Radiographic appearance favors fibrotic NSIP, possibly related to an underlying collagen vascular disease given patulous appearance of the esophagus and presence of axillary lymphadenopathy.2. Mild mediastinal and hilar lymphadenopathy may be related to underlying lung disease or collagen vascular disease.3. Mild cardiomegaly.4. Signs of pulmonary arterial hypertension.5. Unable to assess for the presence of air trapping as no expiration sequence was performed.
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Generate impression based on findings.
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81 year-old female status post fall on coumadin. Mild periventricular hypoattenuation compatible with small vessel ischemic disease of indeterminate age.The ventricles, sulci, and cisterns are symmetric and prominent, representing age related volume loss appropriate for the patient's age. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Lens prostheses.
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No acute intracranial abnormality. Mild small vessel ischemic disease.
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Generate impression based on findings.
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Male 66 years old; Reason: 66 y/o male with unknown metastatic malignancy to liver. Evaluate for progression History: metastatic carcinoma to liver LUNG BASES: Centrilobular emphysema with subpleural atelectasis.LIVER, BILIARY TRACT: There are multiple lesions in the liver which have variable enhancing patterns. A liver dome lesion in segment 8 demonstrates marked arterial enhancement with delayed centripetal washout. Other lesions also enhance arterially and retain contrast. The reference lesion located in segment 7 and measures 3.7 x 4cm (series 12, image 24). When compared to previous precontrast measurement the lesion measures 2.6 x 1.8cm previously 2.4 x 1.7 cm (series 4; image 19), equivocally enlarged compared to prior. Punctate calcification in the inferior aspect of right lobe is most consistent with granuloma. Portal and hepatic veins are patent. Gallbladder appears unremarkable.SPLEEN: Spleen is stable.PANCREAS: No significant abnormality notedADRENAL GLANDS: Thickening of adrenal glands bilaterally is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference gastrohepatic node measures 1.2 x 1.2 cm (image 34; series 11), smaller compared to previous 1.3 x 1.3cm. Reference node anterior to distal portion of duodenum measures 1.6 x 0.6cm previously 0.9 x 1.6 cm (series 11; image 59), equivocally smaller.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: A lucent area in the T12 vertebral body is indeterminate. It demonstrates no evidence of cortical destruction at the current time and is unchanged in appearance (image 33; series 11). Suggest continued longitudinal follow-up or bone scan if clinically indicated.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Multiple hyper and hypoenhancing liver lesions are stable to equivocally enlarged. Continued follow up and as advised.2. Reference lymph nodes are stable. 3. Unchanged and indeterminate lucent area in the T12 vertebral body which should be followed or correlated with bone scan.
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Generate impression based on findings.
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Clinical question: Patient is a 62-year-old male with right internal carotid artery stenosis and history of prior stroke. Signs and symptoms: Dizziness, right internal carotid artery stenosis. Unenhanced head CT:There is no detectable acute intracranial process. CT however insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is a focus of encephalomalacia in the right anterior frontal lobe in the distribution of the right anterior tumor are free and traversing the watershed zone consistent with a chronic ischemic stroke. This finding was noted on prior head CT from Elmhurst Medical Center (dated 5 -- 30 -- 2008) as a focus of subacute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation otherwise. Minimal bilateral cavernous carotids and basilar artery calcification is noted. Examination also demonstrates few punctate foci of vascular calcification of the distal right MCA territory.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells with the exception of a tiny retention cyst in the left maxillary sinus.Neck CTA:There is only partial visualization of the superior aspect of the aortic arch which is unremarkable.The origins of major vessels are are visualized and unremarkable. There is anatomical variation of combined origins of great to cephalic and left common carotid artery.Unremarkable brachiocephalic branch and bilateral subclavian arteries. Mild vascular calcific plaque of left subclavian artery immediately proximal to the patent origin of the left vertebral artery is noted without any vascular lumen compromise.There is complete occlusion of right common carotid artery approximately 12 mm distal to its origin. Examination demonstrates filling of the right external carotid artery branches likely retrogradely through anastomotic pathways with the right vertebral artery as well as possible communication with the left external carotid arch branches as well as the ethmoidal branches of the right ophthalmic artery.There is reconstitution of a very small caliber and poorly visualized distal cervical component of right internal carotid artery which is likely retrograde filling through the external carotid artery branches. It appears to extend through the skull base and cavernous sinus and into the supraclinoid portion of right internal carotid artery. There is also a prominent patent right posterior communicating artery which also appears to contribute any filling of right supraclinoid internal carotid artery and subsequently filling of normal appearing the right anterior and middle cerebral artery proximal segment. The confirmed patency of all these anastomotic pathways conventional catheter angiography would be most helpful in particular if surgical intervention contemplated.Left common carotid artery and including its origin is unremarkable.There is mild calcific atherosclerotic plaques in the dorsal aspect of distal left common carotid and extending into the proximal left internal carotid artery without any significant vascular compromise. There is significant compromise of the origin of the left external carotid artery.Patent and unremarkable bilateral vertebral arteries including their origins.Head CTA:There is a very small caliber right cavernous carotid communicating with a large right supraclinoid internal carotid artery (prominent right posterior communicating artery contributing to right supraclinoid internal carotid artery flow). The right ophthalmic artery is identified and remains patent. There is patent right anterior and middle cerebral arteries. There is also good visualization of a patent right A2 segment of anterior cerebral artery. There is 8 mm long fusiform aneurysmal dilatation of the very proximal right A2 segment and without convincing evidence of involvement of the anterior communicating artery. The caliber of dilated proximal right A2 segment measures approximately 4 to 4.2 mm in size.Left internal carotid artery remains patent in its distal cervical portion and across to skull base and supraclinoid segments. Mild atherosclerotic disease and calcification is noted without vascular lumen compromise. The ophthalmic artery is identified and unremarkable. The anterior and middle cerebral arteries and their branches remain unremarkable.There is normal visualization of similar size bilateral vertebral arteries without vascular lumen compromise. Bilateral pica branches are identified and unremarkable. Basilar artery and its distal branches are also well visualized and unremarkable.
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1.Nonenhanced head CT demonstrate no acute intracranial process. Chronic right ACA territory anterior frontal ischemic stroke with interval evolution since prior outside institution head CT from 5 -- 30 -- 2008. Unremarkable exam otherwise.2.CTA of the neck demonstrates complete occlusion of right common carotid carotid artery approximately 11 mm distal to its origin. There is robust visualization of right external carotid artery branches filling retrogradely via anastomotic pathways and with highly suspected subsequent filling of a very small caliber and poorly visualized right internal carotid artery which appears to extend through the neck and across to skull base into the supraclinoid internal carotid artery. A prominent patent right posterior communicating artery also contributes to filling of the supraclinoid right internal carotid artery. Minimal atherosclerotic disease with calcification at the distal left common carotid and extending into proximal left internal artery without hemodynamically significant vascular lumen compromise. Unremarkable neck CTA otherwise. The confirmed above described finding a conventional angiogram is recommended.3.CTA of intracranial circulation demonstrate patent supraclinoid right internal carotid artery filling primarily fundal a prominent right posterior communicating artery as well as a very small caliber internal carotid arteries as detailed above. There is normal filling of right anterior and middle cerebral arteries. There is a 8mm long fusiform aneurysmal dilatated of the very proximal right A2 without evidence of involvement of anterior communicating artery. The caliber of dilated right A1 measures approximately 4 to 4.2-mm in size. Unremarkable CTA of intracranial circulation otherwise.
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Generate impression based on findings.
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16 year-old male with worsening headache. Examination shows a large, predominantly hypoattenuating (probably cystic) mass with peripheral hyperdense nodules centered at the right thalamus and pineal region with extension into the superior cerebellar cistern. The mass measures 44 x 42 x 43 mm (AP x TR x CC). The mass compresses the third and right lateral ventricles, resulting in mild hydrocephalus. There is about 4-mm leftward midline shift. The cerebellar tonsils appear minimally low lying, which could be either due to mass effect or congenital. The gray-white matter differentiation is normal. There is no intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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Large, predominantly hypoattenuating (probably cystic) mass centered at the right thalamus and pineal region with extension into the superior cerebellar cistern. There is resultant mild hydrocephalus. Differential consideration may include primitive neuroectodermal tumor of the thalamus or pineal gland, and astrocytoma. Contrast enhanced MRI brain is recommend for further characterization.
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Generate impression based on findings.
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Female 64 years old Reason: 64 y/o with colon ca family hx og gastric ca History: abd pain And ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several small hypodense areas seen in the liver all likely cysts as they are unchanged from the prior exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small nodules in the right adrenal gland. Multiple varying size enhancing nodules in the left adrenal gland the largest measuring up to 1.7 cm as seen on series 6 image 44. There are unchanged in size and configuration compared to the prior exam. Note that on the pre-IV contrast virtual colonoscopy exam done at same time not all lesions measure low density. There for by density the do not meet criteria for adenoma yet, adenomas more likely than metastases given its stability compared to 2012.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes sigmoid colon. Long segment moderate wall thickening in the proximal rectum. This area is distal to the anastomosis. Pericolonic fat is normal. No free or loculated intraperitoneal fluid. No signs of carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Several hypodense hepatic lesions either fluid density are too small to characterize but unchanged from 12/1112.Large nodules throughout the left adrenal gland and several small nodules in the right adrenal gland. There are unchanged from 12/11/12. See further details above.Wall thickening rectum.
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Generate impression based on findings.
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33-year-old male. Reason: r/o source of bleeding History: dropping Hgb, unknown source of bleeding CHEST:LUNGS AND PLEURA: Apical septal thickening, scattered areas of basilar predominant ground glass opacity, left more than right, most consistent with edema. Subsegmental consolidation in the left base suspected to represent superimposed infection or aspiration.New moderate bilateral pleural effusions.MEDIASTINUM AND HILA: Endotracheal tube in the expected position. Severe cardiomegaly. No pericardial effusion. New pericardial thickening. Status post median sternotomy and placement of an LVAD. Metallic streak artifacts obscure adjacent details. Right-sided aortic balloon pump catheter has been removed. OG tube terminates in the stomach. CHEST WALL: Left chest wall ICD in place. Catheter fragment embedded in the right chest wall (image 9, series 3). Left PICC line and bilateral chest tubes are in the expected position. ABDOMEN:LIVER, BILIARY TRACT: Stable hepatomegaly, which may be due to passive congestion/heart failure.High density within gallbladder likely represents residual vicariously excreted contrast material from prior exam.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 obstruction or bowel wall thickening. Small amount of free fluid in the lower abdomen and pelvis. OG tube terminates in the stomach. Enteric contrast in nondistended bowel. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in a decompressed urinary bladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No obstruction or bowel wall thickening. Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites.
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1.New moderate bilateral pleural effusions and compressive atelectasis. New LVAD and open median sternotomy. New bilateral chest tubes. ET tube. Foley catheter. Mediastinal drains. 2.Pericardial thickening. Small amount of ascites. Massive cardiomegaly. Anasarca. 3.No specific site of bleeding was found to explain recent hematocrit drop.
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Generate impression based on findings.
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Evaluate for progression of metastatic disease. Metastatic adenocarcinoma to lung. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules consistent with metastases. Index lesion in the superior segment of the left lower lobe measures 16mm, previously 11-mm (5/45). Additional solid nodule more superiorly as also enlarged (5/39). Diffuse thickening of the airways in the left upper lobe with surrounding groundglass opacity and thickening of the peribronchial lymphatic tissues is now consistent with lymphangitic tumor. Nodular thickening of the left major fissure. Mild basal septal thickening may reflect a component of edema. Peribronchial groundglass opacity is seen to a minimal extent in the superior segment of the right lower lobe. No pleural fluid or pneumothorax.Atelectasis in the left lower lobe abutting the cardiac border likely a combination of compressive and postobstructive.MEDIASTINUM AND HILA: Mild bilateral mediastinal lymph node enlargement. Reference left paratracheal lymph node measures 10 mm, previously 9-mm (3/25). New large circumferential pericardial fluid collection. The interventricular septum appears straightened and there is mild flattening of the anterior free wall of the right ventricle.Mildly enlarged hilar and interlobar lymph nodes bilaterally, slightly increased compared to previous. Moderate loculated anterior mediastinal fluid collection appears separate from the pericardial fluid.CHEST WALL: Bilateral breast prostheses. Slightly nodular appearance of soft tissues posterior to the left breast prosthesis of unclear significance but should continue to be monitored.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: Several small lymph nodes are seen in the region of the gastrohepatic ligament, new from previous measuring up to 9-mm (3/91). Several small retroperitoneal lymph nodes in the left periaortic and aortocaval regions, about the same. These are not abnormal in size but is normal in multiplicity.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. Interval enlargement of pulmonary metastases (both index and non-index lesions) with development of left bronchial wall thickening, thickening of the left major fissure and thickening of the peribronchial lymphatic tissues which is now consistent with lymphangitic spread of tumor.2. New large pericardial fluid collection with apparent straightening of the intraventricular septum and mild flattening of the anterior free wall of the right ventricle concerning for right heart strain and impending tamponade, recommend correlation with echocardiography. Dr. Salgia verbally notified at 2 p.m. on 12/11/13.3. Mild diffuse intrathoracic lymphadenopathy.4. Numerous small lymph nodes in the retroperitoneum and gastrohepatic ligament, some of which are new.
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Generate impression based on findings.
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Male 65 years old; Reason: metastatic prostate cancer, evaluation of disease after receiving 15 cycles investigational therapy. History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Nonspecific micronodule along the right minor fissure. No prominent lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Ascending aorta is dilated measuring 3.8 x 3.9 cm, unchanged.Esophagus is patulous and dilated.CHEST WALL: Sclerotic osseous metastatic disease.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Well marginated fluid attenuating lesions in the liver likely representing cysts unchanged. No new suspicious lesions.Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Parapelvic cysts. Bilateral renal cortical cysts. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease of the aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastatic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Post operative changes from prostatectomy with pelvic clips.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic metastatic disease to the pelvis. Postoperative changes in the right femur.OTHER: No significant abnormality noted
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1.Sclerotic osseous metastatic disease. No definite new sites of disease.
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Generate impression based on findings.
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Male 69 years old; Reason: s/p status post transhiatal esophagectomy for esophageal CA History: failure to thrive; dehydration CHEST:LUNGS AND PLEURA: Nonspecific micronodules in the right middle lobe on image 55/series 4.Right basilar atelectasis and a small right effusion occupying approximately 5 to 10% of the right hemithorax.Large left effusion occupying approximately 50% of the left hemithorax with associated atelectasis. Atelectasis and consolidation limits evaluation for metastatic disease to the lung.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There multiple small mediastinal lymph nodes and scattered and mediastinal fluid.Postoperative operative changes from esophagectomy and gastric pull-through.Post operative changes from median sternotomy.Aortic valve replacement ; multiple cardiac pacer leads.CHEST WALL: Extensive sclerotic lesions throughout the osseous structures compatible with metastatic disease.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense hepatic lesions suspicious for metastases. A segment 7 lesion measures 1.0 x 0.9 cm (image 79/series 3). There are least 12 other hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nephroureteral stents. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: The enlarged mesenteric lymph node measures 1.3 x 1.0 cm (image 112/series 3). BOWEL, MESENTERY: Thickening of the duodenum. Status post esophagectomy and gastric pull-through.Nodularity of the peritoneum and mesentery suspicious for peritoneal disease. Small amounts of upper abdominal and right ascites.BONES, SOFT TISSUES: Extensive osseous metastatic disease. Compression fracture of the L3 vertebral body, possibly pathologic .OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive pelvic sclerotic metastatic disease.OTHER: No significant abnormality noted
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1.New metastatic disease to the liver.2.Extensive osseous metastatic disease with a possible pathologic compression fracture of the L3 vertebral body.3.Large left pleural effusion occupying 50% of left hemithorax.4.No hydronephrosis; bilateral nephroureteral stents.5.Findings discussed with Kamm PAC at the time of dictation
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Generate impression based on findings.
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46 year old female with IMV thrombus. Follow-up. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesion. The portal vein, superior mesenteric vein, inferior mesenteric vein (annotated on coronal images), and splenic vein are all patent without evidence of thrombus. No obvious collateralization is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter renal hypodensities are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Inferior mesenteric vein is patent, as clinically questioned.
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Generate impression based on findings.
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Male 69 years old; Reason: Pre-kidney transplant evaluation, evaluate vasculature to support transplant History: past smoker with diabetes, history of CAD ABDOMEN:LUNGS BASES: No nodule or mass detected. Partially visualized is a thoracic aortic stent graft.LIVER, BILIARY TRACT: Calcified granulomas are noted in liver. Cholelithiasis noted without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous hyper dense and simple appearing cysts noted in the kidneys bilaterally. One lesion in the superior pole of the right kidney measures 58 Hounsfield units, which is nonspecific for blood or simple cyst and is indeterminate on this noncontrast examination.The kidneys are atrophic. Small calcifications in the renal pelvis of the left kidney are noted. No hydronephrosis, perinephric fluid collection, or mass lesions detected.RETROPERITONEUM, LYMPH NODES: Mild atherosclerosis of the descending aorta is seen. Bilateral moderate (approximately 120 degrees) calcifications of the posterior medial portion of the bilateral common iliac arteries are noted. Nearly 360 degree calcifications are seen in the internal iliac arteries. Very mild calcifications noted in the external iliac on the left and moderate on the right (approximately 120 degrees on the lateral aspect.)BOWEL, MESENTERY: Surgical clips in the right hemiabdomen without evidence of obstruction, free air, or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: EnlargedBLADDER: 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.Calcifications of the arterial vessels as above.2.Numerous cysts in the kidneys as well is indeterminate lesions incompletely characterized on this noncontrast CT.
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Generate impression based on findings.
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44-year-old female with IBD associated interstitial lung disease, multiple pulmonary nodules LUNGS AND PLEURA: Multiple new bilateral nodules are identified in the upper and lower lobes. Scattered linear scarlike and patchy groundglass opacities. Smoothly marginated right lower lobe nodule measures 1.3 x 1.2 cm and previously measured 1.2 x 1.1 cm (image 51 series 6) not significantly changed.Reference left upper lobe subpleural nodule with adjacent opacity is now replaced by a large subpleural masslike opacity which measures 3.7 x 2.3 cm (image 40 series 6).One previously identified left upper lobe subpleural nodule is decreased in size with residual scarlike opacity (image 33 series 6).MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. Mildly enlarged mediastinal lymph nodes.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. Multiple new pulmonary nodules as well as increase and decrease in size of several old nodules as detailed above, of unclear etiology.2. Unchanged smoothly marginated right lower lobe nodule.
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Generate impression based on findings.
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Newly diagnosed tonsil cancer, likely T2N2B after recent surgery. Head: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is a small right maxillary sinus retention cyst. The extracranial soft tissues are unremarkable. There are prominent occipital arachnoid granulations.Neck: There are postoperative findings related to left tonsillectomy with mild nonspecific ill-defined prominence of the left palatine tonsil. There is also a left tonsillolith. There is a cystic left level 2A lymph node that measures 29 AP x 29 RL x 33 SI mm, previously 22 AP x 254 RL mm (multiplanar reformatted images are not available in the prior CT from another institution). There is mild mass effect upon the left internal jugular vein. The airways are patent. The major salivary glands and thyroid are unremarkable. The osseous structures are unremarkable. The imaged portions of the lungs are clear.
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1. Postoperative findings related to left tonsillectomy with mild nonspecific ill-defined prominence of the left palatine tonsil. 2. Interval increase in size of the left level 2A lymph node, which currently measures up to 33 mm.3. No evidence of intracranial metastases.
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Generate impression based on findings.
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79-year-old male with history of TCC T3 s/p nephroureterectomy August 2013 The absence of intravenous contrast limits evaluation of the solid organs. Given this limitation, the following observations were made:CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious pulmonary nodules identified. Right lower lobe calcified granuloma.MEDIASTINUM AND HILA: Mild atherosclerotic calcification of the thoracic aorta. A calcified hilar and another calcified mediastinal lymph node is seen. A 1.3 x 1.1 cm pretracheal lymph node is identified. Other small subcentimeter mediastinal lymph nodes are appreciated.Dense coronary artery calcifications are noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The gallbladder lumen is heterogeneous. Due to lack of IV contrast, a neoplastic etiology cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy with expected postoperative changes. 5-mm nonobstructing right lower pole renal calculus and two punctate lower pole calculi are identified.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches. Interval development of a tubular structure approximately 6 cm in length in the retroperitoneum posterior to and anteriorly displacing the aorta spanning the levels of L1 to L3 approaches water density and likely represents a lymphocele, which may relate to recent surgery. Scattered, small, subcentimeter retroperitoneal nodes are also identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Subtle asymmetric bladder wall thickening is appreciated ipsilateral to the previous transitional cell carcinoma (image 190, series #3). Recurrence cannot be excluded.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.Study is limited due to lack of IV contrast.2.Heterogeneous gallbladder lumen. Differential includes neoplasm versus sludge versus chronic cholecystitis. Ultrasound is recommended for further characterization due to the patient's compromised renal function.3.Subtle asymmetric bladder wall thickening. Recurrence cannot be excluded.
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Generate impression based on findings.
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65-year-old male with unknown primary of the head and neck, evaluate for disease pre-treatment CHEST:LUNGS AND PLEURA: No suspicious nodules or masses.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the coronary arteries. Scattered atherosclerotic calcifications of the aorta. The heart size is normal. Hiatal hernia.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy. Degenerative changes of the thoracolumbar spine. Several healed left lateral thoracic rib fractures.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Focal hypoattenuation adjacent to the falciform ligament, as well as more diffuse right hepatic hypoattenuation most likely represents fat deposition.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. Focal dilatation of the infrarenal abdominal aorta which measures 3.6 x 4.2 cm (image 151, series 3) and contains eccentric mural thrombus.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. No evidence of metastatic disease.2. Infrarenal abdominal aortic aneurysm with mural thrombus.
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Generate impression based on findings.
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Male 36 years old; Reason: H/o Hodgkin please restage History: H/o masses CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heart size is normal. There are small mediastinal lymph nodes.A right paratracheal lymph node measures 1.3 x 0.6 cm (image 24/series 3) previously, 1.8 x 0.8 cm.Soft tissue soft tissue in the anterior mediastinum is unchanged.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy.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 pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Slight decrease in the size of the anterior mediastinal lymph node.
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Generate impression based on findings.
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36 year old male with history of Hodgkin's lymphoma. Evaluation of the previously measured jugulodigastric lymph nodes shows the one at level 2 on the left measuring 8 x 6 mm (series 6, image 91) compared to 9 x 6 mm previously, and the one at level 2 on the right measuring 10 x 6 mm as compared to 9 x 6 mm previously (series 6, image 91). No pathologic features are present such as cavitation or indistinct margins.Prominent right paratracheal lymph nodes are redemonstrated. The anteriorly located node which previously measured 12 x 10 mm currently measures 11 x 8 mm. A second node located posteriorly measured 12 x 7 mm previously and currently measures 12 x 7 mm (series 80996, image 219). Please see dedicated CT chest for further evaluation. Within the visceral space the thyroid gland appears intact.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 paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.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.
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No neck lymphadenopathy based on imaging criteria. Stable reference lymph nodes.
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Generate impression based on findings.
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Allergic rhinitis, cause unspecified. There are multiple retention cysts within the bilateral maxillary sinuses, left greater than right, with partial obstruction of the infundibula. There is a retention cyst within the right posterior ethmoid sinus with obstruction of the sphenoethmoid recess and thinning of the overlying ethmoid roof. There is an air-fluid level within the right sphenoid sinus. The left sphenoid and bilateral frontal sinuses are clear. The nasal cavity is clear. The mastoid air cells are clear. The optic canals and carotid grooves are covered by bone. The intracranial structures are grossly unremarkable. There are mild degenerative changed in the bilateral temporomandibular joints. There is staphylomatous deformity of the right globe. There is partially imaged periodontal lucency affect ADA 3.
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1. Scattered retention cysts and an air-fluid level within the right sphenoid sinuses, which may indicate acute sinusitis.2. Partially imaged periodontal lucency affect ADA 3.3. Staphylomatous deformity of the right globe.
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Generate impression based on findings.
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Male 83 years old; Reason: muscle-invasive bladder cancer History: muscle-invasive bladder cancer ABDOMEN:LUNG BASES: Bibasilar scarring/atelectasis. Paraseptal emphysema. Unchanged pleural plaques. No pleural effusions.LIVER, BILIARY TRACT: Unchanged bilateral hepatic cysts.SPLEEN: Stable enhancing round nodule in the spleen, possibly a hemangioma. Unchanged splenic calcified granulomata. A small splenule is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal masses evident. No nephrolithiasis or hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Scattered subcentimeter lymph nodes, similar to the prior exam.BOWEL, MESENTERY: No gross abnormalities noted.BONES, SOFT TISSUES: Bilateral chronic appearing pars defects at L4.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Unchanged enlarged prostateBLADDER: Interval increase in size of the and induration of the previously seen thickened bladder wall, since prior exam. The left aspect of the posterior bladder wall is nonenhancing markedly, which is new since previous exam.. The visualized mass measures approximately 5.8 x 2.5 cm (series 3 image 117) previously 2.3 x 1.4 cm.There is a marked inflammatory reaction in the pericystic space with nodularity along the vascular channels.LYMPH NODES: Scattered subcentimeter pelvic lymph nodes. The right obturator node measures 21 x 7 mm, previously 21 x 8 mm. An index left iliac chain node measures 2.3 x 2.0 cm throughBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Marked interval enlargement and induration of the previously known bladder cancer with invasion into the pericystic space, left greater than right.2. Subtle enlargement of the scattered small pelvic lymph nodes.
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Generate impression based on findings.
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47-year-old male with history of Hodgkin's disease and stem cell transplant. 100 day evaluation. The following observations are made given limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: Previously described cavitary lesion in the right upper lobe continues to regress in size and currently measures 2.5 x 0.9 cm (image 15; series 6). A more solid appearing component is noted centrally compared to prior. Slight regression in bilateral pleural effusions. Previous described multiple patchy consolidations appear stable.MEDIASTINUM AND HILA: Multiple calcified mediastinal lymph nodes are unchanged.CHEST WALL: Index right axillary lymph node measures 2.2 x 1.8 cm (image 26; series 401) not significantly changed from previous study. Left chest port.ABDOMEN: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: Left para-aortic lymph node (image 116; series 401) again measures 1.6 x 1.5 cm, unchanged compared to prior (image 121; series 401; 10/2/2013).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: Index. left external iliac node measures 5 mm, unchanged (image 168; series 401).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic bone lesion involving the L3 vertebral body and associated compression fracture with other sclerotic lesions L2 and L4 vertebral bodies are unchanged.OTHER: No significant abnormality noted
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Slight interval regression of one lung lesion with new solid component. Stable abdominal and pelvic lesions. Measurements given above.
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Generate impression based on findings.
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Chronic sinusitis. There is moderate mucosal thickening and bubbly secretions within the bilateral maxillary and right sphenoid sinuses. There is opacification of the bilateral infundibula. There is sclerosis and thickening of the right maxillary sinus walls. There is scattered moderate opacification of the bilateral ethmoid sinuses. There is mild mucosal thickening within the left sphenoid sinus. The frontal sinuses are nearly completely opacified and the left frontal sinus secretions contains calcific density material. The ethmoid roofs appear intact, although the right is 5 mm lower than the left. The carotid grooves are covered by bone. The optic canals may be partially dehiscent bilaterally. The nasal cavity is clear. There is trace fluid within the left mastoid air cells. The intracranial structures are grossly unremarkable.
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Pansinus opacification with features of acute upon chronic sinusitis in a sporadic pattern.
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Generate impression based on findings.
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Lung cancer status post chemo. Also CHF. Shortness of breath on exertion. CHEST:LUNGS AND PLEURA: Several small pleural nodules along the right major fissure are unchanged. Index right middle lobe nodule inseparable from the minor fissure measures 18 x 16 mm, previously 17 x 10 mm (6/49). This nodule is also increased in density in the interim. Mosaic attenuation of lung parenchyma again noted. Scattered calcified pulmonary nodules.MEDIASTINUM AND HILA: Severe multichamber cardiomegaly with ICD leads in place. Large partially calcified mass in the posterior left atrium has a new hypoattenuating component measuring 12-mm in thickness along its left and inferior borders, most consistent with adherent thrombus. Largest dimensions of the mass and presumed adherent thrombus on the coronal image 47 measures 4.8 by 3.3-cm.Severe multichamber cardiomegaly. Severe coronary artery calcifications. Numerous enlarged calcified mediastinal lymph nodes. A lower left paratracheal noncalcified lymph nodes measure up to 16 mm short axis, previously 10-mm (axial series image 29). Mild noncalcified subcarinal lymphadenopathy also noted. Calcified mitral annulus. New small pericardial recess fluid collection. Main pulmonary artery is enlarged to 4.4-cm in transverse dimension, consistent with pulmonary arterial hypertension.CHEST WALL: Just below the left ICD pacemaker generator in the anterior soft tissues of the left chest wall there is a complex fluid collection measuring 6.3 x 7.5-cm in transaxial dimensions (axial image 22) and greater than 7-cm in craniocaudal length (incompletely included within the scanning range, likely larger in this dimension); this is most consistent with a hematoma in the pacemaker generator pocket. The overlying skin of the anterior chest wall is thickened. Moderate ipsilateral axillary lymphadenopathy is new and could be reactive. Subcutaneous edema and soft tissue stranding elsewhere in the chest wall, left greater than right. These findings raise suspicion for infection.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Moderate volume of ascites. Gallbladder is collapsed. The suprahepatic and intrahepatic inferior vena cava and hepatic veins are dilated and there is reflux of contrast material into the hepatic veins.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous hypoattenuating cortical lesions are incompletely characterized but most likely represent cysts. The right kidney is malrotated.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged. IVC and renal veins are dilated. Atherosclerotic calcifications of the ostia of the renal arteries bilaterally.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Assessment limited due to incomplete distention.BONES, SOFT TISSUES: Anasarca. Severe degenerative change of the spine.OTHER: No significant abnormality noted.
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1. Large hematoma in the left anterior chest wall likely arising from the pacemaker generator pocket. The presence of lymphadenopathy, skin thickening and surrounding soft tissue swelling is suspicious for infection. Dr. Hoffman was verbally notified at the time of dictation and will relay the findings to the patient's Cardiologist.2, Interval development of thrombus adherent to the left atrial mass, approximately 12 mm in thickness. Dr. Hoffman notified at the time dictation...3. Minimal increase in measurements of index right middle lobe nodule and non-index lower left paratracheal lymph node.4. Enlargement of the main pulmonary artery consistent with PA hypertension.5. Signs of right heart strain/failure and development of abdominal ascites.
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Generate impression based on findings.
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Adenocarcinoma, follow-up LUNGS AND PLEURA: Left upper lobectomy surgical changes without evidence of local recurrence. No new suspicious pulmonary nodules or masses. No effusions.Small minimal tree in bud deformity in the anterior right upper lobe (image 52 series 5), likely aspirationSmall focal ground glass ill-defined abnormality in the posterior left lower lobe (image 33 series 5), unchanged. Mild emphysema MEDIASTINUM AND HILA: No lymphadenopathy. Mild coronary artery calcifications without additional cardiac or pericardial abnormalityCHEST WALL: Breast implants bilaterallyUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic cyst unchanged and no additional focal abnormality observed in this limited upper abdominal evaluation.
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No evidence for recurrent or metastatic disease. Stable postsurgical changes and mild aspiration
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Generate impression based on findings.
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Newly diagnosed nasopharynx cancer, right thyroid nodule. There is ill-defined thickening of the left and midline posterior nasopharyngeal mucosa with effacement of the fossa of Rosenmller. The tumor measures up to 8 mm in anteroposterior width. There is no evidence of skull base invasion or compromise of the left internal carotid artery. There is no significant cervical lymphadenopathy. There is a partially calcified nodule within the isthmus of the thyroid that measures 7 mm. The major salivary glands are unremarkable. The major cervical vessels are intact. Thre is minimal mucosal thickening within the left sphenoid sinus. The imaged mastoid air cells are clear. Also refer to the recent head and neck CT for additional findings, particularly with regards to the brain.
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1. Ill-defined thickening of the left and midline posterior nasopharyngeal mucosa, which measures up to 8 mm in anteroposterior dimension, compatible with the diagnosis of nasopharyngeal carcinoma. No evidence of skull base or parapharyngeal invasion. 2. Partially calcified nodule within the isthmus of the thyroid that measures 7 mm. This can be further characterized via thyroid ultrasound.3. Also refer to the recent head and neck CT for additional findings, particularly with regards to the brain.
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Generate impression based on findings.
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Right sided weakness. There is apparent hypoattenuation within the left pons. There is also moderate cerebral white matter hypoattenuation, which appears to have progressed since 2011. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable, including bilateral lens implants.
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Apparent hypoattenuation within the left pons may represent artifact, microangiopathy, or infarct. Moderate cerebral white matter hypoattenuation, which appears to have progressed since 2011, may represent microangiopathy as well. However, non-contrast CT is no sensitive for the detection of acute infarct and MRI is recommended for further evaluation if there are no contraindications. No evidence of acute intracranial hemorrhage.
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Generate impression based on findings.
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63 year-old female with right-sided weakness and altered mental status, rule out CVA Significant motor impression artifact limits evaluation. Hypoattenuation in the frontal lobe is likely secondary to volume averaging.There is no evidence of intracranial hemorrhage or mass. There is moderate volume loss. Periventricular and subcortical hypoattenuation is nonspecific but likely represents small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the right sphenoid sinus. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. A nasogastric tube is partially visualized.
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1.Limited study due to patient motion, however there is no gross acute hemorrhage. Recommend repeat examination.2.Mild peri-ventricular and subcortical hypoattenuation is not specific but likely represents small vessel ischemic disease. Please note that CT is not sensitive for the early detection of nonhemorrhagic stroke and if there is strong clinical concern an MRI may be obtained.
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Generate impression based on findings.
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Female 55 years old; Reason: RLQ pain for months. R/o path History: RLQ pain; occ constipation ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific bowel thickening and collapse bowel kidney descending and sigmoid colon.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: Nonspecific bowel thickening and collapse bowel kidney descending and sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Nonspecific colonic wall thickening and loss of haustration, correlate for prior colitis.
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Generate impression based on findings.
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Reason: R/O PE s/p lung txp History: post lung txp protocol to r/o PE PULMONARY ARTERIES: Technically adequate examination with no sign of pulmonary embolism.LUNGS AND PLEURA: Chronic interstitial disease with some pleural fibrosis in the native left lung.Focal airspace and interstitial opacities in the apical posterior segment of right upper lobe and in the right lower lobe, compatible with infection or aspiration.Small right pleural effusion.MEDIASTINUM AND HILA: Extensive abnormal soft tissue opacity in the lower right paratracheal, subcarinal and hilar area compatible with confluent lymphadenopathy or possibly organizing postoperative fluid collection such as hematoma.The no pericardial effusion.CHEST WALL: Fracture of the right fourth rib anterolaterally, likely related to surgery.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. No sign of pulmonary embolism.2. Patchy airspace and interstitial opacity in the right upper and right lower lobes compatible with infection and/or aspiration.3. Abnormal confluent soft tissue in the right perihilar region compatible with lymphadenopathy and possibly resolving postoperative hematoma.
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Generate impression based on findings.
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Breast cancer, follow-up CHEST:LUNGS AND PLEURA: Unchanged left anterior subpleural reticulation and bronchiectasis compatible with post radiation change. Low lung volumes. Scattered pulmonary micronodules some of which are calcified and compatible with granulomatous disease exposure. No suspicious new nodules or masses. No effusions. Mild emphysema.Note is made of soft tissue density in the posterior and right aspect of the trachea at approximately two to 3 cm above the carina. Suspected retained debris although serial follow-up imaging will be helpful.MEDIASTINUM AND HILA: No lymphadenopathy. Calcified mediastinal and hilar lymph nodesThe cardiac and pericardium are within limits. CHEST WALL: No significant abnormality noted. Specifically no lymphadenopathy in the reference left axillary lymph node is currently unmeasurable.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered calcifications with granulomatous disease exposureSPLEEN: Scattered calcific granulomataADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. Injection granulomaOTHER: No significant abnormality noted.
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Stable CT evaluation without evidence of metastatic disease.
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Generate impression based on findings.
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Lung cancer, review right lower lobe nodule. LUNGS AND PLEURA: Postoperative changes of a right upper lobectomy. Subpleural some solid density nodule containing internal poorly defined branching vascular components is inseparable from the lateral pleural surface and the adjacent right major fissure which is slightly thickened, currently 18x 33-mm (5/41), previously 15 x 30 mm in transaxial dimensions. Compared to the remote prior exam of 3/28/11 when viewed on the coronal series the lesion measures a maximum of 2.7-cm in craniocaudal length compared to 2.4-cm and a maximum of 17-mm in transverse dimension compared to 13-mm making the lesion overall slightly larger. There is minimal intercostal herniation of the lung at the cranial aspect of this nodule, raising the possibility of a posttraumatic component to this abnormality. Fine peripheral calcification noted on the high resolution sequence (4/106), unchanged. The lesion occurs at the level of the right fourth lateral rib which was the location of the bony thorax at the level of the patient's original adenocarcinoma. On the examination of 10/5/10, there was mild spiculation of the original tumor causing tenting of the adjacent pleural surface at that time. 5-mm groundglass nodule in the medial aspect of the right middle lobe (5/25) appears similar in size and density for two years and is most likely benign. Patchy peribronchial air space opacities in the right lower lobe are new. Given the clustered appearance, this is most likely the result of aspiration or infection. One of the mixed density nodules is spherical in configuration measuring 8-mm (4/191) and appears to be perivascular rather than peribronchial, new from previous. Given the rapid development this is also most likely to be post inflammatory but should be followed on the patient's subsequent exams.Linear scar or atelectasis in the lingula. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Interval development of circumferential thickening of the esophagus cranial to the tracheostomy with single wall thickness of 11-mm. On image 6 of Series III, there appears to be an internal soft tissue nodule which is hyperattenuating to the remainder of the esophagus, possibly a lymph node. Tracheostomy tube and vocal prosthesis in place. No visible lymphadenopathy within the limitations of unenhanced scan. Severe coronary artery calcification. Mild cardiomegaly. Small fat containing paraesophageal hernia on the left at the level of the esophageal hiatus (3/72).CHEST WALL: Postoperative change anterior neck and chest wall at the level of the thoracic inlet. Please see MEDIASTINUM AND HILA SECTION for discussion of cervical esophagus abnormality.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Colonic diverticuli. Subcentimeter lipid density nodular lesion in the cranial aspect of the pancreatic body new from previous (3/86), incompletely characterized. Splenic and portal veins appear dilated, correlate for portal hypertension.
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1. Slowly enlarging peripheral groundglass right middle lobe nodule involving the pleural surface at the level of the bony thorax where the patient's original adenocarcinoma was resected. A small focal intercostal hernia is noted adjacent to the cranial margin of the lesion. Post traumatic lesion is favored as the etiology (combination of intercostal hernia and a posttraumatic arteriovenous fistula with parenchymal hyperemia) however given enlargement the possibility of a superimposed indolent adenocarcinoma cannot be entirely excluded. If there is clinical suspicion for tumor, a follow-up PET may be obtained, otherwise continued 6 month follow-up is suggested.2. Postinflammatory or postinfectious opacities in the right lower lobe, correlate for signs of infection or history of prior aspiration. CT follow-up may be obtained in 6 weeks if there is any clinical concern for endobronchial spread of tumor but this is considered statistically unlikely.3. Groundglass density micronodules in the medial aspect of the right middle lobe unchanged and may represent an area of atypical adenomatous hyperplasia. This may be followed yearly to confirm stability.4. Soft tissue thickening of the esophagus immediately cranial to the tracheostomy with a possible small adjacent lymph node of unclear etiology or significance. A neck CT with IV contrast (unless contraindicated) may be obtained if there is clinical suspicion for tumor in this area.
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Generate impression based on findings.
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26-year-old female with history of ulcerative colitis status post laparoscopic total abdominal colectomy with end ileostomy, subsequent ileoanal pouch anastomosis with diverting loop ileostomy, now with emesis and leukocytosis. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Congenital or surgical absence of the spleen.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: A right abdominal ostomy is identified. The distal limb of the diverting ileostomy demonstrates multiple dilated loops of fluid-filled bowel with mucosal enhancement throughout its course from the ostomy site to the distal rectum with transition point at the anal anastomosis. Mild focal tapering at the ileoileal anastomosis is also noted. A moderate amount of intraperitoneal free fluid tracks laterally to the mid pelvis and a small amount is also identified in the presacral space. Free fluid is slightly more than expected postoperatively.Trace volumes of free into peritoneal air are seen in the low pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right homogeneous adnexal cystic lesion with no internal septation, wall thickening is likely physiologic.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.Obstructed distal limb of the diverting ileostomy with transition point at anal anastomosis site, may be due to edema at the suture line.2.Moderate amount of free fluid in the abdomen and pelvis is likely postsurgical, however an anastomotic leak may have a similar appearance and cannot be excluded.
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Generate impression based on findings.
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Thyroid cancer LUNGS AND PLEURA: A small punctate suspected calcified nodule in the posterior base of left lung. No additional suspicious nodules or masses. No effusions. Minimal bronchial wall thickening may represent asthma and/or bronchiolitis.MEDIASTINUM AND HILA: No thyroid is observed and presumed removed. No lymphadenopathyThe cardiac and pericardium are within limits.Small hiatal herniaCHEST WALL: No significant abnormality noted.No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology.
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Normal, specifically no findings to suggest metastatic disease. Minimal bronchial wall thickening may represent asthma and/or bronchiolitis.
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Generate impression based on findings.
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57 year old female. Reason: H/O ileocolonic Crohn's s/p ileocecectomy in 8/2013 now with RLQ mass vs abscess vs phlegmon suspicious for anastomotic leak. With PO contrast. History: RLQ pain, fevers ABDOMEN:LUNG BASES: Bilateral pleural effusions with compressive atelectasis of both lower lobes.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcifications are most likely from old granulomatous disease.PANCREAS: 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: Percutaneous drain in the right lower quadrant anterior abdominal wall. No significant amount of associated fluid is present in a subcutaneous cavity (image 104, series 3). There is subcutaneous contained gas surrounding the pigtail catheter. No enteric contrast has entered into the abdominal wall abscess cavity. However, there is a small contained extraluminal collection adjacent to the bowel anastomosis in the right lower quadrant (axial image 102, series 3; sagittal image 34). The connection between the abdominal wall cavity and collection of intraperitoneal contained gas was not demonstrated. There may be an associated entero-enteric fistula in the right lower quadrant (coronal image 56). OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis there
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Abdominal wall cavity contains a pigtail catheter. Intraperitoneal focus of extraluminal air, probably a contained leak with associated entero-enteric fistula originates at bowel anastomosis in the RLQ. Bilateral pleural effusions and associated compressive atelectasis.
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Generate impression based on findings.
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66-year-old male with history of recurrent lung cancer treated with salvage radiotherapy, evaluate for disease control CHEST:LUNGS AND PLEURA: Status post right upper lobectomy with unchanged perimediastinal fibrosis and bronchiectasis consistent with radiation reaction.No suspicious nodules or masses. Unchanged diffuse emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Reference left supraclavicular node is unchanged, measuring 10 mm and previously measuring 10 mm (image 6 series 3). Atherosclerotic calcifications of the coronary arteries and aorta.CHEST WALL: Degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic hypodensities of varying sizes are unchanged from the prior exam, most likely representing cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged left adrenal nodularity, measuring 10 mm and previously measuring 11 mm (image 101 series 3).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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Postoperative and postradiation changes of the right lung without evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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Newly diagnosed tonsillar cancer; no chemo/xrt. 90 pack/yr smoker and alcohol abuse. Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There is an ill-defined, irregular, likely ulcerative mass that involves the right tonsillar fossa, right tongue base, and right soft palate that measures approximately 25 AP x 23 RL x 37 SI mm. The tumor extends towards the right masticator space, but does not appear to involve the pterygoid muscles. There is a conglomerate of partially cystic or necrotic right level 2 and 3 lymph nodes that measure 25 AP x 27 RL x 45 SI mm. Although not significantly enlarged, there is also 5 x 6 mm hyperattenuating right level 5 lymph node that may be involved with metastatic disease. There is irregular thickening and hyperattenuation of the right lateral hypopharyngeal mucosa. The major salivary glands are unremarkable, aside from the mass effect upon the right submandibular gland by the lymphadenopathy. There is a hypoattenuating 3 mm left thyroid nodule. There are no lytic or blastic lesions. There is at least moderate narrowing of the left carotid bifurcation due to atherosclerotic plaque. There is mild skin thickening in the midline of the lower posterior neck, which are nonspecific. There are several subcentimeter right pulmonary nodules superimposed upon a background of emphysema. Refer to the separate chest CT report for additional details.
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1. A mass involving the right tonsillar fossa, right tongue base, and right soft palate that measures up to 37 mm is compatible with tonsillar squamous cell carcinoma with extensive metastatic right cervical lymphadenopathy that measures up to 44 mm.2. Several subcentimeter right pulmonary nodules are suspicious for lung metastases. Refer to the separate chest CT report for additional details.3. Irregular thickening and hyperattenuation of the right lateral hypopharyngeal mucosa may be inflammatory in nature, although a second primary neoplasm is a consideration and can be further evaluated via laryngoscopy. 4. At least moderate narrowing of the left carotid bifurcation due to atherosclerotic plaque. This can be further interrogated via ultrasound or other vascular imaging modality.
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Generate impression based on findings.
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Male 55 years old; Reason: metastatic cholangiocarcinoma please assess and provide index lesion measurements for RECIST CHEST:LUNGS AND PLEURA: Bibasilar atelectasis noted. No nodules detected.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right Port-A-Cath noted with its tip in the cavoatrial junctionOTHER: ABDOMEN:LIVER, BILIARY TRACT: No definite liver lesion detected. Surgical clips noted in the porta hepatis. No evidence of intrahepatic or extrahepatic biliary ductal dilation. No evident mass detected.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: Extensive nodularity in the right upper quadrant (series 3 image 114) is index nodule measuring 1.3 x 0.9 cm are concerning for peritoneal carcinomatosis.Other nodularity is seen in the anterior omentum (series 3 image 96, and series 3 image 115)PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical sutures in the cecum from prior appendectomy.OTHER: No significant abnormality noted
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1.No evident mass in the liver or porta hepatis related to patient's cholangiocarcinoma.2.Omental nodularity compatible with peritoneal carcinomatosis.
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