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Generate impression based on findings.
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28 year old female. Reason: kidney stone History: left flank pain and hematuria 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: Partially obstructing 5 mm diameter calculus at the left UPJ. Mild left 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:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Partially obstructing 5 mm diameter calculus at the left UPJ. Mild left hydronephrosis.
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Generate impression based on findings.
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45 year-old female with lung cancer status post resection LUNGS AND PLEURA: Postoperative changes of left lower lobectomy with associated volume loss are again identified.Unchanged micronodule (image 49 series 5). Peripheral septal thickening on the left is unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Scattered small mediastinal nodes without lymphadenopathy. Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Unchanged prominent gastrohepatic and caval lymph nodes.
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Status post left lower lobectomy without evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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76-year-old female with abnormal cyst on kidney, please perform CT urogram. ABDOMEN:LUNGS BASES: Mild bilateral basilar atelectasis. Small left posterior diaphragmatic hernia containing only retroperitoneal fat.LIVER, BILIARY TRACT: The far superior aspect of the right dome is excluded from the field-of-view. The gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A round, hypodense, 1.2 x 0.7 cm cystic lesion in the interpolar region of the right kidney demonstrates mild enhancement. No other lesions are noted bilaterally. No hydronephrosis.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: Small focus of gas in the bladder. Correlate for recent instrumentation. Alternatively, in the absence of recent instrumentation, the question of a fistulous connection with the vagina or bowel is raised.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis of the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A soft tissue nodule in the cul-de-sac measures 2.1 x 1.6 cm.In the residual vagina demonstrates heterogeneous enhancement, which may represent prolapse of a residual cervix or alternatively a soft tissue mass.
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1.Mildly enhancing cystic lesion of the right kidney is too small to further characterize. 6 to 12 month ultrasound follow up is recommended.2.Soft tissue nodule in the cul-de-sac of unclear etiology. Follow up is recommended.3.Heterogeneous enhancement of the residual vagina. Correlate clinically for focal mass versus prolapse of residual cervix. 4.Small focus of air in the bladder may be the result of recent instrumentation. Alternatively, may represent fistulization with the vagina or bowel.
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Generate impression based on findings.
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Tonsil cancer LUNGS AND PLEURA: Multiple bilateral areas of scattered tree in bud and small subcentimeter focal faint ill-defined nodular densities greater in the upper lungs with mild bronchial wall thickening. No definite discrete focal well-defined nodular abnormalities to suggest metastatic disease and although the appearance is suggestive of aspiration and/or postinfectious changes, serial follow-up imaging will be helpful to confirm. Also correlate and confirm patient is PPD negative. Mild centrilobular emphysema and no effusions.MEDIASTINUM AND HILA: No lymphadenopathyMild coronary calcifications in the LAD without additional cardiac or pericardial abnormality.CHEST WALL: UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Heavy abdominal aortic calcifications
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Minimal changes suggesting aspiration without discrete superimposed findings to suggest metastatic disease. See recommendation above.
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Generate impression based on findings.
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45 year-old female, lung nodule follow-up LUNGS AND PLEURA: No suspicious nodules or masses. Left lower lobe micronodule is unchanged.MEDIASTINUM AND HILA: The heart size is normal. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes of the thoracolumbar spineUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. A gastric banding device is noted.
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No suspicious nodules or masses. Unchanged left lower lobe micronodule.
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Generate impression based on findings.
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45-year-old female with liver lesion seen on ultrasound. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: A nonenhancing hypoattenuating focus of the right lobe in segment 7 corresponds to the lesion seen on recent ultrasound, is nonspecific, and is too small to further characterize.Another nonenhancing hypoattenuating focus in segment 4 is also identified, and also is nonspecific and too small to further characterize.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.
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Two nonenhancing hypoattenuating nonspecific lesions of the liver are too small to completely characterize. 12 month ultrasound follow-up is suggested.
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Generate impression based on findings.
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Status post lung resection for two lung cancers and MIE for esophageal cancer. LUNGS AND PLEURA: Spherical ground glass density nodule containing internal air bronchograms in the left upper lobe measures 14 x 15 mm (4/127) compared to 13 x 14 mm previously. It has increased in size compared to remote earlier exams such as 2012 when it measured 12 x 9 mm and is compatible with an indolent adenocarcinoma such as an adenocarcinoma in situ or minimally invasive adenocarcinoma.A second groundglass density nodule is irregular in shape measuring 9 x 7 mm (4/154), not conclusively changed from the most recent previous study but larger when comparing back to 8/23/12 where it measured approximately 6 x 6 mm. Although this could represent an area of atypical adenomatous hyperplasia, the growth is suspicious for a small adenocarcinoma in situ or minimally invasive adenocarcinoma. Continued follow-up of this lesion is recommended.Thin-walled cyst in the left lower lobe.Emphysema. Postsurgical/post therapeutic changes in the right lung and pleura. Calcified nodule in the lingula. MEDIASTINUM AND HILA: Mildly enlarged upper right paratracheal lymph nodes measuring up to 9-mm (non-index lesion image 17, previously 8-mm). Index lower right paratracheal lesion measures 7-mm, previously 6 mm, not significantly changed (3/33). Focal enlargement of the right lower lobe pulmonary artery (3/55) unchanged, possibly a combination of thrombus in situ and surrounding chronic reactive lymphadenopathy (18-mm on the current study image 55, unchanged compared to 8/23/12, also 18-mm).Neoesophagus unremarkable in appearance; the the lower aspect at the level of the with left atrium is collapsed but appears similar to prior exams. Intrathoracic position of the stomach deviates the heart anteriorly, unchanged.CHEST WALL: Postsurgical architectural distortion of the right bony thorax. Left proximal humerus incompletely included in the scanning range but appears to have abundant callus formation, correlate for history of impacted fracture.Focal sclerosis involving the right lateral fifth rib (3/60) occurring at a pre-existing site of fracture deformity is new; this is at least mildly suspicious for an indolent metastasis. Correlation with bone scan is suggested.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Postsurgical changes in the upper abdomen. Multiple small lymph nodes without significant change.
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1. Left upper lobe ground glass density nodule continues to enlarge, consistent with an indolent adenocarcinoma such as AIS or MIA.2. Second smaller groundglass density lesion unchanged from most recent previous but larger compared to earlier studies, suspicious for a small adenocarcinoma. Continued CT follow-up recommended.3. No evidence of localized recurrence at the lobectomy sites or the esophageal anastomoses.4. No significant change in mild mediastinal lymphadenopathy.5. New sclerotic lesion involving the right lateral fifth rib; an indolent skeletal metastasis cannot be excluded, suggest correlation with bone scan.
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Generate impression based on findings.
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Female 54 years old; Reason: Yes History: Abdominal pain Left lower quadrant ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating lesions in the liver, incompletely characterized on this examination.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: Borderline retroperitoneal adenopathy. Index lesion in the right pericaval space measures 1.1 cm (series 3 image 81)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No acute inflammatory process detected.
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Generate impression based on findings.
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25-year-old male with right-sided abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys are of normal size and morphology without mass. No abnormal calcifications are seen. No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the colon. No intrinsic abnormalities are seen. No evidence of free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal appearing stomach and small bowel to the colon. No intrinsic abnormalities are seen. No evidence of free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Normal CT examination of the abdomen and pelvis. No findings seen to account for patient's symptomatology.
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Generate impression based on findings.
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45-year-old female with liver lesion seen on ultrasound. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: A nonenhancing hypoattenuating focus of the right lobe in segment 7 corresponds to the lesion seen on recent ultrasound, is nonspecific, and is too small to further characterize.Another nonenhancing hypoattenuating focus in segment 4 is also identified, and also is nonspecific and too small to further characterize.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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Two nonenhancing hypoattenuating nonspecific lesions of the liver are too small to completely characterize. 12 month ultrasound follow-up is suggested.
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Generate impression based on findings.
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Clinical question :subarachnoid hemorrhage. Signs and symptoms: Worst headache of life. Nonenhanced head CT:No evidence of acute intracranial process in particular no evidence of hemorrhage as clinically is questioned. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells.
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No acute intracranial process.
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Generate impression based on findings.
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Clinical question: Signs of trauma. Signs and symptoms:MVA. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Examination demonstrate a large CSF none CT extra axial collection on the right in the posterior fossa with several associated flattening of the right cerebellum. This finding is consistent with an arachnoid cyst. The heart ventricle is within normal and in midline.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation are otherwise.Calvarium is intact.Images through the orbits are unremarkable.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized.
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1.No acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.2.Arachnoid cyst in the posterior fossa on the right with subtle mass effect on the cerebellum however with midline position of the fourth ventricle and patent on CSF spaces.3.Unremarkable nonenhanced head CT otherwise.
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Generate impression based on findings.
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Clinical question: Sensation of heaviness/discomfort in head. Signs and symptoms: As above. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells.
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Negative nonenhanced head CT.
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Generate impression based on findings.
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52-year-old male with metastatic urothelial cancer, c/o increased pain, weight loss, evaluate for progression. ABDOMEN:LUNGS BASES: Interval development of scattered bilateral pulmonary nodules, suspicious for metastatic disease. For reference, a new left upper lobe nodule measures 6 x 4 mm (image 51, series #7). No mediastinal or hilar lymphadenopathy is seen. Normal heart size.Numerous osseous metastases of the thoracic spine and ribs are redemonstrated. The right posterior fourth rib and right anterior seventh rib metastatic sclerotic lesions appear more prominent in size. LIVER, BILIARY TRACT: Metastatic lesions in the liver are again identified. The reference lesion in the right lobe measures 2.5 x 1.5 cm (image 91, series #8), decreased from previously 3.2 x 2.7 cm. However, while a few other lesions are also decreased, other lesions have grown in size, for example, a lesion in the right dome (image 84, series #8), now measures 2.2 x 1.5 cm, previously only a punctate subcentimeter lesion. In addition, new lesions are identified, thus indicative of a mixed response to therapy. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule is unchanged, hypoattenuating, and likely of benign etiology.KIDNEYS, URETERS: Bilateral simple renal cysts are noted. Bilateral subcentimeter hypodensities are too small to further characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous osseous metastases are again identified in the vertebrae and iliac bones. The metastatic lesions of the iliac bones are increased in size.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy with continent neobladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous surgical clips, likely from pelvic lymph node dissection.OTHER: No significant abnormality noted.
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1.Progression of metastatic disease is evidenced by interval development of numerous bilateral scattered pulmonary nodules and growth of osseous metastatic lesions in the ribs and iliac bones as well as new and enlarging liver metastases.2.Mixed response of hepatic metastases with prior reference lesion decreased.3.Unchanged left adrenal nodule.
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Generate impression based on findings.
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Clinical question: Patient with stage IV non-small cell lung cancer with metastases to spine. Assess for metastatic brain lesions. Signs and symptoms: As above. Unenhanced head CT:Examination demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. Calvarium is unremarkable and without convincing evidence of metastases.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable images through the orbits.Well pneumatized all visualized paranasal sinuses, mastoid air cells and bilateral middle ear cavities.Unremarkable soft tissues of the scalp.
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Negative enhanced head CT.
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Generate impression based on findings.
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76 old female with recent AAA repair. Presents with left sided abdominal pain and decreased p.o. intake. ABDOMEN:LUNGS BASES: Unchanged severe emphysema.LIVER, BILIARY TRACT: Numerous variable sized cysts in the liver are unchanged. Sludge versus small gallstones in the gallbladder. Punctate calcific densities in the liver likely reflect prior granulomatous disease.SPLEEN: Wedge-shaped hypodensity in the mid spleen most likely represents an infarct, new from prior study.PANCREAS: 6-mm hypodensity in the pancreas is unchanged.ADRENAL GLANDS: Bilateral adrenal nodules meet criteria for benign adrenal adenomas.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval placement of an aortic stent graft. The abdominal aortic aneurysm measures 3.8 cm (image 8, series #12), from 4.8 cm previously. An IVC filter is noted in the expected location.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: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Thrombosis of the right internal iliac artery is identified (image 123, series #11).A right common iliac artery aneurysm measures 2.8 cm (image 109, series #11), from previously 2.9 cm.
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1.Interval splenic infarct may explain the patient's left-sided abdominal pain.2.Interval thrombosis of the right internal iliac artery.3.Interval placement of aortic stent graft, with reduction in size of abdominal aortic aneurysm.4.Right common iliac artery aneurysm, unchanged in size.
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Generate impression based on findings.
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56-year-old male with large B cell lymphoma -- evaluate for progression. CHEST:LUNGS AND PLEURA: New left pleural effusion. Right apical pleural based masses have increased in size and approximately doubled in volume. In addition, the apical non-pleural-based parenchymal mass lesions have increased in size and adjacent new lesions are seen. The reference non-pleural apical lesion (series 5, image 15) now measures 1.1 x 0 .7 cm, previously 0.6 x 0.4 cm.MEDIASTINUM AND HILA: No significant abnormality noted -- no adenopathy or other masses seen.CHEST WALL: Large right shoulder mass extending along the proximal humerus is incompletely imaged on this examination but appears to markedly increased since prior examination. In addition, a number of newly enlarged lymph nodes are seen in the right axilla and extending more inferiorly along the right lateral chest wall, largest of these measures 3.0 x 2.7 cm (series 3, image 50).ABDOMEN:LIVER, BILIARY TRACT: Multiple cysts in the liver, unchanged. No solid masses identified. Vascular structures appear normal. Gallbladder and biliary tract show no abnormalities.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral large adrenal gland masses -- these have increased in size dramatically since prior examination. Reference measurement on the left mass of 10.4 by 9.7 cm, compared with 5.4 x 5.1 cm previouslyKIDNEYS, URETERS: No significant abnormality noted -- benign cysts, unchanged without other abnormality.RETROPERITONEUM, LYMPH NODES: No left para-aortic adenopathy just inferior to the. Adrenal mass (series 3, image 113) with largest node measuring 1.6 x 1.4 cm. More distallyBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral internal hernias containing only mesenteric fat.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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CT demonstration of progressive disease with enlarging and new sites of involvement in the right apical lung and pleural disease, bilateral adrenal sites, right shoulder soft tissue and axillary lymph nodes and retroperitoneal adenopathy.
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Generate impression based on findings.
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Female 83 years old; Reason: Pt is an 83 y/o female with met urothelial cancer, evaluate for recurrence History: met urothelial cancer LUNG BASES: No significant abnormality detected.ABDOMEN: The absence of intravenous contrast limits evaluation of the solid organs and the vasculature . Given these limitations, the following observations were made:LIVER, BILIARY TRACT: Status post cholecystectomy. No liver lesions detected.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic atrophy, fatty replacement and scattered calcifications. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Left soft tissue lesion in the nephrectomy bed measures 1.2 x 2 .5 cm, previously 1.4 x 2.4 cm (series 3 image 36), stable in size. RETROPERITONEUM, LYMPH NODES: Decrease in size of the soft tissue mass abutting the aorta which measures 1.5 x 1.5 cm (series 3 image 50) previously 2 x 3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No metastatic lesions detected.Moderate to severe degenerative disease with mild disk extrusions and ligamentum flavum hypertrophy as well as facet arthropathy suggests mild spinal stenosis worst at L4/L5. There is also retrolisthesis of L5 on L4.OTHER: Fat-containing umbilical hernia.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 metastatic lesions detected.Moderate to severe degenerative disease with disk extrusions and ligamentum flavum hypertrophy as well as facet arthropathy suggests mild spinal stenosis, worst at L4/L5. There is also retrolisthesis of L5 on L4..OTHER: Metallic density in the anterior midline pelvic wall, probably surgical mesh.
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1. Status post left nephrectomy with decrease in size of the reference nodes as above. No other definite evidence of local recurrence, residual disease or metastases. 2. Moderate to severe degenerative disease in the spine.
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Generate impression based on findings.
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90 year-old female with generalized abdominal pain, follow, diarrhea, abdominal distention. Evaluate for obstruction/colitis. ABDOMEN:LUNG BASES: Focal area of air space consolidation in the right middle lobe -- while this may represent old scarring, superimposed acute infection or inflammation cannot be differentiated calcified nodule, consistent with prior granulomatous disease.. Bronchial wall thickening in the left lung base, which may represent chronic inflammation or aspiration.LIVER, BILIARY TRACT: Homogeneous liver parenchyma without mass lesion. Vascular structures appear normal. Marked dilatation intrahepatic and extrahepatic bile ducts are seen with the 1.2-cm diameter common bile duct, which tapers at the ampulla. No surrounding mass is seen or intraluminal stone -- while this may be chronic residual from prior dilatation, if abnormal liver function tests or suspicion of biliary obstruction exists, this cannot be excluded.SPLEEN: Calcified granulomata. No significant abnormality notedPANCREAS: Pancreatic duct is diffusely dilated throughout its entire length and extends to the ampulla. While no mass lesion is seen, the marked, biliary dilatation and pancreatic dilatation does heighten the suspicion of ampullary obstructing process and clinical correlation is recommended. In addition, dense, thick calcifications are seen in the pancreatic duct in the body. Pancreatic parenchyma is moderately atrophic, but appropriately so for a patient of 90 years old and not necessarily indicative of obstructive atrophy.ADRENAL GLANDS: Nonspecific left adrenal mass (series 4, image 29) measuring 2.6 x 1.7 cm. Right adrenal gland appears normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked distention of the stomach and duodenum with dilatation tapering at the fourth duodenum at the level of the aortic -- superior mesenteric artery region. Clinical correlation for potential obstruction at this level is recommended -- as no mass at this level is seen this may represent an SMA syndrome as the jejunum and ileum do not show abnormal distention.The ascending and transverse colon appear normal with feces and fluid. No intrinsic abnormality in these colonic regions, however, the descending colon, sigmoid colon and rectum do show slight wall thickening and raise question of colitis. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel shows no intrinsic abnormalities. The ascending and transverse colon appear normal with feces and fluid. No intrinsic abnormality in these colonic regions, however, the descending colon, sigmoid colon and rectum do show slight wall thickening and raise question of colitis. No free mesenteric fluid is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Marked distention of stomach and duodenum -- question of obstruction at distal duodenum perhaps from SMA syndrome. 2. Marked biliary duct dilatation and pancreatic duct dilatation to the ampulla -- ampullary obstructing process should be considered. Any prior imaging would be helpful to characterize this abnormality. 3. Mild thickening of the distal descending colon, sigmoid colon and rectum, which may represent colitis. In light of a smelling diarrhea, it may be pancreatic obstruction as the etiology as an alternate consideration to colitis.Findings discussed with Dr. Munitz in the emergency room at 9:15 AM.
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Generate impression based on findings.
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65 year-old female with dyspnea, evaluate for PE PULMONARY ARTERIES: The main pulmonary artery is large and measures 3.2 cm. Technically adequate exam without evidence of pulmonary embolus..LUNGS AND PLEURA: Status post right middle lobectomy with loculated air and debris filled cavity adjacent to the surgical bed (image 74 series 8), similar to the prior exam. Slight increase in right pleural effusion. Increased patchy right interstitial and air space opacities suspicious for infection. Right paramediastinal scarring and bronchiectasis consistent with radiation change. Severe diffuse centrilobular emphysema.MEDIASTINUM AND HILA: Atherosclerotic calcifications of the aortic arch and coronary arteries. No mediastinal or hilar lymphadenopathy. Normal heart size with very small pericardial effusion. Small left Bochdalek hernia.CHEST WALL: Right lateral chest wall fluid collection with focus of gas is only partially visualized likely related to thoracotomy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enlargement of pancreatic tail with mild surrounding fixation of the mesenteric fat suggestive of pancreatitis. Cholecystectomy clips. Atherosclerotic calcifications of the aorta. Fat-containing mass within the dome of the liver with peripheral calcification appears similar to the prior study.
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1. No pulmonary embolus.2. Increased patchy right perihilar and basilar air space opacities suspicious for infection superimposed on underlying radiation changes.3. Right lateral chest seroma with focus of gas, correlate for infection.4. Enlargement of the pancreatic tail with adjacent fat stranding suspicious for pancreatitis, correlate with serum markers.
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Generate impression based on findings.
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49 year-old female with tachycardia, hypoxia, metastatic cancer, evaluate for PE PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus. The pulmonary artery diameter and right ventricle appear normal.LUNGS AND PLEURA: Low lung volumes and basilar atelectasis. Small left pleural effusion with associated compressive atelectasis.MEDIASTINUM AND HILA: Right central venous catheter extends to the SVC. Heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest wall portUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Moderate ascites. Multiple dilated loops of bowel in the upper abdomen are only partially visualized..
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No pulmonary embolus. Small left pleural effusion and compressive atelectasis. Abdominal ascites and multiple dilated loops of bowel are partially visualized in the upper abdomen.
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Generate impression based on findings.
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66-year-old male with metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: Innumerable pulmonary metastases are decreased in size.The reference left upper lobe lesion currently measures 1.1 x 1.1 cm, previously measured 1.9 x 2.2 cm (series 5, image 22).MEDIASTINUM AND HILA: Interval decrease in mediastinal lymphadenopathy; reference right paramediastinal mass measures 3.4 x 4.2 cm, previously measured 5.1 x 6.5 cm (series 3, image 30).Heart size is normal.CHEST WALL: Lytic lesion in posterior aspect of left eighth rib not significantly changed (coronal series image 16).ABDOMEN:LIVER, BILIARY TRACT: Decrease in size of metastatic liver lesions, which are currently more hypodense consistent with necrosis. Reference right lobe mass currently measures 5.0 x 6.1 cm, previously measured 6.7 x 8.4 cm (series 3, image 74).SPLEEN: No significant abnormality notedPANCREAS: Diffuse pancreatic atrophy. Metastatic deposit in the pancreatic body appears decreased in size (series 3, image 98).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right renal mass invading surrounding retroperitoneal fat has decreased in size and appears more necrotic compared to prior exam, currently measuring 8.1 x 7.0 cm, previously measured 9.0 x 7.2 cm (series 3, image 115). Additional lesion in superior pole of right kidney not significantly changed (series 3, image 95). Tumor is again seen invading into the right renal vein and IVC.Enhancing lesions in left kidney appear more hypodense and mildly decreased in size; reference lesion currently measures 1.6 cm, previously measured 1.9 cm (series 3, image 121). Multiple additional hypodensities in left kidney compatible with cysts.RETROPERITONEUM, LYMPH NODES: Tumor thrombus in the IVC extending into the right atrium is similar in extent but decreased in thickness.Multiple collateral vessels are seen in the right retroperitoneum. Prominent lymph nodes in the retroperitoneum are not significantly changed.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: Left gluteus medius tumor deposit is decreased in size (series 3, image 169). Lytic lesion in left femoral head and neck not significantly changed.OTHER: No significant abnormality noted
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1.Significant interval decrease in metastatic lesions in the lungs, mediastinum, and liver.2.Interval decrease in size of necrotic right renal mass and IVC tumor thrombus.
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Generate impression based on findings.
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Male 54 years old; Reason: Concern for gut GVH History: Diarrhea, nausea ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic dome lesion with peripheral discontinuous nodular enhancement most consistent with a hemangioma. No other focal lesion detected.The gallbladder is well distended without radiopaque stones. No intrahepatic or extrahepatic biliary ductal dilation seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of the distal ileum, extending into the cecum and portions of the descending and sigmoid colon are noted. There is loss of haustration in the descending and sigmoid colon. Fat is interspersed in the mucosa. No pneumatosis, obstruction, or free air. No inflammatory change the mesentery. No contrast extravasation 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: Wall thickening of the distal ileum, extending into the cecum and portions of the descending and sigmoid colon are noted. There is loss of haustration in the descending and sigmoid colon. Fat is interspersed in the mucosa. No pneumatosis, obstruction, or free air. No inflammatory change the mesentery. No contrast extravasation noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Findings compatible with colitis, with infectious etiology most likely. There is also suggestion of regional enteritis in the distal ileum. Given the discontinuous pattern of edematous bowel and colonic preference, GVHD is not considered.2.No other areas of metastatic disease detected.
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Generate impression based on findings.
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57-year-old male with left ankle pilon fracture with external fixator placement. External fixation rods and screws affix a comminuted, intra-articular fracture of the distal tibia. Two screws traverse the proximal tibial diaphysis, and one traverses the calcaneus. There is a up to 13-mm displacement of the fracture fragments at the articular surface (image 645, series 3), and up to 6 mm depression (image 91, series 8030). The posterior tibial tendon and flexor digitorum longus tendon are located adjacent to two of the distal tibial fracture fragments (image 626, series 4).
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External fixation of comminuted, intra-articular fracture of the distal tibia, as described above.
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Generate impression based on findings.
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77-year-old female with abdominal pain. Rule out mesenteric ischemia. ABDOMEN:The absence of oral contrast limits evaluation of the bowel. Given this limitation, the following observations were made:LUNGS BASES: Bilateral basilar dependent atelectasis versus scarring.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: Extensive diverticulosis of the distal descending and sigmoid colon. A short segment of the affected bowel in the left lower quadrant involving the distal descending colon and proximal sigmoid colon demonstrates wall thickening and pericolic fat stranding, consistent with acute diverticulitis. No intraperitoneal free air or loculated fluid collection to suggest complication. Trace amount of free fluid in the pelvis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Prominence of the hepatic veins and IVC suggest passive congestion.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: Extensive hypertrophic degenerative changes at the facet joints in the lumbar spine, with significant canal narrowing, most prominent at L5.OTHER: A pessary is in place.CT angiogram:The abdominal aorta shows no significant atherosclerotic changes or focal ectasia. Normal origins of the aortic branches, including the celiac, superior mesenteric, and inferior mesenteric arteries, which are patent without significant stenosis. Normal bifurcation of the aorta and to normal appearing iliac arteries.
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1.Findings consistent with acute diverticulitis of the distal descending and proximal sigmoid colon.2.No evidence of mesenteric ischemia, as clinically questioned.3.7-mm pleural-based nodule in the right middle lobe.4.Degenerative changes in the lumbar spine with canal narrowing most prominent at L5.
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Generate impression based on findings.
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Preoperative evaluation for C5 lesion. There are predominantly sclerotic lesions within the C2, C4, and C5 vertebral bodies superimposed upon a background of diffuse osteopenia, which are better depicted on the recent MRI. The largest of these is located in the C5 vertebral body, where there is also extravertebral soft tissue component and associated spinal canal stenosis, that is also better delineated on the prior MRI. There is also multilevel degenerative spondylosis, most pronounced at C5-6, where there is left uncovertebral osteophytosis that results in moderate to severe left neural foraminal narrowing.
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Sclerotic lesions within the C2, C4, and C5 vertebral bodies are compatible with metastases, but are better depicted on the recent MRI. Likewise, the extravertebral soft tissue component and associated spinal canal stenosis at L5, that is better delineated on the prior MRI.
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Generate impression based on findings.
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62-year-old male with esophageal cancer -- abdominal pain and distention. Evaluate for tumor burden, drain placement. Within the limits of a non-IV contrast enhanced examination limiting evaluation of solid parenchymal organs and vessels, structures, the following observations can be made:ABDOMEN:LUNG BASES: Multiple nodules in lung bases consistent with metastatic disease.LIVER, BILIARY TRACT: Numerous solid space-occupying lesions are seen throughout the liver. These appear similar in size and distribution to the MR examination. Stent in the system is seen extending from the right bile duct down to the distal duct and duodenum. A second percutaneous drain is in position into the left hepatic ducts. No intrahepatic biliary duct dilatation is seen suggesting patency of these biliary drains. Gallbladder lumen is of higher attenuation than expected, which may represent intraluminal debris or residual contrast material from prior contrast administration if done elsewhere..SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left periaortic adenopathy is again seen with suggested referenced lymph node (series 3, image 69) measuring 1.4 x 1.9 cm. Additionally, mesenteric, and gastric hepatic ligament, lymph nodes are again seen. The largest of these measures approximately 2.8 x 2.1 cm (series 3, image 61)BOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal-appearing stomach and small bowel to the ileum. No intrinsic abnormalities are seen and no evidence of obstruction. The colon shows feces throughout without intrinsic abnormality. Diffuse ascites is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast rapidly progresses through normal-appearing stomach and small bowel to the ileum. No intrinsic abnormalities are seen and no evidence of obstruction. The colon shows feces throughout without intrinsic abnormality. Diffuse ascites is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Extensive liver metastases appearing similar to 11/22/13. 2. Multiple biliary drains/stents in position with no evidence of dilated intrahepatic biliary ducts. 3. Pulmonary nodules consistent with metastases. 4. Mesenteric and retroperitoneal adenopathy. 5. Large amount of ascites, increasing since 11/22/13.
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Generate impression based on findings.
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59-year-old male with urothelial cancer status post nephrectomy. CHEST:LUNGS AND PLEURA: Calcified and noncalcified micronodules unchanged. No new nodules.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: Thickened right adrenal gland unchanged.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence.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: Reference right external iliac node unchanged, measuring 1.3 x 0.6 cm, previously measured 1.2 x 0.6 cm (series 3, image 181).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable exam without evidence of recurrence or metastatic disease.
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Generate impression based on findings.
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Male 36 years old; Reason: PTLD Restaging History: None CHEST:LUNGS AND PLEURA: Decrease in the previously seen scattered micronodules. For instance the 3-mm nodule in the superior segment right lower lobe is not seen on this examination. Minimal paraseptal emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest port with tip terminating at the atriocaval junction. Gynecomastia.ABDOMEN: Lack of IV contrast limits evaluation of solid organs and the vasculature. Given these limitations, the following findings are main.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Atrophic endstage left kidney. Stable left renal cyst. Transplant kidney in the right iliac fossa, unchanged.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 0.8 x 0 .5 cm, previously 0.8 x 0.6 cm (series 3 image 108) stable.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Stable sclerotic focus in the right iliac bone.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Persistent concentric bladder wall thickening.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. No active disease with stable reference subcentimeter paraaortic lymph node residual as above.
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Generate impression based on findings.
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65-year-old male with pancreatic cancer status post chemoradiation. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are nonspecific but likely benign in nature. Left lung base scarring/atelectasis.MEDIASTINUM AND HILA: Right central venous catheter terminates in right atrium. No significant mediastinal lymphadenopathy. Heart is normal in size without pericardial effusion. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Trace pneumobilia in the left lobe. Interval improvement in hepatic steatosis.Multiple hepatic hypodensities are too small to characterize but appear unchanged. Portal and hepatic veins are patent. No significant biliary ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple surgery. Pancreatic atrophy. Interval decrease in pancreatic duct dilation. No evidence of residual mass.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral peripelvic cysts unchanged. Punctate hypodensities bilaterally too small to characterize but unchanged and most likely represent benign cysts.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Status post Whipple surgery. Stranding in the omentum and anterior mesentery with internal foci of fat may be treatment related (series 3, image 131).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: Nonspecific lucency in left ilium unchanged (series 3, image 159).OTHER: No significant abnormality noted
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1.Status post Whipple surgery without evidence of residual mass.2.New soft tissue stranding in omentum and anterior mesentery is likely treatment related, however, peritoneal carcinomatosis may also have this appearance and continued follow-up is recommended.
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Generate impression based on findings.
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73-year-old male pleural mesothelioma status two cycles of chemotherapy CHEST:LUNGS AND PLEURA: Large loculated left hydropneumothorax involving the left apex and left base. A chest tube extends to the left apex.Marked diffuse pleural thickening and nodularity involving the left lung appears similar to the prior PET/CT. Several calcified and noncalcified right pleural plaques consistent with asbestos exposure. Reference measurements as follows:Pleural thickening at the left apex at 8 o'clock measures 10 mm (image 26 series 5).At the level of the left pulmonary artery, 46 mm at two o'clock and 9 mm at 6 o'clock (image 43 series 5).At the level of the left inferior pulmonary vein 14 mm at two o'clock and 12 mm at 4 o'clock (image 54 series 5).MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. 6-mm left prevascular lymph node (image 39 series 3). Moderate coronary arterial calcifications and atherosclerotic calcifications of the aortic arch. The heart size is normal. Extensive pleural nodularity along the pericardium with obliteration of the pericardial fat pad at several points suggesting invasion. Nodular studding of the inferior surface of the left hemidiaphragm anteriorly suggests invasion. Left chest wall port with catheter extending to the SVC.CHEST WALL: Degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic lesions likely represent cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.
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1. Extensive nodular thickening of the left pleura with probable invasion of the pericardium and left hemidiaphragm.2. Large loculated left hydropneumothorax.
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Generate impression based on findings.
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56-year-old male with history of relapsed DLBCL of the right shoulder, right tongue, and right vocal cord treated with IFRT completed in July 2012, as well as temsirolimus/lenalidomide study. There has been interval increase in size of the incompletely imaged ill-defined, heterogeneous mass within the right posterior triangle of the neck and supraclavicular fossa, now measuring up to approximately 13 AP x 14 RL cm versus 8 AP x 10 RL cm previously. In addition, there is interval development of central necrosis within the mass. No new significant cervical lymphadenopathy is identified elsewhere. There is persistent edema of epiglottis, aryepiglottic folds, and preepiglottic space. There is minimal asymmetry of the right vocal cord. The anterior commissure and thyroid cartilages appear to be intact. The oral tongue and tongue base appear unremarkable without evidence of discrete mass lesions. The palatine tonsils and adenoids are not enlarged. The major salivary and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unchanged. There is staphylomatous deformity of the left globe. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the intracranial structures are unremarkable. There has been interval increase in size and newly apparent right upper lung nodules. Refer to the concurrent chest CT report for addition details.
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1. Interval increase in size of the mass occupying the incompletely imaged right posterior triangle and supraclavicular fossa, now measuring up to approximately 14 cm versus 10 cm previously, compatible with tumor progression. 2. Interval increase in size and newly apparent right upper lung nodules, compatible with progressive metastatic disease. Refer to the concurrent chest CT report for addition details.3. Persistent edema of epiglottis, aryepiglottic folds, and preepiglottic space related to radiation therapy. No evidence of locoregional disease in the tongue or larynx.
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Generate impression based on findings.
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70 year-old female with history of GIST now presents with abdominal pain, chest pain and shoulder pain. Right upper quadrant pain. CHEST:LUNGS AND PLEURA: Reference right middle lobe nodule (series 8, image 47) has decreased in size, measuring 3-mm compared with previous 5-mm. however, many nodules have increased in size, for example, image 57, series 8, now measures 7 x 5 mm, previously 5 x 3 mm.New right pleural effusion and slight decrease in the left pleural effusion with basilar atelectasis. MEDIASTINUM AND HILA: Coronary artery calcification again seen. No adenopathy. Trace pericardial effusion again seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Marked increase in a metastatic disease in liver now replacing nearly the entire parenchyma of the right lobe with lesser involvement in the left lobe. Lack of IV contrast and masses extending to become confluent, making it difficult to provide exact comparative measurements. The best estimate of prior noted reference lesion (series 6, image 71) measures 3.6 x 2 .6 cm, previously 2.1 x 1.6 cm.SPLEEN: Prior splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenalectomy. Right adrenal gland appears normal.KIDNEYS, URETERS: Left nephrectomy. Right kidney shows no diagnostic abnormalities.RETROPERITONEUM, LYMPH NODES: Increasing left periaortic adenopathy.BOWEL, MESENTERY: Post operative changes in the bowel, are again seen. Orally administered contrast rapidly progresses through the stomach and small bowel, without evidence of obstruction in appearance. The bowel is unchanged in appearance.. Small amount of ascites is seen scattered throughout, slightly increased from previous.. Scattered small mesenteric nodules are again seen and the largest one measured as a reference (series 6, image 143) has not significantly changed, measuring 3.2 x 2 .4 cm, previously 3.3 by 2.8 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus, not visualized, probable prior hysterectomy. No other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes in the bowel, are again seen. Orally administered contrast rapidly progresses through the stomach and small bowel, without evidence of obstruction in appearance. The bowel is unchanged in appearance.. Small amount of ascites is seen scattered throughout, slightly increased from previous.. Scattered small mesenteric nodules are again seen and the largest one measured as a reference (series 6, image 143) has not significantly changed, measuring 3.2 x 2 .4 cm, previously 3.3 by 2.8 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Mixed response to parenchymal lung nodules with reference nodule decreased in size, but other nodules, increased in size. 2. New right pleural effusion. 3. Marked increase in liver metastatic disease. 4. Increasing left para-aortic adenopathy. 5. Stable appearance to peritoneal masses/nodules. 6. Slight increase in amount of ascites.
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Generate impression based on findings.
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66 year old male with non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Mild dependent atelectasis/scarring. No suspicious nodules or masses.MEDIASTINUM AND HILA: Stable AP window node measures 1.0 x 1.4 cm, previously measured 1.0 x 1.4 cm (series 4, image 30). Right hilar node measures 1.7 x 1.2 cm, previously measured 1.5 x 1.1 cm (series 4, image 44).Mild coronary artery calcifications. Several calcified hilar lymph nodes consistent with prior granulomatous infection. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver parenchyma suggestive of steatosis. No suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities are unchanged, most compatible with cysts. Nonobstructing punctate stone in inferior calix of left kidney.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy. Reference pre-aortic measures 10 x 6 mm, previously measured 10 x 7 mm; reference periaortic node measures 9 x 7 mm, previously measured 9 x 6 mm (series 4, image 16). 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 significant change of reference measurements.
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Generate impression based on findings.
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59 year-old female with small bowel carcinoid. 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: Subcentimeter hypodensities in both kidneys unchanged and most compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant. Otherwise no significant abnormality.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of disease recurrence or metastatic disease.
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Generate impression based on findings.
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Female 51 years old; Reason: Evaluate vasculature and prior organ placement for kidney transplant History: Two prior abdominal organ transplants The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Bibasilar atelectasis noted.The heart size is mildly enlarged without evidence of pericardial effusion. Coronary artery calcification.LIVER, BILIARY TRACT: No focal lesion detected.SPLEEN: No significant abnormality notedPANCREAS: Atrophic native pancreas. Transplant pancreas is seen in the right lower abdominal quadrant with apparent progression of parenchymal atrophy and unchanged punctate calcification. Vascular supply is not well visualized given lack of IV contrast.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The native right kidney is atrophic and contains punctate calcifications, unchanged.The transplanted kidney is noted in the left iliac fossa. Decrease in the mild perinephric fat stranding and fluid collection previously demonstrated. The transplant artery and vein are not characterized on this examination.The patient is status post left nephrectomy. Previously described curvilinear low density lesion with peripheral high density rim located posterior to the left nephrectomy bed is stable (image 67, series 4).Previously noted second renal transplant in the left lower abdominal quadrant is no longer visualized, presumably status post surgical resection.RETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged retroperitoneal and mesenteric lymph nodes. Stable placement of infrarenal IVC filter.Moderate (approximately 180 degree) calcifications of the abdominal aorta are noted, most prominently on the anterior portion. Moderate, predominantly posterior and medial calcifications of the bilateral common iliac and internal as well as external iliac arterial vessels noted (approximately 180 degrees).BOWEL, MESENTERY: Diverticulosis without diverticulitis. No evidence of bowel dilatation, obstruction or pneumoperitoneum. Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Dystrophic calcifications in the abdominal wall and inguinal regions.OTHER: No pelvic ascites noted.
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1. Stable renal transplant in the pelvis. Status post renal/pancreatic transplant and presumed surgical resection of the initial renal transplant.2. Atherosclerotic disease as described above.3. Stable placement of infrarenal IVC filter.
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Generate impression based on findings.
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Male 48 years old; Reason: colon cancer stage 4 NED restaging History: colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM 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: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cyst. A few other too small to characterize lesions in the kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical sutures noted in the sigmoid colon, compatible with prior resection.BONES, SOFT TISSUES: Degenerative disease in the lumbar spine most pronounced at L5/S1.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical sutures noted in the sigmoid colon, compatible with prior resection.BONES, SOFT TISSUES: Degenerative disease in the lumbar spine most pronounced at L5/S1.OTHER: No significant abnormality noted
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1. No evidence of metastatic or recurrent disease detected. Stable examination.
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Generate impression based on findings.
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70 year-old male with glucagonoma (mets to liver), please do triple phase CT to assess interval change. Please do not give oral contrast. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Multiple hypervascular metastatic lesions are again identified scattered throughout the liver. An index lesion in the right hepatic dome, measures 2.6 x 1.9 cm (image 18, series #9), stable to minimally increased from previous measurements of 2.3 x 1.5 cm, taken in portal venous phase. Another non-reference enhancing lesion in the caudate lobe demonstrates significant interval growth, currently measuring 4.2 x 2.3 cm (image 35, series #9) from previously 2.9 x 2.1 cm. The other metastatic lesions are grossly unchanged and no new lesions are identified from the previous arterial phase images from 6/14/2012.Redemonstrated postsurgical changes in segment 7 near the dome of the liver. The gallbladder is surgically absent, with cholecystectomy clips in the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from pancreaticojejunostomy are redemonstrated. A small arterially enhancing soft tissue focus adjacent to the distal pancreatic duct near the jejunostomy site is identified, which has gradually grown from 1/8/2009 with associated gradually increasing dilatation of the pancreatic duct and pancreatic atrophy. Findings are concerning for local recurrence versus metastasis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple parapelvic cysts of the left kidney are redemonstrated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The previously referenced mesenteric lymph node is measures 0.9 x 0.6 cm (image 67, series #9), not increased from previously 1.1 x 0.6 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Hepatic metastases. While the reference lesion is stable to minimally increased in size, significant growth of the metastasis in the caudate lobe is seen, consistent with mild progression of disease. 2.Gradual growth of an enhancing soft tissue focus at the distal pancreatic duct with associated proximal gradual dilatation of the pancreatic duct is concerning for local recurrence versus new metastasis.
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Generate impression based on findings.
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61-year-old female with metastatic follicular thyroid cancer to the supraclavicular and sternocleidomastoid regions, on therapy, compare with previous. Head:An enhancing lesion in the right temporal lobe is stable, measuring 7 x 6 mm (11/13). There is no significant surrounding low density to suggest vasogenic edema. No new enhancing intracranial lesions are evident. The ventricles, sulci, and cisterns are symmetric and unremarkable. There is mild periventricular and subcortical white matter hypoattenuation which is nonspecific but may represent chronic small vessel ischemic disease. There is no mass effect, midline shift, or extra-axial fluid collections. No intracranial hemorrhage is evident within the limitation of only post-contrast imaging.Neck:There are postoperative changes of a total thyroidectomy and neck dissection.A necrotic mass anterior to the left sternocleidomastoid is unchanged in size measuring 2.2 x 1.4 cm (6/49), previously 2.2 x 1.5 cm. There are several nodules in the anterior supraclavicular subcutaneous tissues which are unchanged in size, including a reference lesion measuring 1.1 x 1.1 cm (6/53), previously 1.2 x 0.9 cm.The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. The oral cavity, oropharynx and hypopharynx are unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid gland is unremarkable. A coarse calcification in the right submandibular gland is unchanged. There is multi-level degenerative disk disease which appear similar to the prior exam with central spinal canal stenosis. The carotid arteries and jugular veins are patent. A right apical lung nodule is grossly similar to the prior exams when allowing for differences in technique, however for findings in the thorax, please see dedicated chest CT performed on the same day.
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1.Enhancing right temporal lobe lesion is unchanged in size and most likely represents a cavernoma given its long-term stability and appearance on prior MRI. No new enhancing intracranial lesions are evident.2.Necrotic metastasis anterior to the left sternocleidomastoid is unchanged in size.3.Nodules in the anterior supraclavicular subcutaneous tissues are unchanged in size.4.Mild periventricular and subcortical hypoattenuation is nonspecific but likely represents chronic small vessel ischemic disease.5.For findings in the thorax, please see dedicated chest CT performed on the same day.
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Generate impression based on findings.
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64-year-old male with history of small bowel lymphoma and obstruction. Reason: h/o NHL and micronodules. Please restage. CHEST:LUNGS AND PLEURA: No infiltrates or pleural effusions . Scattered nonspecific calcified and noncalcified micronodules are unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal. Coronary artery calcifications. No pericardial effusion.CHEST WALL: Median sternotomy wires.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: Atherosclerotic calcifications of the aorta and its branches. No aneurysm. No lymphadenopathy.BOWEL, MESENTERY: No bowel wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable examination. No evidence of recurrent disease in the chest, abdomen or pelvis.
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Generate impression based on findings.
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59 year old female. Enlargement of lymph nodes. Chronic tobacco use, weight loss, and bilateral cervical lymphadenopathy. Swelling, mass, or lump in chest. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Coronary artery calcifications. Calcified azygous lymph node. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia and choledochojejunostomy. Gallbladder is absent. SPLEEN: No significant abnormality noted.PANCREAS: Status post distal pancreatectomy with expected post-operative changes. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cortical atrophy. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple mid-small bowel anastomoses from prior resections. 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: Multiple mid-small bowel anastomoses from prior resections. BONES, SOFT TISSUES: Status post left total hip replacement with prosthesis in expected position. There is streak artifact that obscures adjacent structures. OTHER: No significant abnormality noted.
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Bilateral renal cortical atrophy. No lung mass. Left THR. Pneumobilia, cholecystectomy and prior bowel resections. No acute abnormality to explain weight loss.
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Generate impression based on findings.
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73-year-old male with history of metastatic prostate cancer. Evaluation of disease after 9 cycles of investigational therapy. CHEST:LUNGS AND PLEURA: No suspicious nodules are identified. A calcified granuloma in the right lower lobe is unchanged. Unchanged marked elevation of the right hemidiaphragm.MEDIASTINUM AND HILA: Small, scattered non-pathologically enlarged lymph nodes in the mediastinum are unchanged. Mild atherosclerotic calcification of the thoracic aorta. Coronary artery calcifications are noted. Left thyroid nodule grossly unchanged.CHEST WALL: Degenerative changes of the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple simple cysts of the left kidney are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion of L3 vertebral body likely represents a metastasis, and is unchanged. Degenerative changes throughout the thoracolumbar spine are noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged heterogeneous, nodular prostate.BLADDER: Multiple bladder diverticula, with a left-sided diverticulum again containing a small calculus.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral inguinal hernias containing only mesenteric fat. Degenerative changes of the spine.OTHER: No significant abnormality noted
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1.Unchanged L3 vertebral body sclerotic lesion.2.No CT evidence of disease progression.The patient suffered a minor extravasation of approximately 25 cc of saline in the right antecubital fossa. I personally responded to the incident. The patient denied any pain, paresthesias, or cold hand. Physical exam revealed a 3-cm, nontender swelling in the right antecubital fossa, 2+ bilateral radial pulses, and sensation/strength in distal bilateral upper extremities intact. Patient was given discharge instructions including reasons for return to emergency department and expressed understanding before discharged home in good condition.
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Generate impression based on findings.
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47 year old female with history of colon cancer status post subtotal colectomy. Patient is part of research protocol (IRB 12 -- 2091). ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several subcentimeter hypodensities are unchanged, too small to characterize but likely benign cysts as they are unchanged from the comparison exam. No new or suspicious lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy or other significant abnormality.BOWEL, MESENTERY: Status post subtotal colectomy. No evidence of mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Status post subtotal colectomy without evidence of recurrence or metastatic disease.
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Generate impression based on findings.
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82-year-old male with nausea, weight loss, epigastric pain. ABDOMEN:LUNG BASES: Several cysts and atelectasis noted in the bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Oval soft tissue attenuation lesion in the pancreatic tail measures 1.3 x 1.8 cm (series 3, image 31). There are no other characteristics of this lesion that permit further characterization.Minimal dilation of pancreatic duct in body and head up to 4 mm in diameter, without evidence of obstructing mass or other identifiable cause. ADRENAL GLANDS: Nonspecific left adrenal nodule measures 1.1 x 1.5 cm (series 3, image 43). Right adrenal unremarkable.KIDNEYS, URETERS: Multiple hypoattenuating lesions are seen in both kidneys, many of which are too small to characterize but most likely represent benign cysts. However, there is also a hyperattenuating lesion arising from the superior pole of the right kidney which is incompletely characterized but likely proteinaceous or hemorrhagic cyst (series 3, image 36).Several calcifications in the right renal hilum are likely vascular in nature. An additional punctate hyperdensity in the inferior calix of the right kidney measuring 2 to 3 mm, likely nonobstructing stone (series 3, image 54).RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Atherosclerotic calcifications throughout the aorta and its branches, with minimal ectasia of infrarenal aorta measuring up to 2.3 cm in maximal diameter (series 3, image 69).BOWEL, MESENTERY: Large hiatal hernia. Extensive diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Old fractures left 11th and 12th ribs.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder diverticulum seen along the superolateral aspect.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Well-defined lucency with sclerotic margin in the left femoral neck of unclear etiology but appears benign (coronal series image 46). Additional lucency noted in the superior left pubic ramus, also likely benign in nature.OTHER: No significant abnormality noted
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1.No specific abnormality to account for symptoms.2.Soft tissue attenuation lesion in tail of pancreas of unclear etiology. Additional imaging is unlikely to be helpful in further characterization. Follow-up is recommended.3.Nonspecific left adrenal nodule. 4.Hyperdense lesion in superior pole of right kidney is incompletely characterized but likely represents proteinaceous or hemorrhagic cyst. 5.Large hiatal hernia.Findings were communicated to Dr. Kurtz at 2:30 p.m., 12/12/2013.
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Generate impression based on findings.
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65 old male with shortness of breath, lung transplant evaluation LUNGS AND PLEURA: Severe diffuse bilateral bullous emphysema. Apical scarring. No evidence of acute abnormality. New right posterolateral subpleural scar like opacity.MEDIASTINUM AND HILA: The heart size is normal. Atherosclerotic calcification of the aortic arch. No mediastinal or hilar lymphadenopathy..CHEST WALL: Compression deformity of the T6 vertebral body new since 2/2/2010. Healed left rib fractures, new since 2/2/2010.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications of the abdominal aorta.
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1. Severe diffuse bullous emphysema. New right posterolateral subpleural scar like opacity.2. Compression deformity of the T6 vertebral body new since 2/2/2010.
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Generate impression based on findings.
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Status post chemoradiation for an advanced larynx cancer completed in 2010 and salvage neck dissection followed by salvage laryngectomy in October 2011. There are postoperative findings related to total laryngectomy with flap reconstruction as well as voice prosthesis insertion and tracheostomy. The neopharynx and flap appear unremarkable, without evidence of discrete mass lesions. There is no evidence of significant cervical lymphadenopathy. The remaining right thyroid lobe is unremarkable. The major salivary glands appear unchanged with hyperemia of the submandibular glands likely related to radiation therapy. The left internal jugular vein has been sacrificed. The remaining major cervical vessels are intact. The osseous structures are unchanged. The airway inferior to the tracheostomy is patent. Thre is persistent opacification of the bilateral maxillary sinuses. The partially imaged intracranial structures are grossly unremarkable. There are several dental caries and periodontal lucencies.
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No evidence of tumor recurrence or significant cervical lymphadenopathy.
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Generate impression based on findings.
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70 year-old female with history of stage IIA mucinous lung adenocarcinoma, 14.5 months status post radiotherapy CHEST:LUNGS AND PLEURA: Right middle lobe mass measures 7.3 x 4.3 cm and previously measured 7.2 x 4.8 cm (image 48 series 3), minimally decreased in size. The centrally hypodense mass demonstrates multiple foci of air suggesting cavitation/necrosis. Extensive surrounding opacity with bronchiectasis and scarring consistent with postradiation change.Marked volume loss of the right lung with associated mediastinal shift. New apical paramediastinal consolidation is nonspecific but correlation with PET may be considered for further evaluation. Left basilar reticulonodular opacities may be postinflammatory/infectious. Severe diffuse emphysema.MEDIASTINUM AND HILA: Multiple borderline enlarged mediastinal lymph nodes. Low right paratracheal lymph node measures 8 mm and previously measured 11 mm (image 30 series 3).Severe coronary arterial calcification and atherosclerotic calcification of the aortic arch. The heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.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: Unchanged renal cysts and hypodensities too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Right perihilar mass with interval cavitation and necrosis, overall not significantly changed in size.2. New apical paramediastinal consolidation is nonspecific but correlation with PET may be considered for further evaluation.
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Generate impression based on findings.
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59 years old female. Reason: Stage IV pancreas cancer. Please compare to all previous scans and provide index lesion measurements for RECIST. History: Metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis or scarring. 5 mm nodule adjacent to fissure on image 41, series 4 may be a lymph node. MEDIASTINUM AND HILA: Enlarged thyroid with multiple hypodense nodules. CHEST WALL: Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with better defined hypoattenuating foci consistent with metastatic disease. The lesions are now better defined compared with the prior exam. Stable discrete lesion in the lateral segment of the left lobe measured on series 3 image 80, 1.3 x 1.7 cm. All of the hepatic lesions appear stable in comparison with the prior exam. Status post cholecystectomy. Stable 1.5-cm near water density cyst just caudal to the to the liver of uncertain etiology.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic head enlargement of atrophy of the body and tail consistent with history of pancreatic neoplasm. The distal pancreatic duct is enlarged to 1 cm diameter in the pancreatic neck. The pancreatic head mass measures 3x3 cm at image 106 of series 3, stable since the prior exam. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Pancreatic mass with pancreatic ductal obstruction is unchanged. Diffuse hepatic ill-defined lesions consistent with metastatic disease are stable.
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Generate impression based on findings.
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60-year-old male with history of metastatic/recurrent prostate cancer. Reason: history of prostate cancer, pulmonary nodules and rising PSA. CHEST:LUNGS AND PLEURA: Stable pulmonary micronodules are seen in the right lung. A calcified granuloma seen in the left lung base. Dependent atelectasis is present.Bibasilar scarring in lower lobes. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. Calcified mediastinal lymph nodes. Coronary artery calcifications. Thyroid nodules.CHEST WALL: Degenerative changes are seen throughout the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Gallbladder is collapsed. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple renal cysts within both kidneys are stable. A minimally complex septated cyst is seen in the inferior pole the right kidney, unchanged from the prior study.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications are seen throughout the aorta and its branches. Left periaortic lymph node measures 1.9 x 0.9 cm (image 100, series 4), not significantly changed from the prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple punctate sclerotic foci are seen in the spine and pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Soft tissue nodule in the prostatectomy bed measures 1.5 x 1.2 cm (image 189, series 4). An additional soft tissue nodule is seen in the left posterolateral abdomen measuring 1.0 x 1.0 cm (image 141, series 4). These foci are stable in size since the prior study, however they remain suspicious for metastases.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multiple punctate sclerotic foci are seen, some of which appear more prominent on today's study. Degenerative changes are seen in the lumbar spine, most significantly at L5-S1.
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1.Multiple punctate skeletal sclerotic foci are stable, compatible with diffuse metastases.2.Stable size of soft tissue nodules which remain suspicious for metastases.3.Nonspecific pulmonary micronodules are stable.
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Generate impression based on findings.
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Reason: metastatic thryoid ca to supraclav and sternocleidmastoid, on therapy, eval for dz, compare to previous with measuremetns History: as above CHEST:LUNGS AND PLEURA: Lobe small bilateral pulmonary nodules, slightly increased compared to previous.The reference right middle lobe nodule (series 4/15) measures 6 mm, increased from 5 mm previously.The reference left lower lobe nodule (series 4/42) measures 6 mm compared to 5 mm previously.Other nodules have similarly increased in size.MEDIASTINUM AND HILA: No significant mediastinal lymphadenopathy.Moderate coronary arch or calcification.CHEST WALL: Status post right mastectomy with surgical clips in the chest wall.Hemangioma in the mid thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease in the spine.OTHER: No significant abnormality noted.
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Slight interval increase in size of pulmonary metastases.
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Generate impression based on findings.
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Reason: evaluate LUL lesion History: none LUNGS AND PLEURA: Solid and irregular nodule in the left upper lobe (series 5/62) measuring 11 x 6 mm, unchanged from the previous scan. Though the lack of change is reassuring, this remains moderately suspicious and further follow-up is recommended.Part solid nodule anteriorly in the left upper lobe (series 5/80) with complex morphology, not significantly changed since the previous scan. The maximum dimensions, measured at a different level from previously are approximately 21 x 10 mm with a solid component measuring 7 mm in maximum dimension. This morphology remains suspicious for primary adenocarcinoma with lepidic growth pattern which tends to be extremely indolent.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcification on this ungated scan.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Stable small solid and non-solid left upper lobe nodules which remain moderately suspicious for indolent primary malignancy in spite of the lack of interval change. A follow-up scan is recommended in approximately 6-12 months time.
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Generate impression based on findings.
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79-year-old male. History of rectal cancer on chemotherapy. Restaging. CHEST:LUNGS AND PLEURA: There is an 11 mm diameter right lower lobe lung nodule series 5 image 68 is much larger. Additional smaller right lung nodules are present at images 23 and 38. MEDIASTINUM AND HILA: No pathologic size nodes. Port-A-Cath tip terminates in the SVC RA junction. Large thrombus in the distal right jugular vein. CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the liver dome (series 3, image 81) is too small to characterize, but unchanged. The 1.1 cm hypervascular focus in the dome of the right hepatic lobe was not seen on this exam. No new lesions. No biliary ductal dilatation. Patent hepatic vasculature. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole renal cyst. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is mesenteric nodularity in the left upper quadrant suspicious for persistent carcinomatosis (series 3, image 104). Diffuse rectosigmoid colon circumferential wall thickening, less prominent than on prior exam. No evidence of bowel obstruction. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine with endplate sclerosis. OTHER: Decreased ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse rectosigmoid colon circumferential wall thickening, reduced since the prior exam. No bowel obstruction. Mild infiltration of the perirectal fat with no discrete measurable lymphadenopathy. BONES, SOFT TISSUES: Sacroiliac joint degenerative changes. OTHER: No significant ascites
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1. Rectosigmoid colon wall thickening, reduced since the prior exam. No bowel obstruction is evident.2. Small amount of ascites has resolved3. Hypervascular liver dome lesion is not seen on this exam. 4. Stable mesenteric nodularity concerning for persistent peritoneal carcinomatosis. 5. Enlarged right lower lobe lung nodule, now 11 mm diameter.
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Generate impression based on findings.
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67 year old male. Colon carcinoma. Reason: Metastatic CRC: Restaging. History of prostate cancer. Status post laparoscopic cholecystectomy. CHEST:LUNGS AND PLEURA: No significant change in numerous bilateral pulmonary metastatic mass lesions. Reference right upper lobe nodule best seen on image 19 of series 5 measures 1.4 x 1.3 cm. Reference right lower lobe mass best seen on image 45 of series 5 measures 3.6 x 2.6 cm. Reference left lower lobe mass best seen on image 60 of series 5 measures 6.2 x 2.6 cm.MEDIASTINUM AND HILA: Aortic root and coronary artery calcifications. CHEST WALL: Right sided venous access device. ABDOMEN:LIVER, BILIARY TRACT: Stable hemangiomas. The previously noted posterior segment 7 peripheral low attenuating focus is faintly seen on the current examination at image 74 of series 3. Status post cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy. Reference periaortic lymph node seen on image 118 of series 3 measures 1.2 x 1.7 cm.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: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable examination
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Generate impression based on findings.
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45 year old female. Reason: Evaluate vasculature to support transplant. History: Pre-kidney transplant evaluation. Status post AVR. ABDOMEN:LUNG BASES: Diffuse pleural thickening, especially in the right anterior hemithorax. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic end-stage native kidneys. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Appendix contains radiodense material, but is otherwise unremarkable, located in the RLQ. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites. Diffuse atherosclerotic calcifications of the distal aorta and common iliac arteries, greatest on the right. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Diffuse soft tissue thickening and vascular calcification in small vessels at the right iliac fossa, probably due to prior renal transplant. Minimal scattered focal calcifications in the internal and external iliac arteries as well as the femoral arteries bilaterally.
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Right pleural thickening. Ascites. Bilateral common iliac artery calcifications. Minimal scattered atherosclerotic calcifications in external and internal iliac arteries.
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Generate impression based on findings.
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72-year-old female with history of lymphoma. Reason: NHL, left high cervical nodule on exam. CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Stable residual left axillary fibrotic node measuring 1.3 x 0.6 cm image 26, series 3.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts and cholelithiasis are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic node measures 8 x 9-mm image 111, series 3, unchanged. Other retroperitoneal lymph nodes are enlarged. For reference, an enlarged paraaortic node at the level of the left renal hilum measures 1.4 x 2.1 cm, image 115, series 3. BOWEL, MESENTERY: Index mesenteric lymph node is no longer identifiable. Other small mesenteric lymph nodes are enlarged. New diffuse mesenteric adenopathy. 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: New diffuse pelvic adenopathy bilaterally. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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New retroperitoneal, mesenteric and pelvic lymphadenopathy.
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Generate impression based on findings.
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DLBCL s/p R-CHOP. There has been interval increase in size of numerous bilateral cervical lymph nodes. For example, a left level 4 lymph node measures 7 x 9 mm (image 164, series 4), previously 3 x 4 mm, a right level 4 lymph node measures 8 x 14 mm (image 173, series 4), previously 6 x 9 mm, and a left level 5 lymph node measures 5 x 7 mm (image 128, series 4), previously 4 x 5 mm. There has also been interval increase in size or right axillary adenopathy. The Waldeyer ring structures are unremarkable. There is an unchanged hypoattenuating left thyroid nodule that measures 8 mm and a right thyroid nodule that measures 4 mm. The major salivary glands are unremarkable. The airways are patent. The major cervical vessels are intact. The osseous structures are unremarkable. The partially imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear.
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Interval increase in size of bilateral cervical lymph nodes. Although the lymph nodes are mildly enlarged, this change may indicate disease progression. FDG-PET may be useful for further characterization.
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Generate impression based on findings.
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Reason: h/o larynx cancer History: r/o lung mets LUNGS AND PLEURA: Marked increase in a right upper lobe nodule, previously 4 mm and smoothly marginated, now 20 mm in maximum diameter and extensively lobulated. A smaller new nodule has developed inferiorly and slightly posteriorlyNo other suspicious nodules.MEDIASTINUM AND HILA: Postsurgical abnormalities and neck with absence of the left lobe of the thyroid gland, tracheostomy, and a voice prosthesis.Small superior mediastinal lymph node at the thoracic inlet, stable.New markedly enlarged right hilar lymph nodes measuring up to 16 mm in short axis diameter.Small sliding hiatal hernia.CHEST WALL: Interval increase in the size of several left axillary lymph nodes, measuring up to 8 mm in diameter.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Markedly increased lobulated right upper lobe nodule, with a smaller adjacent nodule and associated hilar lymphadenopathy. While the findings are suspicious for neoplasm, the localized nature of the lymphadenopathy and the presence of an adjacent nodule raises question of histoplasmosis, which can present in this way. Alternatively, a primary carcinoma should be considered.
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Generate impression based on findings.
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Reason: Patient with multiple presentations for chest pain, R/u ACS, EKG with dynamic T wave inversions with chest pain History: chest pain Coronary arteries: Diffuse coronary artery disease is present with an approximate 90% stenosis at the proximal LAD:LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying four diagonal and several septal branches. There is a mixed plaque at the ostium of the proximal LAD with the eccentric, noncalcified component contributing to approximately 90% stenosis. This was discussed with the resident caring for the patient in the emergency room at time of image interpretation. Multifocal mixed plaques contribute to mild stenosis in the mid LAD. The distal LAD is unremarkable. A step-off artifact is noted.The first diagonal branch bifurcates. At the ostium of D1, there is a large calcification, followed by an apparent shallow ulcerated plaque. This plaque is noncalcified, causing approximately 50% stenosis.The anterior branch of the D1 bifurcation demonstrates a non-calcified plaque at its proximal segment, causing approximately 50% focal stenosis. The remaining anterior branch is unremarkable. The posterior branch demonstrates a large calcification at its distal segment, without significant stenosis.Ramus intermedius: There is a punctate calcification at the proximal segment without significant stenosis. This vessel bifurcates and demonstrates mild, multifocal noncalcified plaques.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. It gives rise to 3 obtuse marginal branches. The first obtuse marginal branch is dominant and bifurcates. No significant stenosis is present. OM2 and OM3 are diminutive in caliber.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and several posterolateral branches. There is a mixed plaque in the proximal RCA, approximally 8 mm from the ostium. The noncalcified component contributes to mild stenosis. Within the distal RCA, there is an additional mixed plaque with positive remodeling. The noncalcified component contributes to approximately 40% stenosis.The posterior descending artery is visualized to the mid ventricular level and is unremarkable.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted. A 3-mm micronodule is noted within the right upper lobe adjacent to the pericardium (series 6 image 6).A small hiatal hernia is present.
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Diffuse coronary artery disease with an eccentric, severe ostial LAD stenosis, as above.
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Generate impression based on findings.
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66 year old male. Reason: Follicular lymphoma s/p 4 cycles of Rituxan Bendamustine in need of restaging scans. Please compare to prior. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Interval resolution of the paravertebral adenopathy. The left paravertebral soft tissue mass has resolved and is not seen on this exam. Resolution of retrocrural adenopathy. A representative retrocrural lymph node best seen on image 96 of series 3 measures 9 x 11 mm, no longer enlarged. Coronary artery calcification. Calcified mediastinal nodes. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter low attenuation focus within segment 8 of the right lobe of the liver; favor benign cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval resolution of extensive retroperitoneal adenopathy. Representative left periaortic lymph node at the level of the left renal hilum best seen on image 120 of series 3 measures 7 x 8 mm.BOWEL, MESENTERY: No significant change in mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large ventral hernia. PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate. BLADDER: No significant abnormality notedLYMPH NODES: Interval resolution of confluent pelvic adenopathy. Representative right external iliac lymph node mass best seen on image 161 series 3 measures 1 x 1 cm. Similar interval decrease in right inguinal adenopathy was observed.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Midline ventral anterior abdominopelvic wall nonobstructing hernia.
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Interval resolution of paravertebral intrathoracic, retrocrural, retroperitoneal, and pelvic/right inguinal adenopathy. No new lesions.
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Generate impression based on findings.
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Female 47 years old; Reason: assess extent of metastatic disease History: none CHEST:LUNGS AND PLEURA: Biapical pleural thickening, unchanged. The pleural spaces are clear. Few scattered micronodules.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Right chest wall port and terminates at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Soft tissue anterior to the left hepatic lobe is not well visualized on this examination.SPLEEN: SplenectomyPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 1.3 x 1.4 cm pericaval node is noted (series 3 image 141), stable since previous examBOWEL, MESENTERY: Post operative changes in the descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: Stable left common femoral node measures 1.6 x 1.4cm previously 1.7 x 1.2 cm (image 193/series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Stable enlarged reference lymph nodes without significant change in size.2. No definite peritoneal carcinomatosis as referenced by previous PET scan. If full characterization of peritoneal disease is indicated, PET scan advised as that better showed the peritoneal disease.on prior exams.
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Generate impression based on findings.
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Female 69 years old; Reason: HCC restaging History: HCC on sorafenib CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Dominant right hepatic lobe mass measures 8.7 x 7 .3 cm, previously 10.2 x 8.1 cm,(series 9, image 50). A second mass in the dome of the right lobe is 2.9 x 2 .8 cm, previously 2.4 x 2.7 cm, (series 9, image 18). This lesion has lost vascularity, when compared to previous examination. The third inferior nodule in the right lobe measures 1.8 x 2.1 cm previously 2 x 2.1 cm, (series 10, image 72). Progressive decreased tumor vascularity in these lesions suggests treatment response.The previously referenced hypodense areas in the hepatic dome appears much smaller, measuring 1.8 x 1.0 cm, previously 2.8 x 1.3 cm.Replaced right hepatic artery. Patent portal vein and hepatic veins. SPLEEN: No focal lesions. 12 mm splenic artery aneurysm is unchanged. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. A few hypodense foci are too small to characterize but likely also cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes, not significantly changed. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion with sclerotic borders is stable in a lower thoracic vertebral body (series 9 image 26). Degenerative changes in the lumbar spine.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: Colon diverticulosis. No bowel obstruction. BONES, SOFT TISSUES: Lytic lesion with sclerotic borders is stable in a lower thoracic vertebral body (series 9 image 26). Degenerative changes in the lumbar spine.OTHER: No significant abnormality noted.
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1. Decreased size of dominant right hepatic lobe mass. Remainder of lesions in the liver are also slightly smaller in size. Overall progressive decrease in tumor vascularity of these lesions suggest treatment response.2. Decrease in size of the hypodense lesion in the hepatic dome lesion.3. Stable lytic lesion in the thoracic spine.
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Generate impression based on findings.
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Headache. Rule out intracranial hemorrhage. There is no intracranial mass, hemorrhage, edema, or hydrocephalus. There is mild prominence of sulci diffusely, consistent with cerebral volume loss. There is also mild cerebral white matter hypoattenuation that likely represents small vessel ischemic disaese. There is calcification associated within the wall of the left vertebral artery and bilateral cavernous ICAs consistent with atherosclerotic calcification. The osseous structures are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. There are bilateral lens implants.
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No evidence of acute intracranial hemorrhage.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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57-year-old male with prostate cancer after 12 cycles of an investigational therapy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No lymphadenopathy. Mild coronary artery calcifications. Heart normal in size without effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable left adrenal nodule measures 1.9 x 2.0 cm (series 3, image 80). Right adrenal unremarkable.KIDNEYS, URETERS: Stable hypoattenuating lesions in both kidneys, some of which are too small to characterize, but unchanged and most compatible with cysts.RETROPERITONEUM, LYMPH NODES: Stable infrarenal aortic aneurysm with eccentric plaque/thrombus; maximal diameter measures 3.0 cm, unchanged (series 3, image 112). No significant lymphadenopathy.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild anterior compression deformity of T11 and T12.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable right external iliac lymph node unchanged, measuring 1.2 x 1.3 cm, previous measured 1.2 x 1.4 cm (series 3, image 166). Stable right common iliac node measures 1.3 x 1.4 cm, previously measured 1.3 x 1.5 cm (series 3, image 144).BOWEL, MESENTERY: Bilateral pars defects at L5-S1 with grade 2 anterolisthesis of L5 on S1.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable reference measurements.
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Generate impression based on findings.
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48-year-old female with history of dissection in past with worst headache of life with sharp pains shooting across the back. CHEST:LUNGS AND PLEURA: No significant abnormality noted.No parenchymal nodules or air space consolidation foci. No pleural disease.MEDIASTINUM AND HILA: No adenopathy or masses..CHEST WALL: No significant abnormality noted.CT ANGIOGRAM: Ascending aorta, aortic arch and descending aorta all show normal morphology without aneurysmal dilatation or dissection. No focal areas of narrowing are seen. No significant atherosclerotic changes are noted. Origins of the great vessels appear normal.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.CT ANGIOGRAM: Abdominal aorta shows normal caliber throughout with normal bifurcation into normal. Common iliac arteries. The iliac arteries bifurcate bilaterally into normal. Internal and external iliac arteries without significant atherosclerotic disease or obstruction. Prior noted small focal aortic intimal flap (series 9, image 144) seen over a 5-mm range is unchanged. The celiac axis, superior mesenteric artery, bilateral renal arteries and origins of the inferior mesenteric artery appear normal.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Marked enlargement of the uterus, with bulbous enhancing masses again seen varying in size. The largest of these (series 9, image 255) has increased in size when compared with 5/26/13 and now measures 9.3 x 9.6 cm compared with 7.1 x 7.8 cm. CT cannot characterize uterine masses and while these may represent fibroid tumors most commonly, the increase in size raises the question of left common sarcomatous degeneration. Clinical evaluation and follow-up would be recommended.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. Stable appearing aorta since prior examinations with small focal intimal flap and upper abdominal aorta, unchanged. No evidence for acute dissection. 2. Enlarging uterine mass -- see above.
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Generate impression based on findings.
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91-year-old male with diffuse large B-cell lymphoma status post 6 cycles of R-CHOP chemotherapy. CHEST:LUNGS AND PLEURA: New trace right pleural effusion. Subsegmental bilateral basilar atelectasis.MEDIASTINUM AND HILA: Stable moderate cardiomegaly. Severe coronary artery calcifications.CHEST WALL: Right chest wall port catheter with tip in distal SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable nodularity of left adrenal.KIDNEYS, URETERS: Multiple hypodensities in the left kidney, some of which are too small to characterize, unchanged and compatible with cysts. Stable mild left hydronephrosis. Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in aorta and its branches. No significant lymphadenopathy.BOWEL, MESENTERY: Fluid in the gastrohepatic ligament appears unchanged. Moderate to large amount of stool throughout the colon. No obstruction.BONES, SOFT TISSUES: L1 compression fracture unchanged. Severe degenerative changes in the lumber spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large heterogeneous prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large amount of stool in the colon.BONES, SOFT TISSUES: Hypoattenuating lesion in the left inguinal area is decreased in size, measuring 4.0 x 2.8 cm, previously measured 4.7 x 3.4 cm (series 401, 205). Fat containing left angle hernia.OTHER: No significant abnormality noted
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Decreasing size of hypoattenuating left inguinal lesion. Otherwise, stable exam.
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Generate impression based on findings.
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58-year-old female with history of ARDS on ventilator, status post ECMO decannulation LUNGS AND PLEURA: High density right pleural fluid containing foci of gas and chest tube directed apically. The right lung is partially collapsed. Small loculated fluid collection along the left major fissure. Extensive bilateral interstitial and airspace opacities.MEDIASTINUM AND HILA: Tracheostomy tube extends to the thoracic inlet. Enteric tube extends to the stomach. Mitral valve prosthesis. Pericardial leads are identified.CHEST WALL: Subcutaneous emphysema extends along the right chest wall superior to the chest tube entrance site to the pleura and may represent iatrogenic tract.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Large right hemothorax compressing the right lung. Extensive bilateral interstitial and air space opacities.
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Generate impression based on findings.
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59 year old patient with history of T3NX SCC of the esophagus diagnosed 8/2011 and treated with neoadjuvant chemoradiation FOLFOX/RT completed 12/11 with gastric pull-up 1/12. Head: There is no intracranial mass, edema, hemorrhage, hydrocephalus, or focus of abnormal enhancement. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is mild scattered paranasal sinus opacification. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are posttreatment findings related including those related to the gastric pull-up procedure as well as a right-sided PICC line. The neo-esophagus is unremarkable. There is no significant lymphadenopathy or mass lesions. The nasopharynx, oropharynx and hypopharynx are also unremarkable. The thyroid, submandibular, and parotid glands are unremarkable. The right jugular vein is bulbous. There is a focal filling defect at the confluence of the left internal jugular and subclavian veins that most likely represents thrombus. There is partially calcified nonocclusive thrombus at the left carotid bifurcation. There is degenerative spondylosis, but no lytic or blastic lesions. There are carious ADA 15 and 16.
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1.Unremarkable postoperative findings related to gastric pull up procedure without evidence of locoregional tumor recurrence, significant cervical lymphadenopathy, or intracranial metastases.2.A focal filling defect within the distal left internal jugular vein likely represents thrombus, which appears to be new. This can be further evaluated via ultrasound.3.Carious ADA 15 and 16.Discussed with Dr. Salgia at 3:50 PM on 12/13/13.
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Generate impression based on findings.
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51-year-old female with history of sarcoidosis and possible right upper lobe cavitation, evaluate for interval change LUNGS AND PLEURA: Small residual right pleural effusion. Extensive upper lobe predominant nodular and interstitial opacities as well as bronchiectasis consistent with sarcoidosis. Coarsely calcified upper lobe air space opacities with associated cystic spaces on the right appear similar to the prior exam.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with sarcoidosis. Cardiophrenic lymphadenopathy. The heart size is normal. No pericardial effusion.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.Extensive upper lobe predominant nodular and interstitial air space opacities with associated coarse calcification and cystic spaces in the right upper lobe, not significantly changed from the prior exam, consistent with sarcoidosis.
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Generate impression based on findings.
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Reason: Hx esophageal cancer s/p esophagectomy c/b fistula History: Egus ca CHEST:LUNGS AND PLEURA: Emphysema and paramediastinal fibrosis consistent with radiation reaction.Focal scar in the right middle lobe.No suspicious nodules or pleural effusions.MEDIASTINUM AND HILA: Status post esophagectomy with gastric interposition. Aberrant right subclavian artery, normal anatomic variant. Mild ectasia of the ascending aorta unchanged. Ectasia of right jugular vein unchanged. Port catheter at RA/SVC junction.No significant lymphadenopathy.CHEST WALL: Right jugular port catheter. Postop change on the right.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: One moderately dilated ducts very small cystic lesions, stable.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: Small fat containing left lumbar hernia.OTHER: No significant abnormality noted.
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No evidence of metastatic disease.
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Generate impression based on findings.
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77 year-old female with altered mental status. There is redemonstration of periventricular and subcortical white matter hypoattenuation. There are foci of hypoattenuation in the left thalamus and right basal ganglia. They are unchanged. The ventricles, sulci, and cisterns are symmetric and mildly prominent, representing volume loss. 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. Note is made of irregularity of the floor of the right orbit consistent with an orbital blowout fracture with likely extension to involve the medial wall of the orbit. There is mild proptosis of the right orbit. There is mild to moderate mucosal thickening of the maxillary and ethmoid sinuses. The mastoid air cells are within normal limits. Note is made of intracranial vascular calcifications. Right lens prosthesis.
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1. No acute intracranial abnormality. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists. 2. Small vessel ischemic disease and small lacunar infarcts, likely chronic.
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Generate impression based on findings.
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63-year-old female with history of DVT, increased shortness of breath and hypoxia, evaluate for PE PULMONARY ARTERIES: The main pulmonary artery measures 3.4 cm, suggesting pulmonary arterial hypertension. Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Severe extensive bilateral pulmonary fibrosis with severe honeycombing, traction bronchiectasis, architectural distortion and septal thickening. Underlying emphysematous changes. Apical bullae.MEDIASTINUM AND HILA: Extensive unchanged mediastinal lymphadenopathy. Reference right paratracheal lymph node measures 13 cm and previously measured 13 cm (image 68 series 8). The right thyroid lobe is absent. CHEST WALL: Right posterolateral lipoma.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Technically adequate exam without evidence of pulmonary embolus.2. Extensive pulmonary fibrosis with underlying emphysema with features of both NSIP and UIP, unchanged
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Generate impression based on findings.
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Lymphoma CHEST:LUNGS AND PLEURA: Stable right lobe minor fissure nodular focus best seen on image 49 series 5 measuring 0.9 x 0.7 cm.MEDIASTINUM AND HILA: No significant change in supraclavicular, mediastinal, and hilar adenopathy.CHEST WALL: No significant change in bilateral axillary adenopathy. Reference left axillary lymph node best seen on image 26 series 3 measures 1.3 x 1.9 cm.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 significant change in retroperitoneal adenopathy. Reference left para-aortic lymph node best seen on image 124 series 3 measures 2.6 x 1.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No change in extensive bulky bilateral pelvic and inguinal adenopathy. Reference right obturator lymph node mass best seen on image 24 series 3 measures 3.4 x 8.5 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No significant change in extensive adenopathy.
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Generate impression based on findings.
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64-year-old female with throat pain, MMP, neck pain, evaluate for bony abnormalities. Limited intracranial and orbital views are unremarkable. Limited views of the paranasal sinuses are clear.No soft tissue masses are present in the neck. No exophytic mass or focal effacement of the aerodigestive tract. No lymphadenopathy by CT size criteria.Multiple thyroid nodules some of which are calcified in the left thyroid lobe. The submandibular and parotid glands are free of focal lesions. The major cervical vasculature is patent bilaterally. Atherosclerotic vascular calcifications at the carotid bifurcations. The visualized lung apices demonstrate centrilobular emphysema.Multilevel mild degenerative changes of the cervical spine including anterior osteophyte formation at C3 through C5 and mild scattered posterior disk osteophyte complexes.
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1. No specific findings to account for the patient's presenting symptoms. Mild multilevel degenerative changes of the cervical spine. If clinically indicated, cervical spine MR may be obtained for further details.2. Multiple thyroid nodules which may be further interrogated with sonography if clinically desired.
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Generate impression based on findings.
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Clinical question: Rule out chronic sinusitis. Signs and symptoms: Chronic nasal congestion. Medtronic fusion sinus CT:Frontal sinuses are well pneumatized and unremarkable.Ethmoid sinuses demonstrate minimal mucosal thickening in the left anterior ethmoid cells and unremarkable otherwise.Sphenoid sinus demonstrate very faintly visualized frothy content in the right chamber and of the sinus suggestive of acute sinusitis (axial images 49 through 59 on coronal image 59 ) and with mild associated mucosal thickening along the anterior wall of the sinus. There is complete occlusion of the right sphenoethmoid recess. Minimal mucosal thickening at the level of the left sphenoethmoidal recess with resultant occlusion is also noted.There are bilateral Haller cells present. Maxillary sinuses demonstrate minute mucosal thickening in the dependent portion of the right maxillary sinus and unremarkable otherwise. Patent bilateral ostiomeatal units of maxillary sinuses.Images through nasal passage demonstrate mild nasal septum deviation to the left with mucosal contact with the left inferior turbinate. Mild bilateral middle turbinate concha bullosa and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Images through the orbits are unremarkable.
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1.Acute sinusitis of right chamber of the sphenoid sinus and occluded bilateral sphenoethmoidal recesses.2.Unremarkable paranasal sinuses otherwise. Mild nasal septum deviation to the left and small bilateral middle turbinate concha bullosa.
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Generate impression based on findings.
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22 year-old female with nasal congestion and discharge. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. The patient is status post bilateral endoscopic sinus surgeries, including uncinectomy, antrectomy, and partial ethmoidectomy. The frontal sinuses, frontal-ethmoid recesses, residual ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. There are patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Status post bilateral endoscopic sinus surgeries. No evidence of paranasal sinus inflammatory disease or sinusitis.
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Generate impression based on findings.
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Multiple myeloma status post stem cell transplant with abdominal pain and nausea 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: Vena caval filterBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse mottled lucencies throughout the axial skeleton consistent with known multiple myelomaOTHER: 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: Diffuse mottled lucencies throughout the bony pelvis consistent with known multiple myelomaOTHER: No significant abnormality noted
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No evidence for acute or inflammatory process. No bowel obstruction. Diffuse mottled bony lucencies consistent with known multiple myeloma
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Generate impression based on findings.
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39-year-old female with history of esophageal cancer with recurrence status post CRT. Evaluate. Redemonstration of postoperative changes from previous esophagectomy and gastric pull up. No definite abnormal enhancing tissue is present near the anastomotic site to suggest recurrence.No soft tissue masses are present in the neck. Interval increase in size of multiple level 1 and 2 bilateral lymph nodes which do not meet CT size criteria and are most likely reactive in etiology. No exophytic mass or focal effacement of the aerodigestive tract. Partial opacification of the preepiglottic space. The parotid and submandibular glands are free of focal lesions. Small hypodense left thyroid lobe nodule, unchanged. Minimal effacement of fat in the right tracheoesophageal groove is unchanged.The major cervical vasculature is patent. Limited intracranial views and orbital views are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear. No suspicious osseous lesions are present.Mild biapical scarring, please see dedicated chest CT from today's date for further details.
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1. No specific evidence of metastatic disease.2. Interval increase in size of multiple level 1 and 2 bilateral lymph nodes which do not meet CT size criteria for lymphadenopathy and are most likely reactive in etiology.
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Generate impression based on findings.
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Reason: CAD History: chest pain and lightheadedness Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying two diagonal and septal branches. There are no significant stenoses in the left anterior descending artery.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the left circumflex coronary artery.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is significant motion artifact within the mid RCA; therefore, this segment cannot be evaluated. The proximal and distal segments are unremarkable. The proximal posterior descending artery demonstrates a mild noncalcified plaque. It is visualized over a length of 2 cm.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.This radiology report is limited to the extra cardiovascular structures. Interpretation of the images of the heart and aorta is provided separately in the associated cardiology report.Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.
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Examination is limited by respiratory motion artifact. The mid right coronary artery cannot be evaluated secondary to this motion artifact. In light of these limitations, no significant coronary artery stenosis is visualized.
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Generate impression based on findings.
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50 year-old male with end-stage renal disease status post debris and half gland parathyroidectomy now with recurrence There are postsurgical changes in the region of the thyroid gland with surgical clips present in the tracheoesophageal groove at the level of the right inferior pole of the thyroid. There is an enhancing soft tissue lesion posterior to the inferior pole of the right thyroid, adjacent to the surgical clips, measuring 12.0 x 1.0 cm in size (12/43) and 50, 124, 134, and 105 HU on noncontrast, 25 second, 55 second and 85 second delayed images. No additional enhancing lesions are identified to suggest an additional parathyroid adenoma. The mastoid air cells are clear. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The salivary glands are unremarkable. There is an elongated pyramidal lobe of the thyroid gland, which otherwise appears unremarkable. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. There is a 5 mm diameter skin lesion in the posterior neck, which may represent a sebaceous cyst. In addition, there is probable scarring in the right lower neck.
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A 1.2 x 1.0 cm lesion in the right tracheoesophageal groove demonstrates enhancement characteristics compatible with recurrent hyperplastic parathyroid tissue.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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32 year-old male with ALL and emesis. There are scattered foci of hypoattenuation in the cerebral subcortical white matter, which appear similar to that on the prior MRI. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There has been improvement of the paranasal sinus opacification.
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1. No intracranial mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. 2. Stable nonspecific cerebral white matter hypodensities. Please refer to recent MRI for details. 3. Interval improvement of paranasal sinus inflammatory disease and sinusitis.
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Generate impression based on findings.
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History of recurrent small cell carcinoma of the head and neck, new onset blurred vision, evaluate for brain metastases. Solitary round hypodense subcentimeter lesion in the high right parietal cortex with associated peripheral enhancement. There is no significant mass effect or edema associated with this finding. No additional abnormal intracranial or leptomeningeal enhancement is present. No additional intracranial lesions are identified.Incompletely visualized centrally hypoattenuating rim enhancing lesions are identified in the right parotid space. The adjacent right parapharyngeal space is relatively spared.Patchy hypoattenuation in the periventricular and subcortical white matter is nonspecific but likely representa small vessel ischemic disease of indeterminate age.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No hydrocephalus or intra-/extra axial fluid collections. No mass effect or edema.Partial opacification of the right mastoid air cells. Small left maxillary mucous retention cyst. The visualized portions of the orbits are intact. Note is made of a punctate radiodensity along the anterior aspect of the left globe.
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1. Solitary small hypodense peripherally enhancing high right parietal cortex lesion which was not definitively identified on the comparison study from a year ago. This lesion is suspicious for a metastasis and MRI may be obtained for further characterization.2. Incompletely visualized centrally hypoattenuating rim enhancing lesions are present in the right parotid space which are suspicious for tumor. Recommend dedicated neck CT for further characterization.3. Punctate radiodensity along the anterior aspect of the left globe which is compatible with a foreign body. If MRI is to be obtained, this density should be removed before proceeding with the MRI examination.
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Generate impression based on findings.
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Clinical question: Newly diagnosed lung cancer; dizziness and cognitive impairment; evaluate for metastatic disease. Unenhanced head CT:Examination demonstrates no detectable abnormal enhancement the brain parenchyma or leptomeninges to suggest metastatic disease. There is also no evidence of lytic or sclerotic changes of the calvarium to suggest metastases.There is mild subcortical and periventricular low attenuation of white matter which considering patient's stated age of 85 likely representing age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise. Mild bilateral cavernous carotid and intracranial vertebral artery muscular calcification is present.Unremarkable images through the orbits.Bilateral mastoid air cells and middle ear cavities as well as visualized paranasal sinuses remain well pneumatized.
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Enhanced head CT demonstrate no evidence of parenchymal, leptomeningeal or calvarial metastatic disease. Mild age indeterminate small muscle ischemic stroke is noted.
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Generate impression based on findings.
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Swelling, mass, or lump in head and neck. 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 skull and extracranial soft tissues are unremarkable.
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No evidence of intracranial hemorrhage, mass, or cerebral edema.
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Generate impression based on findings.
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Clinical question:? T12 vertebral lesion; metastatic disease; evaluate for presence. Signs and symptoms: As above. Enhanced CT of thoracic spine:The numbering of the vertebral column is based on the first superior visualized rib confidence T1 and fast visualized rib as T12. The localizer images include only thoracic spine with and without reference visualization of lumbar or cervical spine.There is an ill-defined increased density (presence or absence of bony enhancement cannot be determined on CT and MRI is significantly more sensitive for detection of metastatic lesions of the spine) in the posterior medial aspect of vertebral body at T12 without convincing evidence of bony destruction and enhancement cannot be assessed. This finding measures approximately 10.3 x 13.4-mm in its transaxial dimensions and correspond to a focus of suspected metastatic lesion noted on prior PET scan from 12 -- 3 -- 13 and could represent a metastatic lesion. However to confirm metastases recommend follow-up with an MRI exam. There is no evidence of fracture or malalignment the vertebral column.There is no distinct lytic or sclerotic changes of vertebral column. Partially visualized thoracic ribs also fail to demonstrate any convincing evidence of a lytic or sclerotic lesion to suggest metastatic disease.Mild degenerative changes of thoracic spine are noted however there is no suggestion of central spinal stenosis at any level. There is also no convincing evidence of neural foraminal compromise.There is no evidence of any perispinal soft tissue abnormalities.Partially visualized lung fields demonstrate patient's known tumor.
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1.Nonspecific subtle focus of increased bony density in the posterior midline aspect of T12 vertebral body corresponding to focus of increased uptake on prior PET scan and could represent a metastatic lesion. CT however cannot detect with certainty presence of osseous enhancement. Follow-up with an MRI is recommended for confirmation.2.No convincing evidence of any additional similar findings and no distinct focus of lytic or sclerotic bony changes of vertebral column or visualized ribs.3.Normal anatomical alignment of the vertebral column and without suggestion of central stenosis or neural foraminal compromise at any level.
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Generate impression based on findings.
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41 year old female. Evaluate left renal AML. Recent bleed/embolization. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small nonspecific splenic hypodensity favors a benign etiology and may represent a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A 7.3 x 4.9 cm mass arising from the left kidney is predominantly fat containing with small soft tissue elements, consistent with angiomyolipoma. Near complete resolution of the previously seen bleeding in and around the mass, likely accounting for decrease in size, previously measuring 8.4 x 7.3 centimeters.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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Interval decrease in size of left angiomyolipoma, with near resolution of bleed.
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Generate impression based on findings.
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Male 57 years old; Reason: 57 yr old male with h/o lymphoma, s/p allo SCT, day 30 evaluation History: evaluate CHEST:LUNGS AND PLEURA: Basilar dependent atelectasis. No pleural effusions. Scattered micronodules are stable. No suspicious nodules or masses.Azygos pseudo-lobe.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion.CHEST WALL: No axillary lymphadenopathy. Right port a catheter noted with its tip in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Left subcentimeter hepatic hypodensity is too small to characterize and unchanged, likely a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left periaortic index node is smaller measuring 1.6 x 0.6 cm (series 401 image 113) 1.8 x 1.0 cm.BOWEL, MESENTERY: Mesenteric adenopathy has drastically decreased. Large mesenteric mass measures 3.9 x 1.1 cm (series 401 image 123) previously 4.4 x 3.1 cm. The additional mesenteric nodes and left upper quadrant are not well visualized on this examination however residual haziness does persist. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vague soft tissue seen in the left inguinal canal has regressed.
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Decrease in size and conspicuity of the previously noted metastatic disease with mild residual.
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Generate impression based on findings.
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39-year-old female with history of esophageal cancer status post surgery with recurrence status post CRT CHEST:LUNGS AND PLEURA: Scattered unchanged pulmonary micronodules. Perimediastinal radiation changes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Postsurgical changes of gastric interposition. Previously described soft tissue density along the superior right trachea is unchanged dating back to least 2011 consistent with benign etiology, likely scar tissue.CHEST WALL: Fused T8/T9 hemivertebral bodies with associated thoracic dextroscoliosis.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy with stable dilatation of the common biliary duct.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: Unchanged punctate L3 vertebral body sclerotic focus.OTHER: No significant abnormality noted.
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No significant interval change or evidence of metastatic disease.
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Generate impression based on findings.
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Reason: Pre-Kidney Transplant Evaluation History: Diffuse bilateral centrilobular groundglass opacities are nonspecific noted on previous CT scan abd LUNGS AND PLEURA: Diffuse bilateral groundglass opacity with a centrilobular peribronchial vascular distribution, not significantly changed in the areas that were visualized on the previous scan.Moderate diffuse bronchial thickening.A few small subpleural nodular scar like opacities and micronodules, compatible with previous infection.No pleural effusion.MEDIASTINUM AND HILA: Surgical clips in the neck.No significant lymphadenopathy.Moderate coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized kidneys with multiple cysts.
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Diffuse centrilobular groundglass opacities with bronchial thickening, which is most likely a chronic finding based on the lack of short-term change and review of earlier radiographs dating back to 2009; the differential diagnosis includes hypersensitivity lung disease (if the patient is a nonsmoker) and smoking related lung disease(RBILD or DIP) if the patient is a cigarette smoker. In view of the history of Wegener's granulomatosis, vasculitis and recurrent pulmonary hemorrhage is a possible etiology.
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Generate impression based on findings.
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Male 78 years old; Reason: Cycle 12 Day 28 assessment per IRB 11-0049 History: hx/o RCC CHEST:LUNGS AND PLEURA: Moderate emphysema affects the upper lobes of the lungs. There are a few scattered pulmonary micronodules some of which are calcified. No dominant lung lesion. There are trace effusions.MEDIASTINUM AND HILA: Heart size is normal. Small pericardial effusion stable.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Hypodense segment 7 lesion measures 1.4 x 1.3 cm (series 3 image 84) previously 1.3 x 1.3 cm . The inferior segment 7 lesion measures 1.1 x 1.3 cm (series 3 image 89) previously1.5 x 1.1 cm.No definite new hepatic lesions. No ductal dilatation.SPLEEN: Probable residual splenic tissue located posterior medially.PANCREAS: No significant abnormality notedADRENAL GLANDS: Adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No hydronephrosis of the right kidney. Multiple right renal cysts some of which are hyperdense and possibly are hemorrhagic cysts. Stable perinephric edema.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 2.9 X 1.9cm, previously 2.9 x 1.4 cm (image 112/series 3).BOWEL, MESENTERY: No perforation or free air identified. No bowel obstruction is evident.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: Sclerotic foci in the right ilium are unchanged.OTHER: No significant abnormality noted
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1.Stable size of the provided reference lesions.2.Interval resolution of the colonic wall thickening and edema involving the ascending colon.
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Generate impression based on findings.
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44 year old male. Reason: r/o stone History: left flank pain with hematuria 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: Mild degenerative changes of the lumbosacral spine. L3 vertebral body central calcification may be hemangioma. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Decompressed urinary bladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Medullary sclerosis of right posterior ilium and left supra-acetabular junction of ilium-ischium with intact cortex. May be developmental, early Paget's disease or other etiology. OTHER: No significant abnormality noted
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No renal calculi. No hydronephrosis. No bladder mass or clot. No lymphadenopathy. No specific acute finding to explain hematuria and left flank pain.
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Generate impression based on findings.
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Reason: to assess coronary disease History: none Coronary arteries: LM: The short left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying four diagonal and septal branches. Multifocal non-calcified plaques contribute to mild stenosis, beginning at the proximal LAD. The first diagonal branches arises early, is diminutive and unremarkable. The second diagonal branch bifurcates. The anterior and posterior branches are unremarkable. D3 supplies the anterior apex. D4 supplies the infero-apex. There are no significant stenoses in the left anterior descending artery.LCx: The left circumflex coronary artery is co -dominant with the RCA. It courses normally in the left atrioventricular groove. It gives rise to the obtuse marginal branches and provides a large posterior lateral branch that supplies the basal one third of the inferior interventricular septum. There are no significant stenoses in the left circumflex coronary artery or branches.RCA: The right coronary artery is moderate in size and arises normally from the right sinus of Valsalva. It is co-dominant with the circumflex coronary artery, supplying a posterior descending artery the posterior descending artery arises at the crux and runs along the mid to apical inferior interventricular septum. Mild, noncalcified multifocal plaques are present. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is visually normal.Right Ventricle: Visually the right ventricular late diastolic volume is upper limits normal size.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.On the sagittal reconstructions, there are two columns of contrast that shunt from the left atrium to the right atrium, suggestive of a fenestrated, small atrial septal defect (ASD). The dominant defect is at the expected location for the valve of the fossa ovalis and measures approximately 3.6 mm in transverse dimension on the axial view (series 7 image 20). Slightly more superior, this measures 5.7 mm in transverse dimension. A second, smaller defect is posterior and inferior, approximately 1.7 mm in transverse dimension (series 7 image 21).Right atrium, vena cavae, and coronary sinus: The right atrial volume is normal in size. The superior and inferior vena cavae are unremarkable. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not visualized. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.Partially calcified subcarinal and paratracheal lymph nodes indicative of prior granulomatous disease. Splenic granuloma. Mild elevation of the right hemidiaphragm.
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1. There are no significant coronary artery stenoses present.2. On the scout topogram, there is a nodular opacity projecting over the right mid lung favoring a nipple shadow. Collimation excludes the lung parenchyma in this location. The previous CT did not include this region. Therefore, confirmation of a nipple shadow with PA chest radiograph is recommended.3. Two contrast columns are suggestive of a small, fenestrated ASD, as above. No significant atrial or ventricular chamber dilatation.
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Generate impression based on findings.
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Malignant fallopian tube carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thrombosis of left internal jugular vein associated with surrounding soft tissue infiltration.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Too small to characterize low attenuation focus within the peripheral aspect of segment 7 of the right lobe of the liver best seen on image 82 of series 3 measuring 0.8 x 0.2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. Reference left para-aortic lymph node best seen on image 120 of series 3 measures 2.6 x 1.6BOWEL, MESENTERY: Extensive omental metastatic caking associated with mesenteric adenopathy and moderately severe ascites.BONES, SOFT TISSUES: Unremarkable loop colostomyOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right external iliac lymph node best seen on image 169 of series 3 measuring 2.1 x 1.5 cm.BOWEL, MESENTERY: Loculated cystic focus within the deep pelvis best seen image 183 of series 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Extensive metastatic disease manifest by retroperitoneal and right pelvic adenopathy, extensive omental caking and mesenteric adenopathy. Associated with moderate ascites. Loculated cystic focus within the deep pelvis may represent loculated ascites versus cystic metastatic focus.Indeterminate segment 7 right lobe liver lesion; a metastatic focus cannot be excluded.Extensive left jugular vein thrombosis with surrounding soft tissue infiltration; can not exclude associated thrombophlebitis.Findings communicated to Dr. Hahn 12/12/13; 4pm.
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Generate impression based on findings.
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71-year-old male with metastatic RCC. New baseline. The absence of intravenous contrast limits evaluation of the solid organs. Given this limitation, the following observations were made:CHEST:LUNGS AND PLEURA: Unchanged scattered bilateral pulmonary micronodules likely represent prior granulomatous disease.MEDIASTINUM AND HILA: Reference paraesophageal lymph node measures 1.3 x 0.7 cm (image 47, series #3), previously 1.2 x 0.8 cm, unchanged. Other scattered nonenlarged lymph nodes in the mediastinum are unchanged. Redemonstrated left hilar calcified lymph nodes. Mild atherosclerotic calcification of the thoracic aorta. CHEST WALL: Right posterior 11th rib expansile, lytic lesion is slightly increased in size from prior study, measuring 7.2 x 3.5 cm, previously 6.5 x 3.3 cm.ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour, prominent caudate lobe, and fissural prominence are consistent with cirrhotic morphology, unchanged. Scattered, punctate calcifications likely represent prior granulomatous disease.SPLEEN: Scattered punctate calcifications likely represent prior granulomatous disease.PANCREAS: Fatty replaced atrophic pancreas.ADRENAL GLANDS: Right adrenal mass has increased in size, measuring 4.4 x 3.8 cm (image 98, series #3), from previously 3.2 x 2.6 cm.KIDNEYS, URETERS: Status post left nephrectomy without evidence of recurrence.RETROPERITONEUM, LYMPH NODES: Small scattered retroperitoneal lymph nodes are seen.BOWEL, MESENTERY: Diverticulosis of the descending and sigmoid colon without evidence of acute inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Reference left iliac node is unchanged, measuring 0.9 x 0 .7 cm, previously 1.0 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesion of the left iliac bone lesion exhibits a slightly larger soft tissue component.OTHER: No significant abnormality noted
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1.Interval increase in size of right adrenal mass, suspicious for metastatic disease.2.Posterior 11th right rib lytic lesion is increased in size.3.Slightly larger soft tissue component of a lytic lesion in the left iliac bone.4.Unchanged paraesophageal and and left iliac reference lymph nodes with no new adenopathy identified.
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Generate impression based on findings.
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76-year-old male with esophageal cancer CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged. No evidence of metastatic disease. Mild emphysema and basilar scar like opacities.MEDIASTINUM AND HILA: Large heterogeneously enhancing right thyroid nodule is not significantly changed. Moderate coronary arterial calcification. Moderate atherosclerotic calcifications of the thoracic aorta. Scattered subcentimeter mediastinal lymph nodes. Dilated left ventricle with thinning and calcification of the left ventricular apex suggestive of prior MI. Common origin of the right brachiocephalic and left common carotid artery.CHEST WALL: Marked degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged hepatic hypodense lesions too small to characterize but likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ptotic malformed right kidney is unchanged. Stable hypodense renal lesions, likely benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Unchanged calcification and mild thickening at the EG junction..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastatic disease. Mild GE junction thickening and calcification is unchanged.
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Generate impression based on findings.
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71-year-old female with cough and chest pain, history of tongue cancer, status post placement of marker prior to surgery, evaluate proximity to nodule LUNGS AND PLEURA: Radiodense left lower lobe marker is approximately 2.4 cm superior and anterior to the 4-mm left lower lobe nodule.Linear scarlike opacities identified within both lower lobes.MEDIASTINUM AND HILA: Moderate atherosclerotic calcifications of the aortic arch and coronary arteries. A mildly enlarged superior right paratracheal lymph node measures 6 mm, unchanged (image 12 series 3). No mediastinal or hilar lymphadenopathy. The heart size is normal. Focal anterior pericardial thickening is noted, nonspecific.CHEST WALL: Mild degenerative changes of the thoracic lumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Renal hypodensities likely representing cysts are partially visualized. Extensive atherosclerotic calcification of the aorta and its branches.
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Radiodense left lower lobe marker approximately 2.4 cm superior and anterior to the 4-mm left lower lobe nodule.
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Generate impression based on findings.
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81 year-old female with acute change in mental status, minimally responsive Moderate parenchymal volume loss and patchy hypoattenuation in the periventricular and subcortical white matter similar to the prior.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1. No acute intracranial abnormalities. Please note CT is insensitive for detection of acute ischemia.2. Small vessel ischemic disease of indeterminate age similar to the prior.
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Generate impression based on findings.
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64-year-old male with CLL. CHEST:LUNGS AND PLEURA: Right upper lobe groundglass opacity has resolved. A smaller right apical ground glass opacity is unchanged and measures 4 mm (series 6, image 14).Multiple calcified nodules. No new or suspicious nodules.MEDIASTINUM AND HILA: Mild decrease in mediastinal adenopathy. The right hilar node measures 9 x 8 mm, previously measured 1.2 x 1 cm (series 4, image 46).Right chest wall port tip in right atrium. Severe coronary artery calcifications. Heart size normal.CHEST WALL: No enlarged axillary lymph nodes. Reference right axillary node measures 9 x 6 mm, previously measured 11 x 6 mm (series 4, image 28).ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter segment 6 hypodensity unchanged, likely cyst. No new or suspicious lesions. SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable porta hepatis node measures 1.3 x 3.5 cm, previously measured 1.2 x 3.2 cm (series 4, image 98). Stable portal caval node measures 1.5 x 3.2 cm, previously measured 1.5 x 3.3 cm (series 4, image 103).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: Non-enlarged right obturator node measures 0.6 x 2.0 cm, previously measured 0.6 x 2.1 cm (series 4, image 176).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral fat containing inguinal hernias. Degenerative changes in both hips.OTHER: No significant abnormality noted
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1.Mild decrease in mediastinal adenopathy.2.Resolution of right upper lobe groundglass opacity, which was likely infectious or inflammatory in nature.3.Stable abdominal reference nodes.
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Generate impression based on findings.
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Female 74 years old; Reason: Pt with hx of diverticululitis now with LLQ pain similar to previous episode. Please eval for diverticulitis. History: LLQ Pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Lobulated hypodensities within the both lobes described previously are likely cysts and are unchanged. Few new hypodensities are noted, also likely cysts. There are no enhancing masses or evidence of intrahepatic biliary ductal dilatation. 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: Diffuse diverticulosis without evidence of diverticulitis. PELVIS:REPRODUCTIVE TRACT: Status post hysterectomy. Ovaries are not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality noted
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No acute intraabdominal pathology detected.
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Generate impression based on findings.
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49-year-old male with flank pain. Evaluate for stones and left renal cyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities unchanged and compatible with cysts. No suspicious lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal stones or hydronephrosis. 3.5-cm cyst in left kidney contains a thin septation and thick peripheral calcification, unchanged in size. No enhancing, nodular component.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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1.No stones or other acute abnormality to account for symptoms. 2.Stable complex left renal cyst, without evidence of enhancing component.
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Generate impression based on findings.
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Female 81 years old; Reason: assess for abdominal obstruction/abscess or other pathology History: s/p g-tube replacement at OSH 12/7 w/N/V and L-sided abd pain since then ABDOMEN:LUNG BASES: Interval improvement in the bilateral airspace disease. Bibasilar atelectasis with vascular congestion noted. The heart is enlarged. Atherosclerotic calcification of the descending thoracic aorta. Atherosclerotic calcification of the coronary arteries.LIVER, BILIARY TRACT: Status post cholecystectomy. Stable residual intrahepatic and extrahepatic biliary ductal dilatation.Stable hepatic cyst in the right lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: The pancreatic duct is dilated, and is stable from May, however when compared to 2009 has increased in size..ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Heterogeneous soft tissue mass in the superior pole of left kidney measures 2.2 x 3.1 cm. slightly increased from 5/2013 when measured 2.1 x 2.8 cm. Renal cell carcinoma cannot be excluded. Otherwise, relatively stable right and left renal lesions, which likely represent cysts. RETROPERITONEUM, LYMPH NODES: There is now near total occlusion of the right common iliac artery, which shows no enhancement. Aortobiiliac stents are again seen.BOWEL, MESENTERY: Gastric tube balloon within the stomach lumen. This is abnormally positioned, as the balloon is not up against the gastric lumen and should be repositioned. Mildly dilated loops of small bowel with air. BONES, SOFT TISSUES: Partially visualized, stable appearing soft tissue mass in the proximal posterior left thigh.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bulbous uterus with calcified fibroid. BLADDER: Interval removal of the Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticula of the sigmoid and descending colon without evidence of diverticulitis. Contrast within the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Interval resolution of the aspiration pneumonia1.malposition of the peg balloon which is not flush with the gastric lumen, and should be repositioned2.gradual increase in dilation of the pancreatic duct when compared 3/09 with stable intrahepatic and extrahepatic biliary ductal dilation, of uncertain significance as no obstructing mass or intraluminal abnormality seen3.large heterogeneous mass off the superior pole left kidney, concerning for renal cell carcinoma4.near total occlusion of the right common iliac artery, with no residual enhancement of the artery, new since prior contrast CT.5.Incompletely characterized left thigh lesion unchanged.
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