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Generate impression based on findings.
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Reason: Evaluate coronary arteries as well as thoracic aortic diameter for potential aortic surgery. Unable to cannulate coronary arteries on cath due to ver large aortic root. History: shortness of breath Coronary arteries: Normal origins of the coronary arteries are noted. However, there is mild clockwise rotation of the aortic root, resulting in mild leftward shift in origins of the coronary arteries relative to the sternum. For example, the origin of the right coronary artery arises from the right cusp at the one o'clock location, relative to the sternum. The left main coronary artery arises from the mid left coronary cusp. On the axial view, relative to the sternum, this arises at approximately 4 o'clock position, coursing slightly anterior from its ostium.LM: There is a short left main coronary artery with eccentric calcification. Due to the extensive calcification, the assessment of potential stenosis cannot be made. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying at least one diagonal branch. There is extensive calcification which is mild in its proximal segment. However, at the origin of D1, the heavy cast of calcification bifurcates into the mid LAD and the first diagonal branch. This precludes visualization of the lumen. Beyond this heavy cast of calcification within the mid LAD, the distal LAD is not well visualized. This raises a question of a possible high-grade stenosis beyond the calcification or possible occlusion. LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left atrioventricular groove. The first 3.3 cm of the circumflex artery is visualized, containing eccentric calcification. Beyond this level, the circumflex coronary artery is not well-visualized. This also raises the question of either occlusion or high-grade stenosis beyond the calcification. The obtuse marginal branches are not visualized.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. Approximately 5 mm from its origin, there is a mixed plaque which appears to be causing at least moderate stenosis. Beyond this lesion, the right coronary artery lumen is visualized with multifocal mixed plaques. The possibility of retrograde flow via collaterals is raised.There is high origin of the posterior descending artery, arising from the crux. This traverses the inferior interventricular groove from mid-chamber to the apex. At the basal inferior interventricular groove, there is a small vessel arising from the distal RCA, suggestive of a small posterior lateral branch. Only the first few millimeters are visualized.Left Ventricle: The left ventricle appears moderately dilated. There is subendocardial low density in the apical septum which raises the question of a prior myocardial infarct. 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 mild calcification of the aortic valve. Punctate calcification is present on the basilar and midportion of the anterior leaflet of the mitral valve. Benign calcification of the anterior papillary head is present. Great vessels: The thoracic aorta is aneurysmal. The following orthogonal dimensions were obtained:Sinus of Valsalva: 4.4 x 4.8 x 4.2 cmAscending thoracic aorta at the level of the main pulmonary artery:6.0 by 6.1 cmAscending thoracic aorta, immediately proximal to the innominate artery: 3.9 x 4.0 cmDistal transverse arch, immediately distal to the left subclavian artery: 3.0 x 3.4 cmThe aortic arch is not visualized. The main pulmonary artery is large, measuring 37 mm transverse.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Soft tissue density is noted at the superior field of view, anterior to the trachea, which may represent the inferior aspect of an intrathoracic goiter. However, multiple enlarged mediastinal lymph nodes in the aortopulmonary, bilateral paratracheal and right hilar locations raise the question of additional lymphadenopathy. A representative low right paratracheal lymph node measures 20 mm (series 80466 image 24). The left axilla is included in the field of view. No left subpectoral or axillary lymphadenopathy is present. This lymphadenopathy is atypical for sarcoidosis; lymphoma is a consideration.Multilevel degenerative changes of the thoracic spine.
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1. Extensive coronary artery disease with significant calcification.2. The ascending thoracic aorta is aneurysmal with maximal dimension of 6.0 by 6.1 cm at the mid ascending level. The aneurysmal dilation results in mild clockwise rotation of the aortic root, as above.3. Mild to moderate enlargement of multiple mediastinal and right hilar lymph nodes. Possible lymphadenopathy in the high paratracheal location at the superior edge of field. No associated left axillary or subpectoral lymphadenopathy. This is atypical for sarcoidosis. Lymphoma is a consideration.
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Generate impression based on findings.
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Male 61 years old; Reason: Pt is a 61 y/o male with met prostate cancer, c/o worsening pain in hip, XR with possibility of acetabular fracture History: met prostate cancer, hip pain, possible fx Extensive osseous metastatic disease affects the left ilium, left sacrum and pubis.There are several fracture lines through the left acetabulum including the superior acetabulum, anterior column and pubis. The fracture fragments are not significantly displaced. No evident callus formation.The left femoral head and neck are unremarkable. No soft tissue component or mass is evident. No hematoma is evident.
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1.Multiple pathologic minimally displaced fractures through the acetabulum.
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Generate impression based on findings.
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82-year-old male with abdominal pain, vomiting, status post hemicolectomy 3 months ago. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions and basilar scarring/atelectasis. Several cysts are seen in the lung bases.LIVER, BILIARY TRACT: Small amount of ascites fluid around the liver. Cholelithiasis. Lack of IV contrast limits evaluation for hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland thickening.KIDNEYS, URETERS: Bilateral moderate hydronephrosis and hydroureter. Interval increase in cortical scarring and atrophy, right more than left. Multiple hypodensities in the kidneys are compatible with cysts.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: Small to moderate amount of ascites fluid. No evidence of obstruction. Status post right hemicolectomy. Large amount of stool is present throughout the remaining colon.BONES, SOFT TISSUES: Multiple sclerotic lesions throughout the osseous structures consistent with metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Large heterogeneous prostate.BLADDER: Suprapubic catheter is in place. Air in the bladder consistent with recent instrumentation. LYMPH NODES: Multiple prominent pelvic lymph nodes.BOWEL, MESENTERY: Moderate amount of ascites fluid. No obstruction.BONES, SOFT TISSUES: Multiple sclerotic foci in the osseous structures consistent with metastases. Right inguinal hernia containing fluid.OTHER: No significant abnormality noted
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1.Status post right hemicolectomy without evidence of obstruction.2.Moderate amount of ascites fluid.3.Bilateral hydronephrosis and interval progression of cortical scarring/atrophy. Superpubic tube is in place.4.Multiple sclerotic lesions in the osseous structures as well as prominent retroperitoneal nodes most consistent with metastatic disease.
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Generate impression based on findings.
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Female 26 years old; Reason: r/o nephrolithiasis or ruq pathology. History: s/p left lope hepatectomy for donation and cholecystectomy 7/14/2013, w/overnight RUQ and epigastric sharp pain lasting 15-45 min x 1 week ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Patient status post partial hepatectomy and cholecystectomy. Surgical clips remain in the upper quadrant with post surgical changes. No fluid collections, free air, or contrast extravasation.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: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Status post left lobe hepatectomy without acute abdominal pathology detected.
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Generate impression based on findings.
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Female 51 years old; Reason: LLQ pain, r/o diverticulitis History: LLQ pain, rectal pain, rectal bleeding ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Few too small to characterize hypoattenuating lesions in the liver.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: Atherosclerotic disease of the aorta and iliac vessels.BOWEL, MESENTERY: Stool noted in the colon with a normal appearing appendix.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: Stool noted in the colon with a normal appearing appendix.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No acute intra-abdominal pathology detected.
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Generate impression based on findings.
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56 year old male with cirrhosis. Evaluate for HCC and hepatic vein thrombosis. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions.LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious liver lesions. Trace amount of ascites fluid around the liver. Hepatic veins, hepatic arteries, and portal vein are patent.Small amount of sludge is present in the gallbladder. SPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small lymph nodes are noted, which may be reactive in nature.BOWEL, MESENTERY: No obstruction. Trace amount of ascites fluid. Collateral vessels/varices are seen around the lesser curvature of the stomach and GE junction.Significant compression/narrowing of proximal celiac artery along its superior aspect, most suggestive of median arcuate ligament as etiology. The pancreaticoduodenal arterial arcade is prominent, consistent with increased compensatory flow from SMA. However, no discrete aneurysm is identified. 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.Cirrhotic liver morphology without suspicious lesions. Hepatic vasculature appears patent.2.Collateral vessels around the lesser curvature of the stomach and GE junction.3.Significant narrowing of proximal celiac artery likely due to compression by median arcuate ligament. The pancreaticoduodenal arterial arcade is prominent, consistent with increased compensatory flow from SMA. No discrete aneurysm is identified.
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Generate impression based on findings.
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Female 49 years old; Reason: stone with hydro? History: vaginal pain, left flank pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calcification noted the left aspect of what is suggested to be UVJ, which could correlate with a passing stone. No obstructing stones in the ureters or kidneys. No hydronephrosis or perinephric stranding. No hydroureter to suggest pyelotubular backflow.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: Punctate calcification noted the left aspect of what is suggested to be UVJ, which could correlate with a passing stone. No hydroureter to suggest pyelotubular backflow.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 intra-abdominal pathology detected. Likely uncomplicated passed 2-3 mm stone in the left bladder adjacent to the left UVJ.
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Generate impression based on findings.
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Dyspnea rule out PE. History of sarcoidosis. PULMONARY ARTERIES: Technically adequate infusion quality without evidence of pulmonary embolus.LUNGS AND PLEURA: Focal left upper lobe groundglass opacity with peripheral/subpleural sparing (8/39) and no associated septal thickening, occurring over an approximately 5 x 3 cm region.Low lung volumes with marked elevation of the right hemidiaphragm, chronic. Elsewhere in the lungs, there is mild dependent atelectasis and faint diffuse groundglass abnormality, most pronounced in the sub-pleural regions. Scattered sub-solid nodules measuring up to 3 mm, possibly related to sarcoidosis though not specific.Within the left lower lobe, there is a subcentimeter patchy nodular opacity with incomplete visualization of the adjacent airway and probable associated air trapping, nonspecific in appearance and could be secondary to patient's known sarcoidosis or post inflammatory.Pre-existing scarring in the right lower lobe is now associated with a bandlike area of hypoattenuation which measures fluid density; this had a similar appearance on the exam of 11/2009. Atelectasis or scarring in in the superior segment of the right lower lobe is new.MEDIASTINUM AND HILA: New thrombosed saccular aneurysm or pseudoaneurysm along the lateral wall of the aortic arch associated with some calcification, new from previous and measuring 2-cm by 1.2-cm on coronal image 39. Numerous prominent mediastinal and hilar lymph nodes bilaterally, most likely related to sarcoid, slightly larger compared 2010.Normal heart size. No pericardial fluid.CHEST WALL: Prominent lymph nodes in the left axilla measuring up to 11-mm, also slightly larger, right axilla incompletely included in the field of view however numerous small lymph nodes are also identified.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Limited scanning range.
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1. Technically inadequate examination without evidence of acute pulmonary embolus. 2. Diffuse parenchymal ground glass abnormality in the lungs and bilaterally with scattered subcentimeter nodular opacities may be an atypical manifestation of sarcoidosis and appear new compared to the previous examination. There is a superimposed regional groundglass abnormality within the left upper lobe which could represent focal infection especially if the patient is on systemic steroids, including pneumocystis pneumonia or other viral/atypical infection. Given the lack of septal thickening, acute pulmonary hemorrhage is considered less likely. Drug reaction may be considered in the appropriate clinical context. Patient had a similar abnormality in 11/2009.3. Mild diffuse lymphadenopathy most likely related to sarcoidosis, minimally increased overall since the previous examination.4. Interval development of 2 x 1.2 cm thrombosed aneurysm or pseudoaneurysm arising from the lateral wall of the aortic arch. This is incompletely assessed due to the phase of contrast enhancement and may be further assessed by a dedicated exam if clinically warranted.
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Generate impression based on findings.
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27-year-old female. Evaluate for SVC syndrome. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Left-sided central venous hemodialysis catheter terminates at the cavoatrial junction. The SVC opacifies very poorly and is significantly narrowed. The right innominate and left brachiocephalic veins are similarly narrowed. The right common femoral vein is opacified through the extensive anterior body wall collaterals, which are indicative of chronic SVC obstruction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Evidence of renal osteodystrophy.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: Evidence of renal osteodystrophy.OTHER: No significant abnormality noted.
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1.Narrowing of the mediastinal veins with extensive anterior body wall collaterals are suggestive of chronic SVC obstruction. If the patient has clinical signs of SVC syndrome, would suggest IR consultation for angioplasty and possible stenting.2.Mild hepatomegaly.
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Generate impression based on findings.
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back pain hx of breast cancer. 72 years old female Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a mild dextrocurvature present. Vacuum joint phenomenon is present along the sacroiliac joints with small osteophytes.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level without significant compromise to the spinal canal and only mild narrowing of the neural foramina. The exiting nerve roots are surrounded by fat within the neural foramina. There is a narrowing of the facet joints, subchondral cysts and some mild ligamentum flavum hypertrophy present.At L4-5 there is loss of disk space height, vacuum disk phenomenon and endplate reactive changes associated with endplate osteophytes. There is bilateral facet hypertrophy of a mild degree at this level. The fat adjacent to the nerve roots at the lateral recesses is partially effaced. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a mild degree of spinal stenosis at this level.At L3-4 there is loss of disk space height, vacuum disk phenomenon and endplate reactive changes associated with endplate osteophytes. The fat adjacent to the nerve roots at the lateral recesses is partially effaced. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a mild degree of spinal stenosis at this level.At L2-3 there is loss of disk space height and vacuum disk phenomenon. The fat adjacent to the nerve roots at the lateral recesses is not effaced. The exiting nerve roots within the neural foramina are surrounded by fat. There is no significant compromise to spinal canal or neural foramina at this level.At L1-2 there is loss of disk space height and vacuum disk phenomenon. The fat adjacent to the nerve roots at the lateral recesses is not effaced. The exiting nerve roots within the neural foramina are surrounded by fat. There is no significant compromise to spinal canal or neural foramina at this level.Incidental note is made of a left to site of the renal cyst at its inferior pole measuring 55 mm in diameter which was a also present on CT of the abdomen from 11/28/2004 where it measured 43 mm. A second cyst along the midpole of the left kidney is not included on this exam. Atherosclerotic calcifications are present along the aorta and some of its branches.
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1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is mild spinal stenosis.2.No lesions convincing for osseous metastatic disease are appreciated, however, bone scan and MRI are more sensitive for the detection of spinal metastases than CT.
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Generate impression based on findings.
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37-year-old male with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic hypoattenuation consistent with steatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypoattenuating foci in both kidneys most compatible with cysts.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 acute abnormality to account for symptoms.2.Hepatic steatosis.
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Generate impression based on findings.
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20 year-old female with hematuria and dysuria. The following observations are made given the limitations of an unenhanced study.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 renal stones or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an oval hypodensity in the right hemi-abdomen measuring approximately 3 cm which is surrounded by bowel loops, unclear if this represents fluid in the bowel loop or is extraluminal (series 4, image 68).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No genitourinary abnormality to account for symptoms.2.Oval fluid density in the right hemiabdomen which may represent fluid in a bowel loop, however, if there is persistence of symptoms, a contrast-enhanced study is recommended for better characterization.
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Generate impression based on findings.
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33 year old male with chest pain, left calf pain, please rule out PE. PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: No pleural effusion or focal lung consolidation. Bibasilar dependent atelectasis, more than expected for patient's age. Bronchial wall thickening suggestive of reactive airway disease or bronchiolitis.MEDIASTINUM AND HILA: Cardiac size is normal without pericardial effusion. No mediastinal or hilar lymphadenopathy. Residual thymic tissue is noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.No CT evidence of PE.2.Mild bronchial wall thickening suggestive of reactive airway disease or bronchiolitis.3. Significant basilar atelectasis of unclear significance.
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Generate impression based on findings.
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Reason: rheumatological lung condition, likely lupus History: dyspnea LUNGS AND PLEURA: Multifocal, predominantly peripheral, regions of bronchiolectasis and honeycombing involving the subpleural anterior upper lobes, posterior and lateral aspects of the bilateral lower lobes. Interlobular septal thickening is noted within the costophrenic angles. Minimal associated groundglass opacity. The right middle lobe is spared. No associated air trapping. The findings are atypical for UIP and are suspicious for a variant of fibrosing NSIP or mixed connective tissue disorder.There is a nodule associated with the right major fissure (series 10210 image 44) measuring 4 mm in short axis. This favors an enlarged intrapulmonary lymph node. An additional nodular opacity within the intervertebral lobe measures 4 mm (10210 image 25) this may represent a confluent region of groundglass.No suspicious pulmonary nodules or pleural effusion.MEDIASTINUM AND HILA: The distal esophagus is patulous. Prominent thymic tissue remains. Mildly enlarged aortopulmonary, right paratracheal and subcarinal lymph nodes.The heart size is normal. No pericardial effusion.The pulmonary artery is normal in size.CHEST WALL: Small scattered left supraclavicular lymph nodes. The left axilla is excluded from the field of view. Right axillary and bilateral subpectoral lymphadenopathy is present with suggestion of mildly enlarged lymph nodes in the medial left axilla. A representative right subpectoral lymph node measures 10 mm (10209 image 15).UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Regional pulmonary fibrosis in a predominantly subpleural distribution with a paucity of groundglass involving the upper and lower lobes. The right middle lobe is spared. No associated air trapping. The findings are atypical for UIP and are suspicious for a variant of fibrosing NSIP or mixed connective tissue disorder.
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Generate impression based on findings.
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71 year old male with history of metastatic prostate cancer, new onset dyspnea. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: No pleural effusion or consolidation. Scattered pulmonary micronodules are again noted. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Left supraclavicular lymphadenopathy appears similar to prior scan. Mediastinal lymphadenopathy is again present in the prevascular, and retroesophageal regions. Reference prevascular lymph node measures 3.6 x 3.5 cm (image 63, series 7) previously 3.3 x 3.6 cm. Extensive coronary artery calcifications. Duplicated SVC is again noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating hepatic lesions consistent with simple cysts are unchanged. Left adrenal nodule measures 3.7 x 2.9 cm (image 24 series 7) previously 4.1 x 3.1 cm. Bulky retroperitoneal and retrocrural lymphadenopathy appears similar to prior exam, but is incompletely evaluated on this exam.
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1.No CT evidence of PE.2.Mediastinal, retrocrural, supraclavicular, and retroperitoneal lymphadenopathy, similar to prior exam.
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Generate impression based on findings.
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71 year-old male with renal cell carcinoma and memory loss, evaluate for metastasis There is no acute intracranial hemorrhage or extra-axial collection. Sulci are prominent, compatible with a moderate degree of atrophy, prominent in the cerebellum. The ventricles are unremarkable. There is scattered periventricular and subcortical hypoattenuation which is nonspecific but may represent moderate small vessel ischemic disease. There are no intracranial masses, midline shift, or basal cistern effacement. The visualized portions of the paranasal sinuses are clear. The mastoid air cells are underdeveloped. The orbital contents are unremarkable. The osseous structures are unremarkable.
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1.No enhancing intracranial masses. 2.Prominent sulci compatible with a moderate degree of volume loss3.Scattered periventricular and subcortical hypoattenuation is nonspecific but may represent moderate small vessel ischemic disease.
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Generate impression based on findings.
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77-year-old female with thumb pain, evaluate for abscess or osteomyelitis There is a defect in the soft tissue along the radial aspect of the tuft of the distal phalanx of the first digit containing a mixture of gas density and high density that presumably represents packing material. The gas density extends to within 1 mm of underlying bone but no specific imaging features of osteomyelitis are seen. There is also diffuse soft tissue edema involving the thumb as well as skin thickening, compatible with cellulitis. No discrete fluid collection is seen. The remaining visualized soft tissues structures are unremarkable. Mild degenerative arthritic changes affect the hand.
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Cellulitis and soft tissue defect of the thumb without imaging features of osteomyelitis or discrete abscess.
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Generate impression based on findings.
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72-year-old female with diffuse abdominal pain. Evaluate for obstruction. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Rim calcified vascular lesion near the right renal hilum suggests small renal artery aneurysm.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Dilated loops of fluid-filled small bowel proximal to the transition point in the left lower abdomen in the distal jejunum or proximal ileum (coronal image number 67), likely due to adhesions. Surgical clips are noted adjacent to the transition point. No mass lesion is identified. No pneumatosis, free air, or fluid collection is identified. Gastroduodenal intussusception is noted is likely due to distal obstruction though may be transient. 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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Small bowel obstruction without evidence of complication.
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Generate impression based on findings.
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56-year-old male with history of urothelial cancer on therapy. Evaluate for progression. CHEST:LUNGS AND PLEURA: Interval resolution of pulmonary nodules. The reference nodules are not visible on this exam.MEDIASTINUM AND HILA: A right-sided central venous catheter terminates in the distal SVC. New focal calcification in the azygos vein is noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in the right lobe is again seen with interval decrease in size, measuring 1.8 x 1.5 cm (image 81, series #4), previously 1.9 x 3.0 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The previously seen ureteral calculi are not visualized on this exam with interval decrease in degree of hydronephrosis. Mild to moderate right-sided hydronephrosis persists. Mild left hydronephrosis with no ureteral stone identified. Redemonstrated bilateral mild wall thickening of the distal ureters bilaterally with periureteral stranding, stable.RETROPERITONEUM, LYMPH NODES: An IVC filter is noted in the expected of age. Small scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right ileal loop conduit is again noted in the right lower abdomen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Redemonstrated bilateral inguinal hernias containing only mesenteric fat. Postsurgical changes about the penile urethra.
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1.Interval regression of disease indicated by resolution of pulmonary nodules and decrease in size of presumed liver metastasis.2.Mild to moderate right hydronephrosis, decreased in grade. Persistent mild left hydronephrosis.
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Generate impression based on findings.
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Female, 33 years old, with nasal congestion. The right frontal sinus is hypoplastic. The left frontal sinus is clear. The frontoethmoidal recesses are clear.The sphenoid sinuses and sphenoethmoidal recesses are clear. The ethmoid air cells are also clear.The maxillary sinuses are normally aerated and free of significant mucosal thickening or debris. The maxillary outflow pathways are unobstructed.The nasal cavity is clear. The nasal septum is intact. The turbinates are morphologically normal.Limited soft tissue views demonstrate small well circumscribed nodules within the parotid glands which likely represent lymph nodes and which are of doubtful significance.
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No evidence of active sinus inflammatory disease.
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Generate impression based on findings.
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Prior CLL, and now large cell lymphoma of the colon, s/p RICE chemotherapy. Maxillofacial: There is mild mucosal thickening and retention cyst formation in the bilateral maxillary sinuses. Otherwise, the paranasal sinuses are clear. The nasal cavity is also clear. There are prominent arachnoid granulations in the middle cranial fossa, particularly in the right greater wing of the sphenoid, where there is marked thickening of the skull. There are 3 mm calcifications in the left superificial parotid and left submandibular glands, which may represent a sialolith. There is a carious ADA 14. There is a partially opacified left mastoid air cell. The partially imaged intracranial structures are grossly unremarkable. Neck: There is no significant cervical lymphadenopathy by size criteria. The Waldeyer ring structures are unremarkable. The airways are patent. The thyroid gland is unremarkable. There is a right internal jugular venous catheter. The major cervical vessels are otherwise patent. There are unchanged findings related to diffuse hypertrophic skeletal hyperostosis (DISH) of the cervical and upper thoracic spine and associated ossification of the posterior longitudinal ligament (OPLL), with likely severe spinal canal stenosis at multiple levels. The imaged portions of the lungs are clear.
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1. No evidence of significant cervical lymphadenopathy or mass lesions to suggest recurrent lymphoma.2. Mild maxillary sinus opacification, without evidence of acute sinusitis.3. Carious ADA 14. 4. Diffuse hypertrophic skeletal hyperostosis (DISH) of the cervical and upper thoracic spine and associated ossification of the posterior longitudinal ligament (OPLL).
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Generate impression based on findings.
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Unspecified pulmonary tuberculosis, confirmation unspecified. low back pain w/ hx of tb. Clinical question: potts? cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. No bony lesions are identified in the cervical spine. No abnormal enhancing lesions are appreciated in the cervical spineAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No bony lesions are identified in the thoracic spine. No abnormal enhancing lesions are appreciated in the thoracic spinelumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. No bony lesions are identified in the lumbar spine. No abnormal enhancing lesions are appreciated in the lumbar spineAt L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
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1.CT of the cervical, lumbar and thoracic spine do not demonstrate any evidence for tuberculosis.2.There is no compromise to the cervical thoracic or lumbar spinal canal or exiting nerve roots3.Please note that MRI is more sensitive in the early detection of spinal tuberculosis.
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Male 46 years old; Reason: evaluate for ileus, nephrolitiasis, abdomino-pelvic pathology History: pt having constipation w/o urge to defecate. LLQ tendnerness, hematuria The following observations are made given the limitations of an unenhanced study.ABDOMEN: 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:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is no hydronephrosis or kidney stone detected. There is extensive stranding around the left ureter all the way to the bladder. No definite renal stone detected. Mild perinephric edema around the left kidney.Complex partially calcified cystic lesion noted midpole left kidney.Suggestion of an expanded hyperdense left renal vein, incompletely characterized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Extensive fat stranding around the ureter on the left, correlate for passed stone or pyelonephritis. No hydronephrosis or obstructing calculi detected.2.Incompletely characterized renal lesion and possibly hyperdense expanded left renal vein, also incompletely characterized. Dedicated Renal CT (pre-enhanced, enhanced, and delayed/excretory phase) is advised for further characterization.3.Dr. Walter notified of the findings at 10:05 on 12/13/13
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Female 76 years old; Reason: Pancreas Cancer: Restaging History: none CHEST:LUNGS AND PLEURA: There is minimal dependent basilar atelectasis.MEDIASTINUM AND HILA: There is no evidence of significant mediastinal or hilar lymphadenopathy. Atherosclerotic calcifications of the thoracic aorta and coronary arteries are again noted.CHEST WALL: A Port-A-Cath is seen in the right chest wall with the tip terminating distal SVC. ABDOMEN:LIVER, BILIARY TRACT: Numerous hypoattenuating foci are seen scattered throughout the hepatic parenchyma, which appear unchanged in size since the prior examination. The largest lesions appeared to be hepatic cysts and a smaller lesions are too small to characterize. There is no definitive evidence metastatic disease to the liver. There is persistent pneumobilia likely related to prior instrumentation. There is prominent mesenteric haziness surrounding the left lobe of the liver at the site of the choledochojejunostomy anastomosis.SPLEEN: No significant abnormality noted.PANCREAS: The patient is status post Whipple procedure, and the distal pancreas is normal in appearance with interval gas noted in the pancreatic duct, likely from stent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several hypoattenuating foci are seen in the renal parenchyma which are too small to characterize and likely represent simple renal cysts.RETROPERITONEUM, LYMPH NODES:Stable filling defect in the SMV just distal to the confluence, likely SMV thrombosis. Numerous small retroperitoneal lymph nodes are evident.BOWEL, MESENTERY: The patient is status post Whipple procedure. There stranding in the mesentery surrounding left hepatic lobe.BONES, SOFT TISSUES: Soft tissue defect is seen in the anterior abdominal wall consistent with prior laparotomy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is not seen on this exam and may represent a prior hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes are seen throughout the thoracic and lumbar spine.OTHER: No significant abnormality noted.
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1.Stable SMV thrombosis.2.The patient is status post Whipple procedure without evidence of local recurrence or metastatic disease.
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Generate impression based on findings.
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Mild bilateral conductive loss. On the right, the external auditory canal is patent and clear. There is a tympanostomy tube positioned in the tympanic membrane. The middle ear and mastoid air cells are well-pneumatized and clear. There is perhaps mild elongation of the short process of the incus that appears to contact the lateral epitympanic wall. The ossicles are otherwise intact. The facial nerve describes a normal course. The inner ear structures are unremarkable, without evidence of semicircular canal dehiscence or enlarged vestibular aqueduct. On the left, the external auditory canal is patent and clear. There is a tympanostomy tube positioned in the tympanic membrane. The middle ear and mastoid air cells are well-pneumatized and clear. There is possible mild elongation of the short process of the incus that appears to nearly contact the medial and lateral walls of the fossa incudis. The ossicles otherwise appear to be intact. The facial nerve describes a normal course. The inner ear structures are unremarkable, without evidence of semicircular canal dehiscence or enlarged vestibular aqueduct.
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1. The short process of the right incus appears to contact the lateral epitympanic wall and the short process of the left incus appears to nearly contact the medial and lateral walls of the fossa incudis. This may represent an anatomic variant with prominent components of the posterior incudal ligaments, although ossicular fixation is a consideration.2. Bilateral tympanostomy tube in position without evidence of cholesteatoma, tympanomastoid effusions, or inner ear anomalies.
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62-year-old male with history of colon cancer. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Left lower lobe nodule is again seen (image 36, series #5) and has slightly increased in size, measuring 5.7 x 5.0 cm from previously punctate 4-mm focus. One other new micro-nodule is identified in the right lower lobe (image 51, series #5). Unchanged left upper lobe pleural thickening (image 48, series #5). MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large densely calcified inferior right lobe hepatic mass is grossly unchanged in size and appearance, measuring 9.4 x 4.4 centimeters. Satellite lesions are grossly unchanged, including a reference, lesion in the dome of the right lobe measuring 2.2 x 1.2 cm, previously 2.0 x 1.6 cm. Adjacent capsular retraction is unchanged. A large bore biliary stent is redemonstrated with a plastic stent within. Pneumobilia is unchanged. New single dilated intrahepatic bile duct in the left lobe is identified (image 88, series #3). Interval development of moderate perihepatic ascites extends to the pelvis and left flank, tracking inferiorly in the left paracolic gutter. The portal vein, superior mesenteric vein, and splenic vein are patent.SPLEEN: Moderate splenomegaly, with interval increase in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse peritoneal nodularity is suspicious for progression of metastatic disease. Mesenteric haziness likely reflects mesenteric edema.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: Moderate amount of pelvic ascites.
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1.Progression of metastatic disease is suggested by new peritoneal nodularity, ascites, and growth of pulmonary nodule.2.New moderate ascites and diffuse mesenteric edema.3.New focal left hepatic lobe intrahepatic biliary ductal dilatation of the left lobe.4.Stable hepatic metastases.
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69 year old female, status post CEA, complicated by CVA. Right upper lobe resection, now with pneumothorax. LUNGS AND PLEURA: Small to moderate right apical air collection, with suspected bronchopleural fistula involving the upper lobe bronchus (image 43 coronal series). Changes status post right upper lobe resection. Severe centrilobular emphysema. Pulmonary edema, more pronounced on the left. Small left, trace right pleural effusions. Left basilar atelectasis/consolidation. Debris is present in the left lower lobe bronchus, with bronchial wall thickening reflecting chronic aspiration.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the coronary arteries and aorta. No mediastinal or hilar lymphadenopathy. Endotracheal tube tip proximally 4 cm above the carina. Heart size is normal without pericardial effusion.CHEST WALL: Air seen in the soft tissue of the right chest wall, likely in a vessel, likely due to power injection.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enteric tube tip in the stomach. Diffuse heterogeneous attenuation of the liver parenchyma. Ascites is present.
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1.Changes status post right upper lobe resection, with small moderate right apical air collection, and suspected bronchopleural fistula.2.Small left and trace right pleural effusions.3.Severe centrilobular emphysema, and pulmonary edema.4.Heterogeneous liver parenchyma. Recommend correlation with LFTs.5.Tracheal debris, with findings compatible with acute on chronic aspiration.
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Reason: lung cancer on chemotherapy ck response History: noen CHEST:LUNGS AND PLEURA: Left apical scarring with radiation reaction.Moderate diffuse centrilobular emphysema.Further decrease in the left upper lobe nodule, now almost completely resolved.No new nodules.MEDIASTINUM AND HILA: Further decrease in a reference high right paratracheal lymph node (series 3/22) now 7 mm decreased from 8 mm previously.Decrease in anterior mediastinal lymph node (series 3/27) now 4 mm compared to 6 mm previously.Chronic mural thrombus in the left main pulmonary artery unchanged.Previously questioned thrombus in the left atrial appendage is no longer visible.Diffuse thickening of the mid and distal esophagus, unchanged.Moderate coronary artery calcification.CHEST WALL: Port-A-Cath in the right anterior chest wall with the catheter extending to the SVC.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hemangioma in the right lobe.Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Decrease in left upper lobe nodule and reference mediastinal lymph nodes.2. No new findings.
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For assessment of drain locations. Stable intracranial abnormalities related to remote hemispherectomy including fragmentation of the overlying right calvarium are demonstrated. A left parietal ventriculostomy catheter is in unchanged position, extending through the left trigone with its tip in the periventricular parenchyma. The right-sided catheter has been intervally repositioned, entering via right parietal approach and extending along more laterally. There is an increase in the amount of air adjacent to this catheter as well as scattered intraventricular foci of hemorrhage, presumably both on the basis of catheter repositioning. There has been no increase in the size of the epidural increased size of the right epidural effusion. Orbits and visualized paranasal sinuses are unremarkable.
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Interval repositioning of the right-sided ventriculostomy catheter which is now located more laterally. Scattered intracranial air and intraventricular hemorrhage presumed due to repositioning.
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69 year old female with pleural effusion. LUNGS AND PLEURA: Moderate left pleural effusion with compressive left basilar atelectasis. Left VP shunt is seen coursing through the soft tissue of the left neck and chest wall into the pleural collection. The pleural effusion is organized, with mild enhancement, perhaps due to chronic inflammation of the pleura. No specific evidence of empyema. Right basilar atelectasis and consolidation, likely due to chronic aspiration. Right apical scarring is noted. No suspicious pulmonary nodules or masses. Large globular debris is noted in the right mainstem bronchus (image 35, series 4). Calcification along the right fissure is unchanged.MEDIASTINUM AND HILA: Cardiac size is upper limits of normal without pericardial effusion. Moderate coronary artery calcifications. No mediastinal or hilar lymphadenopathy. Left thyroid nodules, unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Retrocrural lymphadenopathy, unchanged.
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1.Moderate left pleural effusion with mild peripheral enhancement, perhaps representing chronic inflammation of the pleura.2.Large globular debris in the right mainstem bronchus, with right basilar atelectasis and consolidation concerning for chronic aspiration. Given the size of the tracheal debris, consider endoscopic removal.
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Pleural plaque and right nodule being followed. Shortness of breath. LUNGS AND PLEURA: 2 x 1.9 cm solid spherical nodule in the posterior segment of right upper lobe (6/23) increased in size from prior study where it measured 1.4 x 0.8 cm. Though it does not appear smoothly marginated, irregularity could be due to exclude pseudo-spiculations from adjacent emphysema. The lesion is inseparable from the posterior pleural surface over a length of 2.1-cm (6/22).Numerous new clustered micronodules in the right costophrenic angle are most likely postinflammatory. Scattered areas of endobronchial impaction comments pseudo-nodules. Peripheral groundglass density nodular opacities are seen in the subpleural region of the lungs measuring up to 5-mm in size (6/35), not conclusively changed and should be followed on subsequent exams.Several small nodules in the right major fissure are unchanged.Multiple high density pleural plaques on the right, correlate for prior pleurodesis. 5-mm in nodule in the right upper lobe (6/23) contains internal areas of high CT attenuation suggestive of fine calcification, unchanged in size. Scattered calcified micronodules are seen in the periphery of the right upper lobe, too small to characterize and could be granulomas or dendritic ossification.Moderate centrilobular and paraseptal emphysema. No pleural fluid or pneumothorax. MEDIASTINUM AND HILA: Calcification in the inferior left thyroid lobe. Atherosclerotic calcification of the aorta and coronary arteries. Normal heart size. No lymphadenopathy.CHEST WALL: Subchondral cysts in the scapulae.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Calcification in the liver suggestive of prior healed granulomatous infection.
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Significant interval enlargement of right apical nodule adherent to the posterior pleura suspicious for primary pulmonary malignancy; atypical infection cannot be excluded but is considered less likely. Tissue diagnosis with cultures recommended. Clustered micronodules in the right lower lobe are most likely postinflammatory or postinfectious. High-density pleural plaques are unilateral and atypical in appearance for those related to asbestos, correlate for history of prior pleurodesis.
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Reason: pt with lung ca on Tarceva therapy over 4 yrs History: now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Multiple bilateral groundglass and solid nodules are not significantly changed when compared to the previous exam. Right apical pleural thickening and calcification stable.The reference left upper lobe lesion measures 13 x 18 mm (series 4 image 12), increased from prior 16 x 11 mm. The right apical subpleural nodule appears similar in density but is has continued to enlarge when compared to the previous. This currently measures 11 x 18 mm (series 4 image 14). In the anterior upper and right middle lobes, tree-in-bud opacities with bronchial wall thickening persists suggestive of bronchiolitis, consider infection with atypical mycobacteria.No interval pleural effusion.MEDIASTINUM AND HILA: Moderately sized hiatal hernia containing food material.The heart size is normal. No interval pericardial effusion. Significant mitral annular calcification, somewhat globular on the superior annulus. Triple-vessel mild coronary arterial calcification. Mild aortic valvular calcification. There is eccentric, partially calcified mural thrombus involving the ascending thoracic aorta.Reference, previously described precarinal lymph node is stable at 8 mm. No interval mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: Calcified granulomas with a low density lesion in the medial aspect, likely stable cyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical atrophy, left greater than right.PANCREAS: Stable cystic lesion measuring 11 by 15 mm in the pancreas (series 3 image 120).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine, unchanged. No interval compression fracture. Mild thoracic dextroscoliosis.OTHER: No significant abnormality noted.
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1. The right apical subpleural nodule appears similar in density but is has continued to enlarge when compared to the previous.2. The reference left upper lobe lesion measures 13 x 18 mm, increased from prior 16 x 11 mm. 3. Tree-in-bud opacities with bronchial wall thickening within anterior upper and right middle lobes suggestive of bronchiolitis, consider infection with atypical mycobacteria.
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Reason: lung cancer History: s/p LUL for stage IA NSCLC 2010 LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema.Scarring and micronodules, unchanged.Postsurgical volume loss consistent with upper lobectomy.No suspicious nodules.MEDIASTINUM AND HILA: Moderate diffuse thyroid enlargement.Calcified left hilar nodes compatible with previous infection.Moderate coronary artery calcification.No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Emphysema and scarring with no sign of recurrent lung cancer.
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44 year old man with hypertension and hyperlipidemia who presents with sharp chest pain which radiates to the left arm. It only lasts for 2 minutes and spontaneously resolves. It is never associated with exertion or physical activity.CPT Code: 75574 Coronary arteries: LM: The 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 the diagonal and septal branches. There is dense calcification in the mid LAD with an associated maximal stenosis <50%. The second diagonal artery has dense calcification at its ostium which precludes visualization of the lumen. The remainder of the LAD is free of any obvious stenoses.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx. The distal LCx is small.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 are no significant stenoses in the right coronary artery. There is mild coronary calcification in the proximal, mid, and distal portion of the vessel. 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 appears to be normal in size. The superior and inferior vena cavae are grossly normal. 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 seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
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1.The patient has a high burden of coronary calcium for a 44 year old man. 2.There are no obvious significant coronary artery stenoses present. The maximum stenosis is in the mid LAD and is <50%. The lumen of the ostium of the 2nd diagonal artery is not visualized due to the presence of severe calcification. 3.The study is technically limited due to infiltration of the IV during contrast infusion.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
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Male 34 years old; Reason: 34 yo with history eosinophilic colitis History: abdominal pain/cramping ABDOMEN:LUNG BASES: Bilateral significant pleural calcifications and pericardial calcifications. Small amount of pleural fluid, right greater than left.LIVER, BILIARY TRACT: There are several peritoneal calcifications surrounding the liver. Liver is slightly enlarged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal adenopathy.BOWEL, MESENTERY: Interval resolution of the previously seen dilated loops of bowel and bowel wall thickening. Few enlarged mesentery lymph nodes in the midabdomen have markedly decreased in size. Index node now measures 0.8cm previously 1.3 x 1 .4 cm, image number 71, series number 4.Oral contrast freely extends to the colon without any evidence of extravasation, obstruction, or free air.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Interval resolution of the previously seen colitis and enteritis with no significant residual obstruction or bowel wall thickening.2. Extensive pleural and pericardial calcifications.3. Peritoneal calcifications around the liver.
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Malignant neoplasm of head, face, and neck. Malignant neoplasm of tonsil. Chemotherapy follow-up examination. Radiotherapy follow-up examination. h/o HNC, CRT, compare to previous, measurements pls Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mild thickening of the right platysma muscle, stable since prior exam .At the site of a prior lymphadenopathy in the right neck level 3. No lymphadenopathy is currently appreciatedWithin the visceral space the thyroid gland appears stable and intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells demonstrate opacity in the right maxillary sinus which is stable.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes present in the cervical spine with a disk protrusion at C3-4 narrowing the spinal canal and endplate and uncovertebral osteophytes at C5-6 and narrowing the neural foramina bilaterally and narrowing the spinal canal.
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1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy.2.Infiltration of soft tissues in the right neck is suspected to be a result of treatment.3.Degenerative changes are present in the cervical spine
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22 year-old female with recent C-section on 12/5/2013 presents with abdominal pain. ABDOMEN:LUNGS BASES: Trace bilateral pleural effusions. Nonspecific left lower lobe groundglass opacity.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: A retrocecal appendix is visualized and appears normal (image 56, series #3). Pericecal fluid and stranding is likely secondary to adnexal inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Anterior and to the right of the uterus there is a moderate amount of stranding and inflammation. A fluid collection is identified in the right adnexa tracking laterally. Enlarged uterus is consistent with postpartum status.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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Inflammatory changes with presumed abscess in the right adnexal region. Findings were relayed via telephone to Dr. Floyd at 11:12 a.m. on December 13, 2013.
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Male 74 years old; Reason: Gastric cancer surveillance scan please compare to all previous scans and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Focal area of ground glass opacity in the right upper lobe appears stable since previous exam. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: A Port-A-Cath is stable with its tip in the cavoatrial junctionABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Gastrohepatic and porta hepatis lymph nodes areBOWEL, MESENTERY: Right omental mass appears stable and measures 4.0 x 1.7 cm completely 4.1 x 1.8 cm on image number 117, series number 3. Small ascites, unchanged. Peritoneal nodularity is unchanged.Large gastric mass identified, and appears relatively stable.BONES, SOFT TISSUES: Numerous lucent lesions throughout the osseous structures are stable, incompletely characterizedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: Thickening of the bladder wall is likely related to outlet obstruction from the large prostate.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic, peritoneal soft tissue representing carcinomatosis, not significantly changed from previous study.BONES, SOFT TISSUES: Numerous lucent lesions throughout the osseous structures are stable, incompletely characterizedOTHER: No significant abnormality noted
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1. No significant change in the peritoneal carcinomatosis and lymph nodes.2. Stable focal area of groundglass opacity in the right upper lobe.
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Generate impression based on findings.
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70 months after thoracoscopic right upper lobectomy for adenocarcinoma stage Ia LUNGS AND PLEURA: Part solid nodule in the superior segment of the left upper lobe measures 28 x 18 mm (4/116), previously 27 x 16 mm on 5/22/13 and 23 x 16 mm on 4/14/12. The cranial aspect of the lesion is ground glass in density, this component has not significantly changed in size (5/36). On the current study, the anterior aspect of the lesion is in contact with the minor fissure, the exam of 2012 there was a definite separation between the lesion and the pleural surface.Postsurgical changes of a right middle lobectomy. Ground glass density nodule in the right upper lobe measures 13 x 10 mm, previously 13 x 9 mm (5/29) a component of this lesion seen on series 5 image 30 has increased in density compared to exams of the 2012. Patchy subcentimeter ground glass opacities are seen at the extreme right apex, several of which are nodular in appearance, unchanged. A linear-appearing groundglass lesion in the anterior left upper lobe is unchanged in size at 16mm (5/30) however also has a focal solid nodular component in its anteromedial aspect (5/30) which is new from the 2012 exams..No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta and coronary arteries. Normal heart size. No pericardial fluid. No significant lymphadenopathy. Small sliding hiatal hernia.CHEST WALL: Degenerative change of the spine. Nonspecific areas of hypoattenuation within the thyroid gland are incompletely assessed CT.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Cholecystectomy clips. Atherosclerotic calcifications of the aorta and its branches.
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1. Part solid nodule in the left upper lobe with a slow rate of growth is most compatible with an indolent adenocarcinoma, possibly minimally invasive versus invasive based on its appearance. This lesion comes into contact with the adjacent left major fissure.2. Right upper lobe mixed density nodule not significantly changed in size but has developed an increase in density since 2012, suspicious for AIS/MIA.3. Anterior left upper lobe groundglass lesion not significantly changed in size but has developed a small solid focal nodular component, suspicious for AIS or MIA.4. Numerous ground glass to semisolid nodular opacities in the upper lobes are not appreciably changed and could represent respiratory bronchiolitis if the patient is a smoker; any of these could reflect areas of AAH, especially the larger groundglass opacity lesions. Recommend yearly CT monitoring.4. No signs of lymphadenopathy, pleural or pericardial fluid.
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Generate impression based on findings.
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Chemoradiation for a left T4 N2b tonsillar cancer, completed in 2004. There are post-treatment findings in the left tonsillar fossa and jugulodigastric lymph node chain. There are no enhancing masses or evidence of significant cervical lymphadenopathy. There are secretions within the trachea. The remaining aerodigestive tract is otherwise unremarkable. The parotid and thyroid glands are unremarkable. The left submandibular gland is surgically absent and the right submandibular gland is atrophic. The thyroid gland is unchanged. The carotid arteries are patent. The right jugular vein is absent, which is unchanged. The left jugular vein is narrowed throughout its course. The partially imaged paranasal sinuses are clear. There is mild partial opacification of the left mastoid air cells. There is unchanged mild degenerative spondylosis, but no lytic or blastic lesions. The partially imaged intracranial structures are grossly unremarkable. There is biapical scarring.
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Stable post-treatment findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.
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Generate impression based on findings.
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Reason: lung cancer surveillance. History: cough, dyspnea CHEST:LUNGS AND PLEURA: Scarring and volume loss at the left apex consistent with previous surgery and radiation therapy.At least 3 new very small nodules in the right lung, the largest measuring 4 mm (series 5/26).MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple cysts, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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New small nodules in the right lung, nonspecific but suspicious for metastases. A follow-up CT scan could be obtained in approximately 6 weeks to evaluate for interval growth or stability.
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Generate impression based on findings.
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Female 53 years old; Reason: history partial nephrectomy for renal cancer with residual parenchymal positive margin; assess for recurrence History: none CHEST:LUNGS AND PLEURA: Scattered micronodules in the lungs measuring up to 3 mm (series 5 image 47). No dominant nodule or mass detected. Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial nephrectomy on the right without overt focal lesion detected. There is no evidence of hydronephrosis, perinephric fluid collections, or mass lesion detected. No calculi notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evident metastatic disease or recurrence detected.2.Micronodules too small to characterize but continued follow up advised.
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Generate impression based on findings.
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59-year-old male with laryngeal cancer, evaluate for recurrence Postsurgical changes of total laryngectomy as well as subtotal thyroidectomy. There are no new enhancing lesions to suggest tumor recurrence. A tracheoesophageal stent is unchanged in position. No lymphadenopathy.The orbits are unremarkable. There are small mucus retention cyst/polyps in the bilateral maxillary sinuses. The mastoid air cells are clear. The oral cavity, oro/nasopharynx, and hypopharynx are unremarkable. There is small plaque of the right common carotid artery which is unchanged. The left carotid and internal jugular veins are patent. The osseous structures are unremarkable. No gross abnormalities identified within the visualized brain. For findings in the thorax, please see dedicated chest CT performed on the same day.
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1.Postsurgical changes of laryngectomy without evidence of recurrence or lymphadenopathy.2.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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69-year-old male with alcoholic hepatitis and cirrhosis. Follow-up of liver lesions. CHEST:LUNGS AND PLEURA: Biapical cortical scarring appears unchanged. There is a somewhat spiculated -- appearing nodular density in the left lower lobe on image 37/99. Although this may represent bronchial artery hypertrophy, the appearance has changed when compared to the prior chest CT and given the patient's history of head and neck cancer, continued follow-up is recommended in 6 months. There is also a new, irregular nodular density in the right middle lobe on images 68 and 69/99. There is basilar parenchymal scarring which is stable.MEDIASTINUM AND HILA: Multiple small to borderline lymph nodes are seen in the aorta- pulmonary window, prevascular space and pretracheal region which appear stable. No hilar adenopathy.CHEST WALL: Collaterals identified associated with portal hypertension.ABDOMEN:LIVER, BILIARY TRACT: Liver has a significant, cirrhotic morphology. A area of decreased attenuation in the right lobe is unchanged from prior studies and was considered benign by MR. Near the hepatic dome on image 15/95, arterial phase is a small focus of enhancement with potential washout on portal venous phase image 79/156. Most likely, this represents a flow abnormality rather than a small hepatocellular carcinoma. There is a second focal area of increased vascularity on image 43/95 inferior right lobe which is too small to characterize and not definitely seen on delayed imaging.The portal venous system is patent although there is a patent umbilical vein and other collaterals consistent with portal at retention.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing calculus in both kidneys. Stable, small renal cysts and parenchymal loss right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Number one. Bilateral nodular densities within the lung. Follow-up recommended.2. Small hepatic lesions which are felt unlikely represent hepatocellular carcinoma.
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Generate impression based on findings.
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Reason: 3 yrs s/p esophageal cancer surgery History: please evaluate for recurrent esophageal cancer CHEST:LUNGS AND PLEURA: No new pulmonary nodules or masses.Left lower lobe subpleural nodule which target calcification is unchanged, measuring 11 x 8 mm (image 48, series 5). New, ill-defined foci of ground glass within the left upper lobe favors inflammatory origin, possibly related to aspiration. Other scattered micronodules are unchanged.No pleural effusions. The central airways are clear.MEDIASTINUM AND HILA: Postsurgical changes status post esophagectomy with gastric interposition. There is an air-fluid level in the superior esophagus which is dilated.No mediastinal or hilar lymphadenopathy.Heart size normal no pericardial effusionCHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate bilateral nonobstructing renal stones. Bilateral hypodenserenal lesions, some of which are too small to adequately characterize, unchanged andlikely representing 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 visualized spine.OTHER: No significant abnormality noted.
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No evidence of metastatic disease.Ill-defined ground glass in left upper lobe with associated proximal esophageal dilation and air-fluid level suspicious for aspiration.
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Generate impression based on findings.
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Male 67 years old; Reason: history of prostaet cancer with rising PSA History: prostate cancer ABDOMEN: The lack of IV contrast was evaluation of solid organs in the vasculature, given these limitations the following findings were made:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small non obstructing nephrolith noted in the inferior pole left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Post prostatectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitisBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evident metastatic disease detected.
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Generate impression based on findings.
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Metastatic medullary thyroid cancer on vandetinib. Neck: There are postoperative findings related to total thyroidectomy and neck dissection. There is no evidence of tumor recurrence in the surgical bed. There is no significant cervical lymphadenopathy. The carotid and vertebral vasculature appears intact. The left jugular vein is not identified inferior to the C2 vertebral level, which is unchanged. There is evidence of right laryngeal nerve palsy. The airways are patent. The parotid and the submandibular glands appear unchanged. There is an unchanged ill-defined sclerotic focus within the C3 vertebral body. The vertebral body heights are intact. The imaged lung apices appear clear. Head: There are multiple lytic lesions within the calvarium, many of which have associated extra-axial soft tissue intracranial extension. Although there is no significant interval change in size of many of these lesions, some have continued to increased in size, particularly in the left parietal bone. There is an unchanged sclerotic focus within the left mandibular body, which measures up to 12 mm and likely represents a enostosis or similar entity. There is no evidence of intraparenchymal mass lesions. The ventricles are stable in size and configuration. There is mild maxillary sinus opacification. The mastoid air cells are clear. There is right optic nerve Drusen.
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1.No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2.Multiple calvarial metastases, many of which are stable and a few of which have continued to increase in size.3.Unchanged sclerotic lesion in the C3 vertebral body.
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Generate impression based on findings.
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Reason: work-up for liver transplant History: volume overload LUNGS AND PLEURA: Previously described wedge-shaped opacity at the right base is obscured by a large right pleural effusion with compressive atelectasis involving the entire right lower, lateral segment of the right middle and inferior segment of the right upper lobes. A subpleural nodule (series 4 image 50) has remained stable since 2/2010 and is associated with the minor fissure, likely intrapulmonary lymph node. There is new ground glass within the aerated right lung consistent with mild edema. Focal ground glass in the upper lobe (series 4 image 20) raises the question of aspiration.Small left pleural effusion, increased from prior. There is associated atelectasis within the left upper and lower lobes.MEDIASTINUM AND HILA: Within the mid to superior esophagus, a small amount of food material/debris and fluid is noted. There is evidence of respiratory motion artifact.Two right central catheter is terminate within the central right brachiocephalic vein and superior SVC, respectively. A femoral venous Swan-Ganz catheter terminates in the proximal left pulmonary artery.The heart size is within limits of normal. There is low density of the blood pool suggestive of anemia. No pericardial effusion is present.CHEST WALL: Mild anasarca is noted. Symmetric gynecomastia.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. There are surgical clips at the suprahepatic IVC compatible with prior hepatic transplant. The pattern of splenomegaly is evident with limited views of the upper abdomen. A small amount of ascites is present.
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Interval appearance of large right and increasing small left pleural effusions with associated atelectasis. Mild edema with basilar atelectasis.A focus of groundglass the right apex in the presence of food debris in the superior esophagus raises the question of aspiration.Hepatosplenomegaly with ascites and anasarca.
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Generate impression based on findings.
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66-year-old male with metastatic gastric cancer. Restaging. Additional history: Patient had primary GE junction gastric cancer and known peritoneal disease by positive cytology on washings. FNA of stable pancreatic tail lesion revealed adenocarcinoma, concerning for drop metastasis versus primary pancreatic adenocarcinoma. CHEST:LUNGS AND PLEURA: Scattered calcified micronodules likely represent prior granulomatous disease. No suspicious nodules identified.MEDIASTINUM AND HILA: Small unchanged mediastinal lymph nodes. The previously described small right paraesophageal lymph node is not visualized on this exam. Stable thickening of the wall of the distal thoracic esophagus (image 64, series #6).A right-sided central venous catheter terminates in the proximal SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating homogeneous mass in the tail of the pancreas is grossly unchanged, measuring 2.7 x 1.9 cm (image 90, series #6) from previously 3.3 x 2.2 cm. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney, unchanged. Compensatory right kidney hypertrophy. Multiple simple cyst of the right kidney are redemonstrated. Other subcentimeter right renal hypodensities are too small to further characterize.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Streak artifact from left hip orthopedic prosthesis significantly limits evaluation of the low pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No CT evidence of disease progression.
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Generate impression based on findings.
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Metastatic medullary thyroid carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Slight increase in size of left axillary lymph node best seen on image 32 of series 3, now measuring 1.3 x 2.2 cm; this is in comparison to 1.9 x 1 cm on 8/9/2013.No change in bony mixed sclerotic and lytic rib metastases and left humeral head metastasis.ABDOMEN:LIVER, BILIARY TRACT: Stable reference segment 7 low attenuation focus best seen on image 92 of series 3 measuring 0.8 x 0.5 cm. Segment 6 right lobe low-attenuation focus also stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable peripheral 0.6-cm intermediate attenuation lesion arising from the right kidney best seen on image 110 of series 3. Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable vertebral body bony metastasesOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable lytic pelvic bony metastases.OTHER: No significant abnormality noted
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Slight interval increase in size of left axillary adenopathy. Otherwise, stable examination.
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Generate impression based on findings.
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Reason: h/o HNC, CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged.No suspicious nodules.Moderate bronchial thickening compatible with bronchitis.MEDIASTINUM AND HILA: No significant lymphadenopathy.Moderate coronary artery calcification and a stent in the proximal right coronary artery.CHEST WALL: Vertebral hemangioma at T4.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small nonspecific hypodensities unchanged. No suspicious lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal adenoma, unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Vertebral hemangiomas at L2 and L4.OTHER: No significant abnormality noted.
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No sign of metastases.
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Generate impression based on findings.
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Pulmonary carcinoid post chemo and RT LUNGS AND PLEURA: Right middle lobe partially calcified mass obstructing the airway measures 27 x 32 mm, unchanged (4/44). Postobstructive consolidation unchanged.Loculated right pleural fluid collection increased in volume compared with previous examination, extending into the right major fissure. Extensive paramediastinal consolidation of the right lower lobe and hilum is unchanged. Mild ground glass and septal thickening bilaterally consistent with hypervolemia.MEDIASTINUM AND HILA: Numerous lymph nodes in the left hilum slightly increased in size compared to previous (4/30, 34). For reference, a lymph node on image 30 measures 18 mm, previously 1 mm. Several enlarged interlobar lymph nodes on the left have increased in size. Mildly enlarged left inferior pulmonary ligament lymph nodes are new. Several mildly enlarged paraesophageal lymph nodes surrounding the lower esophageal segment are unchanged.No discernible lymphadenopathy at the right hilum however assessment is limited given extensive post therapeutic change. Left atrial enlargement. Coronary artery calcifications.CHEST WALL: Chronic minimally displaced rib fractures on the right.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Elevation of the right hemidiaphragm. Limited scanning range is unremarkable.
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1. Calcified right middle lobe mass not appreciably changed in size. Postobstructive consolidation in the right middle lobe also not appreciably changed. 2. Mild pulmonary edema. Interval development of a moderate circumferential right pleural fluid collection which appears loculated as well as contralateral hilar and mediastinal lymphadenopathy. Given the presence of cardiomegaly and pulmonary edema it is conceivable that these findings are reactive. Suggest short-term follow-up after volume management to assess for resolution, although the asymmetry of lymphadenopathy is atypical.
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Generate impression based on findings.
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Mental status. Rule out CVA. There are prominent CSF spaces diffusely in keeping with age-related atrophic change. There is patchy periventricular and subcortical white matter hypoattenuation which was demonstrated previously and most likely represents sequela of chronic small vessel ischemic disease. There is no intracranial mass, hemorrhage, hydrocephalus or edema. The midline is intact. Orbits, and mastoid are cells are unremarkable. There is soft tissue attenuation within the maxillary sinuses bilaterally most likely representing chronic mucous retention cysts.
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Age-related changes and sequela of chronic small vessel ischemic disease. No acute intracranial abnormality demonstrated. CT is suboptimal in sensitivity for acute CVA and if there is persisting concern, MRI could be considered.
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Generate impression based on findings.
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Reason: lung ca, on Tarceva, pls c/w previous study and evaluate dz status,. History: lung ca CHEST:LUNGS AND PLEURA: Postoperative changes of the left apex demonstrates increasingnodularity (series 5 image 13). The nodular component measures 8 mm, as compared to 6mm on the previous exam. This remains suspicious for local recurrence.Stable size of previously referenced ground glass nodule measuring 9 x 10 mm (series 5image 21). A reference right middle lobe nodule is also stable, 7 x 11 mm (series 5 image 40). Stable emphysema appearance of the staple line in the posterior right upper lobe. Additional scattered micronodules are unchanged.No new pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No axillary lymphadenopathy. Previous bilateral mastectomies. Postoperative changes involving the chest wall with a stable sclerotic focus in left lateral rib.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: Stable size and number of multiple low density lesions favoring renal cysts, some of which remain of high density.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable size of retroperitoneal lymph nodes, some of which are calcified.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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Progressive increase size of the nodularity associated with the left apical scar. This now measures 8 mm and is highly suspicious for local recurrence.No interval lymphadenopathy.Additional previously referenced pulmonary nodules are stable.
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Generate impression based on findings.
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Nasal congestion and discharge. There is mild left and minimal right maxillary sinus mucosal thickening. The other paranasal sinuses are otherwise clear and the infundibula are clear. The nasal cavity is also clear. The right fovea ethmoidalis is approximately 2 mm lower than the left, but these are otherwise intact. There is pneumatization of the left anterior clinoid process with possible dehiscence of the adjacent optic nerve canal. The carotid grooves are covered by bone. The mastoid air cells are clear. The imaged intracranial structures are grossly unremarkable.
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No significant sinonasal opacification.
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Generate impression based on findings.
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Reason: eval for lung mets History: h/o larynx cancer LUNGS AND PLEURA: Mild apical emphysema and scarring.Multiple micro-nodules, some of which are calcified, compatible with previous infection.No suspicious nodules.MEDIASTINUM AND HILA: Phonation devic in place. Tracheostomy defect noted in the superior trachea.Moderate coronary artery calcification. Heart size remains normal. No pericardial effusion. The esophagus is mildly dilated.No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic hypodensity consistent with a cyst, unchanged.
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No evidence of metastatic disease.
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Generate impression based on findings.
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66-year-old male with history of gastric cancer post therapy. Evaluate for interval change. CHEST:LUNGS AND PLEURA: Small micronodules without obvious change.MEDIASTINUM AND HILA: Reference paratracheal lymph node on image 33/224 is unchanged, measuring 1 x 1.7 cm. No new nodal enlargement.CHEST WALL: Port identified with catheter tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: The liver is a somewhat cirrhotic morphology. Multiple hepatic masses are identified. Reference lesion in the dome measures 1.1 x 1.3 cm on image 77/224 without significant change. However, this may actually represent a hepatic cyst. There are multiple other less well-defined areas of decreased attenuation throughout the liver. Although these are difficult to measure, they were more poorly defined on the prior exam and may have progressed. A lesion in the right lobe on image 87/224 measures 2.6 x 3 cm.SPLEEN: Splenomegaly without focal abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in periportal node measuring 0.9 x 1.2 cm on image 96/244. No new adenopathy. There is infiltrative change in the retroperitoneum about the celiac axis and superior mesenteric artery of uncertain significance but without change.BOWEL, MESENTERY: Stomach is underfilled and the patient's known gastric mass cannot be adequately measured.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: Artifact from left hip replacement obscures detail.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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Findings worrisome for progressive hepatic metastases. See above.No change in measured lymph nodes in the chest and abdomen.Known gastric mass medically visualized.
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Generate impression based on findings.
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SCC neck status post chemoradiation. COPD. Pneumonia. Left lower lobe opacity superimposed on bullous emphysema and fibrotic changes evaluated with CT for further Dr. station and to determine if pneumonia. LUNGS AND PLEURA: New small left pleural fluid collection. Bulla in the periphery of the left upper lobe now contains an internal air/fluid level which measures the density of simple fluid no fluid fluid levels are appreciated to suggest blood products. Septal thickening, atelectasis and consolidation surround the bulla. Within the caudal aspect of the left lower lobe proper and lingula, there is extensive air space consolidation and septal thickening. The nodular appearance could be caused by the presence of emphysema. Distribution is inconsistent with aspiration. Emphysema and scarring at the lung apices with subpleural consolidation and nodules, not significantly changed. Elsewhere, the lungs are unchanged in appearance compared to prior studies.MEDIASTINUM AND HILA: Right chest port tip at the SVC/RA junction. Normal heart size. Trace pericardial fluid. Atherosclerotic calcifications of the aorta and coronary arteries. Small mediastinal lymph nodes are unchanged. Allowing for limitations of unenhanced technique. There is probable mild left hilar region lymphadenopathy.CHEST WALL: Percutaneous gastrostomy tube. No evidence of periosteal reaction adjacent to this he left upper lobe parenchymal abnormality.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Gastrostomy tube retention device in the stomach. Extensive pancreatic calcifications consistent with chronic pancreatitis.
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Extensive air space opacity and septal thickening throughout the left upper lobe most compatible with infection since the patient has a recently negative PET scan less than one month ago. If the patient has hemoptysis, pulmonary hemorrhage may appear similar. Fluid in the bulla and pleural space is the density of simple fluid. Mild left hilar region lymphadenopathy is most likely reactive. Conservative imaging follow-up with PA and lateral chest radiographs are recommended in 6 weeks unless there is concern for atypical infection in which case closer interval follow-up may be obtained as clinically warranted
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Generate impression based on findings.
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Chronic sinusitis Redemonstrated are findings from prior partial endoscopic sinus surgery including bilateral infundibulectomies and partial ethmoidectomies Frontal sinuses: No evidence of disease, unchanged.Ethmoid sinuses: Minimal bilateral chronic sinus disease demonstrating interval improvement.Sphenoid sinus: Compromised bilateral sphenoethmoidal recess albeit demonstrating interval improvement. Unremarkable exam at this level otherwise.Maxillary sinuses: Mild mucosal thickening of bilateral maxillary sinuses, unchanged. Bilateral nasoantral windows remain patent.Nasal septum is deviated leftward, unchanged. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The visualized intracranial as well as nasopharyngeal structures are unremarkable.
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1.Ethmoid sinuses: Minimal bilateral chronic sinus disease demonstrating interval improvement.2.Sphenoid sinus: Compromised bilateral sphenoethmoidal recess albeit demonstrating interval improvement. 3.Maxillary sinuses: Mild mucosal thickening of bilateral maxillary sinuses, unchanged.
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Generate impression based on findings.
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Reason: h/o HNC, compare to previous, measurements pls History: none LUNGS AND PLEURA: Calcified micronodules and calcified lymph nodes compatible with previous infection.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.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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No change and no sign of metastases.
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Generate impression based on findings.
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Lung cancer. LUNGS AND PLEURA: Postoperative changes of left upper lobectomy. Well-circumscribed 5-mm solid nodule in the left lower lobe (4/30) unchanged compared to the most recent previous study however increased in size and compared to an earlier exam of 10/22/10 where it measured 3-mm. On the current study it contains internal Hounsfield units consistent with lipid attenuation. At the left costophrenic angle, there is a 5-6 mm nodular density which is stable since the 2010 and could represent a subpleural lymph node, most consistent with a benign lesion. No pleural fluid or pneumothorax. No new nodules or signs of localized recurrence at the resection site.MEDIASTINUM AND HILA: Main pulmonary artery upper limits of normal in size. Mild left ventricular cardiomegaly. Mildly enlarged posterior paraesophageal lymph node (3/73) along the lower esophageal segment unchanged, likely benign. No suspicious lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. The liver appears slightly hyperattenuating relative to the spleen on this unenhanced study.
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No signs of localized recurrence or metastatic disease. Well-circumscribed 5-mm nodule the left lower lobe is most likely a hamartoma.
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Generate impression based on findings.
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Nephrectomy for renal cancer evaluate for recurrent or residual disease. LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Stable linear scarlike abnormality right upper lobe (4/30). Left lower lobe pleural calcification with adjacent scarring in the left lower lobe parenchyma, likely post infectious.MEDIASTINUM AND HILA: Subcentimeter lymph nodes in the low cervical region on the left are unchanged compared 8/31/12. Mild cardiomegaly. No pericardial fluid or suspicious lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range, adrenal glands are incompletely included. Hypoattenuating lesion in the right hepatic lobe incompletely characterized without IV contrast, please refer to MR abdomen which will be reported separately.
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No signs of thoracic metastatic disease. Incompletely characterized hepatic lesion, please refer to separately reported MR abdomen.
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Generate impression based on findings.
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40 year-old man with stabbing chest pain radiating to the back. Hypertension, evaluate for dissection. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality noted. The ascending aorta measures 2.9 cm in diameter and the descending thoracic aorta measures 2.4 cm in diameter (image 54; series 9). There is no evidence of aortic dissection.CHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No evidence of aortic dissection. No findings to explain chest pain.
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Generate impression based on findings.
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Head and neck cancer and CRT. LUNGS AND PLEURA: Very mild paraseptal and centrilobular emphysema. No suspicious pulmonary nodules or masses. Subcentimeter calcified micronodules most likely representing granulomas. Pleural lipoma in the left costophrenic angle.MEDIASTINUM AND HILA: Small anterior pericardial fluid collection. Small volume of pericardial recess fluid which should not be mistaken for lymphadenopathy. Severe coronary artery calcifications. Calcified left hilar lymph nodes. Severe atherosclerotic calcification of the thoracic aorta and its branches. Left chest port tip in the low right atrium.CHEST WALL: Left chest port. Degenerative change spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating lesions in the left hepatic lobe (4/79, 4/90) were present previously, incompletely characterize but possibly cysts. Left adrenal gland lesion measuring 10 Hounsfield units is consistent with an adenoma. Severe atherosclerotic calcifications of the splenic arteries. Posterior peritoneal calcification adjacent to the right hepatic lobe may be a spilled gallstone as the patient is post cholecystectomy per prior exams.
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No evidence of thoracic metastases. The left jugular chest port tip in is low in the right atrium, consider repositioning.
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Generate impression based on findings.
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52 year old male with history of base of tongue cancer, status post CRT. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for a left maxillary sinus retention cyst. Limited view of the intracranial structure is unremarkable. Volume loss of the right tongue base is redemonstrated similar to the prior examination and consistent with treatment related change. The visualized aerodigestive tract is free of focal masses or suspicious enhancement.Treatment related change is redemonstrated elsewhere including thickening of the right platysma, mild infiltration of the fascial planes and infiltration of the epiglottic space. Asymmetry of the piriform sinuses. No mass lesion is seen. No pathologic adenopathy is identified by size criteria. A reference right jugulodigastric node measures 9 x 5 mm (image 82 series 5), previously 9 x 6 mm. Salivary glands and thyroid are unremarkable. Cervical vessels remain patent. Lung apices are clear. No concerning bony lesions are detected. There is evidence of degenerative disk disease in the cervical spine.
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Stable posttreatment changes in the neck with no evidence of tumor recurrence or pathologic adenopathy.
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Generate impression based on findings.
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Base of tongue SCC (HPV positive) status post chemo radiation cycle 5 of TFHX on IRB 10-069 completed 7/2012 CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural fluid. Faint ground glass foci in the left upper lobe proper and lingula most likely related to aspirated secretions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter focal hypoattenuation in the right hepatic lobe near the dome. Branching on the current exam. Although this is too small to the accurately characterize this features suggestive of a focal intrahepatic biliary ductal dilatation lesion within the anterior right hepatic lobe adjacent to the falciform ligament is in a location commonly affected by perfusion abnormalities and there is no evidence of distortion of the hepatic capsule.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: Mild atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.T-tacks in the anterior abdomen consistent with prior gastrostomy tube.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No specific signs of metastatic disease.
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Generate impression based on findings.
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34 year-old female with recurrent sinusitis. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is moderate mucosal thickening in the left maxillary sinus, resulting in obstruction of the left infundibulum. There is mild mucosal thickening in the right maxillary sinus with mild narrowing of the right infundibulum. There is mild mucosal thickening in the left frontal ethmoid recess. There is mild nasal septal deviation. The frontal sinuses, right frontal-ethmoid recess, anterior/posterior ethmoids, and sphenoid sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes. The intersphenoid septum is normal. The nasal turbinates are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Mild to moderate inflammatory disease affecting bilateral maxillary sinuses and left frontoethmoid recess with obstruction of the left maxillary infundibulum.
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Generate impression based on findings.
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77 year-old female with metastatic breast cancer. CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified micronodules. No new or suspicious nodules.MEDIASTINUM AND HILA: Multiple hypodense thyroid nodules again noted. Reference nodes are not thickened a change. Left supraclavicular node measures 8 mm, producing measured 8 mm (series 401, image 14). Right hilar node measures 13 mm, previously measured 12 mm (series 401, image 41).CHEST WALL: Status post left mastectomy. Reference right axillary node measures 8 mm, previously measured 8 mm (series 401, image 39).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver, consistent with steatosis. No suspicious liver lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter hypodensities in the kidneys too small to characterize but most consistent with cysts.PANCREAS: Hypoattenuating lesions in the pancreatic head and body not significantly changed and incompletely characterized, likely IPMN.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications and mural plaques in the aorta and its branches. Multiple small retroperitoneal lymph nodes are not significantly changed.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality noted.
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No significant change in reference lesions.
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Generate impression based on findings.
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Trauma. INR of 13. Please evaluate for hematoma. Altered mental status. CHEST:LUNGS AND PLEURA: Moderate right hemothorax. Calcified granuloma noted at the right lung base. Left lung is clear.MEDIASTINUM AND HILA: No significant abnormality noted. Coronary artery calcifications. Subcentimeter lymph nodes.CHEST WALL: There is a moderate to large intramuscular hematoma extending up the right posterior lateral chest wall into the left flank. There are no displaced rib fractures although there are several nondisplaced lower rib fractures (image 70; series 3 and image 49; series 3) versus an old healed fracture.ABDOMEN:LIVER, BILIARY TRACT: Multiple probable hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described right posterior chest wall hematoma extends into the right flank musculature.OTHER: No evidence of intra-abdominal bleeding.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple non-displaced right lower rib fractures with large intramuscular right posterior chest wall and right flank hematoma. Moderate right hemithorax. Findings were discussed with the emergency room at the time of dictation.
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Generate impression based on findings.
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HNC status post CRT. LUNGS AND PLEURA: Moderate centrilobular emphysema. No pleural fluid or pneumothorax. The lower lung zones, several subpleural pulmonary arterial branches are noted to be dilated. No signs of pulmonary edema. Scarlike lesion at the right apex similar in size and configuration, measuring 10 x 6 mm in its cranial aspect (4/23), previously 9 x 7 mm. A small nodular component in its caudal aspect is unchanged in size (4/24).MEDIASTINUM AND HILA: Right chest port tip at the cavoatrial junction. Focal hypoattenuation surrounding the catheter tip is suspicious for catheter-associated thrombus. Main pulmonary arteries normal in caliber.CHEST WALL: Focal sclerotic lesion in the superior endplate of the T12 vertebral body was present previously and appears similar right jugular chest port takes a tortuous course in the chest wall.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Probable hepatic cysts. Mild intrahepatic and extrahepatic biliary ductal dilatation as well as dilatation of the pancreatic duct unchanged in appearance; the pancreatic head is not included within the scanning range an obstructing lesion cannot be ruled out. Peripherally enhancing left adrenal gland lesion measures 2.2 x 1.5 cm (3/94), previously 1.8 x 1.4 cm when measured at the same level. This lesion does not meet the criteria for a benign adenoma. Incompletely visualized cystic lesion in in the upper pole of the left kidney. Atherosclerotic disease.
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1. Left adrenal gland nodule is slightly larger and does not meet the criteria for a benign adenoma. Metastasis cannot be excluded. Further characterization may be made with dedicated CT or MRI (unless contraindicated). 2. Small thrombus at the tip of the chest port catheter. Dr. DeSouza notified via paging tool at 1:53 p.m. on 12/13/13.3. Indeterminate scarlike lesion at the right apex not conclusively change but should continue to be monitored for growth to exclude an indolent primary pulmonary neoplasm. No pulmonary metastases are identified.4. Dilatation of peripheral subsegmental pulmonary arteries in the lower lung zones may be seen in hepatopulmonary syndrome; consider nuclear scintigraphy for confirmation if clinically warranted.5. Unchanged sclerotic bone lesion.6. Intrahepatic and extrahepatic biliary ductal dilatation with dilatation of the pancreatic duct. The pancreatic head is not included within this scanning range and an obstructing lesion, stenosis or stone cannot be excluded. This may be evaluated at the time of dedicated imaging of the adrenal gland nodule.
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Generate impression based on findings.
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Female 75 years old; Reason: assess for History: History colon CA ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable focal biliary ductal dilatation in the left hepatic lobe.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: Redemonstrated postsurgical changes of a abdominal perineal resection and left lower quadrant colostomy. Interval development of a small parastomal hernia containing a focal segment of small bowel loop. No evidence of adenopathy, carcinomatosis, ascites, or recurrence.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Nonspecific small lucent lesion in the L1 vertebral body is unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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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53 year-old male status post right upper lobe lobectomy, lung cancer, right-sided chest wall trauma, July 2013. LUNGS AND PLEURA: Changes status post right upper lobectomy. Scarring is again noted in the right lower lobe, likely due to previous hematoma. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes, none of which are pathologically enlarged. Cardiac size is normal without pericardial effusion.CHEST WALL: Osseous bridging and heterotopic ossification involving the posterior right sixth and seventh ribs, likely due to prior surgery, appear similar to prior exam.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mildly enlarged portacaval lymph node is incompletely visualized on today's exam, but appear similar to previous.
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No specific evidence of local recurrence or metastatic disease in the chest.
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Generate impression based on findings.
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Metastatic melanoma. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusions. Scattered nonspecific micronodules. No suspicious nodules or masses.MEDIASTINUM AND HILA: Unchanged left supraclavicular lymph node measures 1.2 x 0.9 cm (image 4; series 3). No mediastinal or hilar lymphadenopathy. Heart size is normal. No pericardial effusion. CHEST WALL: Scattered small left axillary lymph nodes are unchanged. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenulePANCREAS: Bifid pancreatic tail, a normal variant.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cortical calcification is unchanged. Subcentimeter wedge-shaped hypodensity in the left midpole is unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Circumaortic left renal veins a normal variant.PELVIS: UTERUS, ADNEXA: Uterine fat-containing lesion is unchangedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No substantial interval change compared to previous. No definite evidence metastatic disease in the chest, abdomen, and pelvis.
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Generate impression based on findings.
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68 year-old male with head and neck cancer. CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified punctate nodules in both lungs appear stable. Reference 3-mm nodule in the right upper lobe is unchanged since 2011, compatible with benign nodule (series 5, image 42).MEDIASTINUM AND HILA: No lymphadenopathy. Moderate coronary calcifications. Heart normal in size without effusion.CHEST WALL: Stable sclerotic focus in T6 vertebral body, most consistent with bone island. Degenerative changes affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodensities in left kidney unchanged, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Scattered atherosclerotic calcifications in aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes without suspicious lesions.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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66-year-old male with metastatic lung cancer status post 18 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Postsurgical changes in the left lung with stable mild thickening adjacent to the suture line. No new or suspicious nodules. No consolidation or pleural effusions.MEDIASTINUM AND HILA: No significant change in reference lesions. Right supraclavicular soft tissue density measures 1.5 x 1.7 cm, previously measured 1.5 x 1.8 cm (series 3, image 8).Right lower paratracheal node measures 8 mm, previously measured 7 mm (series 3, image 34).Subcarinal node measures 1.3 cm in short axis, previously measured 1.6 cm (series 3, image 47).Moderate coronary artery calcifications. Heart is normal in size without pericardial effusion.CHEST WALL: Tortuous aorta. Severe degenerative changes with multiple compression deformities of thoracic vertebral bodies appearing similar.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hypodensities in segment 6 and dome are unchanged and likely cysts. No suspicious lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule measures 1.4 x 2.1 cm, previously 1.5 x 2.0 cm (series 3, image 86).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Atherosclerotic calcifications and aorta and its branches. IVC filter in place. Minimal ectasia of both common iliac arteries unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes appear similar.OTHER: No significant abnormality
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Stable reference measurements.
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Generate impression based on findings.
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40 year-old male with base of tongue cancer, follow up examination. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusion or focal lung consolidation.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Right chest port with tip at the cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastatic disease in the chest or upper abdomen.
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Generate impression based on findings.
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63-year-old female with cough and right upper lobe nodule. LUNGS AND PLEURA: Right upper lobe mass continues to slightly decreased in size and density, measuring 1.8 x 3.2 cm, previously 2.0 x 3.2 cm (series 5, image 37). A small metallic clip is again seen adjacent to this lesion along its cranial margin.Peripheral nodular lesion in the right lower lobe is decreased in size, measuring 1.1 x 0.6 cm, previously measured 1.7 x 1.2 cm (series 5, image 53). New centrilobular and tree in bud opacities as well as subsegmental consolidation in the right lower lobe with associated bronchial wall thickening.Persistent tree in bud opacities are also seen in the superior aspect of the left lower lobe and right middle lobe, not significantly changed.Chronic mild localized bronchial wall thickening in the left lower lobe (5/55), unchanged.Mild centrilobular emphysema.MEDIASTINUM AND HILA: Status post right thyroidectomy. Hypodense nodule in left thyroid lobe unchanged. No significant lymphadenopathy. Heart is normal in size without effusion.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Decreased size of reference right lung lesions, favoring an infectious or inflammatory etiology.2.New centrilobular and tree in bud opacities in right lower lobe as well as persistent tree in bud opacities in the left lower lobe most consistent with bronchiolitis, possibly from aspiration or infection though noninfectious causes may also produce this appearance..
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Generate impression based on findings.
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Female 75 years old; Reason: evaluate for metastasis. History: angiosarcoma. CHEST:LUNGS AND PLEURA: Reticular opacities in both upper lobes, with mild bronchial wall thickening, unchanged. MEDIASTINUM AND HILA: The left and middle hepatic veins insert directly into the right atrium.CHEST WALL: Right chest wall Port-A-Cath with its tip in the cavoatrial junction.Stable sclerotic focus with linear trabeculation in the T8 vertebral body, likely represents a body hemangioma though a metastatic lesion cannot be entirely excluded. No new sclerotic lesions are identified in the visualized osseous structures.ABDOMEN:LIVER, BILIARY TRACT: Stable simple cyst in the medial left hepatic lobe. SPLEEN: Stable hypodense anterior splenic lesion, unchanged and likely benign. Stable 9 mm artery aneurysm. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodensities in both kidneys, too small to characterize, but not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable postoperative changes from resection of left flank mass, without evidence of tumor recurrence in the surgical bed.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evident tumor recurrence or distant metastases from prior left flank resection. Stable examination when compared to the previous.2.Stable sclerotic lesion in the T8 vertebral body with findings suggestive of a vertebral body hemangioma. While a metastasis could have this appearance, this is considered less likely. Attention to this region on follow-up examinations is recommended. No new sclerotic lesions are identified.3. Stable benign hypodense lesions in the liver and spleen
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Generate impression based on findings.
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Evaluate for chronic pancreatitis, pseudocyst, divisum or other abnormalities. Epigastric pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is significant pancreatic atrophy and the remaining gland contains numerous calcifications throughout compatible with history of chronic pancreatitis. There is no evidence of acute inflammation currently. Splenic vein is widely patent. No evidence of pseudocyst or pseudoaneurysm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small lymph nodes noted throughout the base of the mesentery.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Intrauterine device.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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Atrophic pancreas with numerous calcifications compatible clinical history chronic pancreatitis. No evidence of pseudocyst.
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Generate impression based on findings.
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67-year-old male with history of metastatic renal cell cancer. Assess for progression. CHEST:LUNGS AND PLEURA: Minimal bronchiectasis and atelectasis in the right lower lobe.Scattered calcified micronodules are consistent with prior granulomatous disease. Right upper lobe spiculated nodule measures 7 x 7 mm, unchanged from prior exam, though decreased from 7/25/2013.MEDIASTINUM AND HILA: Unchanged enlarged right hilar node measures 1.8 x 1.7 cm (image 42, series #5), previously 2.0 1.8 cm. Unchanged enlarged precarinal node measures 1.2 x 0.9 cm (image 41, series #5), previously 1.2 x 1.2 cm. Other scattered non-enlarged mediastinal nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The soft tissue lesion in the right renal fossa is again identified and is confluent with a predominantly hypodense lesion in the right hepatic lobe. The lesion is overall similar in size, measuring 5.0 x 4 .7 cm, previously 5.3 x 5.6 cm. However, its soft tissue component of this lesion has grown with mildly increased perihepatic extension, involving more of the right crus than previously seen. This lesion is again seen to abut the IVC, with an adjacent intraluminal filling defect, likely representing thrombus which is grossly unchanged.Other satellite hepatic lesions are stable to minimally decreased in size.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonvisualization of the right adrenal gland.KIDNEYS, URETERS: Left kidney appears normal. Status-post right nephrectomy. Soft tissue focus in the right renal fossa is described in detail above.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.Mild progression of disease evidenced by interval growth of soft tissue mass in the right renal fossa, either invading the liver or alternatively confluent with a liver metastasis.2.Stable adjacent IVC thrombus.3.Stable hepatic metastases.4.Growth of the right upper lobe spiculated mass may reflect progression of metastatic disease. Primary lung malignancy is also a differential consideration.5.Unchanged mediastinal adenopathy.
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Generate impression based on findings.
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81 year old female with history of head and neck cancer (laryngeal cancer), CRT, compared to previous. LUNGS AND PLEURA: Mild centrilobular emphysema. Interval resolution of right middle lobe nodular opacity, and improvement in basilar consolidation. There is persistent bronchial wall thickening and chronic interstitial opacities. There is a residual nodular opacity in the left base.MEDIASTINUM AND HILA: Moderate to severe calcifications of the coronary arteries and aorta. Right chest port with tip at the cavoatrial junction. Cardiac size is normal without pericardial effusion. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes are again noted in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left renal cysts are unchanged. Mild intrahepatic biliary ductal dilatation is again noted. Nodular thickening of the left adrenal gland appears similar to prior exam.
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1.No evidence of metastatic disease in the chest.2.Interval improvement in basilar consolidation, bronchiolitis, and right middle lobe nodular opacity consistent with aspiration and infection.
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Generate impression based on findings.
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77 year-old female with metastatic breast cancer. CHEST:LUNGS AND PLEURA: Multiple calcified and noncalcified micronodules. No new or suspicious nodules.MEDIASTINUM AND HILA: Multiple hypodense thyroid nodules again noted. Reference nodes are not significantly changed. Left supraclavicular node measures 8 mm, previously measured 8 mm (series 401, image 14). Right hilar node measures 13 mm, previously measured 12 mm (series 401, image 41).CHEST WALL: Status post left mastectomy. Reference right axillary node measures 8 mm, previously measured 8 mm (series 401, image 39).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver, consistent with steatosis. No suspicious liver lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter hypodensities in the kidneys too small to characterize but most consistent with cysts.PANCREAS: Hypoattenuating lesions in the pancreatic head and body not significantly changed and incompletely characterized, likely IPMN.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications and mural plaques in the aorta and its branches. Multiple small retroperitoneal lymph nodes are not significantly changed.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality noted.
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No significant change in reference lesions.
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Generate impression based on findings.
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Male 27 years old; Reason: assess for mass/lesion History: history of ca ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cyst of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gaseous distention of the colon and small bowel. A rectal catheter is in place. No evidence of adenopathy, recurrence, or metastatic disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No CT evidence of recurrence or metastatic disease.
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Generate impression based on findings.
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64-year-old female with melanoma of the skin and scalp and neck, reevaluate Limited intracranial and orbital views are unremarkable. The visualized mastoid air cells and paranasal sinuses are clear. Torus palatinus, normal anatomic variant.Redemonstration of postsurgical changes of a right neck dissection with scarring, volume loss and resection of the right parotid and submandibular glands. There is no soft tissue mass or pathologic enhancement.Scattered lymph nodes are present throughout the neck. Several right-sided cervical lymph nodes have slightly increased in size. Right level 5 reference node measures 13 x 10 mm (series 6 image 91), previously measured 10 x 8 mm. Reference left level 4 lymph node has slightly decreased in size and measures 11 x 6 mm (series 6 image 120), previously measured 13 x 10 mm.No exophytic mass or focal effacement of the aerodigestive tract. The remaining the salivary glands are free of focal lesions. The thyroid remain slightly heterogeneous, with a nodule in the thyroid isthmus, unchanged. The cervical vessels are patent. No suspicious osseous lesions are identified. The visualized lung apices are clear. Please see dedicated chest CT from today's date further details.
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1. Several right sided cervical lymph nodes have slightly increased in size. This is a nonspecific finding and continued follow-up is recommended.2. No specific evidence of residual/recurrent disease in the neck.
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Generate impression based on findings.
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Male 47 years old; Reason: eval for intraabdominal trauma as a result of fall History: pt has severe luq ttp after syncopal episode. likely had trauma to that side of the abdomen during syncopal episode CHEST:LUNGS AND PLEURA: Bibasilar atelectasis with bibasilar bronchiectasis noted. No mass or mass detected.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No acute intra-abdominal trauma detected.2.Bibasilar bronchiectasis of unclear etiology
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Generate impression based on findings.
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Female 62 years old; Reason: pt with LE edema evaluatd for pelvic mass also f/u on plumonar infiltrate noted on last CT History: coug milder but increased dyspnea CHEST:LUNGS AND PLEURA: Interval resolution of the right subpleural air space opacity. Interval development of groundglass opacity in the left lingula. Stable nonspecific pleural thickening at the right apex. No new pulmonary nodules. Scattered punctate pulmonary nodules are unchanged previous.MEDIASTINUM AND HILA: Venous catheter tip at RA/SVC junction. Stable esophageal dilation with wall thickening. No pathologically enlarged mediastinal or hilar lymph nodes.CHEST WALL: Known osseous metastases are poorly visualized but unchanged. Coarse calcifcations in the breasts. Left chest wall port. Postop change right axilla. Stable sclerosis in left ninth rib ABDOMEN:LIVER, BILIARY TRACT: Treated hepatic metastases with retained contrast. Focal biliary dilatation at site of prior hepatic surgery. Pneumobilia. The reference left lobe lesion has decreased to 2.7 x 2.2 CM previously 3.2 x 2.2 cm on image (87/4).SPLEEN: Multiple small hypodensities in the spleen are again noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate nonobstructing right nephrolith.RETROPERITONEUM, LYMPH NODES: Stable borderline retroperitoneal adenopathy with 9 enlarged by CT criteria.The reference gastrohepatic lymph node has decreased to 1.0 x 0 .7 cm, previously 12 x 7 mm on image 87 of series 4.IVC filter in stable position.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized C7 vertebral body has a sclerotic lesion. Metastatic disease cannot excluded.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Stable hepatic lesions with stable adenopathy. 2. New area of ground glass opacity in the lingula with resolution of the previously seen opacity in the right middle lobe.
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Generate impression based on findings.
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37-year-old female with history of pulmonary embolus in 8/2013. Please check for resolution. PULMONARY ARTERIES: Diagnostic quality exam without evidence of pulmonary embolus. Resolution of previously seen emboli.LUNGS AND PLEURA: Resolution of basilar consolidation and effusions. No focal opacities or effusions on current exam.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Resolution of previously seen emboli and basilar consolidation, without evidence of emboli or other significant abnormality on current exam.
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Generate impression based on findings.
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48-year-old male with history of tongue cancer, CRT, reevaluate No mass effect, focal edema or suspicious enhancement is present to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact.No exophytic mass of the aerodigestive tract. Interval increase in reticulation of the subcutaneous fat and fascial planes of the neck compatible with radiation therapy. Similar to the prior, the lingual tonsillar tissues are uniformly thickened and enhancing as is the overlying tongue mucosa and mucosa of the soft palate.The epiglottis is edematous as are the pre-glottic space and aryepiglottic folds. Asymmetry of the piriform sinuses, with partial effacement of the left piriform sinus. Small hypoattenuating focus at the base of the time may represent cystic change. These findings are most compatible with post-therapy changes.Previously referenced left level 2/3 lymph node is not discretely identified on the current examination. No evidence of cervical lymphadenopathy by CT size criteria.The parotid glands are unremarkable. The submandibular glands are hyperemic. The thyroid is free of focal lesions. No suspicious osseous lesions are identified.Partially visualized right chest port catheter. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details.
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1. Treatment related change in the neck without evidence of progressive primary tumor or pathologic lymphadenopathy.2. No intracranial metastatic disease.
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Generate impression based on findings.
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55 year old female with dyspnea, restriction on PFTs, evaluate for ILD. LUNGS AND PLEURA: No findings to suggest interstitial lung disease. No pleural effusion, or focal lung opacity. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size is normal without 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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No findings to suggest interstitial lung disease.
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Generate impression based on findings.
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T3N2cM0 supraglottic SCC s/p 2C IC with carbo/taxol and CRT with TFHX on 11/20/13. There has been evolution of post-treatment findings with interval extubation and decreased supraglottic mucosal edema. There is no discernable residual supraglottic tumor. There is no significant cervical lymphadenopathy. The airways are patent. The major salivary glands are unchanged. The thyroid gland is unremarkable. There is a retropharyngeal course of the internal carotid arteries. There is moderate stenosis of the right carotid bifurcation secondary to atherosclerotic plaque. There is a right internal jugular venous catheter. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable.
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Evolution of post-treatment findings with interval extubation and decreased supraglottic mucosal edema. No discernable residual supraglottic tumor or significant cervical lymphadenopathy.
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Generate impression based on findings.
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76 year old female with metastatic thyroid cancer on therapy, evaluate for disease progression with measurements. CHEST:LUNGS AND PLEURA: Trace dependent atelectasis. Scattered pulmonary micronodules are unchanged. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Enhancing necrotic mass in the superior mediastinum posterior to the clavicular head measures 2.8 x 2.4 cm (image 26, series 3) previous the 2.6 x 2.4 cm. The mass extends inferiorly to the level of the aortic arch, and laterally to the trachea. Necrotic bilateral paratracheal lymph nodes unchanged (image 30, series 3). Cardiac size is normal without pericardial effusion.CHEST WALL: No axillary lymphadenopathy. Left lower cervical necrotic lymph node is present, please refer to neck CT for further evaluation.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable small hepatic hypoattenuating lesions, too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes in the spine. No suspicious osseous lesions.OTHER: No significant abnormality noted.
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Stable to minimally increased superior mediastinal mass. Mediastinal adenopathy is unchanged. No new sites of disease identified.
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Generate impression based on findings.
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Male, 68 years old, history of base of tongue cancer, and thyroid cancer, status post radiotherapy and chemotherapy. Post-treatment alterations are redemonstrated in the neck including thickening of the platysma, infiltration of the subcutaneous and deep fat planes and perhaps some mild infiltration/edema of the lung base.The oral tongue and floor of mouth are free of suspicious masses and pathologic enhancement. Partial effacement of the left piriform sinus is again seen. Otherwise, the aerodigestive mucosa is unremarkable.The patient is status post thyroidectomy. No concerning lesions are seen within the thyroidectomy bed. A few foci of nonspecific soft tissue are evident within or around the thyroid bed, unchanged.No pathologic adenopathy is detected in the neck by size criteria. A left level 2 reference node measures 4 x 4 mm (image 28 series 6), previously 5 x 4 mm.The salivary glands are free of focal lesions. Cervical vessels are patent. Lung apices show no gross abnormalities. No focal concerning osseous lesions are detected. Again seen is a prominent posterior disk-osteophyte complex at C5-6 which results in some degree of spinal stenosis.
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Posttreatment change in the neck with no evidence of recurrent disease or pathologic adenopathy.
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Generate impression based on findings.
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90 with fall at home and blow to headSigns and Symptoms: fall at home with head trauma The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is present in involving part of the right middle and inferior frontal gyri measuring approximately 30 7 x 48 mm in axial dimension. It is unchanged since prior exam from 4/30/13.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. The right eyeball lens is thin. The AP dimension of the left eyeball is long and stable since prior examAtherosclerotic calcifications are present along the distal internal carotid arteries.There is redemonstration of a couple punctate hypodensities in the basal ganglia which are stable
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.3.There is a focus of encephalomalacia in the right middle cerebral artery territory probably related to prior infarction4.punctate lesions in the basal ganglia probably are present old lacunar infarcts.
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Generate impression based on findings.
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64-year-old female with history of floor of the mouth cancer, status post CRT, reevaluate Postoperative changes of the right mandibulectomy, fibular graft reconstruction, and plate and screw fixation. There is been some interval osseous fusion of the mental aspect of the mandible reconstruction. No osseous erosions are present. Interval resolution of the previously identified fluid collection anterior to the fibular graft. There is residual soft tissue thickening anterior to the mandibular reconstruction. The previously identified nodular areas of enhancement along the left lateral margin of the resection cavity are less conspicuous on the current examination.Ill-defined enhancement in the mid to distal tongue is more well defined and solid appearing on the current examination measuring 2.1 x 1.6 cm (series 5 image 44). This finding is suspicious for residual tumor. Additionally, there has been interval development of an avidly enhancing left level Ia submental lymph node which is suspicious for tumor (series 5 image 73). Enhancing soft tissue is present anterior to the hyoid bone in the right submental space (series 5 image 95). There is thickening of the thyrohyoid membrane and asymmetric fullness of the right strap muscles which may be secondary to post therapy changes although tumoral involvement cannot be excluded.The parotid glands are free of focal lesions. The submandibular glands are not well visualized what to the prior. The thyroid gland is free of focal lesions. The major cervical vasculature is patent bilaterally. Mild atherosclerotic plaque in the region of the bilateral carotid bifurcations.Limited intracranial and orbital views are unremarkable. Mucosal thickening with flocculent secretions in the left maxillary sinus suggestive of acute sinusitis. No suspicious osseous lesions are identified.Partially visualized right chest port catheter. Emphysematous disease of the lungs with right apical scarring and more focal right lateral apical scar like opacity, unchanged. Please see dedicated chest CT from today's date for further details.
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1. Solid appearing enhancement in the mid to distal tongue is suspicious for tumor.2. Avidly enhancing left level Ia lymph node is new and suspicious for pathologic adenopathy.3. There is thickening of the thyrohyoid membrane and asymmetric fullness of the right strap muscles which may be secondary to post therapy changes although tumoral involvement cannot be excluded.
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Generate impression based on findings.
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Male, 19 years old, chronic nasal congestion, facial pain and pressure, recurrent sinus infections. History of septoplasty and turbinate reduction. The frontal sinuses are small but well aerated. The frontal ethmoidal recesses are clear. The left sphenoid sinus is larger than the right. The intersphenoid septum deviates towards the right. The sphenoid sinuses are normally aerated and the sphenoethmoidal recesses are clear. The ethmoid air cells are also clear.The maxillary sinuses are free of significant mucosal thickening and debris. The maxillary outflow pathways are patent bilaterally. Infraorbital air cells are seen bilaterally.The nasal septum is intact but is thin anteriorly. The nasal septum deviates significantly towards the left which results in a relative effacement of the left nasal cavity and relative expansion of the right. The turbinates are intact and within normal limits.
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No evidence of active sinus inflammatory disease.
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Generate impression based on findings.
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16-year-old male with hip pain, concern for femoral acetabular impingement. Elongated 1.6-cm maximum transaxial dimension os acetabulum is noted. Contralateral right hip also demonstrates a CAM deformity and smaller os acetabulum.MEASUREMENTS: CAM location : Two o'clock position.Alpha angle : 73 degrees.Coronal center-edge angle : 37 degrees, correcting the image by 3 degrees of rotation.Sagittal center-edge angle : 73 degrees.Femoral neck-shaft angle : 135 degrees.Acetabular version (1 o’clock) : Acetabular version was calculated using zero degrees of correction. These were measured including the os acetabulum. One o'clock acetabular version is -10 degrees.Acetabular version (2 o’clock) : -12 degrees.Acetabular version (3 o’clock) : +13 degreesFemoral version angle (+anteverted, -retroverted) : Positive 10 degrees.McKibbin index : 23 degrees.AIIS width : 1.4 cm. Type 1A.Distal base of AIIS to acetabular rim : 1.3 cm
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CAM deformity and os acetabulum with measurements as above.
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Generate impression based on findings.
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Malignant neoplasm of nasopharynx, unspecified siteRadiotherapy follow-up examinationChemotherapy follow-up examination. Clinical question: h/o HNC, CRT, compare to previous, measurements pls CT neck:There is redemonstration of a destructive mass along the left skull base without where a function of the left sphenoid bone extending into the left carotid canal and extension into the left side of the clivus. This appears stable when compared to the prior exam from 4/15/13.There is associated opacification of the left mastoid air cells and a thickening of the soft tissues of the left nasopharynx and soft palate which is stable since the prior exam Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Previously noted lymph nodes in the posterior triangles and jugular chains are stable in measure under 5 mm short axis diameterWithin the visceral space the thyroid gland appears intact.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with multilevel degenerative changes in the form of endplate osteophytes and uncovertebral osteophytes with normal from encroachment worse at C3-4, C4-5 , C5-6 and C6-7.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are partially opacified and the general appearance of the paranasal sinuses demonstrate some mild clearing along the right and left maxillary sinuses. The right mastoid air cells are clear. There is opacification of the left mastoid air cells The visualized portions of the orbits are intact.
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1.Since the prior examination destructive changes along the left skull base are stable.2.Since the prior examination nasopharyngeal mucosal thickening involving the predominately the left soft palate and left nasopharynx stable. There is associated opacification of the left mastoid air cells suspected to be related to some compromise to the eustachian tube3.No evidence for neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy4.No evidence for brain metastases.
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Generate impression based on findings.
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Abdominal pain. Anastomotic leak status post drainage. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter hypodensities are too small to further characterize. Presumed angiomyolipoma at the upper pole of the left kidney is redemonstrated, unchanged. This meets size threshold for embolization if desired clinically.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality identified..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Decompressed with Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Since the prior examination, there's been interval placement of a trans-gluteal drainage catheter with marked reduction in the perirectal fluid collection. Minimal residual collection persists. If drainage continues from this catheter, consider obtaining a sinogram to determine site of fistula if desired clinically. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Interval drainage of a perirectal fluid collection which has markedly decreased in size.2.Left renal mass likely represents an angiomyolipoma, unchanged. Consider embolization if desired clinically
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Generate impression based on findings.
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Acute desaturation, tachycardia in cancer patient status post mesenteric thrombosis. PULMONARY ARTERIES: Limited quality study due to suboptimal opacification of the central pulmonary vasculature. Additionally, there is significant respiratory motion artifact present, which results in slice misregistration. No filling defects within the main or proximal lobar pulmonary arteries; pulmonary emboli beyond this level cannot be ruled out.LUNGS AND PLEURA: Trace pleural fluid. Dependent atelectasis at the lung bases. Extensive patchy, geographic air space opacities ranging from solid to groundglass in density. Mild intralobular septal thickening is seen in some areas. No pneumothorax.MEDIASTINUM AND HILA: Left subclavian VAD tip in the left brachiocephalic vein. Normal heart size. No pericardial fluid.Numerous nonenlarged mediastinal and hilar lymph nodes, abnormal in multiplicity. Mild right inferior interlobar lymphadenopathy. Mild left hilar lymphadenopathy.CHEST WALL: Sclerotic lesion in the T11 vertebral body is indeterminate, suspicious for metastasis given history of malignancy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. At lease to moderate volume of intra-abdominal fluid. Nasogastric tube tip in the gastric body.
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1. Limited assessment for PE due to motion artifact and sub-optimal contrast opacification of the central pulmonary vasculature. No evidence of pulmonary embolus to the proximal lobar level. PE in the distal lobar, segmental and subsegmental arteries cannot be ruled out.2. Extensive geographic appearing airspace opacities throughout the lungs unchanged compared to recent chest radiographs. Differential diagnosis includes infection (including but not limited to Mycoplasma pneumonia), pulmonary hemorrhage, acute interstitial pneumonia or in the appropriate clinical setting, drug reaction. 3. Mild lymphadenopathy.4. Indeterminate T11 vertebral body sclerotic lesion which could be a metastasis.5. Ascites.
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Generate impression based on findings.
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Facial paralysis, right sided ear and mandible pain. Evaluate for mass. Head: There is no evidence of intracranial mass or abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a large left maxillary sinus retention cyst. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There is no evidence of neck mass or significant lymphadenopathy. The major salivary glands are unremarkable. The temporomandibular joints are intact. The dentition is unremarkable. There are no lytic or blastic lesions. There is prominent ossification of the bilateral stylohyoid ligaments, which can be a normal variant. The airways are patent. The thyroid gland is unremarkable. The major cervical vessels are intact. The imaged portions of the lungs are clear.
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No evidence of neck or intracranial masses. MRI with contrast of this region may be useful for further evaluation.
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