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Generate impression based on findings.
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25 year-old female with history of AML, nasal and facial congestion and increasing drainage and progressing cough. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure shows a small area of hypodensity with minimal peripheral calcification in the right anterior frontal lobe. There are surgical wires at the bilateral coronal sutures. Examination shows bubbly fluids in the frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses. The osteomeatal complexes including infundibuli are opacified. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. Nonunion of the C1 posterior arch.
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Evidence of acute sinusitis.
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Generate impression based on findings.
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Breast cancer CHEST:LUNGS AND PLEURA: Interval decreased volume on the right with suspected post surgical partial resection and volume loss more pronounced in the immediate prior exam in October. The bronchiectasis and architectural distortion in the proximal right middle and right lower lobes has increased with similar position of the two markers observed in the right lower lobe presumably at the site of prior removed nodules.Persistent nodules including two along the major fissure presumably visual nodes appear unchanged, including the 8mm nodule adjacent to the right hilum (image 45 series 5). Of more concern is the reference nodule in the right lower lobe adjacent to the major fissure (image or 5) which is increased in size, currently measuring 1.5 x 1.4 cm from a prior measurement of 1.2 x 1.0 cm. Adjacent thickening of the fissure may represent extension to the pleural surface versus fluid. Overall a moderate effusion and thickening has increased again supporting suspected pleural disease. Of particular note is a small focus of gas anteriorly are present a small pneumothorax, possibly from a prior recent procedure/sampling (image 65 series 5).Left lung remains clearNo significant abnormality noted.MEDIASTINUM AND HILA: The reference high right paratracheal node or nodal mass has increased in size, currently measuring 2.8 x 1.3 cm (image 32 series 3) for a prior measurement of 1.9 x 1.0 cm. The reference left prevascular has also increased in size, currently measuring 1.1 cm from a prior measurement of 0.8 cm (image 30 series 3). The centrally necrotic and peripherally enhancing lesion immediately to the right of the sternum (image 53 series 3) remains immediately and grossly unchanged focally and difficult to measure similarly given differences in gantry angle and positioning. The adjacent anterior fluid collection and pleural nodular thickening however has increased in size and suspicious for progression.CHEST WALL: Chest port unchanged. Right surgical clips and mild asymmetry in the underlying pectoralis musculature. Sclerotic lesion in the right fourth rib again suggests old prior fractureABDOMEN: 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: Stable nonspecific 1 cm peripancreatic nodule (image 97 series 3).RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the aorta and the branchesBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval progression of multiple intra-pulmonary and pleural suspected metastatic lesions and lymphadenopathy, see reference measurements provided
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Generate impression based on findings.
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Female; 90 years old. Reason: eval for intra-abd bleeding s/p surgery History: increasing abd distension, decreasing hgb Examination of the solid organ parenchyma and vascular structures is limited by lack of intravenous contrast.ABDOMEN:LUNG BASES: Minimal bibasilar atelectasis.LIVER, BILIARY TRACT: Massive perihepatic ascites. Cholelithiasis unchanged. No evidence of intra-or extrahepatic ductal dilatation.SPLEEN: Splenic capsule calcifications with hypodense subcapsular areas.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe diffuse atherosclerotic disease of the aorta and iliacs.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of ascites, heterogeneously dense in some areas, with densities that could represent mucin or blood products. Scattered areas of subcutaneous air, likely secondary to recent surgery.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter present within a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Large pelvic mass has been subsequently removed.
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1.Moderate amount of abdominal and pelvic ascites. Differential diagnosis should include hemoperitoneum and mucin spillage.2.Interval removal of large pelvic mass.3.Cholelithiasis.
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Generate impression based on findings.
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Breast cancer CHEST:Clinical informationLUNGS AND PLEURA: Persistent unchanged bilateral and largely apical nonspecific micronodules. No suspicious new abnormalities including new nodules or masses. No effusionsMEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within normal limitsCHEST WALL: Interval right mastectomy with a residual axillary fluid collection and surgical clips. For reference the suspected sterile mild measures 4.6 x 2.1 cm axially (image 25 series 3).Similar focal sclerotic lesions in multiple ribs and vertebral bodies, including T3, T5, T6 and T11.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous multiple hypodensities throughout the liver greater in the right lobe are unchanged. The reference cystic lesion remains 2.4 x 1.9 cm (image 86 series 3).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: Scattered focal sclerotic lesions in L1, L2 and L4, unchangedOTHER: No significant abnormality noted.
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1. Status post right mastectomy with residual postsurgical changes and a suspected seroma. Reference measurements above2. Sclerotic skeletal metastatic disease unchanged.
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Generate impression based on findings.
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Female, 50 years old, unrelenting sinus congestion. The right frontal sinus is undeveloped. The left frontal sinus is small but clear. The left frontoethmoidal recess is clear.There is at most minimal scattered ethmoid mucosal thickening. The ethmoid air cells are however largely clear.The sphenoid sinuses and aerated sphenoid wings are clear. The sphenoethmoidal recesses are somewhat obscured but probably not obstructed.The right maxillary sinus is free of significant mucosal thickening and debris. The right maxillary outflow pathway is patent though the infundibulum may be somewhat narrowed by a large ethmoid bulla. Mild stranding debris is evident within the left maxillary sinus likely representing adherent mucus. The left maxillary sinus is otherwise clear. The left maxillary outflow pathway is patent and unobstructed.The nasal septum is intact and deviates toward the left. This results in a relatively smaller left nasal cavity and larger right nasal cavity. The nasal turbinates are unremarkable.The mastoid air cells and middle ear cavities are well pneumatized.
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Mild strandy mucous is present in the left maxillary sinus. There may be minimal mucosal thickening through the ethmoid air cells. Otherwise, no evidence of significant mucosal inflammatory disease.
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Generate impression based on findings.
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Reason: PE? History: SOB, tachycardia PULMONARY ARTERIES: No evidence of a pulmonary embolus to the segmental level.LUNGS AND PLEURA: Status post left upper lobectomy with volume loss in the left lung. New moderate sized bilateral pleural effusions with underlying atelectasis.Right lower lobe nodule (image 71 series 9) has increased in size from prior exam now measuring 5 mm.Right middle lobe calcified granuloma.MEDIASTINUM AND HILA: Multiple calcified mediastinal and hilar lymph nodes compatible to prior granulomatous disease.Large left cardiophrenic lymph node (image 188 series 7) is increased in size now measuring 18 mm previously measuring 12 mm.CHEST WALL: Status post median sternotomy.Large destructive left into chest wall soft tissue extending into the anterior mediastinum (image 125 series 7) has decreased in size now measuring 3.3 cm x 6.8 cm previously measuring 4.2 cm x 8.2 cm). UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Suggestion of a large central hepatic mass that is only partially visualized and is incompletely evaluated. Hypodensity peripherally in the right lobe of the liver also suspicious for hepatic metastasis. Interval increase in size of a left perinephric nodule most likely metastatic (image to 45 series 7).
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1.No evidence of a pulmonary embolus to the segmental level.2.New moderate size bilateral pleural effusions3.Minimal reduction in size of the large left anterior wall destructive mass.4.New right lower lobe pulmonary nodule suspicious of metastatic disease.5.Hepatic hypodensities suggestive of metastatic disease. Recommend dedicated CT of the liver.6.Interval increase in size of a nodule in the left perinephric retroperitoneum most likely metastatic in origin.
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Generate impression based on findings.
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Clinical question: Cyst in the fourth ventricle causing obstructive hydrocephalus. Preoperative planning. Signs and symptoms: Headache and papilledema. Surgical planning unenhanced head CT:Examination is performed while a stereotactic surgical guidance device in place.The fourth ventricle remains within normal size and in midline.Images through supratentorial space demonstrate previously known obstructing hydrocephalus similar to prior study. No evidence of midline shift. There is no detectable calvarial abnormalities.Examination is performed for surgical planning and is not a diagnostic test.
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Surgical planning nonenhanced head CT demonstrate obstructive supratentorial hydrocephalus without change since prior studies.
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Generate impression based on findings.
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Breast cancer, follow-up metastatic mediastinal lesions CHEST:LUNGS AND PLEURA: Stable right over left apical volume loss with bronchiectasis and scarring. The appearance remains nonspecific with multiple scattered small micronodules, unchanged. No new findings to suggest intrapulmonary metastatic disease or new acute abnormality. No effusions.MEDIASTINUM AND HILA: Mild interval increase in size of the mediastinal lymphadenopathy. The reference node currently measures 1.6 cm in short axis from a prior measurement of 1.4 cm (image 43 series 4). This mild interval change is otherwise observed are multiple additional lymph nodes.The cardiac and pericardium are within limits other than mild coronary calcifications.Small hiatal herniaCHEST WALL: Focal unchanged small left breast focal fluid collection with surgical clips and/or markers measuring under 2 cm (161 series 4) 43 series 4). Old healing right rib fractureABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: A suspected new lytic lesion is observed in the medial right iliac with associated cortical breakthrough laterally. No discrete soft tissue associated mass. Prior imaging does not include this region, so comparison in change in size cannot be determined. Specifically no lesion is observed on prior bone scan of 5/1/13.OTHER: No significant abnormality noted.
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Interval increasing mediastinal lymphadenopathy and suspected recurrence of breast metastatic disease. Although the interval immediate change is not reversed to studies and imaging from 5/1/13 lymph nodes demonstrate interval increase in size since September. Questionable new iliac lytic osseous lesion and metastatic disease. Please see detail provided
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Generate impression based on findings.
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68-year-old male. SOB, cough. LUNGS AND PLEURA: Subpleural reticulation, traction bronchiectasis, and honeycombing more prominent at the lung bases is compatible with UIP pattern with etiologies including idiopathic and mixed connective tissue disease. No suspicious pulmonary nodules or masses. No groundglass opacities. Diaphragmatic pleural calcifications are noted.MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes which is commonly seen in UIP. Moderate calcified atherosclerotic disease of thoracic aorta. Severe coronary artery calcifications. Mildly prominent main pulmonary artery at 31 mm suggestive of pulmonary artery hypertension.CHEST WALL: Degenerative disk disease of thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. 1 cm exophytic hyperdense lesion arising from interpolar region of right kidney is incompletely characterized. Geographic hypoattenuation in the hepatic dome is most likely focal fatty infiltration (series 3, image 78).
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1. Findings consistent with UIP which may be idiopathic in origin or secondary to other etiologies including connective tissue disease.2. Findings suggestive of pulmonary artery hypertension.
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Generate impression based on findings.
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Female; 55 years old. Reason: rectal cancer History: rectal cancer s/p combined neoadjuvant chemo/RT CHEST:LUNGS AND PLEURA: Two distinct nodules were identified. A 6-mm nodule in the periphery of the right lower lobe adjacent to the major fissure best seen on image 44 of series 4. A second nodule in the left lower lobe is best seen on image 57 of series 4 and measures 6 mm. Scattered micronodules bilaterally are nonspecific. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No evidence of intra-or extrahepatic ductal dilatation. No evidence of cholelithiasis, color wall thickening, or pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvises.RETROPERITONEUM, LYMPH NODES: Retrocrural lymph node as seen on image 64 of series 3 measures 2.6 x 1.2 cm. No evidence of retroperitoneal lymphadenopathy.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: The bladder is moderately distended and unremarkable.LYMPH NODES: Scattered pelvic mesenteric lymphadenopathy with reference node best seen on image 146 of series 3 measuring 1.6 x 1.2 cm.BOWEL, MESENTERY: Heterogeneously enhancing soft tissue mass with indistinct margins arising from the sigmoid colon abutting the uterus measures 2.7 x 5.9 cm and is best seen on image 157 of series 3. There is partial obstruction of the bowel in this segment.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Heterogeneously enhancing soft tissue mass involving the sigmoid colon and uterus with scattered pelvic and retrocrural lymphadenopathy.2.Subcentimeter bilateral pulmonary nodules. Close follow up is recommended.
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Generate impression based on findings.
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HNC, CRT. CHEST:LUNGS AND PLEURA: No pleural fluid. Interval clearing of bronchiolitis seen previously with new groundglass opacity in the right middle lobe abutting the fissure, consistent with mild aspiration pneumonitis. Scattered pulmonary micronodules measuring up to 5-mm unchanged. Right lower lobe nodule (5/73) has a location and appearance most consistent with an enlarged intrapulmonary lymph node; this has been unchanged compared 11/2012, favoring a benign lesion.MEDIASTINUM AND HILA: Several upper normal to mildly enlarged mediastinal lymph nodes in the left anterior mediastinum measuring up to 11-mm (3/40) previously measuring up to 10-mm and minimally larger when comparing back to 11/20/12 at 7-mm. Previously seen mild esophageal thickening has resolved. Aberrant right subclavian artery compresses the esophagus at the level of the arch and could cause cause dysphagia lusoria. Chest port tip at the SVC/RA junction.CHEST WALL: Right chest port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Chronic thickening of the gallbladder wall most likely adenomyomatosis; this may be confirmed with abdominal ultrasound.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating cortical renal lesions are too small to accurately characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Distal abdominal fusiform aortic aneurysm measuring 4.3-cm in AP dimension (3/152), occurring over a roughly 4-cm length. Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Anterior facet joint fusion bilaterally with sclerosis on the both sides of the sacroiliac joint space bilaterally, suspicious for inflammatory arthritis. Severe sacral facet degeneration and osteophyte formation on the left. Bilateral enthesopathy of the anterolateral iliac wings.OTHER: No significant abnormality noted.
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1. No conclusive signs of pulmonary metastases.2. Mildly prominent lymph nodes in the left anterior mediastinum nonspecific at this time but should continue to be monitored on subsequent exams.3. Sacroiliac joint sclerosis and anterior facet joint effusion suspicious for inflammatory arthritis.4. Fusiform abdominal aortic aneurysm.5. Cholelithiasis with chronic thickening of the gallbladder wall most likely due to adenomyomatosis.
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Generate impression based on findings.
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Female, 66 years old, history of breast cancer metastatic to the bones. Assess disease status. Cervical:No significant interval change is seen in the conformation or size of a mixed lytic and sclerotic lesion affecting the C6 vertebral body, left transverse process, left pedicle and interarticular zone. Loss of height of the left aspect of the vertebral body is unchanged. The left pars interarticularis remains collapsed. As before, the left transverse foramen is encompassed by lesional bone, but does not seem to be stenosed. The left C5-6 neural foramen remains narrowed. Mild posterior vertebral body expansion is again seen causing minimal bony canal encroachment. No new cervical spine lesions are suspected. Scattered small nonspecific lucencies elsewhere are unchanged.Lumbar:No significant interval change is seen in the conformation or size of an expansile lytic lesion involving the right L5 vertebral body, transverse process, pedicle and pars interarticularis. Collapse of the pars interarticularis is unchanged. Loss of vertebral body height at the right lateral aspect is also unchanged. The bony right L5-S1 neural foramen is significantly narrowed secondary to bony destructive change. The soft tissue component of the tumor continues to encroach slightly upon the more lateral aspect of the canal where it seems to contact the exiting L5 nerve root. This appearance is unchanged.Elsewhere, mirror image lucent foci with sclerotic margins affecting the articulating surfaces of the L3 and L4 spinous processes are not significantly changed. No new suspicious osseous lesions are detected. Disk bulge and prominent facet arthropathy are redemonstrated at L4-5. Small nonspecific renal lesions are redemonstrated bilaterally.
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1. No significant interval change in the appearance of metastatic lesions involving the C6 and L5 vertebrae. Associated bony collapse and foraminal compromise are also unchanged.2. Scattered nonspecific lucent areas involving the cervical spine and the lumbar spinous processes as above are also unchanged.3. No new lesions are detected.
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Generate impression based on findings.
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Clinical question: evaluate for CVA. Signs and symptoms: unresponsive nursing home. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates extensive periventricular and subcortical low attenuation white matter which considering the stated age of 83 likely representing age indeterminate small vessel ischemic strokes. Mild prominence of cortical sulci and ventricular system is noted. Midline is maintained. Calvarium and soft tissues of the scalp as well as visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.
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1.Extensive age indeterminate small vessel ischemic strokes.2.No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.
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Generate impression based on findings.
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Fevers and hypoxia. Unresolved pneumonia question secondary process. LUNGS AND PLEURA: Small pleural fluid collections, right greater than left. The previously seen omental measuring up to 6-mm (5/22). Linear subsegmental atelectasis right lower lobe. Compressive atelectasis at the lung bases. Scattered calcified micronodules consistent with granulomas. The patient probably has a partially incomplete major fissure on the left.MEDIASTINUM AND HILA: Hypoattenuating and hyperattenuating lesions in the thyroid gland bilaterally nonspecific by CT; please note that CT cannot differentiate between benign and non-benign appearing pathology.Atherosclerotic disease of the thoracic aorta. There appears to be mild esophageal stasis just above the level of the left main bronchus where the esophagus could be focally compressed along the thoracic spine. Small pericardial fluid collection. Main pulmonary artery enlarged measuring 37-mm in transverse dimension, consistent with pulmonary arterial hypertension. Moderate coronary artery calcifications. Calcifications involving the aortic valve noted.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Mild intrahepatic biliary ductal dilatation. Renal cystic lesions incompletely included in the scanning range. Atherosclerotic calcification of the abdominal aorta including the ostium of the renal arteries and SMA. Visualized portion of the pancreas appears atrophic.
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1. Improving right upper lobe pulmonary opacities and bronchial wall thickening consistent with resolving pneumonia. Small pleural fluid collections.2. Main pulmonary artery is enlarged compatible with pulmonary arterial hypertension.3. Apparent mid-esophageal stasis may be anatomic in etiology due to compression of the esophagus between the the spinal column and left main bronchus. This could potentially place the patient at increased risk for aspiration. Suggest esophagogram for further evaluation. 4. Severe atherosclerotic disease including calcification of the aortic valve; aortic valve stenosis cannot be excluded. Further evaluation may be made with echocardiogram if clinically warranted.5. Thyroid gland lesions are nonspecific by CT and may be further assessed with nuclear scintigraphy and/or ultrasound.
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Generate impression based on findings.
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Male 62 years old; Reason: 61 year old man with mantle cell NHL s/p autologous stem cell transplant in 2011. Compare to prior scans. History: none CHEST:LUNGS AND PLEURA: The lungs remain clear. The pleural spaces remain clear. The central airways remain patent.MEDIASTINUM AND HILA: Reference mediastinal lymph node measures 0.6 x 0.5 cm (image 36/series 3), unchangedCHEST WALL: Small right axillary node measures 0.6 x 0.4 cm (image 27/series 3), unchangedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydronephrosis in either kidney. Probable right renal cortical cyst near its lower pole, unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis. No surrounding inflammatory changes. Small bowel is normal in caliber and course.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right obturator lymph node measures 2.0 x 0.7 cm (image 179/series 3), unchangedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine. Sclerotic changes in the right ilium, unchanged.OTHER: No significant abnormality noted
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Stable exam. No recurrent lymphadenopathy. Measurements are given above.
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Generate impression based on findings.
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Malignant neoplasm of unspecified part of the peritoneum. (Mesothelioma) LUNGS AND PLEURA: Small left pleural fluid collection persists. Multiple small nodules along the left minor fissure measuring from 1 to 4-mm in size; though difficult to identify on the prior examination these may have been present previously but were difficult to visualize due to motion. Multiple bilateral pulmonary nodules and micronodules bilaterally, largest lesion in the right lower lobe measures 7-mm (9/77), unchanged. Some of the nodules are calcified and although smaller previously can be faintly seen on the study 8/7/13.In the anterior left costophrenic angle (please refer to 0.9-mm thin section), there are two foci of questionable pleural nodularity seen on series 5 images 259 and 267. The remainder of the appearance in the costophrenic angle regions most likely can be attributed to compressive atelectasis and subdiaphragmatic disease.MEDIASTINUM AND HILA: Right chest port tip at the SVC/RA junction. Normal heart size. No pericardial fluid or significant lymphadenopathy.CHEST WALL: Right chest port. Stable punctate sclerotic focus at the head of the right 12th ribUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. CT abdomen will be reported separately. Ascites and peritoneal thickening noted. Numerous hypoattenuating hepatic lesions.
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Persistent small left pleural fluid collection with very small and questionable foci of pleural nodularity in the anterior costophrenic angle. Small pulmonary and left pleural nodules appear unchanged compared to the most recent previous examination. Occult metastases cannot be excluded. Abdominal findings will be reported separately.
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Generate impression based on findings.
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Male 54 years old. Reason: mesothelioma, s/p 4 cycles of immunotherapy needing repeat CT scan for confirmation of response. Please evaluate and compare with previous scans using same target lesions. ABDOMEN:LUNG BASES AND PLEURA: No significant abnormality notedLIVER, BILIARY TRACT: Numerous hypodense lesions in the liver appear stable. Reference lesion in the right lobe measures 1.2 cm (axial series, image 28). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense cystic renal lesions are stable. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate ascites and diffuse peritoneal thickening, consistent with history peritoneal mesothelioma, has increased from prior study. No measurable lesion is identified. For reference, the peritoneal thickness increased at the level of the calcification near the umbilicus and measures 2.5 cm.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: Status post sigmoidectomy. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Increased diffuse peritoneal thickening and ascites.2.Hypodense liver lesions are stable.3.Bilateral cystic renal lesions are stable.
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Generate impression based on findings.
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53-year-old with headache and intracranial hemorrhage. EXTERNAL DEVICES:When compared to the prior exam, there has been interval placement of an intracranial pressure bolt over through the right frontal bone. Patient is intubated.BRAIN PARENCHYMA:Centered within the right basal ganglia, and extending into the right superior temporal gyrus, is a very large hematoma with mixed internal density. Other smaller right frontal and right temporal lobe hematomas are identified that are similar in size to the prior exam. Surrounding edema is more conspicuous than on the prior exam.VENTRICLES/CSF SPACES:Hemorrhage is identified layering within within the atria, and occipital horns of the lateral ventricles. Compared to the prior exam, extent of hemorrhage within the third and fourth ventricle has improved. The fourth ventricle appears patent. Surrounding the hemorrhage there is prominent surrounding vasogenic edema and sulcal effacement with a right to left midline shift of 1.7 cm. Stable from the prior exam there is stable previously identified subfalcine, tentorial, and uncal herniation and cerebellar tonsils are above foramen magnum.BONE:No fractures. Visualized bony structures are normal.
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Mixed density large hemorrhage centered within the right basal ganglia and extending into the right superior temporal gyrus. Small right frontal and right temporal lobe hematomas are identified that are similar in size the prior exam.Extensive vasogenic edema and sulcal effacement result in a persistent right to left midline shift of 1.7 cm.Stable subfalcine, tentorial and uncal herniation.Interval placement of an intracranial pressure bolt within the right frontal bone.
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Generate impression based on findings.
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54 year old male. Reason: evaluate for renal cancer recurrence. History: hx of renal cell ca, thyroid ca. 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: Status post right partial nephrectomy at the superior and inferior poles since 4/17/2013 outside exam. Enlarged right midpole cyst since the prior exam, now measures 2.2 x 2.5 cm at image 49, series 4. Radiodense 3.4 cm diameter left upper pole cyst. 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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Status post right partial nephrectomy with expected postop changes. Interval enlargement of the right midpole dorsal cyst now measuring 2.5 cm in greatest dimension, increased from 1.7 cm and the 4/17/2013 examination. Left kidney has scarring and cysts, stable since 4/17/2013. No local recurrence at the operative sites. No lymphadenopathy.
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Generate impression based on findings.
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Male, 59 years old, history of left neck cancer, s/p chemotherapy and radiotherapy. Findings compatible with left neck dissection are again seen including scarring/infiltration through the fascial planes and a relatively small left sternocleidomastoid muscle. Additional treatment related changes include generalized infiltration of the fat planes as well as mucosal edema affecting the glottis and supraglottic larynx. There is a thin retropharyngeal effusion. These findings are mildly more prominent than on the prior exam.In the background of these treatment related changes, no discrete mucosal lesions are identified. No pathologic adenopathy is detected by size criteria.The salivary glands and thyroid are free of focal lesions. The cervical vessels are patent allowing for atherosclerotic disease at the carotid bifurcations. Scarring is seen in the lung apices similar to prior. Nodular soft tissue in the prevascular space is better assessed on the separately dictated chest CT. Aberrant right subclavian artery noted incidentally. No worrisome osseous lesions are seen.
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1. No evidence of recurrent disease in the neck. 2. Treatment related changes in the neck are slightly more prominent.3. Nodular soft tissue in the mediastinal prevascular space is better assessed on the separately dictated chest CT.
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Generate impression based on findings.
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Microscopic hematuria. Hydronephrosis. 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: A few hyperdense foci are noted bilaterally which may represent tiny stones. There is no hydronephrosis of either kidney. Hypodense nodules bilaterally likely represent cysts but some are too small to characterize. The visualized portions of both ureters are within normal limits.RETROPERITONEUM, LYMPH NODES: Subcentimeter shotty lymph nodes noted retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild dilatation of the proximal right hypogastric and left hypogastric arteries may be atherosclerotic in origin but is nonspecific.
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No definite findings to explain microscopic hematuria. No evidence of hydronephrosis.
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Generate impression based on findings.
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Female, 54 years old. Reason: history of ovarian cancer, currently receiving treatment. eval for progression and response using measurements if applicable. Please compare with previous. CHEST:LUNGS AND PLEURA: Index right lower lobe mass series 5 image 64 measures 3 x 2 cm. No new nodules.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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Postsurgical changes. No pathologic size lymph nodes. Status post retroperitoneal node dissection. BOWEL, MESENTERY: Status post omentectomy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent. Previously measured possible soft tissue abutting the left aspect of the vaginal cuff, series 3 image 166 measures 1 x 1.5 cm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable examination. No new sites of disease.
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Generate impression based on findings.
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Reason: Re-staging scans s/p 8 cycles of investigational systemic immunotherapy. Please compare to outside scans dated Aug2013 History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Coronary artery stents are unchanged. Hiatal hernia.CHEST WALL: Right chest port.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: Enhancing soft tissue lesion along the distal right ureter (series 3, image 139) is unchanged. Left hydronephrosis unchanged. Right hydronephrosis and hydroureter is slightly more severe compared to prior.RETROPERITONEUM, LYMPH NODES: Unchanged left paraaortic lymph node measures 0.9 x 0.6 cm (series 3, image 116). Atherosclerosis of the abdominal aorta and its branches. BOWEL, MESENTERY: Postoperative changes of ileal conduit.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy. Neobladder appears stable.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. Enhancing soft tissue lesion along the distal right ureter described in detail previously is unchanged. Right hydronephrosis and hydroureter are slightly worse compared to prior2. Stable left paraaortic lymph node.
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Generate impression based on findings.
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Female 44 years old; Reason: kidney donor History: kidney donrs ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild periportal edema. No focal mass detected.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney measures 6.3 x 10.2 x 5 cm.. The left kidney measures 5.8 x 10.5 x 4.8 cm. There are two renal arteries on the right. Single renal artery on the left. No enhancing mass identified.There are single renal veins, the left being pre-aortic. The left is early branching. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Conventional Celiac artery anatomy noted.BOWEL, MESENTERY: Patient status post gastric bypass surgery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus..BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Patient status post gastric bypass surgery.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Single left renal artery and two right renal arteries. Single renal veins. Single collecting systems with no masses or filling defects noted. A right ureterocele is suggested.
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Generate impression based on findings.
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Adenocarcinoma in the right upper lobe. Follow-up LUNGS AND PLEURA: Postsurgical right upper lobectomy without evidence of interval change or recurrence. Focal right lower lobe thickening and/or subpleural nodule remains 13 mm in short axis (image 74 series 5). Scattered micronodules also unchanged. No suspicious new abnormalities or effusions.MEDIASTINUM AND HILA: No lymphadenopathyModerate aortic calcifications and mild coronary calcifications unchanged. The cardiac and pericardium are otherwise within limitsCHEST WALL: Right breast punctate calcification similar in appearance mediallyUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips
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Stable pulmonary appearance and probable scarring without distinct new findings to suggest recurrent disease. Reference measurements provided
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Generate impression based on findings.
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Female, 96 years old, with recent falls and high INR. Evaluate for intracranial bleeding. Moderately extensive periventricular hypodensity is seen, a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease.No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss. The basilar cisterns are patent. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bones of the calvarium and skull base are intact.
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1. Moderately advanced age indeterminate microvascular disease.2. No acute intracranial hemorrhage or other posttraumatic sequelae.
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Generate impression based on findings.
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History of ulcerative colitis, status post ileostomy takedown , increased white cell count 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: Left lower pole stone without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy. Postsurgical Jay's in the abdomen. No evidence of bowel obstruction. Small amount of ascites.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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Postsurgical changes in the abdomen. No evidence of abscess or collection. Left lower pole stone.
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Generate impression based on findings.
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Small cell lung cancer, follow-up CHEST:LUNGS AND PLEURA: Left paramediastinal opacities, bronchiectasis and architectural distortion again compatible with radiation fibrotic change. No superimposed new abnormalities an interval resolution of the previously described large and moderate left or right pleural effusions. Only minimal residual left pleural thickening and/or fluid is currently observed.Of concern is a somewhat spiculated peripheral focal nodule or mass (image 39 series 4) associated with irregular pleural thickening along the anterior left hemithorax. This focal finding measures 2.2 x 1.5 cm and previously approximate 1.6 x 1.0 cm.Interval partial reexpansion of the underlying left lung with residual streaky patchy densities suggesting atelectasis and/or scarring. No discrete focal additional nodular or masslike abnormalities. Interval resolution of the multiple small micronodules seen in the left lower lung base peripherally and the reference right basilar nodular abnormality along the medial aspect. This larger right basilar lesion currently measures less than 5 mm, previously over 13 mm; again most likely these lesions collectively are postinflammatory..MEDIASTINUM AND HILA: No discrete lymphadenopathy. Mild leftward shift of the mediastinum. Postoperative CABG with coronary artery and aortic calcifications.Small hiatal herniaCHEST WALL: Median sternotomy wires. Scattered nonspecific punctate tell stations throughout both breastsABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy. Previously described hyper density is not currently appreciatedSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable mildly nodular left adrenal gland unchangedKIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changesBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes scattered throughout the descending thoracic and lumbar spinesOTHER: No significant abnormality noted.
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Questionable left upper lobe mass with associated dural thickening somewhat concerning for recurrence given patient history. PET imaging may be helpful.
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Generate impression based on findings.
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Postsurgical hypothyroidism. Crest syndrome. Former smoker. Pulmonary hypertension. LUNGS AND PLEURA: Right upper lobe nodule posteriorly inseparable from the major fissure measures 4 x 6 mm, previously 4 x 5 mm. Irregularity at the lung its medial border appears new when compared to the previous exam. Comparing back to 4/29/10 exam thin sections and nodule previously measured 5 x 8 mm; differences in measurement may be the result of scan variability.Predominantly solid nodule at the same level in the right upper lobe situated more laterally in the posterior segment measures 8 x 10 mm, previously 8 x 12 mm, slightly smaller. This is stable to slightly smaller compared to 4/29/10.Suture line from prior wedge resection of the right. Subpleural nodular opacity in the right lower lobe laterally has largely resolved, now linear and scarlike in appearance (5/173).6-mm ground glass density nodule at the left apex is unchanged compared to exams last year but may be minimally larger when comparing back to 12/2011 (4/14). This could be an area of atypical adenomatous hyperplasia but should be monitored yearly. Mosaic attenuation of the lung parenchyma is suspicious for chronic thromboembolic disease in the setting of severe pulmonary hypertension.MEDIASTINUM AND HILA: Surgical clips from interval thyroidectomy at the level of the thoracic inlet. Enhancing left paratracheal soft tissue nodule measures 8 x 11 mm, likely residual thyroid. On the right there is soft tissue isoattenuating to the adjacent musculature which could represent residual thyroid tissue containing an internal nodule.Enlargement of the central pulmonary vasculature consistent with pulmonary hypertension. Large circumferential pericardial fluid collection again noted. Severe multichamber cardiomegaly. Coronary artery calcifications. Right jugular catheter tip at the SVC/RA junction.Variant arterial anatomy with a duplicated right sided dominant aortic arch. Mildly enlarged mediastinal lymph nodes are not significantly changed.CHEST WALL: Right jugular central venous catheter.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Mild intrahepatic biliary ductal dilatation and enlarged portal vein. Splenomegaly.
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1. Right upper lobe posterior segment nodule inseparable from the nature fissure not conclusively changed allowing for differences in scan variability.2. The second nodule seen more laterally the posterior segment of the right upper lobe is stable to slightly smaller compared to prior examinations.3. Stable subcentimeter groundglass density nodule in the left apex, favor atypical adenomatous hyperplasia; yearly screening CT recommended given history of smoking.4. Signs of portal hypertension.5. Severe pulmonary hypertension with large pericardial fluid collection and findings suspicious for chronic thromboembolic disease.6. Double aortic arch which is right sided dominant and forms a vascular ring around the trachea and esophagus, variant anatomy.7. Soft tissue in the thyroid bed incompletely assessed by CT.
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Generate impression based on findings.
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Male, 75 years old, history of retromolar trigone cancer status post CRT. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. No suspicious soft tissue masses or pathologic enhancement is seen at any point along the aerodigestive mucosa. This includes the region of the retromolar trigones.No pathologic adenopathy is detected in the neck by size criteria. The left parotid gland is atrophic, a stable finding. The remaining salivary glands are unremarkable. The thyroid is free of focal lesions. Cervical vessels remain patent. Mild reticulation persists in the lung apices. No concerning osseous lesions are detected. Redemonstrated is fairly advanced degenerative disease in the cervical spine.
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1. No evidence of disease recurrence in the neck.2. No intracranial metastatic disease.
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Generate impression based on findings.
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Reason: hx of RMT Ca, s/p CRt, eval for dz, compare to previous History: as above CHEST:LUNGS AND PLEURA: Elevation of the right hemidiaphragm and volume loss in the right lung compatible with history of a previous right upper lobectomy.Right middle lobe nodule unchanged (image 56 series 5) measuring 5 mm. . Additional micronodules stable.No new suspicious nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Degenerative changes within the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable small hepatic hypodensities most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable bilateral adrenal nodules. Right adrenal nodule (image 98 series 3) measures 3.1 cm x 2.2 cm previously measuring the same. Left adrenal nodule measures 24 mm x 18 mm previously measuring the same. These are unchanged since 2008.KIDNEYS, URETERS: Nonobstructing left renal calculus. Stable left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable aneurysm of the infrarenal aorta measuring 4.3 cm.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Marked levoscoliosis of the lumbar spine with subsequent marked degenerative changes.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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13-year-old male with Crohn's disease/celiac disease, evaluate for stricture and/or structural abnormality ABDOMEN:LUNG BASES: Central line with the tip at the superior cavoatrial junction. Mild atelectasis at bilateral bases.LIVER, BILIARY TRACT: Distended gallbladder with thin normal. No radiopaque calculus. Liver enhancement is normal. No focal liver lesions.SPLEEN: No significant abnormality noted. The spleen measures 11.3 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nasogastric tube with tip in the gastric body. The duodenojejunal junction is normally positioned. There is a segment of bowel wall thickening in the proximal jejunum. The appendix is not visualized. The terminal ileum could not be evaluated due to underdistention with oral contrast despite a two hour delay after administration.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free peritoneal fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Small segment of the jejunal bowel wall thickening.2.Distal TI was not visualized due to lack of oral contrast despite a two hour delay after administration of contrast.
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Generate impression based on findings.
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71-year-old female. History of smoking, COPD, CHF, chronic descending aortic dissection and large nodule consistent with cancer in 2012. CHEST:LUNGS AND PLEURA: Moderate bilateral pleural effusions, right greater than left. Bibasilar atelectasis/consolidation, left greater than right. Very mild upper lobe centrilobular emphysema. 8 mm spiculated solid nodule in the right upper lobe was previously ground-glass in attenuation and has progressively increased in size from 11/2006 (measured 6 mm in 2012, 3 mm in 2006). This is highly suspicious for a primary lung malignancy.Previously seen 17 mm semisolid nodule in the right lower lobe and 7-mm right middle lobe nodule are not visualized and likely obscured by the pleural effusion. Other scattered micronodules, some of which are calcified, are not significantly changed. MEDIASTINUM AND HILA: Noncontrast exam is not diagnostic in evaluating the patient's known T4-T7 dsecending thoracic aorta dissection. The caliber of the aorta at the site of dissection is 36 mm in maximal transverse dimension (series 80256, image 27) similar to prior exam. Diffuse atherosclerotic calcification of the abdominal aorta. Moderate coronary artery calcifications. Interval increase in cardiomegaly. Small pericardial effusion new from prior exam. Hypodense lesions in the thyroid are reidentified. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis and gallbladder wall thickening suggestive of chronic cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Anterior left adrenal nodule is not well seen on this noncontrast exam.KIDNEYS, URETERS: Hyperdense exophytic lesions arising from upper pole of left kidney, not significantly changed from 2006 and likely hemorrhagic/proteinaceous cysts. Additional hypodense lesions in kidneys are unchanged, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe calcified atherosclerotic disease of abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Bone abnormalities in the right anterior iliac crest and posterior ileum are unchanged, likely benign.OTHER: Moderate amount of ascites.
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1. 8 mm right upper lobe spiculated nodule has progressively increased in size and solid component, highly suspicious for a primary lung malignancy.2. Bilateral pleural effusions and basilar atelectasis/consolidation, likely obscures the previously seen 17 mm right lower lobe and 7 mm right middle lobe nodules. Continued follow-up imaging recommended. 3. Given lack of IV contrast, this is a nondiagnostic examination for assessing patient's known descending thoracic aortic dissection. The maximal caliber of the aorta at the site of dissection is not significantly changed. Contrasted enhanced imaging follow-up recommended upon improvement of patient's renal function.4. Cardiomegaly with small pericardial effusion, increased from prior exam. 5. Cholelithiasis with edematous gallbladder wall thickening suggestive of chronic cholecystitis.
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Generate impression based on findings.
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Mesothelioma status post-pleurectomy and decortication. CHEST:LUNGS AND PLEURA: Volume loss in and pleural thickening/fluid on the right consistent with provided history of mesothelioma. Postsurgical changes including diaphragmatic mesh noted. Left lower lobe micronodules has resolved, presumably post inflammatory. Dense scare a scarlike area of parenchymal thickening in the posterior aspects of the right lower lobe appears minimally improved, likely reduction and internal fluid. Reference measurements on the right as follows:1. Level of the aortic arch (3/28): Anteriorly loculated pleural fluid collection not significantly changed with very mild pleural thickening. Measurements at 3 o'clock and 6 o'clock positions remain 0 mm.2. Level of the main pulmonary artery (3/41): Small volume of anteriorly loculated fluid and adjacent minimal pleural thickening unchanged. 4 o'clock position 0 mm 6 o'clock position 0 mm, unchanged. 3. Level of the aortic root (3/55): Four o'clock position 13 mm, previously 21-mm. 6 o'clock position unchanged at 0 mm.Scattered non-index areas of nodular, enhancing pleural thickening on the right not conclusively changed.MEDIASTINUM AND HILA: Right-sided aortic arch with aberrant left subclavian artery. There coronary artery calcifications. Right brachiocephalic vein is severely narrowed between the clavicular head and ascending right-sided aorta.Enhancing soft tissue nodule in the prevertebral fat at the level of T2 unchanged. Small enhancing mediastinal lymph nodes unchanged.CHEST WALL: Scattered left low cervical lymph nodes unchanged. Chronic fluid collection surrounding the head of the right clavicle and extending into the anterior mediastinum unchanged, most likely inflammatory.Subtle areas of intercostal enhancement enhancing nodules in the right chest wall soft tissues , most prominent on series 3 image 105, suspicious for early chest wall disease. Increased collateral vasculature in the right chest wall.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: Left adrenal gland measures 15 x 20 5 mm, unchanged. Additional areas of nodularity unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification at the aorta and its branches. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: High density material within the umbilicus of unclear etiology, correlate with physical exam.OTHER: No significant abnormality noted.
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Right hemithorax mesothelioma with no significant change in index level measurements. Subtle areas of enhancement and nodularity in the intercostal spaces are suspicious for early chest wall disease.
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Generate impression based on findings.
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60 year-old male with history of metastatic prostate cancer. Assess for disease progression. CHEST:LUNGS AND PLEURA: Note is made of left sided pleural thickening along the posteromedial aspect of the left lower lobe. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Sclerotic metastases involving the sixth right rib are again seen. Left scapular and thoracic vertebral body sclerotic metastatic disease is also again seen. There is interval development of sclerotic metastases involving the posterior aspect of the right second rib and lateral aspect of the right third rib as well as within multiple mid and lower thoracic vertebral bodies.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastases in the lower thoracic and lumber vertebral bodies are again seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Again seen are multiple sclerotic metastasis affecting the pelvis. There is interval development of new sclerotic lesions in the iliac bones bilaterally and interval enlargement of sclerotic lesions in the right femur. OTHER: Reference left pelvic fluid collection measures 5.5 x 3 .5 cm, previously 5.4 x 3.7 cm, likely representing lymphocele or seroma. Penile prosthesis and reservoir, are incompletely visualized.
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1. Interval increase in size and number of numerous sclerotic metastases affecting the axial and proximal appendicular skeleton.2. Stable pelvic lymphocele.
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Generate impression based on findings.
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Male; 53 years old. Reason: mets lung cancer, s/p chemo, now with PD, pls c/w previous study and evaluate dz status. History: lung ca Absence of intravenous contrast enhancement limits evaluation of solid organ parenchyma and vascular structures.CHEST:LUNGS AND PLEURA: Centrilobular and paraseptal emphysema in the apices. Interval increase in size of left perihilar mass, best seen on image 33 of series 3 measuring 5.4 cm in width, previously 4.9 cm. Distal to the mass there is an area of consolidation which likely represents atelectasis.MEDIASTINUM AND HILA: Reference left perihilar lymph node seen on image 48 of series 3 has minimally increased in size measuring 1.3 x 2.2 cm, previously 1.4 x 1.8 cm. Right pretracheal lymph node, best seen on image 33 of series 3, has increased in size now measuring 1.3 x 1.0 cm, previously 1.1 x 0.6 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No evidence of suspicious hepatic lesions. No intra-or extrahepatic ductal dilatation. The gallbladder is moderately distended. No evidence of cholelithiasis, pericholecystic fluid, or gallbladder wall thickening.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No suspicious lesions identified.KIDNEYS, URETERS: No suspicious lesions identified. No evidence of hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Enlarged lymph node adjacent to the right common iliac artery as seen on image 163 of series 3 measures 1.3 x 1.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small mesenteric fat containing left inguinal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prostatic calcifications are present.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Interval increase in size of left suprahilar mass and mediastinal/hilar lymph nodes. 2.Scattered small intra-abdominal lymphadenopathy.
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Generate impression based on findings.
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76-year-old male. Cough. Evaluate change in lung nodules and left lower lobe consolidation. History of COPD and MAI, waxing and waning pulmonary nodules. LUNGS AND PLEURA: Severe diffuse centrilobular emphysema. Scarring in the right upper lobe the surgical staples.Flat right upper lobe nodule measures 8 x 9 mm in cross-section, unchanged (series 4, image 38). Interval resolution of previously seen left lower lobe partial atelectasis/consolidation. Left lower lobe bronchial wall thickening and scattered mucus plugging is decreased from prior exam. Extensive mucus impaction in the right bronchus intermedius as well as right middle and lower lobe segmental bronchi, similar to prior exam.MEDIASTINUM AND HILA: Moderate coronary artery calcifications and severe thoracic aorta calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small left Bochdalek hernia. Cholecystectomy clips.
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1. Stable right upper lobe nodule. No new nodules identified.2. Interval improvement in left lower lobe atelectasis/consolidation.3. Extensive mucus impaction in right bronchus intermedius and right middle as well as lower lobe segmental bronchi, similar to prior exam.
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Generate impression based on findings.
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55 year old male with history of head and neck squamous cell carcinoma, compared to previous. Reference nodule, lateral to the right sternocleidomastoid measures 10 x 7 mm (series 6 image 37), unchanged. Right level lymph node now measures 7 x 5 mm (series 6 image 36) unchanged. No new cervical lymphadenopathy. Posttreatment changes are again noted in the right neck with subcutaneous thickening and reticulation.The airway appears patent. The thyroid gland is unremarkable. The visualized lung apices are clear. The carotid arteries are patent. The right internal jugular vein is partially occluded appearing similar to prior study. The left jugular vein is patent. The cervical spine is unremarkable, with no suspicious osseous lesions. The visualized intracranial contents are unremarkable without mass, mass effect, midline shift, or abnormal enhancement. Minimal bilateral maxillary sinus disease is noted.
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Stable reference nodes in the right neck. No evidence of recurrent disease.
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Generate impression based on findings.
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Reason: 55 y/o male with hx of SCC of Skin s/p CRT please r-eval and compare to prior scans History: as above CHEST:LUNGS AND PLEURA: Postsurgical changes are identified in the right lower lobe related to resection of previously identified pulmonary nodules.No new pulmonary nodules identified.No evidence of a pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Mild coronary artery calcifications.CHEST WALL: Stable expansile lytic lesion in the lower sternum.Healing fracture deformity in the right seventh rib related to recent wedge resection.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable small hypoattenuating lesions most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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: No significant abnormality noted.OTHER: No significant abnormality noted.
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Interval right lower lobe wedge resection for metastatic nodules. No new metastatic foci identified.
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Generate impression based on findings.
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Lung cancer status post lower lobectomy. LUNGS AND PLEURA: Postsurgical volume loss from left lower lobectomy. No pneumothorax or pleural fluid. Patchy air space opacities in the right costophrenic angle region with adjacent micronodules are most likely postinflammatory. There is also tree in bud pattern in the dependent aspect of the remaining left lung consistent with bronchiolitis, likely from aspiration. Scattered areas of endobronchial debris are identified. Severe emphysema. Micronodular lesion in the right upper lobe abutting the fissure (5/37) also most likely post inflammatory.Anterior pleural thickening and a small volume of loculated fluid (3/29) as well as and pleural thickening in the left costophrenic angle and may reflect postprocedural scarring given the degree of fluid in the left thorax on previous study but is nonspecific.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. No significant lymphadenopathy.CHEST WALL: Left internal mammary chain lymphadenopathy is mild and unchanged compared to the most recent previous examination. Punctate sclerotic foci in the sternal body present previously.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcifications of the aorta and superior mesenteric artery.
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1. Bronchiolitis and air space opacities in the dependent aspects of the lungs is most likely the result of prior aspiration. Unable to exclude early infection on the right.2. Mild left pleural thickening could be post inflammatory from pleurectomy3. Left internal mammary chain lymphadenopathy was present on the outside pre-operative study with a subtle increase in size of the lymph nodes since 3/30/13. Although with the interval increase could be reactive in nature due to surgery, the pre-existing lymphadenopathy is indeterminate in etiology.4. Residual pleural thickening and loculated fluid on the left could potentially be the result of prior surgery however should continue to be followed to exclude worsening.
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Generate impression based on findings.
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78-year-old male. Reason: Hx minimally invasive bladder cancer with new RUL nodule - adeno. Met vs new primary. History: Asymptomatic LUNGS AND PLEURA: A solid, spiculated mass in the right upper lobe has increased in size measuring 1.4 x 1.0 cm (image 45, series #5), from previously 1.0 x 0.7 cm. Two micronodules in the right upper and lower lobe are unchanged (images 49 and 158, series #4).Paraseptal and centrilobular emphysema. No pleural effusions.MEDIASTINUM AND HILA: Scattered nonenlarged mediastinal lymph nodes are noted. No evidence of hilar or mediastinal lymphadenopathy. Cardiac size is normal without evidence of pericardial effusion. Stents within the left circumflex artery and possible stent in the right coronary artery. CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. A segment 6 hypodense liver lesion in the right lobe measures 1.8 x 1.4 cm (image 89, series #3) and is unchanged in size and appearance from prior exam, with characteristics compatible with a hemangioma. Several other bilobar subcentimeter hypodensities in the liver are too small to further characterize.Stable bilateral renal hypodensities, compatible with cysts.
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Interval growth of right upper lobe spiculated mass, concerning for primary lung malignancy.
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Generate impression based on findings.
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58 year-old female. Cough. Bilateral lower lobe nodules. History of breast cancer. LUNGS AND PLEURA: Previously seen 19 mm nodule has resolved, and was most likely post-infectious/inflammatory. 5 mm left lower lobe nodule is unchanged at 5 mm (series 6, image 49). The remainder of the nodules are unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy within limitations of noncontrast exam. Aortic root and coronary artery calcifications.CHEST WALL: Left breast skin retraction and thickening.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Interval resolution of right lower lobe nodule, and was most likely post-infectious/inflammatory. Remainder of pulmonary nodules are unchanged.
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Generate impression based on findings.
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80 years old female with history of paraganglioma, status post chemo/RT. Post surgical change is redemonstrated status post right mastoidectomy, stable. Postsurgical change is also noted in the right neck with soft tissue volume loss and effacement of the fat planes. Enhancing soft tissue centered within the right jugular foramen is re-demonstrated. This tissue expands the jugular fossa with surrounding lytic bony change. A focal deficiency of the right mastoid bone is present along the external auditory canal, which appears unchanged. Soft tissue in the external auditory canal may reflect an extension of enhancing tumor or postsurgical granulation tissue. Enhancing tissue also extends medially into the right hypoglossal canal which is mildly expanded. Enhancing tissue extends anteriorly and inferiorly along the jugular vein. When compared to the prior exam, there has been no significant interval change in the size or morphology of this tumor.No definite pathologic adenopathy is identified in the neck. A borderline enlarged level Ia lymph node is seen, measuring 1.1 x 0.8 cm, which is unchanged. The mucosal tissues of the aerodigestive tract are free of focal lesions. Again noted is asymmetric effacement of the left piriform sinus, stable. The parotid glands are free of focal lesions. The right submandibular gland is small or absent. Multiple hypodense thyroid nodules are stable. Significant atherosclerotic calcification is present at the aortic arch and carotid bifurcations, a stable finding. The cervical vessels are otherwise patent. Both ICAs take a retropharyngeal course. Micro-nodules in the lung apex are unchanged. No suspicious bony lesions are seen. Osteoporosis.
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Stable enhancing mass centered in the right jugular foramen with stable associated bony expansion/lysis. No adenopathy in the neck.
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Generate impression based on findings.
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Shortness of breath post inflammatory pulmonary fibrosis. Unspecified diffuse connective tissue disease. Worsening PFTs. LUNGS AND PLEURA: Background of diffuse very mild groundglass opacity superimposed upon emphysema. Patchy peribronchial distribution groundglass opacity slightly more dense than the background disease is seen throughout the lungs but most pronounced in the lung bases: Distribution of these abnormalities is unchanged compared to the prior examination however the development of mild honeycombing is new.. Air trapping consistent with small airways disease. Mild paraseptal emphysema. Within the anterior lungs, subpleural reticulation and the suggestion of very early honeycombing is noted bilaterally, a feature which can be seen in rheumatoid lung disease.Suture line from biopsy left lower lobe. Areas of linear scarring noted bilaterally unchanged. Lung volumes appear unchanged.MEDIASTINUM AND HILA: Mildly enlarged mediastinal and right hilar lymph nodes are probably unchanged.Enlargement of the main pulmonary artery consistent with pulmonary arterial hypertension. Normal heart size.Patulous thoracic esophagus containing internal fluid and debris, suggestive of scleroderma.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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Minimal progression of interstitial fibrosis compared to the 2010 examination with development of very mild subpleural reticulation and honeycombing in pre-existing areas of disease. Distribution of these abnormalities can be seen with rheumatoid lung disease. Mild air trapping is indicative of a small airways disease. Patulous thoracic esophagus again noted, which can be a feature of scleroderma. Mild thoracic lymphadenopathy is not appreciably changed allowing for unenhanced technique. Enlargement of the central pulmonary vasculature compatible with pulmonary arterial hypertension.
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Generate impression based on findings.
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84-year-old female. Evaluate pharyngeal mass extension. LUNGS AND PLEURA: Numerous bilateral pulmonary nodules ranging from a few millimeters to 9 mm in the right upper lobe (image 95, series #5). Right lower lobe pulmonary cyst. No pleural effusions.MEDIASTINUM AND HILA: A partially imaged large, heterogeneously enhancing mass arising from the left thyroid lobe and isthmus with maximal axial dimensions measuring 8.1 x 4.9 cm (image 8, series #4). Mass extends inferiorly to the level of the aortic arch in the anterior mediastinum. Significant displacement of adjacent vasculature and rightward tracheal deviation. Significant associated compression of the right internal jugular and innominate veins with development of right anterior chest wall collaterals. Prominence of the azygos vein is also noted.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hepatic hypodensity is too small to characterize.Small splenic hypodensities of uncertain etiology.Small left renal cyst. Other bilateral subcentimeter renal hypodensities are too small to characterize.
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1.Large mass arising from the left thyroid lobe with compression of the adjacent vasculature as well as shift and compression of the trachea.2.Numerous bilateral or nodules suspicious for metastatic disease.
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Generate impression based on findings.
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Paraganglioma (glomus jugulare and multicentric paraganglioma in lung) in 2005 status post chemo and RT. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules and micronodules ranging from solid to groundglass and density similar in number compared to the previous examination. Index nodule in the right middle lobe measures 21 x 21 mm, previously 21 x 17 mm. Remainder of the pulmonary nodules are not significantly changed.MEDIASTINUM AND HILA: Atherosclerotic calcification of the great vessels and aorta. Multi-nodular thyroid gland, nonspecific by CT. Right paratracheal lymph node 8mm, previously 7-mm. Main pulmonary artery enlarged consistent with pulmonary arterial hypertension. Severe multichamber cardiomegaly. Moderate volume of pericardial fluid along the right heart border adjacent to the dominant pulmonary nodule. Calcified subcarinal lymph nodes.CHEST WALL: Severe scoliosis. Osteopenia with numerous lytic/lucent lesions throughout similar to previous. Healed fracture deformity left 11th rib. Facet degeneration at the lower cervical spine is incompletely included with this scanning range but appears to narrow the spinal canal, please refer to separately reported neck CT.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild perihepatic ascites. Scattered calcifications. Focal hypoattenuating lesion at the hepatic dome (3/76-77) unchanged in sizeSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Subcentimeter left adrenal gland nodule (3/94) poorly seen but not conclusively changed.KIDNEYS, URETERS: Hypoattenuating cortical lesions suggestive of cysts as well as a view hyperattenuating lesions which may be hemorrhagic or proteinaceous cysts on the left, incompletely characterized.PANCREAS: Pancreas is atrophic. Focal hypoattenuating lesion in the pancreatic tail unchanged and may be a small IPMN.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the aorta and its branches including the renal arteries and superior mesenteric artery.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Focal sclerotic lesion along the superior endplate of L2 vertebral body unchanged compared to 2012 but more sclerotic compared to 2010 where it had an appearance more typical of a degenerative lesion. Severe scoliosis.OTHER: Mild ascites.
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Multiple pulmonary lesions unchanged in number with reference measurements detailed of the body of the report. Hepatic and skeletal lesions are also unchanged.
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Generate impression based on findings.
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44 year old female. Reason: pt with hx of colon cancer s/p Hyperthermic Intraperitoneal Chemotherapy (HIPEC), needs post op imaging. CHEST:LUNGS AND PLEURA: Right pleural effusion and right lower lobe collapse have resolved. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right sided venous access device is in the expected position. ABDOMEN:LIVER, BILIARY TRACT: 1 cm diameter hepatic hypodensity adjacent to the right portal vein is unchanged since 4/22/2013, most likely a cyst. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate ascites has resolved. Status post omentectomy. PELVIS:UTERUS, ADNEXA: Anteverted uterus. Multiloculated cystic pelvic mass has been removed since 4/22/2013. Possible 3.1 cm diameter cystic pelvic mass at image 173 of series 3 may be residual or recurrent disease. Transvaginal ultrasound examination or MRI may be helpful for further evaluation. 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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Cystic nodular mass(es) in the pelvis up to 3.1 cm diameter may be better evaluated with transvaginal ultrasound or MRI. Large multiloculated cystic pelvic mass is absent. Probable hepatic cyst. Ascites and right pleural effusion have resolved.
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Generate impression based on findings.
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41 year-old female with head congestion. The orbits are unremarkable. The right mastoid is partially opacified, and the left is clear. Limited view of the intracranial structure is unremarkable. There is mild mucosal thickening in the bilateral maxillary sinus with mild narrowing of the infundibuli. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, and sphenoid sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates are normal except for concha bullosa of the right middle turbinate. There is mild leftward nasal septal deviation. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Mild maxillary sinus inflammatory disease.
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Generate impression based on findings.
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Female; 56 years old. Reason: r/o abscess, liver lesions, hematoma History: fever CHEST:LUNGS AND PLEURA: Moderate-sized right pleural effusion with associated atelectasis.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy.CHEST WALL: Right chest port with tip at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Small subcapsular fluid collection on the anterolateral aspect of the liver. Large heterogeneously enhancing lesion with punctate gas bubbles in the right posterior hepatic lobe measuring 2.3 x 4.5 cm likely represents hepatic abscess. Additionally, there is a loculated fluid collection in the right paracolic gutter measuring 3.2 x 1.9 cm extending caudally from the inferior aspect of 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: No significant abnormality noted.BOWEL, MESENTERY: Small mesenteric fluid collection inferior to the proximal transverse colon best seen on image 121 of series 3 measures approximately 3.4 x 1.3 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bilateral inguinal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Large heterogeneously enhancing lesion with punctate gas bubbles in the right posterior hepatic lobe likely represents hepatic abscess. Additionally, a moderate sized subcapsular fluid collection is noted in the anterolateral aspect of the liver.2.Small mesenteric fluid collection inferior to the proximal transverse colon. Given the presence of these small collections, peritoneal carcinomatosis cannot be entirely excluded.3.Persistent right pleural effusion.
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Generate impression based on findings.
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56-year-old woman with history of metastatic chordoma presents with cough. Follow-up examination.Right lower lobe wedge resection April 2011: Metastatic chordoma CHEST:LUNGS AND PLEURA: Reference right upper lobe pulmonary nodule measures 1.0 x 0 .7 cm, previously 0.7 cm x 0.6 cm (series 5 image 41). Right middle lobe micronodule along the fissure (series 5 image 60) is stable. Postsurgical change from right lower lobe wedge resection again noted.MEDIASTINUM AND HILA: Right paramediastinal surgical clips. Heterogeneous subcarinal lymph node inseparable from the thoracic esophagus measures 2.6 x 2 .3 cm, previously 2.6 cm x 2.5 cm (series 3 image 45). Small retrocrural lymph nodes are stable. Normal heart size.CHEST WALL: No significant abnormality noted.ABDOMEN: 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: Subcentimeter hypodensity in the proximal pancreatic body (series 3 image 113) is stable since July 2011.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph node (series 3 image 103) measures 1.3 x 1 .1 cm, previously 1.2 cm x 0.9 cm cm. BOWEL, MESENTERY: No significant abnormalityBONES, SOFT TISSUES: Unchanged thickening along the rectus sheath. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormalityBONES, SOFT TISSUES: Stable postsurgical changes. Note is made of grade 1 to 2 anterolisthesis of L4 on L5. OTHER: No significant abnormality noted.
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Persistent subcarinal and porta hepatis lymphadenopathy with slight interval increase in size of the reference right upper lobe pulmonary nodule, suspicious for metastatic disease.
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Generate impression based on findings.
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56-year-old male presenting with diarrhea and weight loss ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric folds are slightly thickened, nonspecific. Small bowel loops are unremarkable. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.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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Thickened gastric folds particularly in the fundus. Further evaluation with upper endoscopy may be helpful. Small bowel loops are unremarkable.
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Generate impression based on findings.
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malignant neoplasm of the head face and neck There is infiltration of the fat planes of the right neck associated with thickening of the platysma muscle and pharyngeal mucosal tissues. The right valecula is obliterated. The epiglottis remains thick. There is no convincing evidence for local recurrence.The tongue base appears stable.The right jugulodigastric node measures 10x8mm axial dimensions whereas in June it measured 14x10mm. Similarly the abnormal lymph nodes seen last December in the right neck remain small and stable in size.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.Within the visceral space the thyroid gland appears intact with multiple hypodense nodules.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. There is a scleral band and thin eyeball lens on the left eye. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact and have reduced in size.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 worse at C5-6 where there are end plate and uncovertebral osteophytes with neural foraminal encroachment. There is also neural foraminal encroachment at C6-7 due to uncovertebral osteophytes. These findings are stable since the prior exams.
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1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.The thyroid gland appears stable with multiple hypodense nodules which are nonspecific on CT imaging.3.Degenerative changes in the cervical spine are stable
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Generate impression based on findings.
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45-year-old male with history of Hodgkin's lymphoma status post 2 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe previously is no longer visualized. Interval resolution of the previously described small left pleural effusion.MEDIASTINUM AND HILA: The reference conglomerate anterior mediastinal adenopathy measures 14.1 x 11.4 cm, previously 16.2 x 14.3 cm (image 35; series 401). Extensive adenopathy extends throughout the mediastinum.CHEST WALL: Subtle nonspecific sclerosis affecting the L1 vertebral body as well as multiple upper thoracic vertebral bodies (most pronounced at the levels of T2-T4), appearing similar to the prior study.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver, stable.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: Subtle nonspecific sclerosis affecting the L1 vertebral body as well as multiple upper thoracic vertebral bodies, appearing similar to the prior study.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subtle sclerosis affecting the L1 vertebral body as well as multiple upper thoracic vertebral bodies, appearing similar to the prior study.OTHER: No significant abnormality noted
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Interval decrease in the size of the reference conglomerate anterior mediastinal adenopathy. Stable nonspecific sclerosis in both lumbar and upper thoracic vertebral bodies. Fatty infiltration of the liver.
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Generate impression based on findings.
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68 year old male with a history of waldenstrom macroglobulinemia. Pre stem cell transplant. CHEST:LUNGS AND PLEURA: Note is made of elevation of the left hemidiaphragm. There is left basilar scarring/atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left jugular catheter tip terminates at the junction of the SVC and right atrium.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe of the liver is too small to characterize, but likely represents a simple cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensity in the interpolar region of the left kidney is too small to characterize but likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No acute process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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55-year-old male with history of bladder neoplasm CHEST:LUNGS AND PLEURA: Right apical fibrosis. Scattered bilateral micronodules. Index nodule measures 3 mm in the right middle lobe on image number 53, series number 5.MEDIASTINUM AND HILA: Ectatic ascending aorta measuring 4.1-cm image number 52, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 0.7 x 2.1 cm right adrenal mass is unchanged.KIDNEYS, URETERS: Mild right-sided and moderate left-sided hydronephrosis, again noted. A small, ill-defined hypodense lesion in the upper pole of the right kidney measures 1 cm image number 95, series number 3. This lesion is not significantly changed from previous study, however, a small renal cell carcinoma cannot be excluded. Follow-up imaging is recommended for further evaluation.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal nodes are again noted and are slightly larger compared to previous study. An index left para-aortic node measures 1.4 by 1 cm on image number 117, series number 3. Previously this was measuring 6-mm in diameter image number .7, series number 5.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mid small bowel loops are distended measuring up to 3.5-cm. Distal small bowel loops are decompressed. These findings likely represent a distal small bowel obstruction.BONES, SOFT TISSUES: Interval development of a ill-defined soft tissue mass invading the left-sided sacrum measuring 5.2 by 5.3-cm image number 175, series number 3.There are also new pelvic bilateral soft tissue density masses. An index lesion on the left measures 3.1 x 2.3 cm image number 190, series number 3.Ill-defined left retroperitoneal mass anterior to the left iliac is muscle measuring 2.3 x 2.1 cm image number 170, series number 3.OTHER: No significant abnormality noted
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Interval development of a large pelvic soft tissue mass destroying the sacrum. Additional intrapelvic and left retroperitoneal masses are also noted.Interval increase in the size of the retroperitoneal lymph nodes.Left upper pole renal lesion. Renal cell carcinoma cannot exclude. Scattered bilateral small micronodules.CT findings suggestive of distal small bowel obstruction.These findings were discussed with and acknowledged by nurse practitioner Nisha Kumar at the time of dictation.
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Generate impression based on findings.
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Respiratory failure, assess right lung field. Artificial heart. LUNGS AND PLEURA: A right-sided chest tube is present the lung base terminating posteriorly. Centrilobular and paraseptal emphysema, but no pneumothorax.Moderate volume of pleural fluid on the right which may be partially loculated the lung apex. Small left pleural fluid collection extends into the fissure.Extensive consolidation throughout the right lung with minimal uninvolved lung and its non-dependent aspects. Compressive atelectasis left lung base. Left basal chest tube directed posteriorly. Mild septal thickening and scattered centrilobular distribution groundglass nodules in the left upper lobe.MEDIASTINUM AND HILA: Nasogastric tube is present. An endotracheal tube terminates approximately 5 cm above the level of the carina.Biventricular artificial heart. Metallic valves cause significant artifact along the caudal aspect of the mediastinum, chest wall and lung bases. A moderate to large volume of fluid surrounds the artificial heart within the neo-pericardium extending cranially to the level of the aortic and pulmonary anastomoses. The neo-pericardium appears mildly thickened on the left anteriorly (series 5 image 47 for example), correlate with surgical history. The suprahepatic IVC anastomosis is also surrounded by small amount of fluid. The pneumatic drive lines are incompletely included within the scanning range. Presumed felt buttresses in the region of the atrial cuffs noted.CHEST WALL: Sternotomy wires and plates/screw devices appear intact. There is a pre-sternal AICD present; the visualized portion of the lead appears intact. A left lateral chest wall pulse generator is present.Right upper extremity PICC terminates in the right brachiocephalic vein just above its juncture with the left brachiocephalic vein. A right jugular catheter terminates along the lateral aspect of the superior vena cava or adjacent soft tissue, correlate for blood return. There appears to be a vascular shunt device in the subcutaneous tissues of the left upper chest wall, correlate with surgical history.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. At least moderate volume of upper abdominal ascites is noted.
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1. Extensive consolidation throughout the right lung presumably represents a pneumonia. There is an associated moderate volume of pleural fluid on the right which appears partially loculated near the apex.2. Groundglass opacities and centrilobular nodules in the left upper lobe are also most likely infectious however the differential diagnosis also includes hypersensitivity reaction; this is considered less likely as it does not appear to be bilateral.3. Mild nonspecific thickening of the anterosuperior left neo-pericardium should be correlated with surgical history.4. Right jugular catheter terminates more laterally than expected; correlate for blood return to exclude extravascular placement.5. Moderate ascites.
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Generate impression based on findings.
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36-year-old male. Fever, cough. Evaluate for cause of fever. LUNGS AND PLEURA: Interval resolution of previously seen right lower lobe groundglass opacity. No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: Venous catheter tip at the cavoatrial junction. Scattered small subcentimeter lymph nodes. Small amount of residual thymic tissue in the anterior mediastinum.Trace pericardial fluid, unchanged.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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Interval resolution of previously seen right lower lobe groundglass opacity. No new findings.
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Generate impression based on findings.
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Female; 56 years old. Reason: LLQ, evaluate for cause. Creatinine ordered today History: same ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hypoattenuating lesions with peripheral nodular enhancement are identified in the liver. The largest of these lesions is located in the hepatic dome, best seen on image 17 of series 3, and is stable in size measuring 2.3 x 2.2 cm, previously 2.2 x 2.2 cm. These lesions likely represent stable hemangiomas.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of nephrolithiasis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber. No evidence of obstruction, pneumatosis, or pneumoperitoneum. The appendix is well visualized and unremarkable.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 radiographic evidence to explain the patient's left lower quadrant pain.2.Multiple hepatic hemangiomas
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Generate impression based on findings.
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80 year-old female. Assess etiology of left supraclavicular lymph node, sore throat, spitting up mucus. LUNGS AND PLEURA: Mild apical paraseptal emphysema. 7 mm right upper lobe subpleural pulmonary nodule (series 4, image 51) is unchanged dating back to 2007, most likely benign. Additional scattered nodules are unchanged since 2007 and also benign. No focal airspace consolidation or pleural effusion. Mild bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Moderate coronary calcifications. No mediastinal or hilar lymphadenopathy within limitations of noncontrast study. CHEST WALL: Limited visualization of the left supraclavicular region does not demonstrate lymphadenopathy, refer to same day CT neck report for a more detailed evaluation of this area.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Stable hepatic cysts, which are incompletely visualized.
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No specific findings to account for patient's symptoms. Limited visualization of the left supraclavicular region demonstrates no lymphadenopathy, see same day CT soft tissue neck for a more detailed evaluation of this area.
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Generate impression based on findings.
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58 years old Female. Reason: neuro rec, follow up History: s/p arrest Image quality degraded by motion artifact. Since prior examination, the sulci, particularly in the right temporoparietal regions are less conspicuous. This in combination with subtle low-attenuation in the same region is consistent with edema. Also present is transtentorial herniation on the right (series 4 image 15), which is more conspicuous than prior. The gray-white differentiation is preserved. No midline shift is present. Posterior fossa is not well evaluated secondary to motion artifact. Equivocal subtle decreased attenuation of the cerebellum, raises possibility of edema.Air-fluid levels within the maxillary sinuses and ethmoid air cells.
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Progression of cerebral edema, most pronounced in the right tempoparietal region, now with transtentorial herniation on the right.
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Generate impression based on findings.
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Metastatic breast cancer on treatment CHEST:LUNGS AND PLEURA: Mild diffuse septal thickening. Small pleural fluid collections, left greater than right. Nodularity of the fissures consistent with pleural metastases. Scattered micronodules, about the same.MEDIASTINUM AND HILA: Right paratracheal diverticulum no significant mediastinal or hilar lymphadenopathy. Right chest port tip low in the right atrium. No pericardial fluid.CHEST WALL: Right chest port. The postsurgical change of mastectomy a possible left with axillary dissection clip. New skeletal metastases in the spine, right scapula and left humeral head.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic lesions are consistent with metastases and new compared to the previous examination. Future reference, the largest lesion in the left hepatic lobe measures 1.8-cm in diameter (axial series image 94). Right hepatic lobe cyst unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule 2 x 1.8 cm (image 89), previously 2 x 2 cm.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Hypoattenuation in in the tail of the pancreas unchanged since 2012, nonspecific.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.The partially calcified mesenteric mass inseparable from small bowel measures 1.9 x 2.1 cm, previously 1.9 x 2.1 cm (image 124).BONES, SOFT TISSUES: Skeletal metastases in the lumbar spine and pelvis.OTHER: No significant abnormality noted.
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Interval progression of metastatic disease with new skeletal and hepatic metastases, pleural metastases and indeterminate septal thickening which could reflect lymphangitic spread of metastatic disease.
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Generate impression based on findings.
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71 year-old female with AML, neutropenic, fever. Rule out infiltrate. LUNGS AND PLEURA: Scattered nodular and ground glass opacities in the right middle lobe are decreased. Interval development of left lower lobe groundglass opacities with areas of frank consolidation (image 75 of series #5) is compatible with pneumonia.MEDIASTINUM AND HILA: Right-sided central venous catheter tip at the cavoatrial junction. Normal heart size with no pericardial effusion. Mild atherosclerotic calcification of the thoracic aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Nodular appearance of the kidneys bilaterally is incompletely assessed.
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New left lower lobe consolidation is compatible with pneumonia. Interval decrease in previously noted nonspecific right middle lobe opacities.Solid nodular appearance of the cranial aspect of the right kidney. Recommend renal ultrasound for more complete evaluation to exclude neoplasm versus complex cystic lesion.Findings and recommendations relayed via text paging system to the referring physician at the time of this dictation. (PNR). An additional reminder e-mail was sent to Dr. King on 12/20/13.
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Generate impression based on findings.
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Clinical question: CVA? Signs and symptoms: One week of slurred speech and unsteady gait. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are few small foci of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres which considering patient's stated age likely representing minimal age indeterminate small vessel ischemic strokes.In addition there is a focus of low-attenuation in the left basal ganglia with suggestion of subtle mass effect which may represent a recent acute to subacute lacunar infarct. Recommend follow up with MRI exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and this is at the spaces otherwise.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.
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1.Mild age indeterminate small was ischemic strokes. Consider MRI if concern for acute stroke is high.2.Unremarkable exam otherwise.
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Generate impression based on findings.
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Clinical question: Loss of consciousness status post battery. Signs and symptoms: Facial swelling and loss of consciousness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium.Small right parietal subgaleal hemorrhage and edema. Unremarkable soft tissues of the scalp otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
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No acute intracranial process. Small right parietal subgaleal edema/hemorrhage.
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Generate impression based on findings.
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Clinical question: LVAD c/b intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage interval head CT. Unenhanced head CT:Examination demonstrate a large hemorrhagic right PCA territory ischemic stroke involving right posterior temporal -- occipital region. Combination of edema from stroke as well as hemorrhage results in significant mass effect on the adjacent cortical sulci and in the trigone of right lateral ventricle which is deviated anteriorly and superiorly. There is resultant midline shift of approximately 9 mm at the level of the septum pellucidum. The left lateral ventricle remains within normal size and without evidence of hydrocephalus.A hemorrhagic component of stroke measures approximately 63 x 30mm in size. There are no immediate prior exams for comparison.Minimal age indeterminate small vessel ischemic stroke is again noted.Expanded subarachnoid space along the posterior medial aspect of right cerebellar remains similar to prior study and suspected all chronic right cerebellar ischemic stroke.Unremarkable calvarium and soft tissues of the scalp.Images through the orbits demonstrate a chronic blowout fracture of left lamina papyracea without change since prior exam. Unremarkable images through the orbits otherwise. Unremarkable paranasal sinuses and mastoid air cells.
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1.Ischemic hemorrhagic stroke in the right posterior temporal -- occipital region with internal large focus of hemorrhage measuring at 30 x 63 mm size and with resultant 9-mm leftward midline shift.2.Minimal age indeterminate small muscle ischemic strokes and a chronic right cerebellar ischemic or stroke remains very similar to prior study from 2012.3.Images through the orbits demonstrate a chronic blowout fracture of left lamina papyracea stable since prior study.
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Generate impression based on findings.
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Clinical question: Intracranial hemorrhage. Signs and symptoms: Left-sided weakness. Nonenhanced head CT:Acute hematoma in the right basal ganglia/thalamus is again identified. It measures approximately 23 x 13-mm in its transaxial dimensions. Which is only minutely larger than prior study (22 x 11) however this could be slice positioning.Minimal blood in the third ventricle and in the right lateral ventricle with interval decrease since prior study.Revisualization of acute right frontal subdural hematoma measuring at approximately 8.2 mm maximum thickness compared to prior study measurement of 8.8-mm. dilated supratentorial ventricular system and residual air within the right frontal horn shows no significant change.Previously noted a small amount of blood in the dependent portion of the left occipital horn demonstrate minimal interval increase which is likely secondary to precipitation neither new hemorrhage. Interval resolution of minute amount of blood in the right occipital horn since prior exam.
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1.Minute interval increased size of right frontal subdural collection from prior measurements of 8.2 mm thickness to 8.8-mm.2.right basal ganglia -- thalamic hematoma measuring at 22 x 13 compared to prior study measurement of 22 x 11. This minute interval change good be result of slice positioning rather than true increased size.3.Stable enlarged supratentorial ventricular system and right frontal horn postoperative air.
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Generate impression based on findings.
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66 year old female with chest pain and dyspnea and lung abnormality seen on previous CT examination. Follow-up examination. CHEST:LUNGS AND PLEURA: Reference subpleural nodule in the anterior aspect of the left upper lobe measures 4 mm, previously 4 mm (30; series 10).Again seen is a groundglass nodule in the right upper lobe, measuring 17 mm, previously 17 mm (image 17; series 10). Differential considerations include atypical adenomatous hyperplasia and adenocarcinoma in situ. Again seen are several scattered ground glass nodules in the right upper lobe, appearing similar to the prior study.Minimal centrilobular emphysema with an upper lobe predominance. Calcified granuloma in the right lung base, unchanged. Right basilar scarring/atelectasis.MEDIASTINUM AND HILA: Again seen is an enlarged thyroid gland, right lobe greater than left. Multiple nodules are identified in the thyroid gland, appearing similar to the prior study. There is a calcified nodule in the isthmus of the thyroid, unchanged in appearance. Calcified mediastinal lymph nodes suggestive of prior granulomatous disease.CHEST WALL: Status post left mastectomy with left axillary lymph node dissection. No evidence of lymphadenopathy. Again seen is calcification within the right breast. Correlation with recent mammography is recommended. Again seen are small sclerotic foci in the ribs, appearing similar to the prior study. An additional sclerotic focus in the T10 vertebral body also appears unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Again seen are multiple subcentimeter hypodensities in the liver, which are too small to characterize, but likely represent simple cysts. There is no pathologic enhancement on postcontrast sequences.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Again seen is a low-attenuation right adrenal gland nodule measuring less than 10 Hounsfield units, consistent with a benign adrenal adenoma.KIDNEYS, URETERS: Note is made of subcentimeter hypodensities in the kidneys, which are too small to characterize, but likely represent simple cysts. Note is made of a exophytic simple cyst along the inferior left kidney, 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: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Persistent groundglass nodules with the largest measuring 17 mm in the right upper lobe which is suspicious for adenocarcinoma in situ. Differential considerations include atypical adenomatous hyperplasia, although atypical infection cannot be completely excluded and clinical correlation is indicated.2. Lipid rich right sided adrenal adenoma.3. Subcentimeter hypodensities in the liver, likely represent simple cysts. No pathologic enhancement is identified within the liver, as clinically questioned.
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Generate impression based on findings.
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24 year old female. Reason: evaluate pulmonary stenosis, s/p left PA stent angioplasty in 2005; also evaluate possible partial anomalous pulmonary venous connection. History: SOB Height: 60 inWeight: 225 lbsBSA: 2 m^2BMI: 46 kg/m^2Cardiac Morphology:Left Ventricle:EDV: 86 ml The left ventricle is normal in size, shape, wall thickness, and volume. Right Ventricle:EDV: 113 ml The right ventricle is normal in size, shape, wall thickness, and volume. Left Atrium: The left atrial volume minus the pulmonary veins is 65cc, within normal limits. The left atrial diameter is 35 mm. There are four distinct pulmonary veins. Three of the pulmonary veins drain normally into the left atrium. The right superior pulmonary vein drains anomalously into the superior vena cava near its junction with the right atrium, creating a left to right shunt. Pulmonary Vein Measurements:RSPV: 22 x 15 mmRIPV: 13 x 10 mmLSPV: 13 x 10 mmLIPV: 13 x 8 mmRight Atrium: The right atrial volume is within normal limits. The right atrium is structurally normal. Cardiac Veins: The coronary sinus is normal.Cardiac Valves: There are no aortic calcifications. There is no mitral annular calcification.Great Vessels: Aorta: The aortic arch is right sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 28 mm Ascending: 21 mm Sinotubular Junction: 21 mm Descending: 19 mmPulmonary Artery: There is a metallic stent in the left pulmonary artery, near its origin. There is post-stenotic dilation of the left PA. Main PA: 26 mmRight PA: 24 mmLeft PA stent: 12 mm Distal Left PA (post-stent): 22 mmVena Cavae: The right SVC is normal in size and without structural abnormality. There is a persistent left SVC. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary Artery Anatomy:This examination was performed to focus on extracardiac structures, rather than coronary artery anatomy. Limited evaluation of the coronaries was done. 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 is no significant plaque in the left main.LAD: The LAD has no significant abnormality on this limited examination. LCx: The left circumflex artery has no significant abnormality on this limited examination. RCA: The RCA arises normally from the right sinus of valsalva. EXTRACARDIAC CHEST
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1. Left PA stent is 12 mm diameter, compared with right PA 24 mm diameter. Post-stenotic dilation of the left PA is 22 mm in diameter. 2. Anomalous right superior pulmonary vein drains into the superior vena cava near the junction with the right atrium. 3. No significant coronary artery disease on this limited examination. Right sided aortic arch. Persistent left superior vena cava.
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Generate impression based on findings.
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13-year-old male with Crohn's disease/celiac disease, evaluate for stricture or SBO ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality noted. Central line catheter tip at the superior cavoatrial junction.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is contrast within the collecting system.RETROPERITONEUM, LYMPH NODES: Scattered mesenteric lymph nodes.BOWEL, MESENTERY: Enteric contrast is seen within the terminal ileum up to the level of the hepatic flexure. There is bowel wall thickening involving a 6-8 cm segment of the terminal ileum up until the ileocecal valve. No evidence of bowel obstruction. Previously noted segment of jejunal bowel wall thickening is not seen due to migration of contrast distally. No free intraperitoneal air. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended with contrast.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Bowel wall thickening of a 6 - 8 cm segment of terminal ileum. In conjunction with the short segment of jejunal wall thickening seen on prior CT, this is compatible with patient's history of Crohn's disease.
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Generate impression based on findings.
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Clinical question: Intracranial bleed? Resolution of previous bleed? Signs and symptoms: Not responsive. Nonenhanced head CT:No evidence of intracranial hemorrhage.Unremarkable cortical sulci, cerebral cortex, ventricular system, CSF spaces and gray -- white matter differentiation.Midline is maintained.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, well pneumatized mastoid air cells and middle ear cavities. Chronic mucosal thickening of the paranasal sinuses and air fluid in the sphenoid sinus similar to prior exam.
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1.No evidence of intracranial hemorrhage.2.No convincing evidence of any new finding since prior study.3.Unremarkable unenhanced head CT.
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Generate impression based on findings.
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67-year-old male. Reason: SOB, possible saddle embolus on TTE History: SOB, possible saddle embolus on TTE PULMONARY ARTERIES: No pulmonary embolus identified.LUNGS AND PLEURA: Multiple scattered bilateral calcified micronodules, consistent with prior granulomatous disease. Other scattered noncalcified micronodules are unchanged. Mild scarring at the apices. Small focal area of bronchiectasis medially in the left lower lobe.MEDIASTINUM AND HILA: Calcified subcarinal lymph node consistent with prior granulomatous disease. No mediastinal or hilar lymphadenopathy. Coronary artery calcifications redemonstrated. Large paraesophageal hiatal hernia.CHEST WALL: Degenerative changes of the thoracic spine. Dextroscoliosis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Large solitary gallstone without inflammation.
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No evidence of pulmonary embolism as clinically questioned.Unchanged large paraesophageal hiatal hernia.
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Generate impression based on findings.
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42-year-old male. SIRS, cough, tachycardia. PULMONARY ARTERIES: Technically adequate examination for evaluating pulmonary embolism. No pulmonary emboli identified.LUNGS AND PLEURA: No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: Cardiomegaly without a significant pericardial effusion. Patulous esophagus filled with debris.CHEST WALL: Renal osteodystrophy is noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of acute pulmonary embolism or other findings to account for symptoms.
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Generate impression based on findings.
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Female; 33 years old. Reason: r/o stone History: hematuria and left flank pain Lack of intravenous contrast enhancement limits the evaluation of solid organ parenchyma and vascular structures. Given these limitations, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No suspicious lesions identified. The gallbladder is minimally distended. No evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are normal in size and morphology. No evidence of hydronephrosis or nephrolithiasis. No perirenal fluid collections or inflammatory changes.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is well distended and unremarkable.LYMPH NODES: Bilateral benign-appearing inguinal lymphadenopathy.BOWEL, MESENTERY: The appendix is well visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Phleboliths present in the left lower pelvis.
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No radiographic evidence to account for the patient's left flank pain and hematuria.
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Generate impression based on findings.
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SIRS and abdominal distention in 42-year-old male; heart failure ABDOMEN:LUNG BASES: Cardiomegaly; dilated esophagus in a somewhat unusual location, lateral to the aorta. See chest CT reported separately for complete chest evaluation.LIVER, BILIARY TRACT: Hepatomegaly without focal parenchymal mass lesion. Portal venous, and hepatic venous structures appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small atrophic infused horseshoe kidney without hydronephrosis or mass lesion visualized. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Orally administered contrast rapidly progresses to normal-appearing stomach, small bowel, and colon without intrinsic abnormality. No evidence of bowel obstruction. Diffuse mesenteric edema is seen as well as diffuse subcutaneous edema consistent with anasarca. No discrete fluid collections are identified.BONES, SOFT TISSUES: Diffusely sclerotic for cable bodies, consistent with changes of chronic renal failure. No focal skeletal abnormality seen. Diffuse anasarca without other significant abnormality.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted in the bowel. Edema noted in, mesentery, without discrete focal fluid collection.BONES, SOFT TISSUES: Bony changes consistent with chronic renal disease. Diffuse soft tissue anasarca. No other significant abnormality notedOTHER: No significant abnormality noted
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1. Small atrophic fused horseshoe kidney with changes of chronic medical renal disease. 2. Bony changes consistent with chronic renal disease without focal abnormality. 3. Diffuse edema with anasarca. 4. Hepatomegaly. 5. No other abdominal/pelvic abnormality seen.
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Generate impression based on findings.
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Male 79 years old; Reason: evaluate for mass History: malaise, weakness, weight loss CHEST:LUNGS AND PLEURA: Marked centrilobular and paraseptal emphysema noted. Nodular apical opacity is noted on the right, new since 2006. No spiculated masses or nodules.MEDIASTINUM AND HILA: The heart is mildly enlarged.A coronary artery and aortic calcifications are noted. LAD stent is noted. Borderline mediastinal adenopathy detected with reference to vascular node measuring 1.7 cm in short axis. Calcified mediastinal and hilar nodes from old healed granulomatous disease.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Hypodense subcentimeter too small to characterize lesion in segment two but appearance most likely of benign cyst . Otherwise, no focal masses detected. No radiopaque stones noted in gallbladder. No intrahepatic or extrahepatic biliary ductal dilation is evident.SPLEEN: Granuloma noted in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cysts in the kidneys are stable bilaterally. No hydronephrosis, perinephric fluid collections, or stones detected.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative disease with wedge compression deformity of L4.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Is enlarged, and is indenting the bladder base.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable degenerative disease with wedge compression deformity of L4.OTHER: No significant abnormality noted
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1.No acute pathological process detected.2.Apical nodular opacity in the right lung. Differential considerations include scarring versus neoplastic process. Continued follow up advised.
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Generate impression based on findings.
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Clinical question: Evaluate for brain metastases. Signs and symptoms will metastatic prostate cancer presenting with altered mental status. Enhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates no evidence of abnormal parenchymal or leptomeningeal enhancement to suggest presence of metastatic disease.Very minimal patchy low-attenuation white matter considering patient's stated age of 83 likely representing age indeterminate small vessel ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, cisterns and spaces and gray -- white matter differentiation is otherwise within normal patient stated age. Moderately heavy bilateral intracranial vertebral hospital calcification and to lesser degree of bilateral cavernous carotids is noted.Calvarium demonstrate several small foci of sclerotic change consistent with metastatic prostate cancer. There is no evidence of extra osseous spread of tumor and no detectable epidural space abnormal enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized.Images through the orbits are unremarkable.
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1.No detectable parenchymal or leptomeningeal enhancement to suggest metastatic disease.2.Multiple calvarial metastatic lesions without evidence of extraosseous spread.3.Minimal age indeterminate small vessel ischemic strokes as detailed.
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Generate impression based on findings.
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57 year-old female with persistent clear fluid drainage without congestion. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There appears a small discontinuity in the right fovea ethmoidalis (image 41, series 80346). The cribriform plate, left fovea ethmoidalis and lamina papyraceae appear normal. There appears chronic depressive fracture of the right nasal bone. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal.
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1. Probable small defect in the right fovea ethmoidalis with no CT evidence of encephalocele. 2. Chronic depressive fracture of the right nasal bone. 3. Unremarkable CT paranasal sinus otherwise.
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Generate impression based on findings.
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57-year-old male with a history of medullary urothelial carcinoma status post cystectomy and neobladder creation with fever and history of intra-abdominal abscess. ABDOMEN:LUNGS BASES: Note is made of bibasilar atelectasis/scarring. There is interval resolution of the previously described small pleural effusions. No evidence of pneumothorax.LIVER, BILIARY TRACT: Two enhancing masses in the left lobe measuring 1.6 x 2 .1 cm, previously 2.0 x 2.4 cm (image 31, series 3) and 2.0 x 1 .4 cm, previously 1.8 x 1.3 cm (image 15, series 3) are redemonstrated, and grossly stable in size and likely represent hemangiomas. Multiple scattered bilobar hypodensities are too small to further characterize, but likely represent simple cysts, unchanged. The gallbladder is surgically absent with cholecystectomy clips in the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference ill-defined, heterogeneous, hypodense lesion in the interpolar region of the right kidney measures 2.8 x 2 .0 cm, previously 3.6 x 2.7 cm with associated mild perinephric fat stranding (image 38, series 3). No hydronephrosis , hydroureter or detectable renal calculi bilaterally.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Note is made of a small amount of free fluid.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy. Low density round focus in the neobladder is of uncertain significance and correlation for a retained foreign body is recommended (79; series 8). Air is noted within the neobladder which may represent recent instrumentation. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postsurgical changes from cystoprostatectomy. Notice made of a right hydrocele. There is interval development of a 4.6 x 4.6 cm encapsulated fluid collection in the right hemipelvis suspicious for abscess formation. There is associated inflammatory change, fat stranding and wall thickening of the neobladder in the surrounding area
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1.Persistent findings suspicious for intraparenchymal abscess formation within the right kidney.2.Interval development of a 4.6-cm encapsulated fluid collection in the right hemipelvis suspicious for abscess formation. 3.There is wall thickening of the neobladder and fat stranding the surrounding area. Correlation for cystitis is recommended. 4.Low density round focus in the neobladder is of uncertain significance and correlation for a retained foreign body is recommended.
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Generate impression based on findings.
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71-year-old male with hypoxia, hypotension, new RBBB. Assess for PE. PULMONARY ARTERIES: Technically adequate exam with no evidence of pulmonary embolus.LUNGS AND PLEURA: Mild predominantly centrilobular emphysema favoring the upper lobes. Bilateral basilar atelectasis and scarring. MEDIASTINUM AND HILA: Postsurgical changes of previous CABG. A right-sided chest port catheter terminates in the right atrium. No mediastinal or hilar lymphadenopathy. Severe coronary artery, aortic, and valvular calcifications.CHEST WALL: Degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Severe atherosclerotic calcification of the abdominal aorta and its branches without focal ectasia in the imaged portion.
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1.No evidence of pulmonary embolism. 2.Basilar dependent atelectasis and no other acute abnormality.
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Generate impression based on findings.
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Female; 39 years old. Reason: r/o stone History: hematuria with left LBP Lack of intravenous contrast enhancement limits the evaluation of solid organ parenchyma and vascular structures. Given these limitations, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No evidence of suspicious lesions. No intra-or extrahepatic ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are normal in size and morphology. No evidence of gross nephrolithiasis or hydronephrosis. We cannot entirely exclude a punctate stone in the right midpole (image 61 of series 3). No perirenal fluid collections or inflammatory changes.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is well distended and unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No radiographic evidence to explain the patient's symptoms.
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Generate impression based on findings.
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Female 30 years old; Reason: epigastric/RUQ pain with stone on u/s; eval for inflammation History: see above ABDOMEN:LUNGS BASES: No significant abnormality noted.Small hiatal hernia noted.LIVER, BILIARY TRACT: No significant abnormality noted. The cholelithiasis on ultrasound is not well visualized on the CT examination. No biliary abnormality detected.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: Soft tissue mass adjacent to the terminal ileum appears stable to slightly smaller measuring 2.2 x 1.9 cm (series 3 image 98) previously 2.2 x 2.3 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The previously seen complex cystic lesions arising from the bilateral adnexa are decreased in size measuring 7.1 x 3 .9 cm, previously 7.1 x 4.8 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Stable to slight decrease in size of the adnexal and mesenteric masses with no new adenopathy or lesions.
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Generate impression based on findings.
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Female; 56 years old. Reason: complication of pancreatitis? History: abd pain, abn LFT, elevated WBC Lack of intravenous contrast enhancement limits the evaluation of solid organ parenchyma and vascular structures. Given these limitations, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Surgical clips present in the gallbladder fossa likely secondary to cholecystectomy. The common bile duct is slightly dilated measuring 11 mm, which can be normal in cases of cholecystectomy, but this finding is still the exception. No evidence of retained stones or intrahepatic ductal dilatation. No evidence of abnormal fluid collections.SPLEEN: No significant abnormality notedPANCREAS: No CT findings of pancreatitis. The pancreatic duct is minimally dilated at the neck. The body and tail duct is normal. Without contrast enhancement, we cannot exclude an obstructing lesion. No evidence of pseudocyst formation or peri-pancreatic fluid collection.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Ovoid hyperdensity adjacent to the aorta, best seen on image 53 of series 3, may represent a duodenal diverticulum with retained debris or a calcified lymph node.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral benign-appearing inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Calcified circular density in the right lower quadrant, best seen on image 95 of series 3, is nonspecific but may be postsurgical in etiology. Without enteric or intravenous contrast administration, we cannot characterize the location of this lesion, but it's densely calcified characteristics suggest it has been long-standing.
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1.Common bile ductal dilatation measuring 11 mm and minimal dilatation of the pancreatic duct at the neck. If further imaging would be helpful for patient care, MRCP may be considered.2.No CT evidence of acute pancreatitis or complications from pancreatitis.
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Generate impression based on findings.
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24 year-old female. History of PE not on anticoagulation. Evaluate for PE. PULMONARY ARTERIES: Technically adequate study for evaluation of PE. No acute pulmonary emboli evident. Previously seen segmental and subsegmental PE have resolved.LUNGS AND PLEURA: Bibasilar linear scarring now present at sites of previously seen pulmonary hemorrhagic infarcts.MEDIASTINUM AND HILA: Normal heart size without significant pericardial effusion. No mediastinal or hilar 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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1. No acute pulmonary embolism. Interval resolution of previously seen segmenta/subsegmental PE.2. Basilar scarring is now present at previously seen sites of pulmonary hemorrhagic infarcts.
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Generate impression based on findings.
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95-year-old female patient with left hip externally rotated. Evaluate for left hip fracture. Left bipolar hemiarthroplasty with cemented femoral component. No evidence of acute fracture or dislocation. No evidence of loosening or hardware failure. Mild chondrocalcinosis affects the left hip.Moderate degenerative changes affect the right hip.Severe degenerative changes affect the lower lumbar spine.
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Left bipolar hemiarthroplasty without radiographic evidence of acute fracture or dislocation.
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Generate impression based on findings.
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47 year-old female with neutropenic fever, evaluate for infection. The orbits are unremarkable. The mastoids are partially opacified. The middle ear cavities are clear. Limited view of the intracranial structure is unremarkable. There is minimal mucosal thickening in the maxillary and sphenoid sinuses. The frontal sinuses, frontal-ethmoid recesses, and anterior/posterior ethmoids are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. There is leftward nasal septal deviation with a bony spur. The nasal turbinates are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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1. No evidence of sinusitis. Minimal maxillary and sphenoid sinus inflammatory disease. 2. Leftward nasal septal deviation with a bony spur. 3. Partial opacification of the mastoids, which is nonspecific. Clinical correlation for mastoiditis is recommended.
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Generate impression based on findings.
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52 year old female with a history of metastatic breast cancer presents with emesis. Evaluate for tumor burden or SBO. ABDOMEN:LUNG BASES: Note is made of bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: Subcentimeter hypodensity in the right lobe of the liver is too small to characterize, but likely represents a simple cyst, appearing similar to the prior study.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: Note is made of enhancing eccentric wall thickening affecting short segments of the ascending and transverse colon with shouldered margins and associated mesenteric nodularity measuring up to 2.7 x 1 .3 cm, previously 2.5 x 1.2 cm (70; series 3) . There is interval development of a soft tissue mass measuring 2.7 x 2.7 cm in the right lower quadrant adjacent to the cecum (103; series 3). Note is made of free fluid in the paracolic gutter in the surrounding area. There is no evidence of free intraperitoneal air, portal venous gas, or pneumatosis intestinalis. No dilated loops of bowel to suggest obstruction.BONES, SOFT TISSUES: Again seen are multiple mixed lytic/sclerotic lesions in the pelvis, most pronounced in the right iliac bone, appearing similar to the prior study. Again seen are lytic lesions in the L3 vertebral body, appearing similar to the prior study. Multiple sclerotic foci are in identified in the L1 vertebral body, also unchanged.OTHER: 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: Again seen are multiple mixed lytic/sclerotic lesions in the pelvis, most pronounced in the right iliac bone, appearing similar to the prior study. Again seen are lytic lesions in the L3 vertebral body, appearing similar to the prior study. Multiple sclerotic foci are in identified in the L1 vertebral body, also unchanged.OTHER: No significant abnormality noted
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1. Wall thickening of the colon with associated mesenteric nodularity is most consistent with metastatic disease in the setting of a known primary carcinoma. There is interval development of a soft tissue mass in the right lower quadrant adjacent to the cecum, which is suspicious for progression of disease.2. Multiple sclerotic lesions within the axial skeleton are unchanged.
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Generate impression based on findings.
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75 year old female with a history of ulcerative colitis and lung cancer. Status post left lobectomy with right upper quadrant pain x 1 week, status post cholecystectomy. ABDOMEN:LUNGS BASES: Postsurgical changes consistent with the stated history of left lower lobectomy.LIVER, BILIARY TRACT: The liver is diffusely hypoattenuating compatible with fatty infiltration. A subtle hypodense focus in the anterior right hepatic lobe is again seen, unchanged. Status post cholecystectomy; no intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening of the left adrenal gland, unchanged.KIDNEYS, URETERS: There are several renal cysts at the upper pole of the right kidney. Subcentimeter hypodensities in the left kidney are too small to characterize, but likely represent simple cyst. No hydronephrosis is present.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic disease affects the abdominal aorta. Prominent retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The appendix is normal in caliber. The colon is not distended. BONES, SOFT TISSUES: There are extensive degenerative changes of the lumbar spine with a compression deformity of the T12 vertebral body, with at least 50% height loss, appearing similar to the prior study.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: There are scattered colonic diverticula involving the sigmoid colon. BONES, SOFT TISSUES: There is grade 1 anterolisthesis of L5 on S1, unchanged.OTHER: No significant abnormality noted.
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1.No acute intra-abdominal process.2.Marked chronic appearing degenerative changes affecting the lumbar spine including a chronic appearing compression fracture of T12.
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Generate impression based on findings.
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Reason: 76-year-old male with a history of metastatic RCC. Evaluate disease status. History: asymptomatic CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again noted, some which have decreased while some have increased in size.The reference left upper lobe nodule now measures 1.0 cm, previously 1.0 cm (image 39; series 4). The reference left lower lobe nodule now measures 7 mm, previously 8 mm (image 68, series 4).Additional reference right lower lobe nodule now measures 0.9 cm, previously 2.2 cm (image 76, series 4). However, an adjacent nodule appears dramatically increased in size measuring 1.5 cm, previously 0.9 cm (71; series 4).MEDIASTINUM AND HILA: The reference left retrocrural lymph node now measures 2.8 x 2.0 cm, previously 3.1 x 1.6 cm (image 78, series 3). Additional enlarged retrocrural lymph nodes appear similar to the prior study.Small mediastinal and hilar lymph nodes are unchanged from the prior study.Severe coronary artery calcifications. Mild cardiomegaly, unchanged. No pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Calcified gallstones without evidence of acute cholecystitis. There is interval increase in size of a 2.6 cm hypoattenuating lesion in the right lobe of the liver, suspicious for metastatic disease.SPLEEN: Calcified splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Hypoattenuating right kidney lesions appear unchanged from the prior study and remain incompletely characterized without intravenous contrast.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Colonic diverticulosis without complication.BONES, SOFT TISSUES: Degenerative changes are seen throughout the thoracolumbar spine. Note is made of a small fat containing umbilical hernia.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered sclerotic foci in the proximal femurs and pelvis are unchanged from the prior study.
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1.Mixed response of multiple pulmonary nodules, some of which have increased in size and some of which have decreased in size. 2.Interval development of a liver lesion suspicious for metastatic disease. 3.Persistent retrocrural lymphadenopathy.
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Generate impression based on findings.
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Male 42 years old; Reason: eval for sinusitis History: patient with HIV, fevers, tachycardia and nasal ulcer. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. There is a deep bony lucency surrounding the partially remaining right maxillary premolar tooth which probably represents a periapical abscess. The tooth immediately posterior to this has a large dental carry. The mandible, sphenoid boned, nasal bones, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. Hyperdense mucosa of the oropharynx and hypopharynx is of uncertain etiology. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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1.No evidence of acute sinusitis. 2.Hyperdense mucosa of the oropharynx and hypopharynx is of uncertain etiology. Given that the patient received contrast for abdominal and pelvic CT this could represent contrast. Fungal infection is another possibility in an HIV positive patient.3.Poor dentition with the right maxillary periapical abscess.
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Generate impression based on findings.
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Male 52 years old; Reason: HCC screening History: cirrhosis, ESRD on HD ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular..Cholelithiasis is noted in the gallbladder. There is no intrahepatic or extrahepatic biliary ductal dilation. Portal vein: Patent Hepatic veins: PatentHepatic artery: patent with conventional anatomyLesions: No definite lesions are detected. Collateral vessels are again seen with a recanalized umbilical vein. Extensive esophageal varices are noted. Marked ascites is noted which has progressed since previous exam.SPLEEN: The spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodule in the right adrenal gland measures less than 10 Hounsfield units on precontrast imaging, likely resents an adenoma. The left adrenal gland is unremarkable.KIDNEYS, URETERS: Cyst noted in the bilateral kidneys are stable. Few non obstructing nephroliths are noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Porto caval adenopathy likely related to patient's liver disease.BOWEL, MESENTERY: Wall edema and loss of haustration in the transverse colon is noted. The ascending, descending colon, and cecum are spared. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Cirrhotic morphology without evidence of lesion to suggest HCC2.cholelithiasis3.Abnormal appearance of the transverse colon. While it is common for the ascending colon and cecum to demonstrate this pattern in cirrhosis, it is not expected in the transverse colon. This raises the concern for infectious versus inflammatory colitis. Ischemic is not likely given its focal nature.
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Generate impression based on findings.
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57 year-old female with nasal congestion and discharge. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure shows mild ventriculomegaly. The frontal sinuses are hypoplastic. There is mucosal thickening in the anterior/posterior ethmoids and maxillary sinuses. The sphenoid sinuses are well developed and clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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1. Mild ethmoid and maxillary sinus inflammatory disease. 2. Mild ventriculomegaly shown on this nondedicated exam.
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Generate impression based on findings.
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47-year-old female. Neutropenic fever status post unrelated donor stem cell transplant. Evaluate for infection. LUNGS AND PLEURA: 11-mm nodule in the left lung base on series 5, image 210. Minimal basilar scarring. 5-mm right upper lobe nodule (series 4, image 31). No pleural effusion.MEDIASTINUM AND HILA: Right IJ catheter tip is at the cavoatrial junction. Small pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative arthritic changes of thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips.
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11-mm nodule in the left lung base possibly fungal infection.
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Generate impression based on findings.
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Male 50 years old; Reason: rectal cancer restaging History: rectal cancer CHEST:LUNGS AND PLEURA: There is minimal basilar atelectasis.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: There is no evidence of axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: There is a single hypodense lesions in hepatic segment VII, which is too small to characterize and appears unchanged since the prior examination. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Numerous subcentimeter mesenteric lymph nodes are present. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Several enlarged pelvic lymph nodes are smaller than previous. Reference node measures 0.9 x 0.9cm previously 1.3 x 1.1 cm (image 172, series 3). There are numerous small pelvic lymph nodes present.BOWEL, MESENTERY: The referenced hypodense mass in the right inguinal mesentery is stable measuring 3.7 x 2.6 cm previously 3.5 x 2.6 cm (image 188, series 3). This likely represents a hernia repair mesh.. There is diverticulosis without evidence of diverticulitis. There is non-circumferential thickening of the rectal wall, which may represent the patient's reported rectal cancer.BONES, SOFT TISSUES: Sclerotic changes are seen in the T9 endplate which appears stable since the prior examination.OTHER: No significant abnormality noted
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1.Stable right inguinal mesenteric hypodensity which likely represents a hernia repair mesh.2.Stable to slightly smaller pelvic lymphadenopathy.3.Stable non-circumferential thickening of the rectal wall, representing the patient's reported rectal cancer.
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Generate impression based on findings.
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79-year-old edema. History of lung cancer with lung nodules. Evaluate for progression. LUNGS AND PLEURA: Dense partially calcified areas of pleural thickening in the right lung base, stable dating back to 2012, and likely sequelae of prior pleurodesis or surgery/trauma.Multiple pulmonary calcified and noncalcified nodules are stable dating back to 7/2012. This includes the reference subpleural nodule measuring 5 mm on series 5, image 43. Scattered areas of atelectasis and scarring in lung bases are unchanged. Mild basilar bronchial thickening and mild bronchiectasis, unchanged.MEDIASTINUM AND HILA: Calcified mediastinal nodes consistent with healed granulomatous disease. Mild calcification of the thoracic aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified granulomas in the spleen.
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Stable pulmonary nodules dating back to 7/2012. Continued follow-up to two years is recommended. No new findings.
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Generate impression based on findings.
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Male 70 years old; Reason: Weight loss evaluation History: Unintentional weight loss 20#, negative EGD, ? pulmonary or abdominal pathology CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: Moderate coronary artery and aortic atherosclerotic disease noted.ABDOMEN:LIVER, BILIARY TRACT: Patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple appearing cysts are noted in the left kidney. T00 small to characterize lesions are seen in the kidneys bilaterally. No hydronephrosis or renal stones detected.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis without evidence of diverticulitis. No obstruction or free air 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: Extensive diverticulosis without evidence of diverticulitis. No obstruction or free air identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No acute intraabdominal pathology detected.
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Generate impression based on findings.
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Female; 57 years old. Reason: History of germ cell tumor, s/p transplant, assess for recurrence History: none CHEST:LUNGS AND PLEURA: Reference right upper lobe lung nodule abutting the major fissure, best seen on image 44 of series 5, is stable measuring 1.5 x 0.6 cm, previously 1.4 x 0.5 cm.MEDIASTINUM AND HILA: Reference right hilar lymph node, best seen on image 40 of series 3, is stable measuring 1.9 x 1.3 cm, previously 1.8 x 1.3 cm. Calcified mediastinal and hilar lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No evidence of suspicious lesions. No intra-or extrahepatic ductal dilatation. The gallbladder is unremarkable.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: Status post hysterectomy.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: Stable post surgical changes of a rectosigmoid anastomosis.
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1.Stable right lung nodule and perihilar lymph node.
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Generate impression based on findings.
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45 years old Male. Reason: Hx of Hodgkin's Lymphoma History: s/p 2 cycles of chemotherapy Interval decrease in size of cervical lymphadenopathy. Reference measurements are as follows:Index right level II jugulodigastric node (series 1202 image 43) measures 12 mm in short axis, previously 18 mm.Index right level IIb lymph node (series 1202, image 50) measures 5 mm in short axis, previously 6 mm.Index visceral level VI (series 1202, image 46) measures 4 mm in short axis, previously 7 mm.Index right supraclavicular lymph node (series 1202, image 61) measures 4 mm in short axis, unchanged.Index left supraclavicular lymph node (series 1202, image 48) measures 4 mm in short axis, previously 12 mm.No new lymphadenopathy.The large superior mediastinal soft tissue mass shows decrease in size from prior. Please refer to separate chest CT report for further detail.Limited view of the intracranial structure is unremarkable. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Structures of the upper airway are patent. Focal narrowing is present in the oropharynx secondary to prominence of the lingual tonsils and minimally the palatine tonsils, which may relate to areas of lymphoid tissue. The parotid and submandibular glands are unremarkable. The thyroid gland is suboptimally evaluated secondary to streak artifact.The carotid arteries and jugular veins are patent. The osseous structures are unremarkable.
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1. Interval decrease in cervical lymph node size from prior. No current cervical lymphadenopathy or new masses.2. Please refer to separate chest CT findings regarding the mediastinal mass.
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Generate impression based on findings.
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Female; 57 years old. Reason: evaluate right flank mass r/o hernia History: right flank mass ABDOMEN:LUNG BASES: Small blebs at the right base.LIVER, BILIARY TRACT: No evidence of suspicious lesion. No intra-or extrahepatic ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral subcentimeter round hypodensities are too small to characterize but likely represent benign cysts. No evidence of hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Minimally enlarged left periaortic lymph node, best seen on image 29 of series 4, measures 1.3 x 1.2 cm.BOWEL, MESENTERY: Bowel caliber is normal. The appendix is well visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large, non-enhancing ovoid fat dense lesion in the right flank located between the internal and external oblique muscles, best seen on image 27 of series 4, measures 5.1 x 10.8 cm and likely represents a benign lipoma.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Right flank benign lipoma as described above.2.Minimally enlarged left para-aortic lymph node.
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Generate impression based on findings.
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67-year-old female. History of metastatic medullary thyroid cancer. Compared to previous. CHEST:LUNGS AND PLEURA: Scattered nodules are unchanged. No new or suspicious pulmonary lesions identified.MEDIASTINUM AND HILA: Status post thyroidectomy. Left paratracheal esophageal diverticulum is unchanged. No mediastinal or hilar adenopathy. Normal heart size without significant pericardial effusion.CHEST WALL: Numerous sclerotic skeletal metastases without significant change.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple cystic hepatic metastases contain internal calcifications are redemonstrated, similar in size to prior exam. Index lesion in the right hepatic lobe measures 2.3 x 2.3 cm, unchanged (series 3, image 92). Moderate central intrahepatic and extrahepatic biliary ductal dilatation, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts bilaterally.PANCREAS: Pancreatic head metastases with internal calcification is 2.2 x 2.1 cm, unchanged (series 3, image 109). Mild dilatation of the pancreatic duct, unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Numerous sclerotic lesions in the visualized thoracolumbar spine, ribs, scapulae, and sternum consistent with metastases, definitely change.OTHER: No significant abnormality noted.
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Abdominal and skeletal metastases without significant change. No new lesions identified.
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Generate impression based on findings.
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28-year-old female with a history of stage IIIc germ cell tumor, growing teratoma syndrome, and known mediastinal disease. Six-month follow-up examination. CHEST:LUNGS AND PLEURA: Note is made of multiple bilateral pulmonary micronodules, appearing similar to the prior study. No new pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: Again seen is an anterior mediastinal soft tissue density mass which conforms to the boundaries of the mediastinum, and likely represents thymic hyperplasia, appearing similar to the prior study.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is a interval decrease in the previously described peritoneal disease, which measures 1.5 x 1 .3 cm, previously 2.9 x 2.4 (axial image 62; series 3). No significant interval change in extrahepatic biliary ductal dilation. Calcifications are noted along the lateral aspect of the liver.SPLEEN: Status post splenectomy.PANCREAS: Pancreatic duct is visualized within normal limits. ADRENAL GLANDS: No significant abnormality is identified.KIDNEYS, URETERS: No significant abnormality is identified..RETROPERITONEUM, LYMPH NODES: Interval decrease in the previously described extensive peritoneal hyperdense disease. BOWEL, MESENTERY: Index nodule at the porta hepatis measures 4.9 x 4.1 cm previously 4.8 x 3.5 cm (image 81, 3), appearing slightly increased in size when compared to the prior study. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Interval decrease in ascites. PELVIS:UTERUS, ADNEXA: No significant abnormality noted. BLADDER: No significant abnormality notedLYMPH NODES: Previously described index right inguinal lymph node measures 1.5 x 0 .8 cm, previously 1.2 x 0 .8 cm(image 179; series 3).BOWEL, MESENTERY: Index mesenteric implant in the left of the pelvis measures 0.9 x 0 .8 cm, previously 3.0 x 2.2 cm, (image 138; series 3) significantly decreased in size when compared to the prior study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Interval decrease in previously described peritoneal metastases in the abdomen and pelvis with a persistent mass in the porta hepatis, with reference measurements above.2. Slight interval decrease in size of anterior mediastinal soft tissue density mass likely representing thymic hyperplasia.3. Dilated common bile duct in the midportion with gradual tapering distally, unchanged from prior study, probably due to a benign stricture.4. Multiple bilateral pulmonary micronodules, unchanged.
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