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Generate impression based on findings.
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52-year-old male with history of metastatic melanoma. Status post chemotherapy CHEST:LUNGS AND PLEURA: No pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Note is made of a nodule in the soft tissues along the superior aspect of the posterior right hemithorax, study (18; series 3). A sclerotic lesion along the posterior aspect of the left 6 rib, unchanged, likely a benign bone island.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypoattenuating left renal lesion with internal complexity, likely a complex 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: Reference right external iliac adenopathy measures 3.7 x 1 .9 cm, previously 3.5 x 2.2 cm (image 195, series 3).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical clips are noted in the right inguinal soft tissues. There is soft tissue infiltration along the vessels of the right proximal lower extremity.OTHER: No significant abnormality noted
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Persistent right pelvic adenopathy consistent with metastatic disease. No significant interval change in the subcentimeter nodule in the soft tissues along the superior aspect of the posterior right hemithorax also suspicious for metastatic disease.
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Generate impression based on findings.
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Male 60 years old; Reason: 60M with prostate cancer, s/p prostatectomy, with persistent PSA and small para-aortic LN seen on outside CT 7/2013. restage and compare with prior scan. History: non CHEST:LUNGS AND PLEURA: Minimal bibasilar atelectasis noted.MEDIASTINUM AND HILA: No pathologically enlarged lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion is too small to reliably characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cysts noted in the kidneys bilaterally. No hydronephrosis or perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes detected.BOWEL, MESENTERY: Diverticulosis without diverticulitisBONES, SOFT TISSUES: Degenerative changes are noted in the spine. Lucent lesion in the right iliac fossa is incompletely characterized, however has a narrow zone of transition and a sclerotic border, favoring benign etiology.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Degenerative changes are noted in the spine. Lucent lesion in the right iliac fossa is incompletely characterized, however has a narrow zone of transition and a sclerotic border, favoring benign etiology.OTHER: No significant abnormality noted
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1.Status post prostatectomy without evident metastatic disease detected.
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Generate impression based on findings.
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Status post left lower lobe resection for solitary fibrous tumor. Chest tubes in place with foul-smelling drainage. Please assess for pleural fluid collections or other evidence of infection. LUNGS AND PLEURA: When compared to the prior CT, there has been interval resection of the left lower lung mass. Two chest tubes are present in the left pleural space, one turning anteriorly at the left lung base and a second coursing superiorly along the posterior and medial pleural space. A loculated hydropneumothorax is seen anterior to the left lung apex and coursing inferiorly to the left lung base. A second loculated hydropneumothorax is seen posterior and medial to the aforementioned loculated effusion, and since adjacent to the superior most drain. A small amount of free fluid rests dependently in the left pleural space. There is associated consolidation of the lung adjacent to these effusions and next to the surgical bed. Cannot exclude infection in the consolidated lung, and cannot exclude infection affecting these loculated effusions as there is a small amount of enhancement around the loculated rims which is nonspecific and could be merely inflammatory in nature. There is a small amount of dependent atelectasis on the right posteriorly.MEDIASTINUM AND HILA: Several minimally enlarged lymph nodes are seen scattered throughout the mediastinum, likely reactive in nature. Coronary artery and aortic calcifications are seen. Minimal fluid in the pericardial space.CHEST WALL: Degenerative disease affect the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atherosclerotic calcifications affect the visualized vasculature. Grossly the distended large bowel is seen, without corresponding dilatation of the visualized small bowel although this exam was not tailored to evaluate the abdominal viscera.
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1.Loculated hydropneumothoraces on the left, with a small amount of free left pleural fluid. Cannot exclude infection of these collections.2.Left lower lung areas of consolidation adjacent to the aforedescribed collections in surgical bed, nonspecific but could be due to infection and/or aspiration with atelectasis likely contributing.
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Generate impression based on findings.
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Male; 78 years old. Reason: h/o RCC with abd discomfort History: above ABDOMEN:LUNG BASES: The previously identified left upper lobe lung nodule is not visualized on this exam. Mild bibasilar atelectasis.LIVER, BILIARY TRACT: Evaluation of the liver parenchyma is limited by lack of significant portal venous contrast enhancement. Given these limitations, no suspicious lesions are identified. 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: Status post left nephrectomy without evidence of local recurrence. The right kidney is unremarkable. No evidence of hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Infrarenal aortic aneurysm with irregular concentric mural thrombosis and ulcerated plaques extending into the iliac vessels, best seen on image 48 of series 3, is stable in size and appearance measuring 4.4 x 4.4 cm.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The bowel is normal in caliber. No evidence of obstruction or pneumoperitoneum. The appendix is unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Aneurysm extends into iliac arteries.
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1.No radiographic evidence to account for the patient's abdominal pain.2.Status post left nephrectomy without evidence of local recurrence.3.Stable infrarenal aortic aneurysm.Please note that longer than usual delays are needed to ensure opacification of the portal veins due to slow cardiac output.
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Generate impression based on findings.
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51 year old female with hemorrhage of the rectum and anus. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple subcentimeter hypodensities in the liver are too small to characterize, but likely represent simple cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Note is made of vascular calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large left adnexal septated cystic collection in measures 5.1 x 3.6 cm (73; series 3).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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5.1-cm left adnexal septated cystic lesion. Further evaluation with a dedicated pelvic ultrasound is recommended.
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Generate impression based on findings.
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evaluate L cranial mass for aneurysm that is calcified Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.The left lobe of the thyroid is heterogeneous and enlarged. It measures 73 x 52 mm and contains a punctate calcifications. The airway is displaced towards the right sideThere are multilevel degenerative changes present in the cervical spine with mild intra-subluxation of C3 on C4 and endplate and uncovertebral osteophytes at C3-4, C4-5, C5-6 and C6-7 with multilevel neural foramen encroachment and narrowing of the spinal canal. In general the osseous structures of the cervical spine and visualized thoracic spine have a somewhat mottled appearance which is nonspecificBrain CTA: There is a left middle cranial fossa extra-axial mass present which enhances following contrast administration. It has peripheral rim calcifications. It is adjacent to the posterior aspect of left cavernous sinus in the floor of the middle cranial fossa which is associated with a little bit of adjacent osseous proliferation index is associated with some surrounding vasogenic pattern of edema in the left temporal lobe and external capsule. It has a broad based towards the dura which includes posterior aspect of the left cavernous sinus the anterior aspect of the left tentorium and there lateral aspect of Meckel's cave. It displaces the left temporal lobe superiorly and laterally.There is a 4-mm left ophthalmic segment aneurysm present off of which it appears to be left ophthalmic artery has origin. It has a 2.5 mm neckThere is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right A1 segment is slightly larger than the left A1 segment. The anterior communicating artery is medium-sized were as both posterior communicating arteries are small to medium sizeThe right anterior/inferior cerebellar artery and the left posterior inferior cerebellar artery are dominant compared to the vertebral arteries are similar in diameter.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Temporomandibular joints are narrowed and to numerous to dental caries are present
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1.There is a left middle cranial fossa extra-axial mass present which is suspicious for a meningioma. It is associated with vasogenic edema. An MRI of the brain would help further asses this for it relationship to adjacent critical structures such as the cavernous sinus and brain.2.There is a left ophthalmic segment aneurysm present measuring 4 mm diameter off of which the left ophthalmic artery has origin.3.Heterogeneous and enlarged left thyroid gland which extends into the superior mediastinum and is suspicious for a goiter. Please note that the CT is nonspecific in evaluation of thyroid. If clinically appropriate an ultrasound may be of benefit. No evidence for cervicocerebral occlusive disease4.multilevel degenerative changes are present in the cervical spine.
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Generate impression based on findings.
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49-year-old female with history of soft tissue sarcoma of the left thigh. Evaluate for metastases. Motion artifact degrades this exam.LUNGS AND PLEURA: The reference left lower lobe nodule (series 4 image 46) measures approximately 7 mm, unchanged from prior. No new pulmonary nodules are seen.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal gland is nodular thickening (series 3 image 110) measures approximately 11 x 9 mm, unchanged
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No significant interval change in the 7-mm left lower lobe pulmonary nodule.
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Generate impression based on findings.
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Stage III lung CA status post chemo and RT. Follow-up. Cough and shortness of breath on exertion. CHEST:LUNGS AND PLEURA: Small right pleural fluid collection, minimally larger.The index right lower lobe lesion is overall smaller measuring 22 x 13 mm (4/78) compared to 26 x 15 mm. Tumor immediately cranial to the reference level also appears smaller (3/79). However, new masslike peribronchial opacity has developed cranial to the lesion measuring 27 x 26 mm (3/75). Although this could reflect focal organizing pneumonia related to RT its masslike appearance and focality are suspicious.Mild paraseptal emphysema and paramediastinal radiation reaction elsewhere in the lung.MEDIASTINUM AND HILA: Minimal increase in volume a of pericardial fluid.Index subcarinal lymph node measures 12-mm, previously 8-mm (3/50). Small right paratracheal lymph node is stable at 3-mm (3/35). Other small non-index lymph nodes on the right about the same. A very small contralateral subaortic lymph node (3/39) appears minimally larger and should continue to be monitored.Left vertebral artery arises from the aortic arch, normal variant anatomy.CHEST WALL: Left ninth rib fracture deformity laterally.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesion in the posterior cortex of the left kidney is too small to accurately characterize but more likely to be benign than malignant.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 decrease in right lower lobe index lesion measurement. Adjacent to the lesion there is a new heterogeneous masslike area of peribronchial consolidation which could represent radiation-related organizing pneumonia however is suspicious for an area of active tumor. Suggest correlation with PET scan. In addition, the index subcarinal lymph node and a known index contralateral subaortic lymph node appear slightly more prominent.
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Generate impression based on findings.
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Female; 58 years old. Reason: lymphoma re-staging History: lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right central venous catheter with tip in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No evidence of suspicious hepatic lesions. Minimal intrahepatic biliary ductal dilatation. The common bile duct is dilated measuring 12 mm. Surgical clips in the gallbladder fossa likely secondary to cholecystectomy. These findings are unchanged from prior.SPLEEN: Status post splenectomy with surgical clips in the left upper quadrant.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is scarred and atrophic. Left kidney is unremarkable. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy with reference node best seen on image 112 of series 3, has minimally decreased in size measuring 1.3 x 0.7 cm, previously 1.4 x 1.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right fat-containing paralumbar hernia.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Minimal decrease in size of retroperitoneal lymphadenopathy as described above.2.Stable intra-and extrahepatic biliary ductal dilatation.
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Generate impression based on findings.
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Reason: h/o laryngectomy new bleeding from stoma History: new bleeding from stoma LUNGS AND PLEURA: Fibrosis within the anterior aspect of the upper lobes, left greater than right, stable.Lower lobe bronchial wall thickening with scattered areas of mucoid impaction consistent with recurrent aspiration. No focal pneumonia or interval pleural effusion.No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Interval opacification of the superior esophagus with high density material (42 Hounsfield units) suspicious for blood within the superior esophagus, given stated history of bleeding from stoma. There is diffuse soft tissue induration at the interface of the neck which is unchanged from the prior CT. A phonation device is unchanged in position. The endotracheal tube occupies the superior trachea, unchanged in position. There is a small amount of stranding surrounding the horizontal portion of the endotracheal tube; however, no significant filling defect within the tracheostomy stoma or superior trachea is identified.The heart size remains normal. No interval pericardial effusion. Moderate coronary artery calcification. Stable size of several mediastinal lymph nodes.CHEST WALL: Small amount of subcutaneous edema is present.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Percutaneous gastrostomy tube is unchanged in position. Nodularity of the left adrenal gland is stable.
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Opacification of the superior esophagus with high density material suspicious for hemorrhagic fluid, likely related to hemorrhage at the stomal site. No peri-stomal hematoma or significant debris surrounding the tracheostomy tube or within the superior trachea.Chronic changes in the lower lobes related to recurrent aspiration. No findings suggestive of massive aspiration event or pulmonary hemorrhage.
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Generate impression based on findings.
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AML with previously with noted at nodules and lower lobe and RLL GGO. LUNGS AND PLEURA: Small pleural effusions, right greater than left with associated compressive atelectasis. Several subcentimeter pulmonary nodules bilaterally mixed response, some of the lesions present previously are smaller (left lower lobe 4/58), while others are new or larger, measuring up to 7-mm in size. Background of ground glass opacity appears improved. Prominence intrafissural lymph nodes are are larger.MEDIASTINUM AND HILA: High right paratracheal region lymphadenopathy slightly increased with reference lesion measuring 14-mm compared to 13-mm previously (3/16). Mildly enlarged lymph nodes elsewhere about the same. Severe coronary artery calcifications. Right VAD tip at the SVC/RA junction. Small hiatal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormality.
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Mixed response, overall worse with new and larger pulmonary nodules suspicious for fungal pneumonia or other atypical infection; the nodules at this time are larger than would be expected with CMV and appear to have a peri-bronchovascular distribution. Previously seen small nodules and groundglass opacity have largely resolved, suggesting the possibility of more than one infectious agent.
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Generate impression based on findings.
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Male 76 years old; Reason: hematuria, eval upper tracts with CT with delayed imaging History: none ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Large hepatic cyst and several small hypodensities likely cysts. Punctate granuloma. No focal masses.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Pre-IV contrast shows no pathologic calcifications. Kidneys are normal morphologically without evidence of mass. Collecting system without hydronephrosis or filling defects. No evidence perinephric fat stranding. No lesions to explain hematuria.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes without evidence of aneurysm.BOWEL, MESENTERY: Dense of colonic diverticulosis. No evidence of diverticulitis. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Estimated at 4.2-cm transverse by 2.6-cm AP by 4.4-cm cephalocaudad with mild impression on the bladder base.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: 4.3 x 3 cm fluid density structure seen in the superior aspect of the scrotum incompletely visualized. Represent a large epididymal cystic lesion. This could be evaluated further with scrotal ultrasound.
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1.Findings to explain hematuria.2.Unexpected finding of a cystic lesion visualized in the scrotum could be evaluated further with scrotal ultrasound.
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Generate impression based on findings.
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Female 71 years old; Reason: 71 yr old patient with ovarian cancer s/p surgery 12-5-13 eval post procedure compare to 12-5-13 scan History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heavy atherosclerotic calcifications with multifocal ulcerated plaques. Port-A-Cath tip in SVC just above RA junction. Heavy atherosclerotic calcifications coronary arteries.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Probable fatty liver. No focal liver lesions. Cholelithiasis is stable without cholecystitis. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Marked fatty replacement in the head and neck.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small hypoattenuating foci too small to characterize likely benign.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcification of the aorta and branch vessels. Several ulcerated plaques are seen. No evidence of aneurysm.Surgical clips consistent with node dissection in the iliac distribution.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy and bilateral salpingo-oophorectomyBLADDER: No significant abnormality noted.LYMPH NODES: CT right calcified inguinal lymph node has been removed, with fluid collection in the right inguinal canal, likely postsurgical seroma versus hematoma. Other small lymph nodes in iliac and obturator chains, right greater than left, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Heavy atherosclerotic calcifications. Evidence of aneurysm
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Status post resection of the right calcified inguinal lymph node and resultant postoperative seroma versus hematoma without other complication or metastatic disease detected. Otherwise, stable examination.
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Generate impression based on findings.
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Reason: lung mass History: eval of lung mass LUNGS AND PLEURA: There is a large, hypervascular mass within the left upper lobe measuring 4.9 x 8.9 cm in transverse and AP dimensions, respectively (series 3 image 40). This extends into the left anterior mediastinum. There is a lobule of the mass that appears to extend beyond the parietal pleura (series 3 image 38), but does not obliterate the subpectoral fat plane or contribute to rib destruction.There is surrounding spiculation and groundglass within the left upper lobe, favoring edema from impaired venous return. Several scattered micronodules occupy the right lung.A conglomerate of lymph nodes is closely associated with this, arising from the aortopulmonary window, measuring a maximum of 4.6 x 5.1 cm (series 3 image 38). Additional enlarged lymph nodes occupy the superior aortopulmonary, left hilar and prevascular spaces.The left upper lobe mass obliterates the left upper lobe pulmonary artery immediately beyond its origin (series 3 image 42). It also attenuates the left upper lobe pulmonary vein (series 3 image 46). The left inferior pulmonary artery, distal left main pulmonary artery, left atrial appendage and left inferior pulmonary vein are free of tumor invasion.No pleural effusion is present. MEDIASTINUM AND HILA: Mediastinal and left hilar adenopathy is described, above. The adenopathy is in close proximity to the distal transverse arch; however, a fat plane can be visualized lateral to the transverse arch, which is evidence against aortic invasion. The main pulmonary artery and thoracic aorta are of normal caliber.The heart size is normal. There is no associated pericardial effusion. Mild coronary artery calcification is present. CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered splenic granulomata..
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Large, hypervascular mass within the left upper lobe measuring 4.9 x 8.9 cm that extends into the left anterior mediastinum. Associated large conglomerate of aortopulmonary lymphadenopathy. The mass obliterates the left superior pulmonary artery immediately beyond its ostium. It attenuates the left superior pulmonary vein.
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Generate impression based on findings.
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80 year-old woman with known aneurysm of the ascending aorta. Evaluate for rupture or dissection. CT ANGIOGRAPHY: As noted previously, the aorta and its branch vessels are tortuous but patent throughout their visualized courses. The ascending and proximal descending aorta exhibit aneurysmal dilatation (see specific measurement below). No evidence of vascular trauma, rupture, or dissection. The periaortic soft tissues are within normal limits. No substantial interval change compared to previous. The ascending aorta again measures 4.8 cm in diameter (image number 76; series 9) compared to 4.8 cm in diameter on the prior exam (image 80; series 10; 4/18/2013 study). Descending thoracic aorta (image 56; series 9) again measures 2.8 cm in diameter (image 61; series 10; 4/18/2013 study).CHEST:LUNGS AND PLEURA: New 5-mm opacity in the left upper lobe (image 34; series 8) is nonspecific to the small size. Follow-up imaging may be beneficial to assess stability as clinically indicated.MEDIASTINUM AND HILA: Cardiomegaly. No adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. 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 evidence of bowel obstruction. BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.OTHER: Moderate atherosclerotic changes, with calcification of the distal abdominal aorta and its branches. PELVIS:UTERUS, ADNEXA: Early filling of left ovarian varices may reflect pelvic venous congestion syndrome. Correlate clinically.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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Unchanged aneurysmal dilatation of the aorta without evidence of dissection or other complication.
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Generate impression based on findings.
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Reason: rule out cardiac pseudoaneurym, evaluate lymphadenopathy History: dizziness LUNGS AND PLEURA: Significant respiratory motion artifact. Incidental azygos lobe. The lungs are underinflated with blurring of the pulmonary vasculature. No pleural effusion is identified through.MEDIASTINUM AND HILA: Postsurgical findings reflecting repair of Tetralogy of Fallow with mild right atrial enlargement and right ventricle upper limits normal size. The sternum is well approximated with hardware.Previously described abnormality on the prior MR exam is not a pseudoaneurysm at the RV PA conduit anastomosis. Although it is closely associated with the conduit and left pulmonary artery, it represents a partial anomalous pulmonary venous return to the left brachiocephalic vein (series 80768 image 44 through 51).There are two pulmonary veins that drain to the left atrium. However, the left superior pulmonary vein is diminutive and drains into the superior left atrium (series 80768 image 41). Its ostium measures approximately 7 mm in CC dimension. The left inferior pulmonary vein is unremarkable and drains in normal fashion. The left inferior pulmonary vein ostium measures approximately 14 mm in CC dimension.There are 3 separate pulmonary veins that drain into the right atrium. The right superior pulmonary vein is unremarkable. A separate origin of the right middle pulmonary vein is immediately inferior to the superior vein ostium. The right inferior pulmonary vein demonstrates early branching and is normal in caliber.There is a right-sided, single superior vena cava that drains to the roof of the right atrium. A normal appearing suprahepatic inferior vena cava drains into the floor of the right atrium.There is a valved conduit extending from the superior aspect of the right ventricle with the anastomosis at the main pulmonary artery. At the valve level within the conduit, the transverse dimension is approximately 18 mm. Immediately superior to the anastomosis, the main pulmonary artery is enlarged, approximally 32 mm transverse. The caliber of the right pulmonary artery is within upper limits of normal at 20 millimeters. There is a contour abnormality at the ostium of the left main pulmonary artery, measuring approximately 17 mm transverse (series 9 image 20). Approximately 2 cm distal to this, the left main pulmonary artery is dilated up to 31 mm. The superior and inferior pulmonary arterial branches on the left are markedly tortuous, suggesting a degree of pulmonary artery hypertension.There is a right-sided transverse arch and descending thoracic aorta. There is a separate origin of the right common carotid artery arising from the transverse arch. The left common carotid artery passes posterior to the left brachiocephalic vein. The left common carotid artery does not appear to arise from the transverse arch and may have been reimplanted, superior to the field of view.CHEST WALL: S-shaped thoraco scoliosis. Mild bilateral axillary and subpectoral lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Findings reflect surgically corrected Tetralogy of Fallot with a valved RA to PA conduit. The previously described abnormality on prior cardiac MRI does not represent a pseudoaneurysm but is consistent with partial anomalous pulmonary venous return to the left brachiocephalic vein.There are two pulmonary veins on the left. The superior left pulmonary vein is diminutive and drains into the roof of the left atrium. Three separate pulmonary veins drain into the right aspect of the left atrium.Right-sided transverse arch and descending aorta. Separate origin of the right common carotid artery. The left common carotid artery courses posterior to the left brachiocephalic vein. The left subclavian artery is not well visualized from the distal transverse arch and has possibly been reimplanted.Contour irregularity involving the left pulmonary artery, as described above.
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Generate impression based on findings.
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41 year old with altered mental status. Please evaluate for cerebral edema in the setting of hyperammonemia. No acute infarct, abnormal mass lesions, edema, or hemorrhage. Bilateral basal ganglia calcifications are identified. Calcification is also seen in the pons. There is scattered subcortical hypodensity this is a nonspecific finding and may represent inflammation/infection/or chronic small vessel disease. No midline shift. Mild global volume loss otherwise the CSF spaces appropriate for patient age. Post-surgical changes are identified from a right frontal craniotomy and right temporal craniectomy.
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No evidence of cerebral edema as clinically queried. Nonspecific cerebral white matter hypodensities.
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Generate impression based on findings.
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Male 67 years old; Reason: Hx of thymoma; evaluate for recurrence History: See Above CHEST:LUNGS AND PLEURA: Paramediastinal fibrosis and scarring in the lungs consistent with radiation fibrosis. No lung nodules. No effusions.MEDIASTINUM AND HILA: Soft tissue density in the left superior mediastinum abutting the great vessels as seen on (series 3 image 28) measuring 1.6 x 1.7, previously 1.8 x 1.8 cm.There is ill-defined soft tissue density paralleling the aortic arch unchanged. There is subcarinal or retrocrural fluid density on (series 3 image 48) measures 2 x 1.3 cm previously 2.3 x 1.7 cm. This could represent loculated fluid or low density node.Near fluid density collection is increasing in size in the posterior medial cardiophrenic region dorsal to the inferior vena cava and anterior to the crus of the diaphragm. The axial plane measures 4.5 x 2 .8 cm, previously 3.9 x 2.2 cm and is near fluid density. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Too small to characterize lesion in segment 6 is stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Slightly malrotated left kidney.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease. No aneurysms. No pathologic size nodes.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: Small not pathologic in size.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Surgical clips inguinal canals.
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Stable mediastinal adenopathy and slightly increased size of the retrocaval fluid collection.
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Generate impression based on findings.
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78 year-old female with episode of confusion and possible seizure. There is a wedge shaped hypoattenuation in the right inferior frontal gyrus with loss of gray-white differentiation. There is a focus of hypoattenuation in the left cerebellum, unchanged. There is patchy hypoattenuation in the cerebral white matter. The ventricles, sulci, and cisterns are symmetric and moderately prominent. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. Osteomas are seen in the left ethmoid sinus, left frontal sinus and left frontoethmoid recess. The paranasal sinuses and mastoid air cells are clear.
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1. Wedge shaped hypoattenuation in the right inferior frontal gyrus with loss of gray-white differentiation is concerning for infarct. However, it is difficult to establish its acuity based on the present exam. MRI brain is recommended for further evaluation. 2. No acute intracranial hemorrhage. 3. Mild small vessel ischemic disease of indeterminate age. Moderate brain volume loss. 4. Stable left cerebellar chronic infarct. 5. Paranasal sinus osteomas with obstruction of the left frontoethmoid recess.
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Generate impression based on findings.
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67 year-old male with thymoma. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. No lymphadenopathy or mass is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Degenerative disease of the cervical spine is present. There is anterolisthesis of C4 over C5. Disc space narrowing is seen at C6-C7 level.The previously seen hyperdense foci in the C5 to T1 vertebral bodies appear less conspicuous on the present exam. Limited view of the chest show paramediastinal fibrosis and scarring in the lungs consistent with radiation fibrosis and soft tissue density in the left superior mediastinum.
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1. Partially visualized anterior mediastinal soft tissue lesion. Please correlate with CT chest for further details. 2. No evidence of mass or adenopathy in the neck.
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Generate impression based on findings.
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Saddle embolus of pulmonary artery. PULMONARY ARTERIES: In adequate infusion quality. A radiopaque marker is seen the in the main pulmonary artery anteriorly. Small caliber infusion catheters extend into the right main pulmonary artery (6/149) and into a distal subsegmental branch of a left lower lobe pulmonary artery (6/253).Previously seen saddle embolus has significantly improved with resolution of component extending into the left main pulmonary artery. There is residual embolus at the pulmonary artery bifurcation which extends into the right main pulmonary artery into the right descending pulmonary artery and several segmental branches. There is a residual nonocclusive embolus in the left upper lobe pulmonary artery, the proximal lingular branch, and some distal subsegmental left posterior basal branches. The majority of embolus previously seen within the left main, the orifice of the left upper lobe artery and the left descending pulmonary artery has resolved.LUNGS AND PLEURA: Small pleural effusions, left greater than right with basal compressive atelectasis. The atelectatic lung at the bases appears hypoperfused. No pneumothorax or conclusive hemo-thorax to suggest perforation of the pulmonary artery at this time.MEDIASTINUM AND HILA: The intraventricular septum remains straightened and the right ventricle remains enlarged, though these findings appears slightly improved compared to previous examination suggesting lessening of right heart strain. Subcarinal region lymphadenopathy and mild hilar region lymphadenopathy is unchanged.CHEST WALL: Severe degenerative changes at the right glenohumeral joint space and extensive arthropathy involving the right humeral head and glenoid. Large ossified bodies are seen arising from the humeral head and the anterior right glenoid.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Large air-fluid level in the incompletely visualized gallbladder. A large lamellated gallstone has moved into the region of the neck of the gallbladder, but no intrahepatic biliary ductal dilatation is identified. Inflammatory change is noted surrounding the descending duodenum which is inseparable from the gallbladder at this level. Radiopaque catheters are noted within the inferior vena cava.
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Interval TPA catheter placement from an IVC approach with catheters in the right main and a distal subsegmental branch of the left lower lobe; findings discussed with Dr. Dimmock (4428) at the time of examination. Interval improvement in overall burden of remaining embolus with residual nonocclusive thrombus from the right main to the right descending pulmonary arteries and also within small basal subsegmental branches bilaterally. The majority of thrombus on the left has significantly improved. Although signs of right heart strain are present, they appear improved compared prior examination. Atelectatic lung at the base is appears hypoperfused, areas of infarction cannot be excluded at this time.Air in the gallbladder is presumably due to fistulization between the gallbladder and the descending duodenum, present previously.
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Generate impression based on findings.
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57 year-old male with larynx cancer. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear except for minimal maxillary sinus mucosal thickening. Limited view of the intracranial structure is unremarkable. Postoperative changes are seen from prior tracheostomy, laryngectomy, myocutaneous flap reconstruction, and nodal dissection, as well as post treatment changes from prior radiation therapy. There is slight improvement of subcutaneous reticulation and aerodigestive mucosal edema. The prior tracheostomy tube has been removed. The postcontrast appearance of the salivary glands is unremarkable. The left lobe of the thyroid gland is surgically absent. The remaining right lobe is unremarkable.The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.There are no pathologically enlarged cervical lymph nodes. There is been slight interval decreased prominence of a small low-density minimally peripherally enhancing collection along the left carotid space most likely representing a seroma at the site of prior nodal dissection. The left internal jugular vein appears chronically occluded. The right internal jugular vein is not visualized distal to the surgical clips. Focal atherosclerotic calcification is again noted at the origin of the right internal carotid artery with moderate narrowing. No suspicious osseous lesion.There is redemonstration of a pulmonary micronodule within the right upper lobe.
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Stable to slightly improved posttreatment changes. No definite recurrent mass or new lymphadenopathy.
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Generate impression based on findings.
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Female 30 years old; Reason: assess the status of inflammatory pseudotumor History: none CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodule, unchanged.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue is not significantly changed, measuring 4.3 x 2.5 cm (series 3 image 34), previously measuring 4.4 x 2.3 cm when using the same measuring technique. Calcified right hilar lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenules, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small nonenlarged retroperitoneal lymph nodes. Previous reference left paraaortic lymph node is stable and measures 0.9 x 0.7 cm (series 3 image 101), previously measuring 0.9 x 0.7 cm.BOWEL, MESENTERY: No bowel wall thickening or mesenteric lymphadenopathy is noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Interval decrease in prominent inguinal lymph nodes. No significant lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Stable examination with stable anterior mediastinal and soft tissue and retroperitoneal nodes.
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Generate impression based on findings.
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Male; 32 years old. Reason: stone? History: persistent 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 significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 6-mm nonobstructing stone noted in the left lower pole. Mild left hydronephrosis. No perinephric edema or fluid collections. Also noted is a 2-mm stone in the distal left ureter, best seen on image 44 of series 80256, with adjacent inflammation of the ureter and minimal proximal hydroureter.Punctate hyperdensity in the right lower pole may represent a small non-obstructive stone.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: The bladder is moderately distended and unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted
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1.Left 2 mm distal ureterolithiasis with adjacent inflammation and minimal hydroureter/hydronephrosis.2.Right and left non-obstructing renal calculi.
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Generate impression based on findings.
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33 years old Male. Reason: pls eval for recurrence History: 33M with history of T cell lymphoblastic leukemia s/p resection of thoracic mass now with recurrence of back pain wo neurologic sx Soft tissue evaluation is limited by lack of intravenous contrast. Please also note that MR is more sensitive for delineation of soft tissue findings.THORACIC SPINEKyphosis is again present. Alignment is otherwise anatomic. Vertebral body and disk space heights are maintained.Postoperative appearance of laminectomies of T2 through T8 levels. Soft tissue detail is limited by lack of intravenous contrast and the inherent limitations of CT, however there is an elongated thick walled fluid collection in the surgical bed, extending from the level of the thoracic inlet to the approximate T5 level, spanning 10 cm in craniocaudal dimension and 3.6 x 2.5 cm in maximal axial dimension. This is slightly decreased in size from MRI 6/27/13. Thecal sac appears preserved within the limitations of this CT, however intrathecal extension cannot be entirely excluded. Patchy air space opacities, most pronounced in the right middle lobe, likely infectious. Right central venous catheter tip in the right atrium.Hypoattenuating foci within the thyroid are nonspecific. The left thyroid lobe hypoattenuating lesion contains coarse calcification. Note is also made of a high left paratracheal lymph node, just an AP left thyroid lobe, which was also present on priors. Calcified right hilar and mediastinal lymph nodes are present.LUMBAR SPINEThere is normal lumbar lordosis. The spine alignment is anatomic. Vertebral body heights and disk spaces are maintained. The lumbar paraspinal soft tissues are unremarkable. Limited views of the intra-abdominal viscera is unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12/L1: no neuroforaminal narrowing or spinal stenosis. L1/L2: no neuroforaminal narrowing or spinal stenosis. L2/L3: no neuroforaminal narrowing or spinal stenosis. L3/L4: Mild diffuse disk bulge. no neuroforaminal narrowing or spinal stenosis. L4/L5: Diffuse disk bulge. No neuroforaminal narrowing or spinal stenosis. L5/S1: Diffuse disk bulge with calcification. Mild facet hypertrophy and ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis.
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1. Elongated fluid collection in the posterior thoracic surgical bed, slightly decreased from 9/15/13. Given the limitations CT and the lack of intravenous contrast, the possibility of tumor recurrence, intrathecal extension, and abscess cannot be excluded. MRI with contrast can be considered for further evaluation. 2. Patchy right lung airspace opacities, likely infectious, including atypicals.3. Nonspecific hypoattenuating thyroid lesions, some of which contain calcification. Enlarged lymph node inferior to the left thyroid lobe. While these findings are unchanged from priors, thyroid neoplasm is a consideration. Consider thyroid ultrasound for further evaluation.
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Generate impression based on findings.
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40 year old female with history of left upper lobe subcentimeter nodule. A follow-up. Back pain. LUNGS AND PLEURA: Left upper lobe perifissural nodule (series 5 image 78) is again seen, unchanged in size. The second perifissural nodule (series 5 image 127) measures approximately 4 mm, unchanged in size. No new pulmonary nodules are appreciated.MEDIASTINUM AND HILA: Lipomatous hypertrophy of the interatrial septum, unchanged.CHEST WALL: Degenerative changes of the visualized spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Diverticulosis of the visualized colon.
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Tiny, perifissural micronodules are stable over the interval. The size, shape and location are most compatible with subpleural lymph nodes. No additional CT follow-up is necessary, unless the patient is a smoker or otherwise high risk for malignancy.
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Generate impression based on findings.
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49-year-old female with history of cholangiocarcinoma and pancreatic neuroendocrine tumor. Status post SMV stenting with recurrent upper GI bleeding and varices. Assess patency of the superior mesenteric vein stents. ABDOMEN:LUNG BASES: Small but enlarging right pleural effusion.LIVER, BILIARY TRACT: Since the prior examination, there's been interval placement of portal vein stents which extend into the superior mesenteric vein. The intrahepatic portion of the stent is patent however the extrahepatic portion extending into the SMV has thrombosed. The lower portion of the stents in the superior mesenteric vein appears patent.Left lobe hemangiomas unchanged. Presumed left lobe metastasis (image 32; series 4) is slightly larger measuring 1.4 x 1.8 cm. Several hypodense nodules are too small to characterize and probably represent cysts. A few presumed THADs are again noted. The hepatic artery remains patent. Perihepatic ascites. Status post cholecystectomy.SPLEEN: Status post splenectomy.PANCREAS: Status post pancreatectomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. Circumaortic left renal vein noted.RETROPERITONEUM, LYMPH NODES: As described below, infiltrative soft tissue in upper retroperitoneum suspected to represent tumor. BOWEL, MESENTERY: No bowel obstruction. Presumed infiltrative tumor around the superior mesentery vein and superior mesenteric artery appears similar to previous. There is also increased stranding in the root of the mesentery, suspected to represent edema. Multiple prominent mesenteric lymph nodes in collateral vessels in the upper abdomen.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.Unchanged ill-defined soft tissue in upper retroperitoneum suspected to represent tumor.2.Status post interval stenting of the portal and superior mesenteric veins with interval thrombosis of the central portion of the stents.3.Enlarging presumed left lobe liver metastasis.4.Increasing ascites.
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Generate impression based on findings.
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19 year-old female with a history of tuberous sclerosis. Please evaluate. LAM and renal angiomyolipoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Neural stimulator device along the anterior left hemithorax. 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: Note is made of multiple subcentimeter foci, some with apparent fat density within the kidneys bilaterally which may represent angiomyolipomas and others which may represent cysts, although these are too small to characterize. These are unchanged from the prior exam. ItRETROPERITONEUM, 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: There is a 3.7 x 2.6 cm left adnexal cystic lesion which is poorly characterized on CT examination but may represent a physiologic cyst. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. No significant interval change in small renal masses which are too small to characterize but may represent small angiomyolipomas versus cysts. If follow up examination of renal masses is desired, MRI could be considered, rather than CT. No evidence of LAM as clinically questioned. 2. 3.7 cm left adnexal cystic lesion is likely physiologic in a patient of this age. If follow up examination is desired, pelvic ultrasound could be considered rather than CT examination.
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Generate impression based on findings.
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49-year-old female with history of cholangiocarcinoma and pancreatic neuroendocrine tumor. Status post SMV stenting with recurrent upper GI bleeding and varices. Assess patency of the superior mesenteric vein stents. ABDOMEN:LUNG BASES: Small but enlarging right pleural effusion.LIVER, BILIARY TRACT: Since the prior examination, there's been interval placement of portal vein stents which extend into the superior mesenteric vein. The intrahepatic portion of the stent is patent however the extrahepatic portion extending into the SMV has thrombosed. The lower portion of the stents in the superior mesenteric vein appears patent.Left lobe hemangiomas unchanged. Presumed left lobe metastasis (image 32; series 4) is slightly larger measuring 1.4 x 1.8 cm. Several hypodense nodules are too small to characterize and probably represent cysts. A few presumed THADs are again noted. The hepatic artery remains patent. Perihepatic ascites. Status post cholecystectomy.SPLEEN: Status post splenectomy.PANCREAS: Status post pancreatectomy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. Circumaortic left renal vein noted.RETROPERITONEUM, LYMPH NODES: As described below, infiltrative soft tissue in upper retroperitoneum suspected to represent tumor. BOWEL, MESENTERY: No bowel obstruction. Presumed infiltrative tumor around the superior mesentery vein and superior mesenteric artery appears similar to previous. There is also increased stranding in the root of the mesentery, suspected to represent edema. Multiple prominent mesenteric lymph nodes in collateral vessels in the upper abdomen.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.Unchanged ill-defined soft tissue in upper retroperitoneum suspected to represent tumor.2.Status post interval stenting of the portal and superior mesenteric veins with interval thrombosis of the central portion of the stents.3.Enlarging presumed left lobe liver metastasis.4.Increasing ascites.
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Generate impression based on findings.
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Right shoulder status post Laterjet procedure, now with right shoulder pain. Assess bony healing. Two screws are seen across the bone graft along the anterior-inferior aspect of the glenoid. The bone graft has completely fused with the glenoid compatible with healing. There continues be a small anterolateral cleft at the inferior aspect of the bone graft. The coracoid process has been resected.A screw track is also seen in the superior portion of the glenoid. Calcifications within the right axillary space likely dystrophic from the prior surgery. Hill-Sachs deformity of the humeral head is again noted. No acute fracture or dislocation.
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Status post glenoid fusion of the bone graft to the anterior-inferior aspect .
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Generate impression based on findings.
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65-year-old male with history of stem cell transplant. Now with fever and tachypnea. LUNGS AND PLEURA: Motion from breathing degrades this exam. Small left greater than right pleural effusion, and associated atelectasis. A small amount of pleural fluid tracks within the left major fissure. Dependent atelectasis abutting the fissure in the right upper lobe in a pattern suggestive of prior aspiration.MEDIASTINUM AND HILA: Small amount of pericardial fluid. Several mildly enlarged nodes are seen, likely reactive. Right jugular intravenous catheter tip terminates in the SVC. Mediastinal lipomatosis with extension into the intra-atrial septum and mass effect upon the suprahepatic IVC; this has a lenticular appearance on the sagittal images.CHEST WALL: Degenerative disease affects the spine. Multiple compression fractures of the upper thoracic spine with cement from vertebroplasty, given differences in technique these appear stable when compared with prior MRI from 4/22/13. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Small, left greater than right pleural effusion and associated atelectasis. No specific signs of infection.Lipomatous hypertrophy of the intra-atrial septum and posterior wall of the right atrium/IVC causing mass effect on the suprahepatic IVC; if further workup is clinically warranted, MR may be of use.
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Generate impression based on findings.
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68 year-old male with left ear cancer. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure shows intracranial arterial calcification. There is redemonstration of small nodes at the preauricular space superficially, unchanged. No lymphadenopathy or mass is noted. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. There is carotid artery calcification. The osseous structures are unremarkable. The cervical vertebral bodies in general are intact with no evidence for canal stenosis. The patient is status post anterior and posterior fixation at C5-6. There are endplate of the vertebral osteophytes at C3-4 with neural foraminal narrowing.Limited view of the chest is unremarkable.
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No evidence of local recurrence or lymphadenopathy in the neck soft tissue.
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Generate impression based on findings.
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Lung nodule LUNGS AND PLEURA: Postoperative changes right upper lobectomy. Severe centrilobular emphysema. Interval resolution of previously seen irregular airspace nodule in the right lower lobe. Debris in the right mainstem bronchus. The bronchus intermedius has an irregular contour and the right middle lobe bronchus is severely stenotic, measuring 2-mm. No pleural fluid or pneumothorax. Ground glass density nodule in the anterior left upper lobe (5/173) measures 10 x 9 mm, probably unchanged compared to the prior examination though was difficult to visualize even in retrospect given the degree of motion artifact present previously. Smoothly marginated, centrally calcified 6-mm nodule in the left upper lobe (5/29) is unchanged; the appearance is most consistent with a benign lesion. Scattered 2 to 3-mm nodule micronodules are unchanged. New 4 mm subpleural nodule with unsharp margins (5/96) nonspecific. Incomplete left major fissure. Spiculated nodule in the lingula measures 8 x 7 mm appears adherent to the major fissure, difficult to measure on the prior study although not conclusively changed.MEDIASTINUM AND HILA: Normal heart size. No visible lymphadenopathyCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormality.
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1. Interval resolution of right lower lobe nodules, presumably postinflammatory or postinfectious. 2. Indeterminate spiculated nodule in the lingula, probably unchanged but poorly evaluated on the last exam due to patient motion. CT follow-up may be performed in 6-12 months in a low risk patient. If the patient has a history of smoking or is otherwise at high risk for malignancy, 3 to 6 month follow-up is recommended. Lack of activity on recent PET scan does not alter follow-up as lesion may be too small to resolve on FDG imaging.3. 1 cm groundglass density nodule in the left upper lobe may represent an area of atypical adenomatous hyperplasia versus adenocarcinoma in situ given lack of resolution; this may be followed yearly by CT.
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Generate impression based on findings.
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Reason: oral cancer History: r/o lung mets LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.Mild bronchial wall thickening is present with areas of basilar scarring, unchanged. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Severe coronary artery calcification is present. There are calcified right hilar lymph nodes.Stable small pericardial effusion.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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Fatigue. ASD VESSELS:SINUS OF VALSALVA: 3.0 X 3.2 X 2.9 cmSINOTUBULAR JUNCTION: 2.6 X 2.7 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 2.6 X 2.6 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 2.4 X 2.6 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.0 X 2.0 cmDESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 1.8 X 1.6 cmINFRARENAL ABDOMINAL AORTA: 1.2 X 1.4 cmRIGHT COMMON ILIAC ARTERY: 10 X 10 mmRIGHT EXTERNAL ILIAC ARTERY: 8 X 8 mmRIGHT COMMON FEMORAL ARTERY: 6 X 6 mmLEFT COMMON ILIAC ARTERY: 10 X 10 mmLEFT EXTERNAL ILIAC ARTERY: 8 X 8 mmLEFT COMMON FEMORAL ARTERY: 6 X 6 mmABDOMEN: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: Accessory right renal artery. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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Normal appearance of the access vasculature, as measured above.Please note that the cardiac/coronary CT examination will be reported separately.
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Generate impression based on findings.
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Male 56 years old; Reason: Pt with ETOH cirrhosis. Please eval for lesions History: ETOH cirrhosis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Heterogeneous enhancement is noted throughout the liver, with areas of low attenuation compatible with fatty infiltration.There is cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilation is noted.Portal vein: Patent Hepatic veins: Patent Hepatic artery: Patent with conventionalLesions: Subtle arterial enhancement in segment 4 B. with suggestion of washout is noted (arterial series 9 image 62 and corresponding delayed image series 12 image 63). Varices are noted with very mild perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Cirrhotic morphology with subtle arterial enhancement and washout in segment 4B. Patient's fatty infiltration limits evaluation, for full characterization MRI.Dr. Te notified of the findings at 3:15 on 12/20/13
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Generate impression based on findings.
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Female; 77 years old. Reason: Left breast cancer 1995, now with recurrent dz in skin of left History: recurrent left breast cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Nonpathologic sized mediastinal lymph nodes.CHEST WALL: Left axillary surgical clips. Nonpathologic sized lymph nodes in the right axilla.OTHER: Right thyroid nodule, best seen on image 7 of series 3, measures 1.8 x 1.3 cm.ABDOMEN:LIVER, BILIARY TRACT: No evidence of suspicious lesions. No intra-or extrahepatic ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic nonenhancing fat dense mass in the left superior renal pole measuring 1.7 x 1.0 cm likely represents a benign angiomyolipoma. No evidence of hydronephrosis or perirenal fluid collections.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic calcifications of the abdominal aorta. Left common iliac enlarged lymph node measures 1.7 x 1.2 cm.BOWEL, MESENTERY: Bowel is normal in caliber. No evidence of obstruction.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: 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.Scattered non-pathologic sized lymph nodes without definitive evidence of metastatic disease.2.Cholelithiasis.3.Right thyroid nodule.
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Generate impression based on findings.
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49-year-old male with history of nasal esthesioneuroblastoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significantly enlarged mediastinal or hilar lymph nodes.Incidental note made of a normal variant left vertebral artery arising directly from the aortic arch.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left extrarenal pelvis again seen without change.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No findings to suggest metastatic disease.
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Generate impression based on findings.
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Malignant neoplasm of scapula and long bones of the upper limit (osteosarcoma). Stable pulmonary metastases. LUNGS AND PLEURA: Postoperative findings consistent with multiple bilateral areas of wedge resection.Focal scarring in a delayed apex is stable at 12 x 13 mm.Subsolid nodule in the left lower lobe stable at 8-mm (4/58).Right anterior pleural nodule 6 x 13 mm, previously 7 x 13 mm (4/49).Subpleural scarlike abnormality adjacent to surgical clips in the posterior right lobe (4/44) unchanged and may be related to adjacent skeletal defect.MEDIASTINUM AND HILA: Postsurgical distortion of the right atrium unchanged. Reference high right paratracheal lymph node unchanged 7-mm (3/13), upper normal in size.CHEST WALL: Partial bridging between the right sixth and seventh ribsUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. 3-mm nonobstructing nephrolith upper pole left kidney. Unchanged appearance between the aorta and pancreas are at the expected location of the celiac axis and right diaphragmatic crus where previously described soft tissue was reported. Limited scanning range is otherwise unremarkable.
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Stable exam.
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Generate impression based on findings.
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Female 59 years old; Reason: right breast IDC with positive lymph node; CT for metastatic w/u History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small soft tissue with calcifications noted in the right upper breast. Subcentimeter non pathologically lymph nodes in the right axilla, likely related to patients breast cancer.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evident metastatic disease detected.
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Generate impression based on findings.
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Female; 55 years old. Reason: kidney stones, hydronephrosis History: kidney stones 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: The proximal common bile duct is dilated measuring 9 mm and tapers as it nears the pancreatic head. No evidence of obstructing pancreatic head lesions or obstructing stones. The gallbladder is not visualized. No suspicious hepatic lesions. SPLEEN: No significant abnormality notedPANCREAS: The pancreatic duct is not visualized. No suspicious lesions evident.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or nephrolithiasis. No perirenal fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Residual contrast in the colon. G-tube in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: G-tube present within the stomach.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter present within a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Residual contrast in the colon. G-tube in place.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left paramedian fat-containing hernia. No evidence of fat necrosis.
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1.No evidence of urolithiasis or hydronephrosis.2.Common biliary ductal dilatation. If patient care warrants additional imaging, consider MRCP for further evaluation.
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Generate impression based on findings.
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Three years after right upper lobectomy for stage I A. adenocarcinoma LUNGS AND PLEURA: Postsurgical changes of a right upper lobectomy. Scattered micronodules and areas of mucous plugging. No signs of localized recurrence.6 x 5 mm groundglass nodule in the medial right middle lobe (4/41) has slowly increased in size since 2010 and could represent atypical adenomatous AIS/MIA.MEDIASTINUM AND HILA: Dilated proximal thoracic esophagus and SVC. Atherosclerotic calcification of the thoracic aorta. Hiatal hernia.CHEST WALL: Dense breast glandular tissue atypical for age and incompletely assessed by CT. Nonspecific calcifications and a solid nodule hyperattenuating to the surrounding breast parenchyma measuring 11-mm on the right (3/50), unchanged in size compared to 2010 but nonspecific. Additional dense foci of nodularity are seen bilaterally.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Scattered probable hepatic cysts. Atherosclerotic calcification of the abdominal aorta.
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1. Stable 6 x 5 mm nodule in the medial right middle lobe with differential diagnosis of AAH versus AIS/MIA, continued yearly follow-up recommended.2. No signs of localized recurrence.3. Dense breast tissue with internal nodules which are nonspecific by CT scan, correlate with physical examination and, if clinically warranted, mammography.
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Generate impression based on findings.
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Reason: h/o ear canal cancer History: r/o chest mets LUNGS AND PLEURA: Punctate benign appearing micronodules are unchanged.There is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Moderate to severe coronary artery calcifications are present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable right adrenal gland calcification. Stable renal cystlike hypodensities and nonobstructing calculus.Scattered hepatic hypodensities too small to characterize but most likely benign.
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No evidence of metastases, or other significant abnormality. No change.
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Generate impression based on findings.
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Reason: followup of pulmonary blastomycosis History: cough LUNGS AND PLEURA: The previously seen large left upper lobe residual cyst has scarred down significantly, with an asymmetrically thick wall but overall improvement. Other small nodules and cysts are stable and there is evidence of progression or recurrence of infection.MEDIASTINUM AND HILA: Right aortic arch.No mediastinal or hilar lymphadenopathy present.CHEST WALL: Bilateral breast prostheses.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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Marked reduction in size of residual left upper lobe cysts, although it now has an asymmetrically thick wall probably related to healing than recurrence. No other significant change in nodules and small cysts. No specific evidence of recurrent infection.
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Generate impression based on findings.
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Female; 45 years old. Reason: r/o wound abscess, SBO History: vomiting, pain and drainage from wound 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: Mild bibasilar atelectasis.LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: Round, exophytic, hypoattenuating lesions located in the posterior spleen, best seen on image 24 of series 3, measures 1.6 x 1.7 cm. This lesion cannot be accurately characterized without contrast enhancement.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter in expected location.BOWEL, MESENTERY: Again seen are several small bowel loops adherent to the anterior abdominal wall surgical wound. There has been an interval increase of surrounding mesenteric fat stranding and small bowel wall thickening. Questionable extraluminal fluid and gas-containing collection, best seen on image 97 of series 3, measures 2.8 x 2.3 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Stable soft tissue inflammation surrounding the mid-abdominal wall wound.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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Interval increase in small bowel inflammation adjacent to the midabdominal wall surgical wound. Questionable extraluminal fluid and gas collection may represent an abscess.
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Generate impression based on findings.
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Reason: smoker with asbestos exposure, r/o fibrosis versus COPD. Patient has severe DOE History: DOE, cough LUNGS AND PLEURA: Severe apical paraseptal emphysema with large bullae.No specific evidence of interstitial lung disease, or asbestos related pleural disease.Small benign-appearing micronodules are present some calcified.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.Mild to moderate coronary calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver morphology.
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1. Severe paraseptal emphysema with large bullae.2. No evidence of asbestos-related interstitial or pleural disease.3. Cirrhotic liver morphology.
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Generate impression based on findings.
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Reason: s/p sleeve RUL History: cancer LUNGS AND PLEURA: Status post right upper lobe resection with no evidence of tumor recurrence.MEDIASTINUM AND HILA: Postsurgical changes right hilum.Previously seen right perihilar fluid collection has resolved.Residual thymic tissue is stable in appearance.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of tumor recurrence rather significant abnormality. Prior mediastinal fluid collection has resolved.
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Generate impression based on findings.
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76 year old female. Reason: evaluate TAA s/p TEVAR History: evaluate TAA s/p TEVAR CHEST:LUNGS AND PLEURA: Basilar subsegmental atelectasis and consolidation.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Coronary artery calcifications and stents.VASCULATURE: Stent graft in the aortic arch. Thrombosed saccular aneurysm arising from the left lateral wall of the aortic arch measures 4.3 x 4.0 cm (series 9, image 37), unchanged. No evidence of endoleak. There is peripheral calcification of the aneurysm. The ascending and descending aorta are unchanged. The pulmonary artery remains enlarged but unchanged. Left carotid stent is unchangedCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.VASCULATURE: The infrarenal abdominal aorta is mildly ectatic and demonstrates extensive calcification. The right renal stent is widely patent. The celiac axis, SMA and IMA are patent. There is extensive calcification of the bilateral iliac vessels. The right common / external iliac stent is patent.BOWEL, MESENTERY: Right lower quadrant calcified mesenteric is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right groin postoperative fluid collection has mostly resolved however there is a combination of air inflammation extending to the skin presumably representing an open wound. A surgical incision and drainage.OTHER: Colonic diverticulosis.
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1.Status post TEVAR with persistent aortic arch saccular aneurysm. No evidence of endoleak. 2.Right groin wound as described above.
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Generate impression based on findings.
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56-year-old male with right tonsil cancer. Brain:The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or suspicious contrast enhancement. Left frontal developmental venous anomaly.The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Neck:Examination shows thickening of the right palatine tonsil and no measurable mass lesion. Right level 2a necrotic lymph node which abuts the submandibular gland and is inseparable from portions of the sternocleidomastoid muscle measures 2.1 x 1.7 cm (series 6 image 29), previously measured 3.5 x 3.0 cm. No additional pathologically enlarged by CT criteria lymph nodes are present.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Multilevel degenerative changes of the cervical spine without suspicious osseous lesions.Partially visualized right chest port catheter. The visualized lung apices are clear. Please see dedicated chest CT from today's date for further details.
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1. Right palatine tonsil thickening with no measurable mass lesion. Continued follow up is recommended. 2. Interval decrease in size of a necrotic right level 2a lymph node.3. No intracranial metastases are present.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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Reason: T1N2bMx SCC of R tonsil. Post induction evaluation. History: as above CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules are unchanged.There is no specific evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.A central line extends to the SVC.Minimal coronary calcifications are present. CHEST WALL: Degenerative abnormalities affect the thoracic spine.Right jugular catheter and chest wall port.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially calcified left renal cyst, 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: Partial compression fracture L1 unchanged.OTHER: No significant abnormality noted.
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1. No evidence of metastases.2. Complex left renal cyst, stable.3. Age indeterminate compression fracture of L1, stable.
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Generate impression based on findings.
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Evaluate for progression of metastatic disease. Chemotherapy follow-up. CHEST:LUNGS AND PLEURA: Moderate right pleural fluid collection is slightly larger. Septal thickening and nodularity suggestive of lymphangitic spread of tumor bilaterally with subjective increase in number of septal micro-nodules. Innumerable centrilobular micronodules also noted. Subpleural nodularity most suggestive of lymphatic infiltration. Scattered parenchymal lung nodules are seen at the bases.Solid component of right upper lobe mass increased in size, measuring 8.2 x 4.6 cm (3/28), previously 7 x 3.2 cm. Circumferential tumor slightly narrowing of the right and bronchus also subjectively increased, inseparable from adjacent lymphadenopathy.MEDIASTINUM AND HILA: Index right paratracheal lymph node 11 mm, unchanged (3/33).Mild diffuse mediastinal lymphadenopathy; lymph nodes appear abnormal in multiplicity. Left hilar lymphadenopathy, about the same. Soft tissue density from tumor surrounds the airways of the right lung, causing mild narrowing. Irregular soft tissue opacity extends cranially along the distal trachea for a short distance and the left main bronchus is slightly thickened proximally. Small volume of pericardial fluid. Pulmonary veins appear attenuated.CHEST WALL: Mixed lytic and sclerotic lesion in the right manubrium unchanged compared to most recent previous but new from 1/31/13 (3/24). A few punctate sclerotic foci in the spine appears similar to most recent previous.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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 increase in size of right upper lobe mass, right pleural fluid collection and extent of pulmonary and lymphangitic metastases. Stable sclerotic sternal lesion, likely a metastasis.
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Generate impression based on findings.
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68 year old male with history of mesothelioma status post chemotherapy. Evaluate and compare to prior. CHEST:LUNGS AND PLEURA: Left hemithorax pleural thickening and subpleural consolidation, consistent with mesothelioma, appear similar to prior. Left lower lobe predominant nonspecific in interstitial opacities, unchanged from previous. Persistent small loculated left pleural effusion. Unchanged right lower lobe micronodule (series 4 image 33).Reference measurements as follows:1. At the level of the aortic arch (series 3 image 28): At the 9 o'clock position, 0 mm. At the 7 o'clock position 2 mm not significantly changed.2. At the level of the left main pulmonary artery (series 3 image 33): At 12 o'clock position, no measurable pleural thickening but there is persistent subpleural consolidation. At the 3 o'clock position, 3 mm, not significantly changed.3. At the level of the intraventricular septum (series 3 image 50): 4 mm at the 5 o'clock position, unchanged.4 mm at the 7 o'clock position, unchanged. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Stable postoperative findings from prior sternotomy. Degenerative disease affects the visualized spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Foci of hepatic hypoattenuation are unchanged since 2008.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left superior renal parenchymal hypoattenuating focus, likely cyst but nonspecific is 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 significant abnormality noted.BONES, SOFT TISSUES: Umbilical hernia containing only fat is again seen.OTHER: No significant abnormality noted.
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Stable findings consistent with history of mesothelioma.
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Generate impression based on findings.
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95 year-old male with intracranial hemorrhage. There has been no significant interval change of bifrontal acute on chronic subdural hematomas since prior study. There is no midline shift. Redemonstration of infarcts on the left frontal and parietal lobes, no change since prior study. No new infarct is seen.The ventricles, sulci, and cisterns are symmetric and unremarkable. Intracranial arterial calcifications. The osseous structures are unremarkable except for biparietal bone burr holes. The paranasal sinuses and mastoid air cells are clear.
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No significant interval change of bilateral acute on chronic subdural hematomas. Stable infarcts on the left frontal and parietal lobes
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Generate impression based on findings.
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Lung mass super d protocol LUNGS AND PLEURA: Solid spiculated mass in the in the posterior aspect of the right apical segment measures 5.3 x 3.5 cm on coronal image 51. On the coronal MIP sequence of the outside study the lesion measured approximately 4.1 x 3.6 cm however atelectasis associated with the lesion makes measurement of the long axis difficult on the outside study (no standard coronal reconstructions sequences are available). The lesion has spicules extending to the right major fissure and lateral pleural surface. The subsegmental airway leading into the lesion is thickened and narrowed (6/29). The mass occurs approximately 5 cm from the carina. Scattered micronodules are too small to characterize and nonspecific in appearance. Some of these appear calcified suggesting healed granulomatous. No suspicious appearing nodules are appreciated at this time.No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: No pericardial fluid. Severe calcification of the coronary arteries and mitral annulus. Severe atherosclerotic calcifications of the aorta and its branches. No visible lymphadenopathy, please refer to outside PET exam report which was not available at the time of this dictation for identification of lesions which may be occult by unenhanced CT.CHEST WALL: Nonspecific small sclerotic foci in the right scapula near the glenoid fossa.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Severe atherosclerotic calcification involving the celiac axis splenic artery. No visible lymphadenopathy. Visualized upper aspects of the adrenal glands appear unremarkable. Calcifications in the hepatic parenchyma are most likely healed granulomas.
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5.3-cm irregular mass in the right upper lobe with linear spiculation extending to the pleural surface is suspicious for primary pulmonary malignancy. In the appropriate clinical setting, aggressive atypical infection may have a similar radiographic appearance. The mass occurs approximately 5-cm from the carina. No visible lymphadenopathy or suspicious pulmonary nodules to suggest metastases. No pleural or pericardial fluid.
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Generate impression based on findings.
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52 year old female with persistent CVA tenderness. Evaluate for renal cysts, abscess, mass, or stone. Tenderness on the right. Lack of intravenous contrast limits evaluation of solid organs. Lack of enteric contrast limits evaluation of bowel.ABDOMEN:LUNG BASES: LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral calculi are identified. There is no hydronephrosis or hydroureter. There is no perinephric fat stranding. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of stool throughout the colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Note is made of tubal ligation clips. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of stool throughout the colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No acute intra-abdominal process. There is a moderate amount of stool noted throughout the colon.
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Generate impression based on findings.
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64 year old female with history of cough. Evaluate right middle lobe lung nodule. LUNGS AND PLEURA: The previously described pleural based right middle lobe nodule measures approximately 7 mm in the widest dimension (series 4 image 43), unchanged from prior when using the same measurement technique.MEDIASTINUM AND HILA: No significant abnormality noted.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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Stable right middle lobe nodule, without acute abnormality.
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Generate impression based on findings.
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Face/neck pain, lymphadenopathy prominence in left hilum seen on CT neck. LUNGS AND PLEURA: 2-mm subpleural nodules in the right middle lobe (5/59) are too small to characterize; the medial nodule was visible previously on abdominal CT scan of 6/1/2005 and is compatible with a benign lesion. The lateral nodule is relatively flat and in a location typical for subpleural/intrapulmonary lymph nodes and is statistically most likely benign. Dependent atelectasis bilaterally. Dependent groundglass opacity in the posterior lung fields may be related to underinflation.MEDIASTINUM AND HILA: Mildly enlarged high right paratracheal lymph node, 10-mm (3/20). Mildly enlarged lower right paratracheal chain and subcarinal lymph nodes. No conclusive evidence of hilar lymphadenopathy. Left atrium is mildly enlarged. No pericardial fluid.CHEST WALL: Several small nonspecific lymph nodes seen in the low neck and supraclavicular regions, please refer to separately reported neck CT. Surgical clips in the region of the thyroid.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips.
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1. Mild mediastinal lymphadenopathy is nonspecific in appearance. 2.Mild enlargement of the left atrium may be correlated with echocardiography if there is clinical suspicion for mitral valve disease. 3.Pulmonary micronodules are most likely benign; if the patient has a high risk for primary pulmonary malignancy, one year CT follow-up may be obtained. If the patient is at low risk been no follow-up will be needed.
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Generate impression based on findings.
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T4N1M0 nasopharyngeal carcinoma s/p CRT 9/09, now with systemic metastases. Serial CT images obtained during the aspiration procedure demonstrate the cannula, needle and biopsy gun placement within the prevertebral lesion. Following needle removal images obtained demonstrate no complications.
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C6-C7 prevertebral lesion aspiration and biopsy under CT guidance. The cytopathologist found some cells suspicious for undifferentiated carcinoma.
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Generate impression based on findings.
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31 year-old female with neck stiffness and fever. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There are air fluid levels in the sphenoid and ethmoid sinuses. There is complete opacification of the right maxillary sinus with widening of the right infundibulum and sinus wall thickening. There is mucosal thickening in the maxillary, ethmoid and frontal sinuses. Partially empty sella.
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1. No acute intracranial abnormality. 2. Evidence for acute sinusitis and sinus inflammatory disease. In addition, findings on the right maxillary sinus are suggestive of chronic obstruction/sinusitis. A polyp at the maxillary infundibulum or ostium cannot be ruled out.
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Generate impression based on findings.
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46 year-old female with tongue cancer and status post partial glossectomy. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. Examination shows a necrotic, peripherally enhancing mass along the right lateral tongue extending into the tip, measuring 43 x 23 mm (image 17, series 6). The mass also crosses the midline. There is small defect at the anterior right lateral border of the tongue, consistent with partial glossectomy. There are a few small nodes at levels I and II, none of which is pathologic by CT size criteria. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Limited view of the chest shows nodules in the right upper lobe.
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1. Right lateral tongue necrotic mass extending into the tip and crossing the midline. Status post partial glossectomy. 2. No cervical lymphadenopathy by CT size criteria. 3. Right upper pulmonary nodule.
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Generate impression based on findings.
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22 year old man with ASD who is planning on undergoing closure via robotic procedure is referred for pre-operative assessment of cardiac anatomy.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a large posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 151ml).Right Ventricle: The right ventricular late diastolic volume is severely increased (446ml).Atria: The left atrium is moderately dilatated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus. The right atrium is severely dilated. There is a very large secundum type ASD present spanning almost the entire inter-atrial septum. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The thoracic aorta demonstrates no evidence of dissection or aneurysm. The main pulmonary artery is mildly dilated.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
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1. There are no significant coronary artery stenoses present. 2. Very large secundum type ASD is noted. No other congenital heart defects noted. 3. Very severe RV dilation. 4. Severe RA dilation. Moderate LA dilation. 5. Mild dilation of the main pulmonary artery.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
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Generate impression based on findings.
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66 year-old male with history of tongue cancer, status post CRT and now tongue weakness and difficulty speaking and swallowing. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement. The orbits are unremarkable except for right lens prosthesis. The mastoid air cells are clear. Evidence for acute sinusitis. There is right hemitongue atrophy. No mass or cervical lymphadenopathy is noted. The oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The submandibular glands appear atrophic with fatty replacement. The parotid glands are unremarkable. Coarse calcification is present in the irregularly appearing right thyroid lobe. The carotid arteries and jugular veins are patent. Calcification at the carotid bifurcation. Hypoplasia of the left vertebral artery. There are multilevel disc osteophyte complexes and neuroforaminal narrowing of the cervical spine. Please refer to dedicated chest CT for pulmonary findings.
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1. No intracranial metastasis. 2. Stable posttreatment changes with no evidence of local tumor recurrence or cervical lymphadenopathy. 3. Acute sinusitis.
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Generate impression based on findings.
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54 year-old male with stage 4 lung cancer and altered mental status. There appears a focus of hypoattenuation in the left basal ganglia. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for minimal left maxillary sinus mucosal thickening. Left upper nuchal subcutaneous metallic objects.
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1. No mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. Noncontrast enhanced CT is insensitive to early detection of metastasis. MRI should be considered if clinical suspicion for metastasis persists. 2. Small focus of hypoattenuation in the left basal ganglia, which may represent age indeterminate ischemic change.
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Generate impression based on findings.
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53 year-old male with hepatic encephalopathy and confusion. Examination shows moderate supratentorial ventriculomegaly. The patient is status post right parietal ventriculostomy with a shunt catheter terminating at foramen Monroe on the right. There is edema along the catheter tract. The fourth ventricle is within normal limits. The sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no midline shift, or acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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Moderate supratentorial ventriculomegaly status post right parietal ventriculostomy. CT is insensitive to early detection of CVA or encephalopathy. MRI should be considered if clinical suspicion persists.
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Generate impression based on findings.
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16 year-old female with altered mental status. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No acute intracranial abnormality.
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Generate impression based on findings.
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55-year-old prior pancreatectomy multiple hernia with mesh repair, obstruction or inflammation, ischemia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined hypo-dense peripherally based lesions within the hepatic parenchyma are nonspecific, could represent focal fatty infiltration. No intrahepatic biliary ductal dilatation. Hepatic vessels are patent. Few small non-specific hyperdense subcentimeter lesions are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS:Multiple coarse calcifications of the pancreatic head and uncinate process, compatible with history of chronic pancreatitis. Pancreatic duct is not dilated as noted previously. No peripancreatic collections.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole nonobstructing calculiRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Few dilated small bowel loops especially the distal jejunal and proximal ileal loops with maximum measurement of around 2.7 cm with possible transition point the seen in the midabdomen with small bowel wall thickening (coronal plane 57), suggestive of partial, low grade small bowel obstruction or less likely this transition point might be due to underdistention. No evidence of interloop fluid. Most likely etiology could be focal adhesions.Status post ventral hernia repair with mesh.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus not visualized probably surgically removed. Multiple collaterals noted within the pelvis, probably pelvic congestion syndromeBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascites
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1. Focal areas of fatty infiltration within the liver.2. Sequel of chronic pancreatitis involving the pancreatic head and uncinate process.3. Few distended, measuring up to 2.7 cm small bowel loops in the midabdomen with possibly transition point in the midabdomen without interloop fluid, favor a partial low-grade focal small bowel obstruction over underdistention. Most likely etiology could be due to adhesions.4. Status post ventral hernia repair.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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Post gastric bypass with distention nausea and vomiting ABDOMEN:LUNG BASES: Moderate Pericardial effusionLIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation, which can be explained due to cholecystectomy. No focal lesions. Hepatic vessels are patent.SPLEEN: No significant abnormality notedPANCREAS: Tortuous tubular cystic lesion identified in the pancreatic head, mostly unchanged from prior study. Pancreatic head is enlarged and edematous with ill-defined borders and adjacent fat stranding highly suggestive of acute pancreatitis. The cystic lesion could represent an IPMN or mucinous neoplasm, and should be further evaluated with ERCP after inflammation settles down. SMA, SMV, portal vein are patent. Rest of the pancreas demonstrates homogeneous attenuation. No evidence of peripancreatic collection or necrosis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status-post duodenal switch and a gastric sleeve changes. No evidence of bowel obstruction or wall thickening.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 ascites
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1. Moderate pericardial effusion2. Focal acute pancreatitis involving the pancreatic head without necrosis or fluid collection. Stable tubular, cystic lesion within the hepatic head. This possibly could be the cause of pancreatitis and could represent an obstructed IPMN or a mucinous neoplasm. This should be further evaluated with ERCP after inflammation settles down.3. Status post duodenal switch and gastric sleeve changes without bowel, obstructionI 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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63 year-old male with blurry vision and headache. There is patchy hypoattenuation in the periventricular white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Chronic blowout fracture of the right lamina papyracea.Heavy calcification of the intracranial internal carotid and vertebral arteries.
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No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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55 year-old male with altered mental status. There is patchy hypoattenuation in the periventricular white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for a left maxillary sinus retention cyst/polyp. Empty sella. Mild deformity of the left lamina papyracea. Mild elongation of the bilateral globes, probably staphylomas. Calcification of the intracranial internal carotid and vertebral arteries.
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No acute intracranial abnormality. Small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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68 years old female with intracerebral hemorrhage. There is redemonstration of a hematoma in the left frontal lobe, which has been stable in size since prior. There is a mild degree of surrounding parenchymal edema. No evidence of generalized mass-effect is seen. No new hemorrhage.No evidence of subdural, subarachnoid or intraventricular hemorrhagic extension is seen at this time. Mild periventricular hypoattenuation is suspected, a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease. No significant mass effect is detected. Ventricular system is patent and within normal limits for size.Fluid levels throughout the paranasal sinuses are likely related to nasal and ET tubes.The bones of the calvarium and skull base are intact.
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Stable left frontal parenchymal hematoma with minimal mass effect. No new hemorrhage.
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Generate impression based on findings.
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57 year-old female with left sided neck pain. NONCONTRAST CT HEADThe ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for mild left maxillary sinus mucosal thickening. Empty sella. CTA HEAD AND NECKThere is common origin of the right brachiocephalic and left common carotid arteries. The left subclavian and bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through anterior circulation (bilateral petrous/cavernous/supraclinoid internal carotid arteries, anterior and middle cerebral arteries), posterior circulation (vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries), and distal intracranial vasculature. Mild calcified atherosclerosis is noted in bilateral cavernous/supraclinoid carotid arteries. There is normal contrast opacification through a complete circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage.
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1. No acute intracranial abnormality. 2. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation.
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Generate impression based on findings.
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62 year-old male status post shunt removal. There has been removal of the left frontal shunt catheter. There is trace air in the bilateral frontal horns and catheter tract. The ventricular system has been stable in size, with temporal horns remaining dilated. There are multifocal hypodensities in the periventricular white matter, left basal ganglia, left subinsular, and left external capsule, unchanged. Dense vascular calcifications are again seen. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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Status post shunt removal. Stable ventricular size and multifocal parenchymal hypodensities.
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Generate impression based on findings.
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40 year-old male. Tachycardia, chest pain. PULMONARY ARTERIES: Technically suboptimal exam for evaluating pulmonary embolism. No acute pulmonary emboli identified to the lobar level.LUNGS AND PLEURA: Left basilar linear atelectasis. No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Streak artifact from bullet fragment in posterior elements of upper thoracic spine limits evaluation. Multilevel degenerative disk disease. Partially visualized spinal rods in the lower thoracic spine with heterotopic bone formation.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nodular contour of visualized upper pole of left kidney.
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No evidence of pulmonary embolism to the lobar level or specific findings to explain patient's symptoms.
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Generate impression based on findings.
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34-year-old male. History of SCD, CHF cough, status post AICD, PE, CAD. Shortness of breath. PULMONARY ARTERIES: Technically adequate examination for evaluating pulmonary embolism. Acute completely occlusive segmental pulmonary embolus in the left upper lobe and a subsegmental embolus in the right lower lobe are identified. LUNGS AND PLEURA: Lower lobe mild groundglass opacities. Mild peribronchial thickening. No pleural effusion.MEDIASTINUM AND HILA: Cardiomegaly. Moderate pericardial effusion, similar to prior exam. Left sided ICD with lead in the right ventricle. No signs of right heart strain.CHEST WALL: Mild anterior wedging of lower thoracic vertebral bodies.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips.
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1. Segmental and subsegmental acute pulmonary emboli are identified.2. Mild pulmonary edema in the lower lobes.3. Moderate pericardial effusion.Findings communicated to clinical service, Dr. Worku, at time of dictation.
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Generate impression based on findings.
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68 year-old male patient with history of right leg pain and fever with positive white blood cell scan. Evaluate for right leg infection and fluid collection. There is anatomic alignment without bone abnormality. Specifically, no osseous erosions or other specific findings to suggest osteomyelitis or other acute abnormality. There is somewhat focal minimal subcutaneous fat stranding and skin thickening of the lateral right thigh extending towards the knee, which may represent edema versus cellulitis. Subcutaneous fat stranding is most pronounced in the distal femur and adjacent to the knee and extends beyond the field of view. Subcutaneous stranding does not extend towards deeper muscular compartments or fascial planes. No fluid collection or other findings to suggest an abscess.Vascular calcifications and bilateral fat filled inguinal hernias noted. Prior vascular surgical changes in the right groin.
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No fluid collection or radiologic evidence of osteomyelitis affecting the right leg. Soft tissue fat stranding as above.
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Generate impression based on findings.
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60-year-old female. Hypoxic and tachycardic. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam. No pulmonary emboli identified. LUNGS AND PLEURA: Low lung volumes with basilar/dependent atelectasis. Attenuation of the trachea and bronchi consistent with tracheobronchomalacia.MEDIASTINUM AND HILA: Cardiomegaly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Severe hepatic steatosis. Hypoattenuation adjacent to the falciform ligament does not alter the hepatic contour and may be a perfusion variant.
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No evidence of pulmonary embolism. Severe collapse of the trachea and bronchi consistent with tracheobronchomalacia.
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Generate impression based on findings.
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66-year-old male. History of tongue cancer and left shoulder sarcoma. Evaluate for lung metastases. LUNGS AND PLEURA: Multiple calcified pulmonary nodules and noncalcified micronodules, not significantly changed since 2008, statistically most likely granulomas. Groundglass nodule in the anterior right middle lobe unchanged since 2008 , likely atypical adenomatous hyperplasia or a scar.MEDIASTINUM AND HILA: Unchanged irregularity of the right anterior aspect of the hyoid bone dating back to 2003. Reference right hilar lymph node measures 13 mm in short axis (series 3, image 44), previously 12 mm. Other small mediastinal lymph nodes appear similar to prior exam.Severe coronary calcifications.CHEST WALL: Mild multilevel degenerative disk disease.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. 2.6 x 2.5 cm mildly hypodense mass in the right kidney highly suspicious for primary renal neoplasm. Nodular liver contour suspicious for cirrhosis, not significantly changed. Cholecystectomy clips.
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1. 2.6 x 2.5 cm mildly hypodense mass in the upper pole of the right kidney highly suspicious for primary renal neoplasm.2. No evidence of lung metastasis.3. Right hilar lymphadenopathy, not significantly changed from 2008.Findings regarding the renal mass were emailed to M. Crowley and Dr. Stenson at time of dictation.
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Generate impression based on findings.
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46 year old. Recent diagnosis of right lateral oral tongue cancer status post partial glossectomy. LUNGS AND PLEURA: A 7 mm nodule in the right middle lobe (series 4, image 61) and a 10 mm nodule in the left upper lobe (series 4, image 39) contain coarse calcifications, favoring post-infectious/inflammatory lesions over metastases. Clustered nodules in the right apex are most likely post infectious.MEDIASTINUM AND HILA: 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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Two pulmonary nodules with coarse calcifications are indeterminate, however post-infectious/inflammatory lesions are favored. 3 month follow-up CT recommended given lack of evidence of granulomatous disease elsewhere.
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Generate impression based on findings.
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73 years. Male. Reason: patient with hx of supraglottic CA s/p tx, now w/ new postcricoid lesion found on endoscopy in OR Head: No abnormal enhancing foci to suggest metastases. Ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. A prosthesis is noted in the left orbit with a small calcified appearance to the left lobe, consistent with phthisis bulbi. The paranasal sinuses and mastoid air cells are clear. Periapical lucencies surrounding multiple maxillary molars.Neck: Tracheostomy tube tip terminates just below the thoracic inlet. Air space opacities in the apical segment of the right lower lobe are incompletely evaluated. Enteric tube extends below the field of view within the esophagus.An infiltrative supraglottic mass obstructs the upper airway, resulting in retention of pharyngeal fluid. This mass effaces the piriform sinuses, extends into the posterior cricoid space, and extends inferiorly to effaces the paraglottic space fat pads and involve the vocal cords. A mottled and sclerotic appearance of the arytenoid cartilage and thyroid cartilage contiguous with this mass is consistent with cartilaginous tumoral extension. No cervical lymphadenopathy is identified.The parotid and submandibular glands are unremarkable. The thyroid gland is suboptimally evaluated secondary to streak artifact, but appears unremarkable.Calcified and noncalcified vascular plaque involve the thoracic aorta and common carotids, with apparent high grade carotid stenoses. Multilevel degenerative changes are present throughout the cervical spine.
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BRAIN: 1. No acute intracranial abnormality or evidence of metastases.2. Periodontal disease involving the maxillary molarsNECK:1. Obstructive supraglottic mass with cartilaginous extension and involvement of the vocal cords and posterior cricoid space. No cervical lymphadenopathy is identified.2. Atherosclerosis with apparent high grade carotid stenoses.
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Generate impression based on findings.
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73-year-old male. History of supraglottic cancer status post treatment, now with new postcricoid lesion found on endoscopy. LUNGS AND PLEURA: Right lower lobe atelectasis/consolidation, new from 11/2013 CT. Scattered calcified pulmonary nodules, statistically most likely granulomas.MEDIASTINUM AND HILA: Tracheostomy. Multiple small mediastinal lymph nodes, some in the left paratracheal region have increased in size from prior PET/CT. For reference there is a 7-mm lymph node on series 3, image 21, previously 3 to 4 mm. Refer to outside hospital PET CT report for significance of left inferior pulmonary ligament lymph nodes. Right interlobar lymphadenopathy is likely reactive. Calcified subcarinal lymph node consistent with healed granulomatous disease. Moderate atherosclerotic calcification of the thoracic aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple subcentimeter hypodense lesions in liver are too small to characterize. Bilateral renal cysts. Subcentimeter hyperdense exophytic lesion arising from the interpolar region of the left kidney is too small to characterize. Additional subcentimeter hypodensities in the kidneys are too small to characterize, but likely also cysts. NG tube tip terminates in the stomach.
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1. Small left paratracheal region lymph nodes are increased in size from prior PET/CT and are indeterminate.2. No definite evidence of pulmonary metastasis.2. Right lower lobe atelectasis/consolidation new from 11/2013 PET/CT is compatible with pneumonia.
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Generate impression based on findings.
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41 year-old female with abdominal pain. Evaluate for stone. Lack of intravenous contrast limits evaluation of solid organs. Lack of enteric contrast limits evaluation of bowel.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral calculi are identified. There is no perinephric fat stranding, hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Note is made of multiple prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: The appendix is enlarged, measuring 11 mm in its largest diameter. There is an associated appendicolith in the distal appendix and periappendiceal fat stranding. The kidneys are consistent with acute appendicitis. No free intraperitoneal air is identified. There is no focal fluid collection to suggest abscess formation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 2.1-cm right adnexal cyst is likely physiologic, in a menstruating patient.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is enlarged, measuring 11 mm in its largest diameter. There is an associated appendicolith in the distal appendix and periappendiceal fat stranding. The kidneys are consistent with acute appendicitis. No free intraperitoneal air is identified. There is no focal fluid collection to suggest abscess formation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Findings consistent with acute appendicitis. These findings were relayed to Dr. Sharma at 9:10 a.m. on 12/21/13.
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Generate impression based on findings.
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61 year old with a history of metastatic prostate cancer in retroperitoneal lymphadenopathy with a distended abdomen. New disease reported on outside hospital CT examination. ABDOMEN:LUNG BASES: Again seen are scattered pulmonary nodules. There is made of bilateral pleural effusions, right greater than left, with underlying atelectasis/consolidation.LIVER, BILIARY TRACT: Heterogenous liver attenuation is again seen, consistent with multiple hypodense metastatic lesions which grossly appear increased in size and number when compared to the prior study. Referenced lesion in segment 6 measures 1.6 x 1 .4 cm, previously 1 x 1 cm (image 47, 3). Stable left lobe cyst measuring 1.2 cm is noted. Note is made of a small amount of abdominal pelvic ascites which appears increased compared to the prior study.Prominent cardiophrenic lymph nodes appear slightly increased in size when compared to the prior study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are small and atrophic. Bilateral percutaneous nephrostomy catheters are again seen. There is interval resolution of the previously described right-sided hydronephrosis. There is hypo-attenuation of the heterogeneous appearing right renal parenchyma.RETROPERITONEUM, LYMPH NODES: Mild interval increase in retroperitoneal lymphadenopathy. The reference aortocaval lymph node measures 4.0 x 2 .9 cm, previously 3.2 x 2.7 cm (image 51, 3). There is associated encasement and attenuation of the abdominal aorta and infrahepatic IVC in the surrounding area which appears similar to the prior study. The IVC is slitlike in appearance, unchanged.Enlarged asymmetric left psoas and bilateral iliacus muscle, appearing similar to the prior study. No evidence of abscess or collection within the muscle.BOWEL, MESENTERY: Note is made of apparent wall thickening of the rectosigmoid colon which is nonspecific however correlation for colitis is recommended. Note is made of mesenteric lymphadenopathy which appears increased when compared to the prior study (coronal image 45).BONES, SOFT TISSUES: Innumerable diffuse sclerotic metastatic lesions are identified within the proximal appendicular and axial skeleton, appearing similar to the prior study. Note is made of diffuse anasarca.OTHER: Body wall anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is diffuse wall thickening of the bladder.LYMPH NODES: Multiple bilateral enlarged pelvic lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive osseous metastatic disease. Body wall anasarca.OTHER: No significant abnormality noted
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1. Interval increase in size and number of innumerable hepatic metastatic lesions as well as interval increase in size of retroperitoneal and mesenteric lymphadenopathy with associated encasement and attenuation of the abdominal aorta and IVC, as described above, consistent with the stated history of metastatic prostate carcinoma.2. No significant interval change in asymmetric enlargement of the left psoas and bilateral iliacus muscle.3. Stable enlarged pelvic lymph nodes.4. Extensive osseous metastatic disease.5. Bilateral pleural effusions, right greater than left, with underlying atelectasis/consolidation.6. Apparent wall thickening of the rectosigmoid colon which is nonspecific however correlation for colitis is recommended. 7. Nonspecific heterogeneous enhancement of the right kidney. Differential considerations include pyelonephritis, although infarct, and metastatic disease cannot be excluded.8. Diffuse wall thickening of the bladder. Correlation for cystitis is recommended.
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Generate impression based on findings.
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45-year-old bladder cancer, now with hematuria. Status post cystectomy and neobladder 2009 ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Few gallstones noted within the gallbladder. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A punctate, nonobstructing stone vs. nephrocalcinosis within the right lower pole. Stable contour abnormality of the right kidney suggestive of chronic infection/inflammation or infarction. Symmetric nephrogram and excretion of contrast noted bilaterally. No focal lesions. No filling defects within the collecting system or bilateral opacified ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: Neobladder is well opacified with contrast on delayed images. Normal insertion of the ureters within the neobladder.LYMPH NODES: Surgical clips noted bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Small punctate calcification within the right kidney could represent nonobstructing renal calculus or or nephrocalcinosis2. No evidence of metastatic disease
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Generate impression based on findings.
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32 year-old abdominal pain, rule out obstruction Limited study comment or diskitis is not administered. This limits sensitivity to detect small lesions in solid organs and bowel.ABDOMEN:LUNG BASES: Few it is of interstitial thickening and ground glass opacities, in the periphery in bilateral lung bases. No consolidation or pleural effusion. Evidence of a focal mass within the right retroareolar region is unchanged from prior study and was previously worked up with a breast ultrasound on 6/17/13 without any focal lesion.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys are small in size with hilar calcifications.RETROPERITONEUM, LYMPH NODES: Left sided central venous catheter with tip in the infrahepatic IVC.The few small and medium vessel atherosclerotic changes.BOWEL, MESENTERY: Few punctate coarse calcifications within the terminal ileum and a focal small bowel loop in the left midabdomen could represent ingested material.Appendix is not definitely visualized.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascites 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. Diffuse small and medium-sized vessels atherosclerosis2. Small atrophic kidneys3. No evidence of bowel obstruction.4. Left sided central venous catheter with tip in the infrahepatic IVC.
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Generate impression based on findings.
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67-year-old male. Evaluate for source of enterocutaneous fistula versus undrained intra-abdominal fluid collection. ABDOMEN:LUNG BASES: Note is made of moderate-sized bilateral pleural effusions with underlying atelectasis/consolidation.LIVER, BILIARY TRACT: Status post cholecystectomy. Biliary stent in place. Note is made of a intermediate density collection in the gallbladder fossa, which may represent postop seroma/hematoma although superimposed infection cannot be excluded. A biloma is a differential consideration.SPLEEN: No significant abnormality notedPANCREAS: There is fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are small and atrophic.RETROPERITONEUM, LYMPH NODES: Note is made of vascular calcifications of the abdominal aorta and its branches. There is irregular atherosclerotic plaque noted throughout the abdominal aortaBOWEL, MESENTERY: Gastrostomy tube in place. Note is made of free intraperitoneal air which communicates with a soft tissue defect along the anterior aspect of the right hemiabdomen, consistent with the stated history of enterocutaneous fistula. The foci of free intraperitoneal air is adjacent to the gastrostomy site and appears to communicate with the body of the stomach.BONES, SOFT TISSUES: Note is made of bilateral gynecomastia. Multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place. Foci of gas density within the bladder may reflect recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: None is made of a small fat containing right inguinal hernia.OTHER: Note is made of small amount of free fluid within the pelvis.
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1. Findings consistent with an enterocutaneous fistula with apparent communication with the body of the stomach adjacent to the gastrostomy site, as described above.2. Intermediate density collection in the gallbladder fossa may represent postoperative seroma/hematoma. Differential considerations include biloma formation. Superimposed infection cannot be excluded.3. Bilateral moderate size pleural effusions with underlying atelectasis/consolidation.
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Generate impression based on findings.
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46 year old male. NHL. Reevaluate. CHEST:LUNGS AND PLEURA: Scattered micronodules without significant interval change. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy. Gynecomastia.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: Status post splenectomy. Circumscribed oval 2.5-cm hypodense lesion with adjacent surgical clips could represent a thrombosed aneurysm (series 4, image 90), unchanged. 3.4 cm heterogeneous calcified thrombosed aneurysm arising from the splenic artery next to the tail the pancreas is unchanged (series 4, image 111).Hypertrophied splenule in the left upper quadrant is again seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Diffuse cortical thinning and atrophy of the left kidney are again seen.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology. Predominately cystic oval lesion within the third part of duodenum, believed to be a duplication or mesenteric cyst on prior studies, is not well-visualized on today's exam.Multiple surgical clips in the abdomen.BONES, SOFT TISSUES: Unchanged sclerotic lesion in L1.OTHER: No significant abnormality noted.
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No evidence of enlarged lymph nodes in the chest or abdomen.
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Generate impression based on findings.
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45 year-old female with chronic sinusitis. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure shows a pineal cyst. The patient is status post bilateral uncinectomy, antrectomy and partial ethmoidectomy with patent infundibuli. The frontal sinuses are small. The frontal-ethmoid recesses, residual anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed and clear. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.
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Status post FESS. No evidence of sinusitis.
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Generate impression based on findings.
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60 year-old with periumbilical pain, hypercoagulable, rule-out intra-abdominal abnormality Limited study. Intravenous contrast not administered. This limits the sensitivity to detect small lesions in solid organs and bowel.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholecystectomy clips noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys with hilar calcifications. Small, hypodense lesion arising from the lower pole of right kidney is unchanged. Transplant kidney in the right iliac fossa. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small bowel loops demonstrate normal are coarse and caliber. Few distended jejunal loops in the left upper quadrant without wall thickening or obstruction.BOWEL, MESENTERY: Hiatal herniaSmall bowel loops demonstrate normal are coarse and caliber. Few distended jejunal loops in the left upper quadrant without wall thickening or obstruction.Status post ventral hernia repair.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: Limited visualization due to bilateral hip prosthesis artifacts.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Few diverticuli without evidence of diverticulosis.BONES, SOFT TISSUES: Left femoral vascular graft. Bilateral hip arthroplasties with streak artifactsOTHER: No significant abnormality noted
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1. No evidence of bowel obstruction or ileus. 2. Atrophic native kidneys with transplant kidney in right iliac fossa.
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Generate impression based on findings.
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80 year-old female with left hip/thigh pain and left hip bony erosion. Please assess for possible right lower quadrant mass. ABDOMEN:LUNG BASES: Note is made of bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: There is mild intra-and extrahepatic biliary ductal dilation. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a heterogeneous mass with cystic components within the superior pole of the left kidney, measuring 6.1 x 6.0 cm in the transverse dimension and 6.3 in the craniocaudal dimension (24; series 3). There is invasion of the left renal vein which appears significantly expanded. There is no definitive involvement of the IVC. The left adrenal gland is displaced superiorly and appears to be separate from the mass.There is a punctate, nonobstructing renal calculus in the superior pole of the right kidney.RETROPERITONEUM, LYMPH NODES: Note is made of vascular calcifications of the aorta and its branches.BOWEL, MESENTERY: There is a small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Note is made of an expansile, lytic lesion along the superior aspect of the left acetabulum, suspicious for metastatic disease.OTHER: No significant abnormality noted
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Large left renal mass with invasion into the left renal vein, suspicious for a primary renal carcinoma. Expansile, lytic lesion along the superior aspect of the left acetabulum is suspicious for metastatic disease.
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Generate impression based on findings.
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63-year-old male. Newly diagnosed lung cancer. No therapy so far. Needs baseline prior to initiation of therapy. CHEST:LUNGS AND PLEURA: Spiculated left upper lobe mass which abuts mediastinal pleura measures 2.5 x 2.7 cm, previously 1.8 x 2.7 cm (series 5, image 28). Innumerable bilateral pulmonary nodules, most are not significantly changed but a few are larger. This includes a right lower lobe nodule which measures 9 mm (series 5, image 90), previously 7 mm. Reference 7 mm right lower lobe nodule (series 5, image 90) is unchanged.Small area of patchy groundglass in the right lower lobe is new. No pleural effusion.MEDIASTINUM AND HILA: Multiple bilateral enlarged mediastinal and hilar lymph nodes, not significantly changed. Right paratracheal reference lymph node measures 15 mm in short axis (series 3, image 41) and subcarinal lymph node measures 15 mm in short axis (series 3, image 57). Some of the nodes demonstrate coarse internal calcifications, unchanged.Physiologic volume of pericardial fluid. Mild coronary artery calcifications.CHEST WALL: Mildly enlarged right lower cervical lymph node.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified hepatic granulomas. No focal hepatic mass identified. Extrahepatic biliary ductal dilatation up to 13 mm with transition point at the pancreatic head/uncinate process mass-like enlargement, described in detail below. Mild intrahepatic biliary ductal dilatation the left hepatic lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: 3.4 x 3.5 cm mass-like enlargement of the pancreatic head/uncinate process, which contain multiple calcifications, may represent focal fibrosis from chronic pancreatitis but a pancreatic malignancy cannot be excluded.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. Increased size of left upper lobe spiculated nodule consistent with patient's known primary lung malignancy.2. Innumerable pulmonary nodules, most are not significantly changed but a few are larger.3. Mass-like enlargement of pancreatic head/uncinate process, may represent focal fibrosis from chronic pancreatitis but a neoplastic process cannot be excluded. Consider additional imaging with MRCP wwo contrast. 4. Bilateral mediastinal and hilar lymphadenopathy, not significantly changed. A mildly enlarged right low cervical lymph node is noted.
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Generate impression based on findings.
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68-year-old female with chest pain and back pain. Evaluate for aortic dissection. CHEST:VASCULATURE: Note is made of a type B aortic dissection originating distal to the origin of the left subclavian artery. The major arch vessels are not involved and are supplied by the true lumen. The dissection extends inferiorly and appears to terminate above the level of the origin of the renal arteries. The dissection extends into the celiac axis. The SMA is supplied by the true lumen.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Vascular calcifications of the aorta and its branches.CHEST WALL: No significant abnormality noted.ABDOMEN:VASCULATURE: Note is made of a type B aortic dissection originating distal to the origin of the left subclavian artery. The major arch vessels are not involved and are supplied by the true lumen. The dissection extends inferiorly and appears to terminate above the level of the origin of the renal arteries. The dissection extends into the celiac axis. The SMA is supplied by the true lumen.LIVER, BILIARY TRACT: Note is made of calcified granuloma in the liver and spleen.SPLEEN: Note is made of calcified granuloma in the liver and spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is nodular thickening of the left adrenal gland which asymmetrically enhances compared to the right adrenal gland, which may represent hyperplasia.KIDNEYS, URETERS: Simple cysts in the interpolar region of the right kidney. Note is made of bilateral nonobstructing punctate renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of diverticulosis, without evidence of diverticulitis.BONES, SOFT TISSUES: Note is made of a small fat containing umbilical hernia. There is a hemangioma within the vertebral body of L4.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Findings consistent with a type B aortic dissection with extension into the celiac axis, as described above.2. Bilateral nonobstructing renal calculi.
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Generate impression based on findings.
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53-year-old female with hemoglobin drop status post hysterectomy, evaluate for retroperitoneal hematoma This study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: None is made of bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: The gallbladder is distended, which appears increased when compared to the prior study. Note is made of numerous dependent gallstones.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys.RETROPERITONEUM, LYMPH NODES: IVC filter in place. Note is made of high density fluid layering within the paracolic gutters, right greater than left, as well as within the mesentery, and pelvis, consistent with intraperitoneal hemorrhage. Given the lack of intravenous contrast active hemorrhage cannot be excluded. Vascular calcifications of the aorta and its branches.BOWEL, MESENTERY: There is a small hiatal hernia.BONES, SOFT TISSUES: There is soft tissue high density with foci of gas density internally in the subcutaneous fat overlying the anterior aspect of the abdomen and pelvis, which may be postoperative in nature, however, superimposed infection cannot be excluded. The largest collection measures 6.2 x 2.9 cm (105; series 3).OTHER: Note is made of free intraperitoneal air which may be postoperative in etiology.PELVIS:UTERUS, ADNEXA: Postoperative changes consistent with the known history of hysterectomy.BLADDER: Foci of gas density within the bladder may reflect recent instrumentation.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. High density fluid within the abdomen and pelvis consistent with intra-abdominal hemorrhage. Given the lack of intravenous contrast, active hemorrhage is more likely.2. Multiple gallstones within a distended gallbladder.3. Postoperative changes consistent with the recent history of hysterectomy including multiple hematoma/seroma involving the anterior abdominal wall, superimposed infection cannot be excluded.
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Generate impression based on findings.
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68 year-old female with right NSCLC and acute altered mental status. The patient is status post right frontal craniotomy and anterior circulation aneurysm clipping. The ventricles, sulci, and cisterns are symmetric and unremarkable. There are multiple small areas of encephalomalacia in the bilateral cerebellar hemispheres, consistent with prior infarcts as these were also present on prior imaging.The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable except for craniotomy. The paranasal sinuses and mastoid air cells are clear except for fluids in the left mastoid. Empty sella.
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1. No evidence of intracranial hemorrhage, mass effect, or edema. CT is insensitive to early detection of CVA or neoplasm. MRI should be considered if clinical suspicion persists. 2. Chronic bilateral cerebellar infarcts.
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Generate impression based on findings.
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Left tibial osteosarcoma receiving chemotherapy. LUNGS AND PLEURA: Tree in bud opacities are present in right upper and right middle lobes adjacent to minor fissure. A micronodule in the right lower lobe (image 48/77) is not changed.MEDIASTINUM AND HILA: Ductus arteriosus calcification is identified, normal variant anatomy. The heart size is normal. Mediastinal contours are unchanged.CHEST WALL: Right infuse-a-port tip is at junction of superior vena cava and right atrium.UPPER ABDOMEN: No abnormality is identified.
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Unchanged examination. No evidence of metastatic disease.
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Generate impression based on findings.
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23 year-old female, somnolent, minimally responsive. The ventricular size is top normal without CT evidence of transependymal CSF migration. The sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No acute intracranial abnormality.
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Generate impression based on findings.
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67 year-old female with headache and blurry vision. There is patchy hypoattenuation in the cerebral white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No acute intracranial abnormality. Small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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52 year-old male with tongue cancer and CRT. The orbits are unremarkable. The paranasal sinuses are clear. There is partial opacification mastoid air cells. Limited view of the intracranial structure is unremarkable. There appears increased conspicuity of ill defined enhancement and edema in the right hemitongue when compared to the exam, which may be secondary to recent biopsy and or treatment. There are also increased posttreatment changes at the oral cavity, floor of the mouth and submental and submandibular spaces. Hyperemia of the submandibular glands. Pharyngeal mucosal edema. No lymphadenopathy is noted. The airways are unremarkable/patent. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. The patient is edentulous. There is stable degenerative change of the cervical spine. Limited view of the chest is unremarkable.
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Increased conspicuity of ill defined enhancement and edema in the right hemitongue and new posttreatment changes when compared to the exam 9/20/2013, which may be secondary to recent biopsy and or treatment. No cervical lymphadenopathy.
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Generate impression based on findings.
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59 year-old male with altered mental status. There is patchy hypoattenuation in the cerebral white matter. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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Motion degraded exam. No acute intracranial abnormality. Mild small vessel ischemic disease of indeterminate age. CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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59 year-old female with anisocoria. There is redemonstration of small vessel ischemic change and basal ganglia and cerebellar lacunar infarcts, which appear similar to that on the prior MRI earlier this year. The ventricles, sulci, and cisterns are symmetric and mildly prominent. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Mild stranding is seen in the left parietal scalp. Chronic orbital floor blowout fractures.
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No acute intracranial hemorrhage or territorial infarct. Stable appearance of small vessel ischemic disease and lacunar infarcts. However, CT is insensitive to early detection of CVA. MRI should be considered if clinical suspicion for CVA persists.
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Generate impression based on findings.
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35 year-old male status post fall and with headache and neck pain. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear except for a right maxillary sinus retention cyst. There is straightening of the cervical lordosis. The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The neural foramen are patent. The intervertebral disk spaces are preserved. The paraspinal soft tissues are unremarkable.
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1. No acute intracranial abnormality or calvarial fracture. 2. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended.
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