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Generate impression based on findings.
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The vertebral body heights are preserved. At L1-L2 and L2-L3, there are mild disc bulges that result in mild spinal canal stenosis without neural foramen stenosis. At L3-L4, there is a mild disc bulge, as well as a superimposed right foraminal herniation that results in severe right neural foramen stenosis. There are postoperative findings at L4-L5 related to transpedicular screws and stabilizing rods as well as an interbody spacer and bone graft material. The hardware is intact. There has also been a bilateral facetectomy and L4 right hemilaminectomy. There is a grade 1 anterolisthesis of L4 upon L5. Streak artifact and postoperative changes at this level limits spinal canal and neural foramen evaluation. At L5-S1, there is a minimal disc bulge without significant spinal canal or neural foramen stenosis. There is atherosclerotic calcification of aorta and branch vessels.
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1. Postoperative findings at L4-L5 with spinal canal and neural foramen obscuration at this level secondary to streak artifact and postoperative changes. Thus, a fluid collection with spinal canal stenosis in this region cannot be excluded.2. A right neural foraminal disc herniation at L3-L4 results in severe right neural foramen stenosis. 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: see above History: Clinical trial Cycle 1 Day 11RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 79 mg/dL. Today's CT portion grossly demonstrates left masticator space soft tissue mass and adjacent post surgical changes. Mediastinal and hilar calcified lymph nodes. Bibasilar atelectasis.Today's PET examination again demonstrates hypermetabolic tumor in the left masticator space it has not significantly changed compared to prior. The anterior portion measures a maximum SUV of 8.8, previously 9.2. The posterior portion measures a maximum SUV of 7.5, previously 7.8. Additional hypermetabolic tumor focus corresponding to the left superficial muscles of mastication has also not significantly changed, measuring a maximum SUV of 4.8, previously 5.2. Hypermetabolic activity in the right parotid and submandibular glands are again noted and likely benign in etiology.
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1.Stable hypermetabolic tumor in the left masticator space.2.No new foci of hypermetabolic tumor.
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Generate impression based on findings.
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Reason: evaluate mass, ich, etc History: AMS In general the ventricles are enlarged whereas they sulci are not significantly widened .No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.The lateral ventricles are generous in size and the sulci are not substantially widened. Although this could be result of brain atrophy the possibility of normal pressure hydrocephalus cannot be excluded in the appropriate clinical setting. Please correlate with patient's clinical symptoms.3.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging.
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Generate impression based on findings.
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89-year-old female with bilateral knee pain and bilateral shoulder pain. Right knee:Severe tricompartmental osteoarthritis affects the right knee, most pronounced in the medial compartment. Mild chondrocalcinosis. Vascular calcifications are additionally noted.Left knee:Moderate joint effusion is present. Moderate to severe osteoarthritis affects the left knee. Mild chondrocalcinosis. Vascular calcifications are additionally noted.Right shoulder:Severe osteoarthritis affects the glenohumeral and acromioclavicular joints. No evidence of fracture or malalignment. Left shoulder:Severe osteoarthritis affects the glenohumeral and acromioclavicular joints. No evidence of fracture or malalignment.
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Moderate left knee joint effusion. Degenerative changes, as above.
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Generate impression based on findings.
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Reason: CLL. that has transformed into a large B cell lymphoma History: 83Yrs male with a h/o HTN, CKD, and HL with CLL. that has transformed into a large B cell lymphoma (Richter's transformation). Pt. is s/p 6 cycles R CHOP and in need of end of treatment restaging.RADIOPHARMACEUTICAL: 13.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 120 mg/dL. Today's CT portion grossly demonstrates significant interval decrease in size and number of lymphadenopathy within the bilateral neck, subcarina, bilateral axillary, retroperitoneal, mesenteric, and bilateral pelvic lymph nodes. Resolution of opacification of the left maxillary sinus. Right PICC with tip in SVC. Extensive coronary calcifications. Multiple nodules within the anterior abdominal wall subcutaneous fat likely related to injections.Today's PET examination demonstrates resolution of previously seen hypermetabolic lymphadenopathy throughout the neck, chest, abdomen, and pelvis. Mild FDG uptake in the bilateral hilar lymph nodes without CT or less likely represents inflammation. Mild FDG uptake in the left anterior abdominal wall subcutaneous fat likely related to injection. No new or suspicious FDG uptake.
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1.Complete resolution of hypermetabolic lymphadenopathy in the neck, chest, abdomen, and pelvis.2.Mild FDG uptake in the bilateral hila without CT correlate likely related to inflammation.
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Generate impression based on findings.
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29-year-old male with pain in right thumb and nail changes. Evaluate for psoriatic arthritis. No significant soft tissue swelling is identified. No evidence of fracture or malalignment is evident. No significant arthritic changes are present.
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No significant arthritic changes present.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Dyspnea, hypoxia, rule out PE PULMONARY ARTERIES: No evidence of acute pulmonary embolism. The pulmonary artery is normal in diameter.LUNGS AND PLEURA: Bilateral basilar interstitial and airspace opacities most consistent with edema. No pleural effusions. New bronchial wall thickening, possibly due to edema but nonspecific. Mixed density 10-mm right upper lobe nodule of indeterminate etiology. Mosaic attenuation of the lung parenchyma.MEDIASTINUM AND HILA: Cardiomegaly without pericardial effusion. No evidence of right heart strain. No coronary artery calcifications.Mildly prominent lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal thickening.
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1.No evidence of acute pulmonary embolism.2.Findings consistent with mild to moderate CHF.3. Mixed density 10-mm right upper lobe nodules indeterminate etiology; recommend 3 month follow-up CT.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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Generate impression based on findings.
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53 year old with history of left mastectomy for recurrent DCIS in April 2009. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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22-year-old male with left knee pain Alignment is anatomic. No fracture is evident. There is a small (1.5cm) lesion along the posterior distal femur with sclerotic margins which is most likely benign.
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1. No specific findings to account for the patient's knee pain.2. Small lesion with sclerotic margins along the distal femur that is most likely benign.
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Generate impression based on findings.
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57 year-old female with right hip pain status post surgery in 2010. Also has pain at base of thumb, right greater left. Right hip:Sclerosis suggests mild osteoarthritis. No significant joint space narrowing. No evidence of fracture or malalignment.Right hand:The bones of the right hand appear normal without evidence of fracture or malalignment.Left hand:The bones of the left hand appear normal without evidence of fracture or malalignment.
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Mild right hip osteoarthritis. No osseous abnormality in the hands.
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Generate impression based on findings.
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Male 43 years old Reason: Patient has newly dx CLL with 17p deletion, currently screening for clinical trial protocol IRB: 14-0881 History: newly dx CLL with 17p deletion CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Extensive mediastinal adenopathy. An index pretracheal node measures 2 x1.1 cm on image number 21, series number 3.CHEST WALL: Extensive bilateral axillary adenopathy. Index left axillary node measures 5.5 by 3.3 cm on image number 20, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mild to moderate splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy. An index portacaval node measures 5.2 x 2.7 cm on image number 103, series number 3.BOWEL, MESENTERY: Mesenteric adenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Extensive pelvic adenopathy. The index right external iliac node measures 8.2 x 4.1 cm on image number 185, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Extensive bilateral axillary, mediastinal, retroperitoneal and pelvic adenopathy. Mild-to-moderate splenomegaly.
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Generate impression based on findings.
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Female 17 years old lumbagoVIEWS: Sacroiliac joints AP and bilateral oblique (3 views) pelvis AP and frog leg lateral (two views) 1/23/2015 Partial left posterior fusion defect of L5. No acute fracture or malalignment is evident. A moderate stool burden is present within the imaged colon.
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Posterior fusion defect of L5. No acute fracture or malalignment.
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Generate impression based on findings.
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HNC s/p chemoradiation, compare to baseline CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. Reference anterior right upper lobe micronodule measures 5 mm (series 4, image 57), unchanged. Reference right lower lobe micronodule measures 2 mm (series 4, image 69), unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No coronary artery calcifications. No lymphadenopathy.CHEST WALL: Right chest wall Port-A-Cath tip at the cavoatrial junction.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The gallbladder is distended. The common bile duct measures 11 mm in diameter, previously 3 mm. These findings are nonspecific and could be further evaluated by ultrasound or MRCP if clinically warranted. There are no suspicious hepatic lesions.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 lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Percutaneous gastrostomy tube is new from prior.BONES, SOFT TISSUES: Left Bochdalek hernia.OTHER: No significant abnormality noted.
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1.No evidence of metastatic disease. 2.The gallbladder is distended with mild common bile duct dilatation, which is nonspecific and can be better evaluated by ultrasound or MRCP if clinically warranted.
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Generate impression based on findings.
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Reason: eval for chronic VTE History: pulm HTN The comparison chest radiograph performed on 1/21/2015 demonstrates cardiomegaly with bi-basilar opacities.The ventilation images show slightly decreased activity in the left hemithorax on single-breath and wash-in images. There is abnormal Xe-133 retention during the wash-out phase in the left lung as well. The perfusion images show matched decreased pulmonary perfusion to the left lung.
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Low probability for pulmonary embolism.
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Generate impression based on findings.
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HNC and CRT, cervical esophageal neoplasm post chemo RT. CHEST:LUNGS AND PLEURA: Right middle lobe opacity has cleared. Patchy peribronchial distribution nodules in the anterior right upper lobe suggestive of aspirate. Scattered micronodules unchanged. New linear opacities at the right apex suggestive of developing fibrosis. Right costophrenic angle opacity has cleared.MEDIASTINUM AND HILA: Mild residual soft tissue along right lateral distal esophagus measuring 1.8 x 1.5 cm, previously 2.9 x 2 cm (3/7). Small adjacent right tracheoesophageal lymph nodes have decreased in size, with reference lesion measuring 8mm, previously 10-mm (3/17). Additional small low right paratracheal, right hilar and subcarinal lymph nodes are unchanged. Mild cardiomegaly. Mild coronary artery calcification. Right chest port tip at the SVC/RA junction.CHEST WALL: Abnormal skeletal mineralization consistent with myelofibrosis. Lateral right rib fractures involving ribs 4, 5, 6 and 7, acute to subacute in appearance. Left seventh rib fracture postero-laterally is minimally displaced by one cortical width and also appears acute to subacute . ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Portal vein is enlarged.SPLEEN: Massive splenomegaly compatible with known diagnosis of myelofibrosis. Unchanged nonspecific areas of hypoattenuation. Splenic vein is enlarged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Numerous small retroperitoneal lymph nodes bilaterally appear smaller with reference left para-aortic lesion now measuring 10 mm, previously 13-mm (3/129).BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Signs of myelofibrosis.OTHER: No significant abnormality noted.
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No specific evidence of pulmonary metastases. Decreased size of esophageal mass and thoracoabdominal lymph nodes. Interval development of bilateral rib fractures, correlate with history.
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Generate impression based on findings.
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74 of female with right shoulder pain Again seen is a transverse fracture of the humeral neck with fracture fragments in gross anatomic alignment and several small bone fragments adjacent to the medial humeral neck. Increased inferior subluxation of the humeral head, likely due to hemarthrosis.
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Humeral neck fracture with increased subluxation of the humeral head, likely due to hemarthrosis.
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Generate impression based on findings.
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Reason: fall on head and now with persistent pain over the top and on the right History: fall with ongoing pain The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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21-year-old male with right knee pain Postoperative changes of ACL repair. Alignment is anatomic. No fracture or joint effusion.
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Status post ACL repair without acute abnormality evident.
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Generate impression based on findings.
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Recent sinus infection, now refractory periorbital pain, and history of underlying inflammatory orbital pseudotumor (IGG4 disease). There is decreased thickening of the right lateral and inferior rectus and inferior oblique muscles with mild surrounding stranding of the orbital fat. Likewise, there is diminished swelling of the right lacrimal gland. The right globe and optic nerve are grossly unremarkable. The left orbit is unremarkable. There is minimal mucosal thickening in the maxillary sinuses. The other paranasal sinuses are clear. The nasal cavity is clear. The nasopharynx, facial soft tissues, and imaged intracranial structures appear to be unremarkable.
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Continued interval decreased inflammatory changes in the right orbit related to IGG4 disease.
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Generate impression based on findings.
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Klebsiella pneumonia, evaluate for interval progression LUNGS AND PLEURA: Irregular left apical opacity measures 3.7 x 1.8 cm (series 4, image 62), previously 4.0 x 2.8 cm, now with central cavitation. Multiple new irregular airspace opacities are noted predominantly at the apices. Small left pleural effusion is largely unchanged. Basilar atelectasis appears slightly increased in the prior exam. Scattered calcified micronodules is compatible with previous granulomatous infection.MEDIASTINUM AND HILA: Large prevascular lymph node measures 1.5 cm (series 3, image 28), previously 1.4 cm. Additional prominent mediastinal lymph nodes are noted. Moderate cardiomegaly with an moderate pericardial effusion is unchanged since prior exam. Right IJ pulmonary arterial catheter tip in the right descending pulmonary artery.CHEST WALL: Left chest wall ICD.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Overall increase in ill defined pulmonary nodules consistent with infection. 2.Stable mediastinal lymphadenopathy.3.Stable cardiomegaly, pericardial and pleural effusions.
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Generate impression based on findings.
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30 years old, Female, Reason: RUQ liver and biliary u/s with dopplers, rule out biliary path or clot History: factor V leiden, abd pain PORTAL VENOUS: Main portal vein is patent with a 0.1 m/sec with hepatopetal flow. The right portal vein measures 0.2 m/sec. The left portal vein measures 0.1 m/sec entire portal venous complex appears patent.HEPATIC ARTERIES: Common hepatic artery appears patent with a 0.8 m/sec peak systolic flow. The left hepatic artery has a peak systolic flow of 0.5 m/sec and appears patent. The right hepatic artery has a peak systolic flow of 1.0 m/sec and appears patent. The resistive indices measure from 0.55 to 0.66.HEPATIC VEINS: Left and mid hepatic vein appear patent with a waveform was within normal limits. Right hepatic vein is difficult to visualize due to patient body habitus. The waveforms likely within normal limits.INFERIOR VENA CAVA: Inferior vena cava appears patent with a normal waveform.Kidneys: Hydronephrosis or shadowing foci in the kidneys bilaterally. Spleen: The spleen measures 10.1 cm with a patent splenic vein.Other: No gross biliary tract dilatation.
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Hepatic vasculature within normal limits. No evidence of inflow or outflow thrombosis.
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Generate impression based on findings.
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Reason: 50 yo male with history of leukemia; pre-allo SCT evaluation History: evaluate LUNGS AND PLEURA: Punctate calcified granulomas, benign.No evidence of infection, or other significant pulmonary or pleural abnormality.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.No visible coronary calcifications.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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No significant abnormality. Specifically, no sign of infection.
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Generate impression based on findings.
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Newly diagnosed CLL with 17p deletion currently screening for IRB014-0881. There is extensive cervical lymphadenopathy. For example, a left level 1B lymph node measures 20 x 32 mm, a left level 2A lymph node measures 33 x 53 mm, a right level 5A lymph node measures 15 x 24 mm, and a left supraclavicular lymph node measures 18 x 27 mm. There is also partially imaged mediastinal and axillary lymphadenopathy. There is a hypoattenuating right thyroid nodule that measures up to 9 mm. The salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged paranasal sinuses and mastoid air cells are clear. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. Extensive cervical lymphadenopathy compatible with leukemia. Please refer to the separate chest CT report for additional details.2. Nonspecific subcentimeter right thyroid nodule.
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Generate impression based on findings.
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COPD. 6 month follow-up visit for EMPROVE clinical trial IRB#13-0530, please link to research account #1053580. LUNGS AND PLEURA: No pneumothorax. Severe centrilobular emphysema unchanged. The left upper lobe remains collapsed and its airways contain endobronchial valves which appear unchanged in position. Lung volumes also appear unchanged.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Leftward mediastinal shift. Mild to moderate coronary artery calcifications. Normal heart size. Small volume of pericardial fluid.CHEST WALL: Bilateral breast prostheses. Severe compression deformities of the lower thoracic spine with collapse of the T6, T11 and T12 vertebral bodies, unchanged. Osteopenia.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Vascular calcifications. Granuloma in the spleen.
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Severe centrilobular emphysema without acute change. The left upper lobe remains collapsed, with endobronchial valves in place. Coronary artery calcifications.:
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Generate impression based on findings.
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Reason: Evaluate for areas of hypometabolism, especially in right occipital area History: Intractable epilepsy, Vagus Nerve Stimulator, possible focality on EEGRADIOPHARMACEUTICAL: 1.7 mCi F-18 fluorodeoxyglucose (FDG)BLOOD GLUCOSE (FASTING): 93 mg/dL Today's CT portion demonstrates no gross intracranial pathology.Today's PET exam demonstrates bilateral decreased FDG uptake in the medial temporal lobes, more decreased on the left. FDG activity in the brain is otherwise physiologic. Specifically, no decreased FDG uptake in the right medial occipital lobe as clinically questioned.
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Hypometabolism in the bilateral medial temporal lobes.
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Generate impression based on findings.
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Abdominal distention.VIEW: Abdomen AP (one view) 1/23/2015 The stomach is distended with three air/fluid/fluid levels, which may represent a bezoar. Clinical correlation is recommended. Nonspecific generalized gaseous distention of the bowel is seen without evidence of obstruction or pneumoperitoneum.
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1.Air/fluid/fluid levels in the stomach suggestive of bezoar. Clinical correlation recommended. 2.Generalized nonspecific gaseous distention of the bowel without evidence of obstruction or pneumoperitoneum.
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Generate impression based on findings.
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69 year old with history of ovarian cancer and uptake in a right axillary lymph node who presents for ultrasound guided biopsy. Right ultrasound re-identified the target node for biopsy in the inferior right axilla. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right axilla was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, four 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. Three specimens sank to the bottom of the prefilled container of 10% formalin. One specimen was fragmented. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right MLO views could not demonstrate the clip, likely due to it's position in the axilla. The clip was well seen on post clip placement ultrasound. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Schacht was present during the procedure at all times.
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Successful ultrasound-guided core biopsy of the right axillary node and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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3-year-old male with cough and mild hypoxia.VIEWS: Chest AP/lateral (two views) 1/23/2015 Streaky retrocardiac opacity suggestive of atelectasis. The aortic arch, cardiac apex and stomach left-sided. The cardiothymic silhouette is normal.
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Streaky retrocardiac opacity suggestive of atelectasis.
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Generate impression based on findings.
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Lung cancer with malignant effusion; indwelling right pleural catheter with poor drainage, dyspnea. Please evaluate if the pleurx catheter communicates with the fluid collections. LUNGS AND PLEURA: Large and oh flexion with interval development of a thickened pleural rind measuring up to 12-mm (3/45). The Pleurx catheter has shifted medially in the interim and appears to be at least partially embedded within the pleural thickening, though its lateral surface containing sideholes abuts the fluid (catheter marker is situated medially). The tip of the catheter is at the apex, outside of the pleural fluid collection.Right paramediastinal fibrosis has progressed, with diminished volume of the aerated right lung. The lower lobe is near completely collapsed. Anterior pneumothorax component decreased in volume, though there is a new small loculated pneumothorax component at the lung base. Emphysema, left apical fibrosis. Small volume of pleural fluid on the left is new.MEDIASTINUM AND HILA: Heterogeneous thyroid gland enlargement bilaterally with left retrotracheal extension deviating the trachea and proximal thoracic esophagus. The thyroid extends substernally to the level of the left brachiocephalic vein.Small mediastinal lymph nodes unchanged. Moderate cardiomegaly with small volume of pericardial fluid unchanged. Atherosclerotic calcifications of the thoracic aorta, the aortic valves and coronary arteries, the latter is mild.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Nonspecific hypoattenuating lesion at the hepatic dome is incompletely assessed but was present previously. Motion artifact degrades images of the upper abdomen, limiting assessment.
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Large right pleural fluid collection is now loculated, with development of a thick pleural rind suspicious for empyema in the appropriate clinical setting. Tumor may also produce pleural thickening though it is usually more nodular in appearance. The Pleurx catheter is partially embedded within the pleural rind but the sideholes are directed laterally towards the fluid collection. The tip of the catheter is not in communication with pleural fluid.
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Generate impression based on findings.
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Staging for newly diagnosed esophageal squamous cell carcinoma, weight loss, dysphagia CHEST:LUNGS AND PLEURA: Moderate to severe centrilobular emphysema. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal without pericardial effusion. Mild coronary artery calcifications. Small amount of fluid in the esophagus. Wall thickening of the distal esophagus may represent site of patient's primary malignancy. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple nonspecific hepatic hypodensities. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable exophytic right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate calcifications of the distal abdominal aorta and common iliac arteries. No lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Wall thickening at the distal esophagus/cardia it measures 1.7 cm in maximal thickness.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Wall thickening of the distal esophagus/ gastric cardia with reference measurements as above.. 2.No evidence of metastatic disease.
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Generate impression based on findings.
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69 year old with abnormal PET uptake in the right axilla presents for imaging evaluation of the right breast and axilla. Three standard views of the right breast and repeat MLO view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. A Port-a-Cath obscures the right axillary region. A few lymph nodes are only partially visualized. ULTRASOUND
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Abnormal lymph node in the right axilla. This is amenable to ultrasound guided biopsy.Biopsy and post-biopsy mammogram were subsequently performed the same day. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Rule out solid mass. Abdominal swelling. Isoechoic lesion in the cortex the left kidney. 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: Punctate left lower pole renal calculus (image 46; series 80224). No hydronephrosis or mass. Symmetric excretion from both kidneys. Ureters are normal in course and caliber.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat-containing periumbilical ventral hernia.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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Nonobstructive left lower pole renal calculus.
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Generate impression based on findings.
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Reason: 43 yo f w/ metastatic breast cancer restaging. Attention spine lesion. History: bone pain. New foci of increased radiotracer uptake in the right T6 and T7 vertebra compatible with metastases.
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New right T6 and T6 osseous metastases.
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Generate impression based on findings.
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Severe odynophagia in the setting of AIDS not on HAART. The images are degraded by patient motion. There is mild asymmetry of the oropharyngeal tonsils without evidence of a discrete abscess. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There are multiple carious teeth. There are bubbly secretions within the nasopharynx. The airways are patent. There is a left maxillary sinus retention cyst. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. Mild asymmetry of the oropharyngeal tonsils may represent a tonsillitis, without evidence of a discrete abscess. However, direct endoscopic inspection may be useful for further evaluation.2. Bubbly secretions within the nasopharynx may be related to an inflammatory process.3. Multiple dental caries.
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Generate impression based on findings.
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45 year-old female with left knee pain. The bones are severely demineralized, limiting sensitivity for fracture. Below the knee amputation is noted. There is a transverse distal metaphyseal fracture of the left femur with minimal impaction. No significant joint effusion. No osteolysis to suggest osteomyelitis. Dense vascular calcifications are noted.
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Distal metaphyseal fracture of the left femur.
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Generate impression based on findings.
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31-year-old with palpable lump in the right breast presents for mammographic examination. Three standard views of both breasts with two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at upper outer quadrant of right breast, indicating the area of palpable concern. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted at the area of palpable concern or elsewhere in either breast. With physical exam, no discrete mass was palpated. Focused ultrasound did not detect any abnormalities at the area of palpable concern.
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No mammographic evidence of malignancy. Palpable concern should be managed clinically. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age 40. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.
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Generate impression based on findings.
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New diagnosis lung cancer with confusion and visual changes. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The orbits, skull, and scalp soft tissues are unremarkable.
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No evidence of intracranial or orbital metastases. However, CT is less sensitive than MRI for the detection of metastases.
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Generate impression based on findings.
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Reason: 58 y/o with Cholangio Ca. on chemo. Compare to Prior History: Cholangio Ca CHEST:LUNGS AND PLEURA: Interval decrease in size of numerous small pulmonary basal predominant nodules since prior study. Reference nodule in the right middle lobe now measures 5 x 3 mm (series 10269 image 61) previously 7 x 7 mm, and left lower lobe nodule now measures 5 x 4 mm (image 72) previously 8 x 7 mm. No pleural effusions.MEDIASTINUM AND HILA: Right internal jugular venous thrombosis partially visualized on the most superior images.Scattered small mediastinal lymph nodes. Enlarged main pulmonary artery measuring 3.6 cm may represent pulmonary hypertension. Normal heart size without pericardial effusion.CHEST WALL: Right chest port with tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Interval decrease in size of infiltrative right hepatic mass since the prior study, now measuring 6.9 x 5.0 cm (series 4 image 105). Two biliary stents are in place with a small amount of pneumobilia. Biliary ductal dilation in the left hepatic lobe has significantly decreased since the prior study, and there is increased atrophy of his left hepatic lobe. The portal vein and its branches appear patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Confluent periportal, mesenteric, and retroperitoneal adenopathy is difficult to accurately measure but appears decreased compared with the prior study. Reference aortocaval lymph node measures approximately 2.9 x 2.8 cm (series 4 image 122) previously 5.2 x 3.9 cm.BOWEL, MESENTERY: Mesenteric adenopathy in the upper abdomen appears decreased.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: As aboveBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Interval improvement in disease, with decrease in size of hepatic mass, lymphadenopathy, and pulmonary nodules.2. Right internal jugular thrombosis partially imaged. Findings discussed with Dr. Catenacci by phone at 1629 on 1/23/15.
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Generate impression based on findings.
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39-year-old female with a known mass in the left breast presents for follow-up study. Three standard views of both breasts with two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at lower outer quadrant of left breast, indicating the known palpable lump. An oval mass is redemonstrated at posterior 5 o'clock position in the left breast without significant changes. There is an oval circumscribed mass at upper outer quadrant in the right breast.No suspicious microcalcifications or areas of architectural distortion are noted in either breast. There is an oval anechoic mass measuring 14 x 10 mm at 10 o'clock position, 4 cm from the nipple, in the right breast, consistent with a cyst, corresponding to the mass seen on the mammogram.In the left breast at the 5 o'clock position, 6 cm from the nipple, there is a known hypoechoic mass measuring 11 x 7 x 10 mm, consistent with fibroadenoma. There is no interval change in the size or appearance of this mass.
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No mammographic or sonographic evidence of malignancy. A simple cyst in the right breast and a fibroadenoma in the left breast. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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66 year-old female with pain after fall. Moderate degenerative changes affect the cervical spine, most notably at C5-6. Posterior osteophytes significantly narrow the right neural foramen at C6-7. Partial fusion of C2 and C3 is noted, likely congenital. Alignment, vertebral body heights, and other intervertebral disk spaces are maintained.
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No evidence of fracture or malalignment of the cervical spine.
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Generate impression based on findings.
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Reason: T Cell rich DLBCL s/p 6 cycles of chemotherapy History: 38Yrs old female patient with a H/O T cell rich DLBCL, arising in the background of nodular lymphocyte predominant Hodgkin lymphoma and cycle 6/6 of R-CHOP in need of end of treatment restagingRADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 78 mg/dL. Today's CT portion grossly demonstrates right chest port with catheter tip in the right atrium. Left PICC with catheter tip in the right atrium. Small pericardial effusion, similar to prior. Bibasilar atelectasis. Significant interval decrease in innumerable hypo-attenuating lesions in the liver. No definite discrete hepatic lesions are identified. Postsurgical changes of a cholecystectomy. Anasarca, decreased compared to prior. Prominent bilateral inguinal lymph nodes. Left total hip arthroplasty device.Today's PET examination demonstrates no hypermetabolic tumor in the neck, chest, abdomen, or pelvis. Previously seen hypermetabolic lymph nodes in the neck, chest, abdomen, and pelvis and in numerable hypermetabolic lesions in the liver have completely resolved.
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Complete resolution of previously seen hypermetabolic tumor in the neck, chest, abdomen, and pelvis.
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Generate impression based on findings.
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79-year-old female with recent fall and altered mental status. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes. Atherosclerotic calcifications of multiple intracranial vessels is noted. The paranasal sinuses and mastoid air cells are clear. Calvarium and soft tissues are unremarkable. Multiple fractured teeth of unknown chronicity.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the early detection of acute non-hemorrhagic infarcts.
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Generate impression based on findings.
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Female 3 months old Reason: 3 month old needing central line placement evaluation History: Broviac displacementVIEW: Chest and abdomen AP (two view) 1/23/2015 The nasogastric tube tip is in the body of the stomach. Interval retraction of the left femoral venous catheter with the tip now in the left femoral vein.Improved gaseous distention of the bowel, with no evidence of obstruction. The previously seen basilar subsegmental atelectasis has resolved. Cardiac silhouette size is normal.
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Left femoral venous catheter retraction with the tip now in the left femoral vein.
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Generate impression based on findings.
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49 year-old female with left hip pain. Pelvis:Mild osteoarthritis affects the hips and sacroiliac joints bilaterally. No evidence of fracture or malalignment in the pelvis.Left hip: Mild osteoarthritis affects the left hip. No evidence of fracture or malalignment.
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Mild degenerative changes, as above.
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Generate impression based on findings.
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13-year-old female with knee pain The osseous structures appear normal for the patient's age. Alignment is anatomic. No joint effusion is noted.
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No specific findings to account for the patient's right knee pain.
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Generate impression based on findings.
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Reason: subdural History: fall The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the distal internal carotid arteries. Periventricular and subcortical white matter hypodensities of a moderate degree are present. This is stable when compared to the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.
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Generate impression based on findings.
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Reason: 57 male with metastatic lung cancer, worsening abdominal pain/lipase. r/o obstruction/pancreatitis. Avoiding IV contrast given renal function History: Abdominal pain Evaluation of solid organ pathology limited without intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Unchanged nodular liver contour with ill-defined hypoattenuating diffuse hepatic lesions incompletely evaluated on noncontrast examination but presumed to represent metastatic disease. No biliary ductal dilation. Collapsed gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic and periportal lymphadenopathy. Reference lymph node measures 2.1 x 2.4 cm (image 37; series 3), roughly stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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No substantial interval change in presumed diffuse hepatic metastases.
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Generate impression based on findings.
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Reason: eval for cva History: right sided weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Atherosclerotic calcifications are present along the distal vertebral arteries.Atherosclerotic calcifications are present along the arteries within the scalp soft tissues.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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Worsening fatigue and weight loss evaluate for status of lung cancer. CHEST:LUNGS AND PLEURA: Large left pleural fluid collection slightly increased in volume. There is minimal pleural thickening and enhancement in the cardiophrenic angle on the left, present previously.Nodular pleural thickening on the right compatible with metastatic disease appears worse with a small intrafissural loculated fluid collection unchanged. Right lower lobe is consolidated and the parenchyma is hypoattenuating suggesting necrosis, slightly progressed from the previous examination.Severe emphysema. Spiculated nodule right middle lobe (6/55) unchanged. Progressive right-sided bronchial wall thickening and septal thickening may be due to venous obstruction or lymphangitic tumor spread.MEDIASTINUM AND HILA: Small to moderate volume of pericardial fluid slightly increased. Mediastinal lymphadenopathy, some lymph nodes are larger. Right paratracheal lymph node measures 12 mm, unchanged (4/36). Right hilar lymphadenopathy unchanged. Pericardial metastases on the right, about the same. Coronary artery calcifications.CHEST WALL: Patient appears cachectic. Right internal mammary chain lymphadenopathy about the same. Right intercostal lymph node enlargement about the same. Tumor extends into the right paravertebral fat at multiple levels, encroaching upon the right neural foramen of T11/T12.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Diaphragm is thickened by tumor, with trace adjacent perihepatic fluid.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland thickening unchanged.KIDNEYS, URETERS: Tonic right kidney containing multiple cystic lesions incompletely included within the scanning range. Left kidney contains multiple cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. Small retroperitoneal lymph nodes. Circumaortic left renal vein.BOWEL, MESENTERY: Absence of enteric contrast material 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 right pleural tumor bulk. Some of the nonindex mediastinal lymph nodes are larger. Left pleural effusion is slightly larger and enhancing nodular pleural thickening on the left is consistent with contralateral pleural metastatic disease. Right hemidiaphragm is thickened by tumor. Progressive right lower lobe consolidation
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Generate impression based on findings.
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Newborn male with increased work of breathing. Evaluate line placement.VIEW: Chest and abdomen AP (two view) 1/23/2015 The umbilical venous catheter tip is in the distal umbilical vein.The aortic arch, cardiac apex and stomach are left-sided. No focal air space opacity is evident. The cardiothymic silhouette is normal. The bowel gas pattern is disorganized and nonobstructive. No portal venous gas, pneumoperitoneum or pneumatosis intestinalis is evident.
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UVC tip is in the distal umbilical vein.
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Generate impression based on findings.
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Chest discomfort, decline in lung function. Steroids tapered. Assess for evidence of return of Sweet's in lungs. LUNGS AND PLEURA: Mild subpleural reticulation in the lung periphery consistent with fibrosis, unchanged. Right upper and middle lobe lobe suture lines consistent with a previous wedge biopsies.There are a couple of peripheral subcentimeter foci of groundglass density which appear flat. One is new and the second is more pronounced compared to the prior examination (right lower lobe series 4 images 54 and 56). No signs of pneumonia. No pleural fluid.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. Moderate triple-vessel coronary artery calcifications. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Stable mild subpleural reticulation consistent with pulmonary fibrosis.2. No evidence of pneumonia.3. There are a couple of very small foci of opacity which are new or slightly more prominent compared to the prior study; I am unable to entirely exclude very early recurrence of neutrophilic infiltration due to Sweet's Syndrome, consider short term follow up if warranted.
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Generate impression based on findings.
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40-year-old female with hip/pelvis pain. Pelvis: No fracture or malalignment in the pelvis. Sacroiliac joints and hip joints are normal bilaterally. Deformity of the right iliac wing is compatible with prior biopsy or donor site.Right hip: No significant degenerative changes of the right hip are identified.
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No findings to account for pain.
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Generate impression based on findings.
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Reason: Patient with metastatic esophageal CA, now with right upper quadrant pain \T\ elevated LFTs, please evaluate for obstruction, cholecysitis, cholelithiasis History: RUQ pain, elevated LFTs ABDOMEN:LUNG BASES: New small left pleural effusion.LIVER, BILIARY TRACT: Interval increase in size of marked confluent mesenteric lymphadenopathy which now invades the porta hepatis resulting in biliary ductal dilation which is new since the prior CT examination. There is occlusive thrombosis of the main portal vein and its branches which has also progressed significantly. The hepatic veins are attenuated but remain patent.Mild-moderate perihepatic ascites is new.SPLEEN: The splenic artery is encased and attenuated by tumor.PANCREAS: The pancreatic head and body are inseparable from tumor with likely invasion, as the pancreatic duct is dilated distally.ADRENAL GLANDS: Unchanged left adrenal thickening.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval increase in size of marked necrotic mesenteric lymphadenopathy, now measuring up to 13.0 x 8.4 cm in maximum axial dimension (series 2 image 53) previously 11.4 x 7.2 cm. There is now extension into the porta hepatis as detailed above, as well as encasement of the celiac axis which is markedly attenuated, and the superior mesenteric axis, the proximal portions of which are markedly attenuated. Additionally, the left renal vein and IVC are markedly attenuated but remain patent. There is also a likely nonocclusive thrombus of the inferior mesenteric vein. BOWEL, MESENTERY: A percutaneous gastrostomy tube is in place. The bowel is normal in caliber without evidence of acute obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Marked interval progression of mesenteric lymphadenopathy, now invading the porta hepatis and resulting in biliary ductal dilation and portal venous thrombosis. There is also encasement and significant attenuation of the celiac axis, superior mesenteric axis, IVC, and left renal vein, which appear to remain patent.2. Interval development of mild-moderate abdominal ascites.3. Small left pleural effusion.
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Generate impression based on findings.
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Tachypnea and tachycardia evaluate pleura and mediastinum status post esophageal perforation. LUNGS AND PLEURA: Small bilateral pleural fluid collections with associated compressive atelectasis. 7-mm groundglass density nodule in the left upper lobe (4/30) appears slightly increased in density compared to the exam of 1/18/2015 however differences could be due to changes in lung volumes. 9-mm groundglass density peripheral nodule (4/34) also in the left upper lobe probably unchanged.A single left anterolateral chest tube enters from the left fourth rib interspace, extends through the left upper lobe parenchyma to terminate abutting the left major fissure. A small fluid collection surrounds the tube.Bilateral chest tubes entering the chest wall laterally; the right terminates at the lung apex and contains a small volume of internal pleural fluid as it passes posterior to the lung. Left chest tube terminates at a slightly lower level and contains an internal filling defect near its tip, possibly a small hematoma, this also contains pleural fluid as it passes posterior to the lung. No pneumothoraxMEDIASTINUM AND HILA: Esophageal stent extending from the level of the left atrial roof and a second stent extends through the GE junction to terminate in the gastric body.Mildly enlarged mediastinal lymph nodes measuring up to 17-mm (subcarinal 3/43), present previously.Soft tissue density collection surrounding the distal esophagus measuring 5.8 x 2.8-cm (3/69) seen from the level of the subcarinal space to the right of the esophagus at the GE junction. This appears to communicate with soft tissue density in the right postero-lateral mediastinum inseparable from the adjacent pleura (3/66) measuring 2-cm in thickness. There are a few adjacent small clustered lymph nodes in the nearby paracaval fat (3/66, 3/72). This abnormality is seen to a lesser extent to the left of midline and is suspicious for a complex fluid collection. It previously measured the density of simple fluid.No pneumomediastinum; the appearance chest radiograph was caused by paramediastinal lung collapse and air bronchograms.CHEST WALL: Incompletely visualized left axillary fat containing mass measuring greater than 5-cm in AP dimension. The fat within the mass is stranded.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Tip of the gastric stent appears occluded by gastric tissue extending into its lumen. The stomach is collapsed around the tip of the stent. A nasogastric tube extends beyond the caudal margin of the scan. A loop of a smaller caliber catheter is situated anterior to the stent.
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1. Distal esophageal collection has increased in density, consistent with complex fluid and could be due to blood products or an infected collection; abscess cannot be excluded.2. Two indeterminate ground glass density nodules left upper lobe may be followed by CT in 6 to 12 months.3. The superolateral anterior left chest tube extends through the lung parenchyma.4. No pneumothorax or pneumomediastinum.5. Incompletely evaluated fat-containing left axillary mass which could represent a lipoma however lack of complete visualization precludes exclusion of liposarcoma.
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Generate impression based on findings.
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59-year-old female with possible breakage Bilateral deep brain stimulator devices with leads are visualized with their tips projecting intracranially. No lead fracture is noted.
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Bilateral deep brain stimulator leads as described above without evidence of lead fracture.
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Generate impression based on findings.
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17 year-old male status post second toe reductionVIEWS: Right foot AP/lateral (two views) 01/23/15, 2243 hrs Interval reduction of a distal phalanx subluxation of the second toe with mild swelling of the soft tissues. No fracture is evident. Alignment is anatomic. Hallux valgus deformity.
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Reduction of second distal phalanx subluxation now in anatomic alignment.
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Generate impression based on findings.
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Extensive restricted diffusion is noted within the bilateral cerebral hemispheres, pons, occipital lobes and temporal lobes. There is corresponding dark signal on ADC indicating acute ischemic infarct. Susceptibility weighted abnormalities are noted within the posterior medial aspect of the right cerebral hemisphere as well as within the pons indicating blood product. Additional periventricular and subcortical white matter T2/Flair hyperintensities indicating small vessel ischemic changes, in particular within the centrum semiovale bilaterally. A flow void in the basilar artery may represent thrombus. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. There is bilateral maxillary sinus mucosal thickening. Fluid is noted in the bilateral mastoid air cells and sphenoid and ethmoid sinuses.
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1.Bilateral cerebellar, pontine, occipital lobe and temporal lobe infarcts with evidence of blood product in the right cerebellar hemisphere and pons.2.Flow void in the basilar artery may represent thrombus.3.Chronic small vessel ischemic disease, particularly in the centrum semiovale bilaterally.
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Generate impression based on findings.
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17 year-old male with toe injury on exam, swelling, tender with angulationVIEWS: Right foot AP/oblique/lateral (3 views) 01/23/15, 1647 hrs There is lateral subluxation of the distal phalanx of the second toe with the medial border of the distal phalanx overlying the lateral fourth of the middle phalanx. No fracture is evident. Hallux valgus deformity.
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Lateral subluxation of the distal phalanx of the second toe.
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Generate impression based on findings.
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13-year-old female status post trauma, evaluate for fractureVIEWS: Cervical spine AP/lateral, chest AP, pelvis AP (4 views) 01/23/15 Vertebral body heights, disk spaces, and alignment are preserved. No prevertebral soft tissue thickening. Left cervical rib is present. Mild to moderate enlargement of the adenoids causing mild narrowing of the nasopharyngeal airway.Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Small amount of feces within the rectum and ascending colon. No acute fracture or malalignment is evident in the pelvis.
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Normal examinations.
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Generate impression based on findings.
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Female 34 years old; Reason: Eval for PE History: Tachycardia, SOB PULMONARY ARTERIES: Technically adequate study. No filling defects suggest acute pulmonary embolism. Main pulmonary artery caliber is 3.0 cm, upper limits of normal. No evidence of right heart strain.LUNGS AND PLEURA: There is a new nodule in the right upper lobe measuring 12 mm x 8 mm (series 7, image 48) is contiguous with the adjacent fissure and appears flat on coronal images. There is interval development of bilateral interlobular septal thickening and subpleural ground glass opacities also new from prior study.Bilateral small pleural effusions, right greater than left with adjacent compressive atelectasisNo significant abnormality noted. MEDIASTINUM AND HILA: Normal sized heart with new moderate pericardial effusion. No visible coronary artery calcification.There is no mediastinal or hilar adenopathy.Hypodense nodule in right thyroid glad is not adequately visualized due to artifact from adjacent contrast material, however does not appear significantly changed.Central venous catheter is noted with tip in the right atrium.CHEST WALL: No significant abnormality noted..UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Please refer to same day CT abdomen and pelvis report for additional findings.
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1. No evidence of acute pulmonary embolism.2. Findings compatible with mild edema with atelectasis.3. New nodule in the right upper lobe which appears flat on coronal images and is contiguous with the adjacent fissure, indeterminate but may represent a benign intrapulmonary lymph node. Follow up CT scans are recommended to confirm stability.4. Bilateral small pleural effusions, right greater than left with adjacent atelectasis. PULMONARY EMBOLISM: PE: NoneeChronicity: Not applicable..Multiplicity: Not applicable..Most Proximal: Not applicable..RV Strain: Not applicable..
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Generate impression based on findings.
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12-year-old male with left ankle painVIEWS: Left ankle AP/oblique/lateral (3 views) 01/23/15, 1855 No acute fracture or malalignment is evident. The bones are normal. No joint effusion or soft tissue swelling is present.
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Normal examination.
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Generate impression based on findings.
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34-year-old female patient postoperative day two status post retroperitoneal mass resection, IVC tumor thrombus resection, IVC resection with Gore-Tex graft reconstruction presents with hemoglobin drop. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with overlying compressive atelectasis. Central venous catheter tip in the right atrium.LIVER, BILIARY TRACT: There is high-density layering material in the gallbladder, compatible sludge and possible stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right perinephric inflammatory changes likely postsurgical in etiology.RETROPERITONEUM, LYMPH NODES: There are surgical clips in the right retroperitoneal area and foci of gas and induration surrounding the IVC graft. There is no evidence of active extravasation from the graft IVC in this portal venous phase study. There is a fluid collection tracking into the intraperitoneal pelvis anterior to the uterus that measures 6 x 13 cm (series 9 image 125) and contains punctate foci of air. No evidence of gross hemorrhage.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Intrauterine device in place.BLADDER: Foley catheter in place with iatrogenic air in the bladder. 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.Gas and induration surrounding the IVC graft without active extravasation. While findings may be postoperative in etiology, continued follow-up imaging is recommended as superimposed infection cannot be excluded.2.Intraperitoneal collection in the pelvis may represent developing abscess given foci of air. Follow up imaging can be obtained as clinically indicated.
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Generate impression based on findings.
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15-year-old male with abdominal pain, history of appendicitis two weeks ago ABDOMEN:LUNG BASES: No pleural effusion. No focal pulmonary opacities.LIVER, BILIARY TRACT: No focal hepatic lesions. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality is noted.BOWEL, MESENTERY: There is bowel wall thickening of the cecum and terminal ileum with surrounding inflammatory changes with soft tissue density measuring 5.3 x 2.7 x 3.9 cm (LR x AP x CC), previously 7 x 5 x 6 cm.Small bowel dilatation has decreased since the prior exam with the exception of the terminal ileum proximal to this process which is dilated measuring up to 3.9 cm. Contrast is visualized distal to this process. No loculated fluid collection to suggest abscess. No pneumoperitoneum. There is a small amount of free fluid in the abdomen. Enlarged reactive mesenteric lymph nodes are noted in the right lower quadrant.BONES, SOFT TISSUES: Minimal anterior wedging of L1 is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Enlarged, reactive mesenteric and right common iliac lymph nodes are present.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Right lower quadrant phlegmon is decreased in size since the prior exam. Continued cecal and terminal ileal wall thickening. Proximal dilation of the distal ileum due to partial small bowel obstruction. Differential considerations include perforated appendicitis, inflammatory bowel disease, or infectious etiology including campylobacter or yersinia.
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Generate impression based on findings.
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Female 85 years old; Reason: eval for pneumonia vs malignancy given LLL mass History: AMS, nausea, hyponatremia LUNGS AND PLEURA: There is a residual small left pleural effusion with adjacent compressive atelectasis which accounts for the opacity seen on recent chest radiograph, which is improved from prior radiographs. There is a well defined spiculated subpleural nodule in the lingula measuring 1.9 cm x 1.5-cm (series 5, image 40) contiguous with the pleura anteriorly, which is an incidental finding and does not correspond to the findings on the recent chest x-ray. No other suspicious pulmonary nodules are noted.There are aspirated secretions in the left mainstem and left lower lobe bronchi. MEDIASTINUM AND HILA: There is mild cardiomegaly. There is mild coronary artery calcification. There is a mildly enlarged aorticopulmonary lymph node measuring up to 1.3 cm (series 4, image 36).There is no hilar adenopathy.There is a small hypodense nodule in the right thyroid lobe.Endotracheal tube is in appropriate position.CHEST WALL: There are degenerative changes of the visualized osseous structures. There is scoliosis of the visualized spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. NG tube is noted in the stomach.
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1. New incidental subpleural spiculated nodule in the lingula is highly suspicious for neoplasm given size, morphology and associated enlarged aorticopulmonary lymph node. 2. Residual trace left pleural effusion with adjacent compressive atelectasis corresponds to the findings on recent radiographs with interval improvement.3. Aspirated secretions in the left main bronchus and left lower lobe bronchi.
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Generate impression based on findings.
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18 year-old female for ET tube assessment. Bone marrow transplant and lymphoma. VIEW: Chest AP (one view) 01/24/15, 0547 ET tube tip is below thoracic inlet and above the carina. Right upper extremity PICC with tip in the atrium. Left subclavian central venous catheter with tip at the superior cavoatrial junction.Low lung volumes. Cardiothymic silhouette is mildly enlarged, unchanged. No pleural effusion or pneumothorax. Mild interval increase in bilateral multifocal lung opacities.
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Mild interval increase in bilateral multifocal lung opacities for which pulmonary edema is a consideration.
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Generate impression based on findings.
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Female 57 years old; Reason: 57 female with metastatic breast cancer, known lung mets. Now with new SOB/hypoxia/tachycardia. r/o PE History: Hypoxia, tachycardia PULMONARY ARTERIES: Technically adequate study. There are no filling defects to suggest an acute pulmonary embolism. Main pulmonary caliber measures up to 2.9 cm. There is no evidence of right heart strain.LUNGS AND PLEURA: There is redemonstration of innumerable bilateral pulmonary nodules consistent with patient's known metastatic disease, which are increased in number and size. Right lower lobe mass measures 5.7 cm x 4.7 cm (series 7, image 72) previously measured 5.4 cm x 4.7 cm. Additional reference nodule in the left upper lobe measures 1.4 cm x 1.1 cm (series 7, image 43) previously measured 1.2 cm x 1.2 cm. The majority of the remaining lung nodules also appear slightly increased in size.There is interval development of ground glass opacities in the bilateral apices, as well as diffusely throughout the left lung.There are bilateral small pleural effusions.MEDIASTINUM AND HILA: Normal size heart with no pericardial effusion. There is no visible coronary artery calcification.There is redemonstration of prominent mediastinal and hilar lymphadenopathy. Reference right hilar lymphadenopathy measures 2.3 cm x 2.2 cm (series 10551, Image 118), previously measured 2.6 cm x 2.6 cm, not significantly changed. Additional lymph nodes in the mediastinum appear increased in size, for example right paratracheal lymph node measures 16 mm x 14 mm (series 10551, image 65) previously 8 mm x 7 mm.CHEST WALL: There is degenerative changes of the visualized osseous structures.There are postsurgical changes in the left breast. Left axillary dissection clips.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There are numerous hepatic nodules which appear confluent and poorly defined this arterial phase of contrast, limiting the ability to give an accurate measurement for comparison is. There is a 5.0 cm x 4.6 cm (series 10551, image 226) in the spleen previously measured 4.4 cm x 4.2 cm.
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1. No evidence of acute pulmonary embolism.2. Interval development of ground glass opacities in the left lung and right apex is highly suspicious for a drug reaction and less likely hemorrhage or atypical infection such as viral or pneumocystis jiroveci pneumonia.3. Diffuse pulmonary metastatic disease with definite interval progression. Interval increase in size of the mediastinal lymphadenopathy.4. Unable to give accurate measurement of the liver lesions given arterial phase of contrast. The splenic mass has increased in size. Per Stat consult, on-call resident Dr. Aaron Bos discussed findings with oncology team, noting that patient received a dose of Taxotere approximately 11 days ago. Per oncology team, plan to start steroids for drug reaction.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 43 years old; Reason: chest pain, ro pe History: chest pain PULMONARY ARTERIES: Technically adequate study. There are no filling defects to suggest an acute pulmonary embolus. Main pulmonary artery caliber measures up to 2.5 cm. There is no evidence of right heart strain.LUNGS AND PLEURA: No significant abnormality noted. No suspicious pulmonary nodules are noted.No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Normal sized heart without pericardial effusion. No visible coronary artery calcification.No mediastinal or axillary lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of pulmonary embolism.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 49 years old; Reason: PE (highest priority) vs extension of traumatic aortic dissection History: pleuritic chest pain on right PULMONARY ARTERIES: Technically adequate study. No filling defects to suggest acute pulmonary embolism. Main pulmonary artery caliber measures up to 2.1 cm. There is no evidence of right heart strain.LUNGS AND PLEURA: No suspicious pulmonary nodules.No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Normal sized heart with no pericardial effusion. There is no visible coronary artery calcification.No mediastinal or hilar adenopathy. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Please note study is suboptimal for evaluation of aortic dissection, given the timing of the scan after contrast injection to maintain a diagnostic exam for evaluation of pulmonary embolism. There is a poorly visualized small focal aortic intimal flap in the upper abdomen, however does not appear to be significantly changed.
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1. No evidence of acute pulmonary embolism.2. Please note study is suboptimal for evaluation of aortic dissection, given the timing of the scan to maintain a diagnostic exam for evaluation of pulmonary embolism. If there is a high level of suspicion, dedicated CT aortic dissection protocol can be obtained. Previously noted focal aortic intimal flap in the upper abdomen is poorly visualized, however probably not significantly changed.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 40 years old; Reason: h/o PE p/w SOB r/o PE History: h/o PE and protein S deficiency p/w SOB off Lovenox PULMONARY ARTERIES: Technically adequate study. There are no filling defects to suggest an acute pulmonary embolism. Main pulmonary artery caliber measures up to 2.6 cm in diameter. There is no evidence of right heart strain.LUNGS AND PLEURA: No suspicious pulmonary nodules are identified.There is no pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Normal sized heart with no pericardial effusion. There is no visible coronary artery calcification.There is no mediastinal or hilar adenopathy. There are calcified mediastinal lymph nodes consistent with prior infection. Stable, mildly enlarged bilateral axillary lymph nodes. Central venous catheter with tip in the SVC.CHEST WALL: Stable sclerotic focus in the inferior endplate of T1 vertebral body likely bone island.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Symmetric bilateral adrenal gland enlargement is unchanged.
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No evidence of acute pulmonary embolism.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 27 years old; Reason: s/p cholecystectomy, r/o PE History: CP/SOB PULMONARY ARTERIES: Technically adequate study. There are no filling defects to suggest an acute pulmonary embolism. Main pulmonary caliber measures up to 2.4 cm in diameter. There is no evidence of right heart strain. LUNGS AND PLEURA: Subpleural micronodules in the left lower lobe compatible with previous infection.No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Normal sized heart with no evidence of pericardial effusion. There is no visible coronary artery calcification.There is no mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postcholecystectomy clips with small focus of air likely in the biliary tree consistent with postsurgical changes.
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No evidence of acute pulmonary embolism.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable.
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Generate impression based on findings.
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Female 53 years old; Reason: hx of PE, on xarelto, here with hemoptysis History: hemoptysis PULMONARY ARTERIES: Technically adequate study. There are no filling defects suggestive of acute pulmonary embolism. The pulmonary artery caliber measures up to 2.0 cm in diameter. There is no evidence of right heart strain.LUNGS AND PLEURA: There has been near complete resolution of prior infarcts with mild residual scarring. There is a calcified granuloma in the right lung base.There is no pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Normal sized heart with no evidence of pericardial effusion. There is mild thickening of the anterior pericardium which appears stable. There is no visible coronary artery calcification.There is no mediastinal or hilar adenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted.
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No evidence of pulmonary embolism. PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable..Multiplicity: Not applicable..Most Proximal: Not applicable..RV Strain: Not applicable..
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Generate impression based on findings.
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2-year-old male with coughVIEWS: Chest AP/lateral (two views) 01/24/15, 0052 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate bronchial wall thickening suggestive of reactive airway disease/bronchiolitis pattern. Large lung volumes.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. Incidental note is again made of a subcentimeter hyperdense focus along the inner table of the right parietal bone which is unchanged dating back to 2009. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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Negative unenhanced brain CT.
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Generate impression based on findings.
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There is soft tissue swelling and fat stranding of the face, right cheek greater than left. There is also right sided periorbital preseptal swelling and fat stranding. There is no evidence of acute facial bone or orbital fracture. The globes are intact without evidence of intraorbital hematoma or stranding. The temporomandibular joints are intact. The imaged paranasal sinuses and mastoid air cells are clear.
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1.No evidence of acute fracture. 2.Bilateral cheek and right periorbital pre-septal soft tissue swelling.
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Generate impression based on findings.
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Bone tenderness. Evaluate for fracture.VIEWS: Right wrist PA/lateral/oblique (3 views) 01/24/15 The bones are normal in appearance. No fracture is identified. There may be a small joint effusion; the pronator quadratus fat pad is displaced.
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No fracture identified.
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Generate impression based on findings.
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Surgery for thoracic metastasis from clear cell sarcoma.VIEW: Chest AP (one view) 01/24/15, 0552 Right chest tube remains in place. Surgical clips and staples are noted on the right. Small right apical pneumothorax persists. A small amount of subcutaneous emphysema is noted.Anterior fifth and sixth ribs have been resected. Subsegmental atelectasis is noted in both bases. Cardiac silhouette size is normal.
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Continued small right apical pneumothorax.
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Generate impression based on findings.
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11 year old female with respiratory distressVIEW: Chest AP (one view) 01/24/15, 0329 hrs Persistent levoscoliosis. Low lung volumes. Right middle and lower lobe opacity likely represents atelectasis. Mild bronchial wall thickening suggestive of reactive airway disease/bronchiolitis pattern.
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Right middle and lower lobe opacity likely atelectasis, unchanged. Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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Negative unenhanced brain CT.
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Generate impression based on findings.
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Intubated. Seizure disorder. Hip surgery.VIEW: Chest AP (one view) 01/24/15, 0542 Endotracheal tube tip is above carina. Gastrostomy tube is in place. Right upper extremity PICC tip is at junction of superior vena cava and right atrium. Cast overlies the upper midabdomen.Pulmonary edema pattern is resolving. Hazy opacities in the lung bases are decreased. Pleural effusion is decreasing. Cardiothymic silhouette size is normal.
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Resolving pulmonary edema pattern.
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Generate impression based on findings.
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2-year-old female with fall, tender forearmVIEWS: Left forearm AP/lateral (two views) 01/24/15, 0353 Buckle fractures of the distal radius and ulna with mild posterior angulation. Soft tissue swelling.
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Both bones fracture of distal forearm.
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Generate impression based on findings.
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1-year-old female with cough and wheezingVIEWS: Chest AP/lateral (two views) 01/24/15, 0410 Low lung volumes. Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. Mild bronchial wall thickening suggestive of reactive airway disease/bronchiolitis pattern. No focal pulmonary opacities.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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27-year-old female patient with fever, diarrhea and periumbilical pain. ABDOMEN:LUNG BASES: Trace dependent atelectasis.LIVER, BILIARY TRACT: Hypoattenuating focus in the right lobe of the liver is too small to characterize and likely represents a cyst and is unchanged compared to prior examination. There is no CT evidence of cholelithiasis or cholecystitis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal calculi, hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy. The abdominal aorta is normal in caliber.BOWEL, MESENTERY: No bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: An intrauterine device is in place. The right ovary is enlarged compared to the left, measuring up to 3.9 cm in axial plane. The position of the right ovary is unchanged compared to prior examination.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy in the pelvis.BOWEL, MESENTERY: The appendix is not well visualized, however, there is no pericecal inflammation.BONES, SOFT TISSUES: Again noted is a cystic structure arising from a right sacral neural foramina that may represent perineural cyst that currently measures 2.3 x 1.5 cm (series 3 image 80), previously 1.9 x 1.4 cm.OTHER: There is no free fluid in the pelvis.
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1.Enlarged right ovary may represent a physiologic cyst, however, ultrasound is recommended if there is clinical concern for ovarian torsion.2.No radiologic evidence of appendicitis.3.Slight increase in size of suspected right sacral perineural cyst.
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Generate impression based on findings.
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Reason: evaluate STA-MCA bypass History: recurrent CVAs Brain CTA: There is opacification of the right internal carotid artery up to be level of the ophthalmic artery, distal to which there is no opacification of the ophthalmic segment. A branch of the right superficial temporal artery has been anastomosed to the right angular artery via a right sided craniotomy site.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The patient is status post right craniotomy for EC-IC bypass. There is extra-axial air present intracranially. There is adjacent right scalp soft tissue swelling.The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. Punctate hypodensities are present in the basal ganglia, left centrum semiovale and brainstem.Atherosclerotic calcifications are present along the distal internal carotid arteries.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 mucosal thickening in the right maxillary sinus as well as thickening of the walls of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.A branch of the right superficial temporal artery has been anastomosed to the right angular artery via a right sided craniotomy site.2.Occlusion of the right internal carotid artery at the ophthalmic segment. The right internal artery is the supply to the right ophthalmic artery.3.Status post recent right craniotomy. 4.No evidence for acute intracranial hemorrhage, mass effect or edema.5.Punctate lesions in the basal ganglia, brainstem and the left centrum semiovale are suspected to represent lacunar infarcts of indeterminate age.6.CT is insensitive for early detection of nonhemorrhagic CVA.7.Periventricular and subcortical white matter changes of a mild degree are nonspecific.
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Generate impression based on findings.
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A focus of restricted diffusion is noted along the left precentral gyrus peripherally. There is associated dark ADC signal indicating acute ischemic infarct. Additional scattered periventricular and subcortical white matter flair/T2 signal abnormalities that are nonspecific but compatible with small vessel ischemic changes. Additional T2/Flair signal abnormality noted in the left parietal lobe involving cortex that does not restrict on diffusion weighted imaging indicates prior chronic ischemic insult.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. There is opacification of the right greater than left frontal and ethmoid sinuses. Maxillary sinus mucosal thickening is noted, left greater than right. Fluid is also seen within the right greater than left mastoid air cells. This is similar to the prior exam.
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1.Acute ischemic infarct of the peripheral left precentral gyrus.2.Scattered small vessel ischemic changes and old parietal infarct, similar to prior exam.
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Generate impression based on findings.
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55-year-old male "status post fall" Lumbar spine: There is erosion of the posterior elements at L3 and L4, representing an erosive mass measuring approximately 9 cm in cc dimension. The anterior osseous elements including vertebral body heights and disk spaces are preserved.Knee: Small osteophytes indicate minimal degenerative disease. No joint effusion. Atherosclerotic changesPelvis and bilateral hips: Moderate osteoarthritic changes affecting each hip with more mild changes of both SI joints. Vascular calcifications are noted.
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Findings indicating an erosive mass involving the posterior elements of L3 and L4. See subsequent MRI for further evaluation.
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Generate impression based on findings.
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Again seen is a left parietal approach shunt catheter with the intracranial tip terminating at the midline, similar to prior exam. No kinking or discontinuity is noted the visualized portions. The ventricles are partially decompressed but this is unchanged.There is no evidence of intracranial hemorrhage or edema. There is agenesis of the corpus callosum, effacement of the basal cisterns, and inferior displacement of the cerebellar tonsils all consistent with the patient's known Chiari malformation and appearing similar to prior studies. The posterior left cerebral hemisphere encephalomalacia is similar to prior. No new parenchymal findings are evident.There is diffuse thickening of the cranial vault, similar to prior. The visualized paranasal sinuses and mastoid air cells are clear.
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Stable ventricular size, shunt catheter location and brain appearance without evidence of an acute intracranial process.
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Generate impression based on findings.
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15-year-old male with pain and vomitingVIEW: Abdomen AP (one view) 01/24/15, 00 06 Relative paucity of bowel gas in the right lower quadrant. Gas distended loops of small bowel in a nonobstructive bowel gas pattern. Small amount of stool within colon. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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23-year-old male with pain, evaluate for fracture There is dislocation of the proximal interphalangeal joint of the little finger with dorsal and lateral displacement of the middle phalanx relative to the proximal phalanx. No fracture is visualized.
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Fifth finger PIP joint dislocation.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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22-year-old female with pain, worst at third digit Hand: No fracture or malalignment.Shoulder: Glenohumeral joint alignment is within normal limits. No fracture is visualized.
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No fracture or other specific findings to explain the patient's symptoms.
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Generate impression based on findings.
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84-year-old female patient with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy with expected mild common bile duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal calculi, hydronephrosis or hydroureter. No significant change in small right renal cyst.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy. Mild atherosclerotic changes affect the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: No significant bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: Slight levoscoliosis and moderate to to severe multilevel degenerative changes are noted in the thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Evaluation of the bladder is limited due to lack of distention.LYMPH NODES: There is no pelvic lymphadenopathy.BOWEL, MESENTERY: A retrocecal appendix is well-visualized and is within normal limits. Mild colonic diverticulosis without evidence of diverticulitis. No significant bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: Moderate to severe multilevel degenerative changes are noted in the thoracolumbar spine. Findings compatible with Paget's disease again noted in the left iliac wing.OTHER: No significant abnormality noted.
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No acute intra-abdominal pathology to account for patient's abdominal pain.
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Generate impression based on findings.
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67 year old male with metastatic pancreatic cancer and altered mental status. There is no evidence of abnormal enhancement. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable. There are postoperative findings related to endoscopic sinus surgery with bilateral uncinectomies, ethmoidectomies, and turbinectomies. There is minimal mucosal thickening within the left maxillary sinus. There degenerative changes of the bilateral temporomandibular joints.
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No evidence of intracranial mass. Please note that MRI is more sensitive for intracranial metastases.
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Generate impression based on findings.
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PICC placement. Not in the IVC. Where is it? 9-week-old former 27 week gestational age patient.VIEW: Left femur AP (one view) 01/24/15, 0130 Lower extremity PICC tip is at level of knee joint. Minimal metaphyseal irregularity is noted in the femur and proximal tibia. No fracture is seen in this single plane.
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PICC tip not located centrally. Early changes from rickets.
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Generate impression based on findings.
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27-year-old male patient with left perinephric mass. ABDOMEN:LUNG BASES: Scattered dependent atelectasis.LIVER, BILIARY TRACT: Layering hyperattenuating material in the gallbladder represents sludge and/or gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney appears normal without hydronephrosis or hydroureter.There is a hypoattenuating perinephric lesion posterior to the left kidney that measures 4.7 x 1.5 cm (series 13 image 45) and 5.2 cm in craniocaudal dimension. This lesion has peripheral enhancement and enhancing septations. There is an infiltrative process associated with the lesion that is most notable in the superior posterior margin of the left kidney.RETROPERITONEUM, LYMPH NODES: There is no retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Given patient's clinical history of infection, the left perinephric lesion likely represents a loculated abscess with direct extension into the left kidney and resultant pyelonephritis. Infiltrative tumor is considered less likely, but consider follow up imaging to resolution.
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Generate impression based on findings.
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CT HEAD:There is no evidence of intracranial hemorrhage. There are a few patchy regions of low-attenuation within the supratentorial white matter compatible with age indeterminant small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull is unremarkable. There is a 5 x 10 mm sessile lesion of the right parietal scalp soft tissues.CTA NECK: There is a common origin of the right subclavian and left common carotid artery from the aortic arch. There is mild atherosclerotic narrowing of both carotid bulbs and proximal internal carotid arteries including a small right-sided ulcerated plaque, without hemodynamically significant stenosis. There is little to no contrast opacification of the bilateral vertebral arteries although the vertebral transversarium foramen are normal in appearance. CTA HEAD: There is reconstitution of at least the right intracranial vertebral artery to form the basilar artery. There is then a short segment near complete occlusion of the basilar artery which is then reconstituted. The superior cerebellar arteries are patent and there is a fetal origin of both posterior cerebral arteries which are patent and likely supply the posterior circulation via retrograde flow. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is no evidence of aneurysm.
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1.No evidence of intracranial hemorrhage. If there is concern for acute ischemia, MRI is suggested. 2.Probable complete occlusion of the bilateral vertebral arteries (favored over bilateral hypoplasia due to normal vertebral transversarium foramen) with the posterior circulation mainly fed by large posterior communicating arteries. There is also short segment occlusion of the basilar artery with distal reconstitution from retrograde flow.3.Age indeterminate small vessel ischemic disease. 4.5 x 10 mm sessile lesion of the right parietal scalp soft tissues.
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Generate impression based on findings.
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Left varus derotational osteotomy.VIEW: Left hip frog leg (one view) 01/24/15, 0822 Plate and screws device in the proximal femur is again seen. Femoral osteotomy is not seen in profile. The femoral head is well directed into the mildly dysplastic acetabulum in a single plane.
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Postoperative changes.
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Generate impression based on findings.
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26 year old female patient with history of inflammatory bowel disease, likely UC, with worsening colonic dilatation and abdominal pain. ABDOMEN:LUNG BASES: Minimal dependent atelectasis.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 retroperitoneal lymphadenopathy. The abdominal aorta is normal caliber.BOWEL, MESENTERY: The descending and transverse colon is mildly dilated. There is collapse of the proximal descending colon and splenic flexure with mild to moderate colonic wall thickening, mild adjacent inflammatory changes and mildly prominent pericolonic lymph nodes. No evidence of bowel perforation. The appendix is well-visualized and is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: An intrauterine device is noted.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: There is intramural fat in the rectum and sigmoid colon, compatible with chronic changes from inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Findings compatible with active inflammation in the proximal descending colon and splenic flexure given patient's history of IBD without evidence of obstruction.
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Generate impression based on findings.
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There has been a slight increase of CSF intensity fluid within the subarachnoid spaces about the falx anteriorly and to a much lesser extent over the frontal lobe convexities. This is not associated with mass effect.. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. There are no subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is again noted within bilateral mastoid air cells and middle ear cavities. Calvarial scalp soft tissue asymmetry is decreasing compared to prior.
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1.There has been a slight increase of CSF intensity fluid within the subarachnoid spaces about the falx anteriorly and to a much lesser extent over the frontal lobe convexities, consistent with effusion.2.Otherwise negative noncontrast brain MRI.
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Generate impression based on findings.
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43 day old former 28 week gestational age patient with history of medical NEC. Is there pneumatosis?VIEW: Abdomen AP (one view) 01/24/15, 0524 Feeding tube tip is in stomach with side port at GE junction.Bowel gas pattern is disorganized. Few mildly dilated bowel loops are present. No fixed loop is seen. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is identified.There appears to be an umbilical hernia.
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No evidence of complication from NEC.
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Generate impression based on findings.
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43 day old former 28 week twin gestation with history of medical NEC.VIEW: Abdomen AP (one view) 01/24/15, 0528 Feeding tube tip is in stomach with side port at GE junction. Left lower extremity PICC tip is in right atrium.Less bowel gas is present than on prior exam. No dilated loops are identified. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is seen.There appears to be an umbilical hernia.Hazy opacities are noted in the lung bases.
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No evidence of complication from NEC.
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