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Generate impression based on findings.
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Male 38 years old Reason: please compare to previous s/p additional systemic therapy and provide bidimensional measurements per RECIST v1.1 thanks History: melanoma CHEST:LUNGS AND PLEURA: Pleural based micronodular right mid lobe series 5 image 67, unchangedplace micronodules right middle lobe image 61 also unchanged. Small micronodules left lung best seen on the maximal intensity projection images, unchangedNo new nodules. No effusions.MEDIASTINUM AND HILA: No pathologic size nodes.Reference right paratracheal lymph node is actually located anterior to the right main bronchus and on series 2 image 48 measures 1 x 0.6 cm. Previously 1 x 0.9 cm. No new nodes.Indicates thyroid nodules - finding questionable. I do not see any discrete nodules.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable indeterminate subcentimeter left adrenal nodule, series 2 image 110, 0.8 cm in diameter unchanged. Right adrenal gland normal.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered colonic diverticulosis. No evidence of ascites.BONES, SOFT TISSUES: Bone island L2, and proximal femurs, unchangedOTHER: No significant abnormality noted
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No definite evidence of metastatic disease. Nonspecific pulmonary micronodules in nonpathologic size mediastinal nodes are unchanged. Nonspecific subcentimeter left adrenal nodule also unchanged.
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Generate impression based on findings.
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CT HEAD:There is no evidence of intracranial hemorrhage. There are scattered patchy foci of hypoattenuation within the supratentorial white matter that are most compatible with age indeterminant small vessel ischemic disease. There is diffuse volume loss of the cerebellum and to a lesser extent the brainstem. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion. MISCELLANEOUS: There are subcentimeter thyroid nodules. There are degenerative changes of the cervical spine with multilevel disc height loss and end plate degenerative changes as well as grade 1 anterolisthesis of C3 on C4 and minimal grade 1 retrolisthesis of C4 on C5 and C5 on C6. There is probable resultant mild spinal canal stenosis at C3-C4.
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1.No evidence of intracranial hemorrhage.2.Moderate age indeterminant small vessel ischemic disease.3.Cerebellar and brainstem volume loss compatible with diagnosis of spinocerebellar ataxia.4.No evidence of significant steno-occlusive lesion within the head or neck.5.Subcentimeter thyroid nodules that could be further characterized with ultrasound.6.Cervical spine degenerative changes as detailed above that could be further characterized with an MRI as clinically indicated.
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Generate impression based on findings.
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Female 73 years old Reason: 73 F with new dx of breast cancer, staging CTs History: right breast cancer. CHEST:LUNGS AND PLEURA: Several right and left apical subpleural blebs and small bullae.Somewhat triangular shape discrete nodule right upper lobe series 6 image 37, 0.9 x 0.7 cm.no other lung nodules. No effusions.MEDIASTINUM AND HILA: Thyroid gland is enlarged bilaterally with ill-defined nodule seen in the left lobe.CHEST WALL: 1.6 x 1.1 cm discrete nodule right breast series 5 image 24. Correlate with clinical exam and mammogram.ABDOMEN: Blurring due to the respiratory motion.LIVER, BILIARY TRACT: Possible fatty liver.SPLEEN: No significant abnormality noted.PANCREAS: Bulbous appearance of pancreatic tail. See series 5 image 80. This could represent normal variant bifid tail anatomy.Focal dense calcification in the lateral inferior aspect of the pancreatic head, see coronal image 74. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild to moderate atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild anterolisthesis L4 on L5. Discogenic disease L5-S1.OTHER: No significant abnormality noted.
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Right breast nodule.Possible fatty liver.Nonspecific right lung nodule. Enlarged nodular thyroid gland.Focal calcification pancreatic head correlate for history of pancreatitis. Bulbous pancreatic tail suspect normal variant.
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Generate impression based on findings.
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Redemonstrated is parenchymal and intraventricular hemorrhage, unchanged in appearance. There are no foci of interval new hemorrhage. Ventricular sizes are stable. There is no significant mass effect with stable minimal midline shift to the left. There is no extraaxial fluid collection. There is mild scattered mucosal thickening within the ethmoid air cells. The visualized portions of the mastoids/middle ears are clear.
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1.Redemonstrated is parenchymal and intraventricular hemorrhage, unchanged in appearance. 2.There are no foci of interval new hemorrhage. 3.Ventricular sizes are stable. 4.There is no significant mass effect with stable minimal midline shift to the left
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Generate impression based on findings.
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Pain. Rule out fracture/dislocation.VIEWS: Left humerus AP/lateral (two views) 01/24/15 The humerus is normal in appearance. No fracture is identified. No significant soft tissue swelling is seen.
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Normal examination.
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Generate impression based on findings.
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Pain. Rule out fracture/dislocation.VIEWS: Left elbow AP/lateral/oblique (3 views) 01/24/15 A joint effusion is not present. The bones are normal in appearance. No fracture is identified.
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Normal examination.
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Generate impression based on findings.
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67-year-old male with new confusion 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 again noted. 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 internal carotid and vertebral arteries. Atherosclerotic calcifications are present along the arteries within the scalp soft tissues. The visualized portions of the paranasal sinuses redemonstrate 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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64-year-old male with intracranial hemorrhage. No significant change in the size of the large intraparenchymal hemorrhage and associated vasogenic edema centered in the left thalamus with intraventricular extension. No significant change in the midline shift. Redemonstrated is hypodensity along a track from a previous right transfrontal ventricular catheter. The left lateral ventricle has slightly decreased in size, with the remaining ventricular system stable. Again visualized is persistent hyperattenuation along the posterior aspect of the cerebellum which is similar to the prior exam. There is persistent periventricular hypoattenuation that likely represents transependymal CSF flow versus confluent small vessel ischemic disease.
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1.No significant change in the large ICH and associated vasogenic edema centered in the left thalamus with intraventricular extension.2.The left lateral ventricle has slightly decreased in size, with the remaining ventricular system stable.
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Generate impression based on findings.
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Female 40 years old Reason: 40 yr old female with stage IV cervical cancer. S/P 3 cycles neoadjuvant Taxol/Cisplatin/Avastin. Please assess current disease status and compare with previous scans. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Port-A-Cath tip in proximal right atrium.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Punctate nonspecific nodule segment 6, series #4 image #77. No other liver lesionsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Poorly marginated periaortic adenopathy both vena cava left right and anterior to the aorta. The appearance may represent treatment effect. For baseline purposes left periaortic component as measured on series 4 image 118, 1.2 x 1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Proximal left common iliac node series 4 image 144, 1.4 x 1.8 cm.Small nodes are seen along the right and left common iliac chains as well as external iliac and obturator chains.BOWEL, MESENTERY: Physiologic free fluid in dependent portion of the pelvis. No evidence of carcinomatosis.BONES, SOFT TISSUES: Bone island left acetabulum posterior column.OTHER: No significant abnormality noted.
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Retroperitoneal and pelvic lymphadenopathy.
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Generate impression based on findings.
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Male 68 years old Reason: restaging scans s/p 6 cycles of investigational immunotherapy History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: Reference lung with lesions as follows:Irregular shape left lower lobe lesion, series 8 image 70, 2.9 x 1.6 cm. Previously 2.6 x 1.9 cm.Para-mediastinal left lower lobe mass series 8 image 47, 2.4 x 1 cm. Previously 2.3 x 1.5 cm.Left apical mass series 8 image 11.9 x 3.2 cm. previously 3.1 x 1.9 cm.Mixed response other lesions some stable some decreased some slightly increased.MEDIASTINUM AND HILA: Stable scattered mediastinal nodes. Index left perihilar node measures 1.4 x 1.1 cm on series 9 image 48. Previously 1.4 x 1 cm.Port-A-Cath tip in SVC RA junction, unchanged.Heavy atherosclerotic calcification coronary arteries.CHEST WALL: Port-A-Cath left chest wall not visualized on today's study.ABDOMEN:LIVER, BILIARY TRACT: Punctate foci nonspecific likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Blood flow and showed no No significant abnormality notedKIDNEYS, URETERS: Renal cysts, unchanged in the right kidney. Left kidney is surgically absent.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease in aneurysmal dilatation infrarenal abdominal aorta unchanged. There is a multifocal mural thrombus and possible ulcerated plaques. Heavy calcification thick right renal artery. Patient and prominent caliber right and left iliac arteries, unchanged.Calcification and surgical clip left retroperitoneum with multifocal fatty masses in the left retroperitoneum extending from the dorsal to the spleen, thoroughout the length of the abdomen and pelvis down to the left iliac fossa. It may be postsurgical in nature and likely represents fat necrosis.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: Sclerotic foci likely bone islands, unchanged. Presumed postsurgical fat necrosis left iliac fossa to retroperitoneum, also described above.OTHER: Fat-containing left inguinal hernia unchanged. Atherosclerotic disease.
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Progression of disease based on a lung findings.Other findings as above.
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Generate impression based on findings.
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Left arm weakness.VIEWS: Left clavicle AP/tangential (two views) 01/25/15 A fracture of the proximal humeral metaphysis has buckling and greenstick component is. The humeral head is well directed toward the glenoid fossa.The clavicle is normal in appearance.
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Fracture of proximal humeral metaphysis.
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Generate impression based on findings.
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Shoulder pain.VIEWS: Right shoulder internal/external rotation (two views) 01/25/15 Humeral head is well directed into glenoid fossa. No fracture is seen.
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Normal examination.
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Generate impression based on findings.
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Male 70 years old; Reason: pt hcc needs surveillance scans History: none CHEST:LUNGS AND PLEURA: Right lung granuloma. Moderate/severe emphysematous changes. Right basal scarring/atelectasis.MEDIASTINUM AND HILA: Heart size is normal. Subcarinal lymph node measures 2.1 x 1.2 cm (series 15, image 55), previously 1.9 x 1.2 cm. There is mild coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. Multiple hepatic lesions are again noted. The dominant right hepatic lobe lesion measures 3.9 x 3.4 cm (series 15, image 104), previously 4.2 x 2.7 cm. The solid enhancing nodules centrally are not significantly changed. Additional HCC lesions are again noted two in the right hepatic lobe and one in the left hepatic lobe. Subtle enhancing focus possibly representing biopsy tract extends from the left hepatic lobe lesion and this is less conspicuous on today's study. Patent hepatic vasculature. Cholelithiasis is again noted. The previously described nonobstructive stone in the distal CBD is not well seen on today's study. SPLEEN: Splenomegaly measuring 14.4 cm.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The reference aortocaval lymph node measures 2.0 x 1.2 cm (series 15, image 123), previously 2.0 x 1.0 cm. Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Upper abdominal ascites, stable/mildly increased.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Upper abdominal varices.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the lower lumbar spine.OTHER: Pelvic ascites, stable to mildly increased. Bilateral fluid containing inguinal hernias. Fat attenuation lesion in the right gluteal musculature suggestive of a lipoma.
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1.Multifocal HCC is detailed above. Decrease in size of the dominant right hepatic lesion.2.Subcarinal and retroperitoneal lymphadenopathy.3.Cholelithiasis.
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Generate impression based on findings.
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Fatigue and new diagnosis of neuroblastoma. CHEST:LUNGS AND PLEURA: No focal opacity is present. A pleural effusion is not identified.MEDIASTINUM AND HILA: A mass in the left neck measures approximately 8 cm in maximum diameter. The superior aspect of the mass is above C6 and not included in this examination. The mass extends into the left anterior mediastinum. It measures greater than 2 cm in diameter just superior to the level of the origin and of the great vessels. The left brachiocephalic vein is compressed and the great vessels are displaced slightly to the right. In the neck, the trachea is displaced to the left as is the left lobe of the thyroid. The left internal jugular vein is displaced anteriorly and flattened by the mass in the neck.The heart size is normal.CHEST WALL: T6 vertebral body has sclerotic areas and destruction is noted anteriorly with loss of height.ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance.SPLEEN: Normal in appearance.PANCREAS: Displaced superiorly by retroperitoneal mass.ADRENAL GLANDS: Left adrenal gland appears contiguous with retroperitoneal mass.KIDNEYS, URETERS: Left kidney is displaced inferiorly and laterally by a retroperitoneal mass. Mild to moderate pelvicaliceal dilation is due to compression by mass.RETROPERITONEUM, LYMPH NODES: A left retroperitonea heterogeneous soft l tissue mass measures greater than 10.5 cm transversely. It extends approximately 11.5 cm longitudinally and approximately 5 cm anteroposteriorly. It encases and attenuates the left renal vein, the renal arteries, the aorta and inferior mesenteric artery. Spinal artery is are also encased and displaced.. The mass abuts the superior mesenteric artery. The superior mesenteric artery is displaced anteriorly. It displaces the inferior vena cava anteriorly and laterally and compresses it. The mass extends across the midline and passes slightly lateral to the right lateral aspect of the vertebral body.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A moderate amount of feces is present in the rectosigmoid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Neuroblastic tumor in the left retroperitoneum extending across the midline. Metastatic disease in left neck and mediastinum.
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Generate impression based on findings.
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Male 45 years old Reason: Melanoma. History: s/p 4 cyles of Yervoy. Restage. CHEST:LUNGS AND PLEURA: Several both calcified and noncalcified pulmonary micronodules. Favor granulomatous disease. No effusions.MEDIASTINUM AND HILA: Scattered nodes most are calcified. Several small nodes are not calcified. Nonpathologic in size.CHEST WALL: Clusters of several small high axillary nodes. Clustering is abnormal but they are still nonspecific.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific segment 6 hypoattenuating lesion 0.7 x 0.6 cm Series III image 88. No other measurable liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of ascites or carcinomatosis.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: Scattered colonic diverticulosis. No evidence of diverticulitis. No free or loculated fluid. No evidence of carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Calcified and noncalcified pulmonary micronodules and mediastinal nodes. Clusters of small axillary nodes, nonspecific. Solitary sub-centimeter hypoattenuating focus liver.No prior exams for comparison.
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Generate impression based on findings.
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Female 81 years old; Reason: evaluate for occult malignancy/masses History: unexplained wt loss Motion artifact degrades image quality. The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:CHEST:LUNGS AND PLEURA: Mild basal atelectasis/scarring. Scattered micronodules are nonspecific.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.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: Calcific arteriosclerosis of the thoracic and abdominal aorta and branch vessels. Caval filter in situ.BOWEL, MESENTERY: Narrow necked ventral abdominal wall Richter's hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Orthopedic hardware stabilizing the lower lumber spine with associated degenerative changes. Healed bilateral inferior pubic ramus fractures.OTHER: No significant abnormality noted.
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1.No evidence of occult malignancy within the limitations of this noncontrast study.
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Generate impression based on findings.
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Reason: r/o PE, eval possible PNA, hx of peritoneal mesothelioma, PE History: cough, CP, SOB, hypoxia. PULMONARY ARTERIES: Exam is limited by poor contrast opacification of the pulmonary arterial system. No pulmonary embolism is identified to the lobar level.LUNGS AND PLEURA: Minimal scarring at the lung bases. No focal consolidation or pleural effusion. No suspicious pulmonary nodularity. Pulmonary nodule along the right minor fissure laterally likely represents an intrapulmonary lymph node.MEDIASTINUM AND HILA: Heart size is normal and no pericardial effusion. Mild enlargement of the pulmonary trunk raises the question of pulmonary arterial hypertension. Multiple prominent mediastinal lymph nodes in the prevascular, AP window, precarinal, and subcarinal regions measure up to 10 mm in short axis it appear increased from the previous exam. Given history mesothelioma, neoplastic etiology favored over reactive adenopathy. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Soft tissue nodularity/confluent adenopathy in the gastrohepatic ligament extends through the esophageal hiatus to the right paraesophageal region in the chest, appearing stable to minimally increased in size from the previous exam. Peritoneal nodularity again noted, compatible with known peritoneal mesothelioma.
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1.Limited exam without evidence of pulmonary embolus to the lobar level.2.Slight increase in size of prominent mediastinal lymph nodes and gastrohepatic ligament soft tissue/confluent adenopathy, concerning for neoplastic extension of known peritoneal mesothelioma.3.Findings compatible with pulmonary arterial hypertension.PULMONARY EMBOLISM: PE: Negative.Chronicity: 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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76 year old male with lung mass and right vocal cord paralysis. There is a 31 x 47 mm spiculated mass within the right lung apex with adjacent reticular opacities as well as pulmonary emphysema. There is extensive mediastinal and right supraclavicular lymphadenopathy. For example, a right supraclavicular lymph node measures up to 39 mm and a right paratracheal lymph node measures up to 52 mm. There is inward bowing of the right vocal cord. There are secretions within the trachea but the airways are patent. There are mild degenerative changes throughout the cervical spine with multilevel endplate degenerative change, loss of disc height, and anterior osteophytes. The osseous structures are otherwise unremarkable. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures are unremarkable. There is an apparent filling defect within the left internal jugular vein and partial compression of the right jugular vein by the nodal mass although it maintains patency. There are bilateral lens implants.
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1.Right upper lobe spiculated mass highly suspicious for primary lung neoplasm with nodal mediastinal and right supraclavicular nodal disease was better characterized on recent CT chest. 2.Right vocal cord paralysis likely secondary to mediastinal and supraclavicular disease involvement of the recurrent laryngeal nerve. 3.Secretions within the trachea suggestive of aspiration. 4.Apparent filling defect within the left internal jugular vein suspicious for thrombosis and partial occlusion. The right jugular vein is compressed by the nodal mass although it maintains patency. Findings discussed with Dr. Joan Miedema by Dr. Michael Rozenfeld on 1/25/15 at 11:15am.
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Generate impression based on findings.
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Hypodensity is present within the white matter without associated mass effect. There is equivocal hyperdensity within the left MCA just distal to the bifurcation, imaged on one slice only (series 4 image 10). The ventricles and sulci are unremarkable for age. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. 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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1.Small vessel ischemic disease of indeterminate ages.2.There is equivocal hyperdensity within the left MCA just distal to the bifurcation, imaged on one slice only (series 4 image 10). 3.If there is continued clinical concern for acute ischemia, MRI would be recommended.
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Generate impression based on findings.
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29-year-old male with laceration. Evaluate for foreign bodies, fracture. No radiopaque foreign body. No underling fracture or malalignment is evident. Soft tissue irregularity at the base of the thumb is compatible with stated history laceration.
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No evidence of radiopaque foreign body or underlying fracture.
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Generate impression based on findings.
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30 year-old female with left shoulder pain, lateral ankle pain and swelling, and rib pain. Left shoulder: Minimally displaced greater tuberosity fracture. No additional fracture or malalignment is evident.Left ankle: Moderate soft tissue swelling about the ankle, particularly laterally. Minimally displaced oblique distal fibular metaphyseal fracture. Two ossific densities projecting in the medial gutter may represent medial malleolar avulsion fracture fragments. No widening of the medial gutter on stress view.Left tibia/fibula: Oblique distal fibular metaphyseal fracture is redemonstrated. No additional fracture or malalignment is evident. There is a bony excrescence arising from the lateral aspect of the distal tibial metaphysis, likely representing an exostosis rather than acute fracture.Ribs: No rib fracture is identified.
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Greater tuberosity fracture of the proximal left humerus.Oblique distal fibular metaphyseal fracture and likely medial malleolar avulsion fracture.
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Generate impression based on findings.
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56-year-old male with pain. No joint effusion or significant soft tissue swelling. No evidence of fracture or malalignment in the elbow.
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No evidence of fracture.
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Generate impression based on findings.
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81-year-old male with poor dentition. Preop assessment prior to potential CABG. Multiple metallic fillings and missing teeth are noted. Multiple teeth are fractured. There are periapical lucencies suggestive of periodontal disease. No specific evidence of osteomyelitis.
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Fractures, fillings, and periapical lucencies, as above.
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Generate impression based on findings.
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50 year-old female with fall. Complaining of tenderness/swelling in right calf/foot. Right tibia/fibula: No evidence of fracture or malalignment.Right ankle: Diffuse mild to moderate soft tissue swelling about the ankle. No joint effusion present. No evidence of underlying fracture or malalignment. Right foot: There is an avulsion fracture at the plantar/medial aspect of the base of the proximal phalanx of the great toe, seen only on the oblique view.
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Avulsion fracture of the base of the proximal phalanx of the great toe.
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Generate impression based on findings.
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71-year-old male with muscle weakness, stroke activation. Encephalomalacia is present involving the anteromedial left frontal lobe with peripheral gliosis and slight right frontal horn ex-vacuo dilatation. This was not present on the right/19/2000 study, yet demonstrates a chronic appearance.Previously demonstrated hypoattenuation lesions in the left medial temporal lobe and occipital lobe from acute infarction now demonstrate encephalomalacia with ex vacuo dilatation of the adjacent left lateral ventricle consistent with expected stroke evolution.There are hypodense foci within the white matter without associated mass effect which have progressed. There is no evidence of intracranial mass, acute territorial, cortical infarct, or acute hemorrhage. Other than the aforementioned ex-vacuo dilatation, the ventricles are unchanged in size or shape without evidence of obstruction. A mucous retention cyst is present within the right maxillary sinus, otherwise the paranasal sinuses and mastoid air cells are clear.
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1.Chronic infarcts involving the right frontal, left temporal, and left occipital lobes.2.Small vessel ischemic disease of indeterminate ages which has progressed. If there is continued clinical concern for acute ischemia, MRI would be recommended.
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Generate impression based on findings.
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50-year-old female with midline tenderness to palpation after MVC. Cervical spine: Straightening of the normal cervical lordosis likely positional. Moderate degenerative changes affect the cervical spine. Vertebral body heights and intervertebral disk spaces are maintained without evidence of acute fracture or malalignment.Lumbar spine: Alignment, vertebral body heights, and intervertebral disk spaces are maintained in the lumbar spine. No evidence of acute fracture or malalignment. Right upper quadrant surgical clips and suture material is present.
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No evidence of acute fracture or malalignment in the cervical or lumbar spine.
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Generate impression based on findings.
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Left proximal humerus fracture. No trauma history.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 01/25/15 Fracture of the left proximal humeral metaphysis is again visualized. Sclerosis is noted in the proximal mid right tibia laterally. No other fracture or a possible fracture is seen. Bone mineralization and modeling are normal.Cardiothymic silhouette is normal in size. Bowel gas pattern is normal.
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Left humeral fracture. Possible right tibial fracture. AP and lateral radiographs of right tibia/fibula may be helpful.
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Generate impression based on findings.
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35-year-old female with neck pain. Rule out fracture. Straightening of the normal cervical lordosis is likely positional. Vertebral body heights, intervertebral disk spaces are maintained. No evidence of fracture in the cervical spine.
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No evidence of fracture.
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Generate impression based on findings.
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37 year-old female with right sacral decubitus ulcer. Evaluate for osteomyelitis. There is complete bony fusion of the right hip joint. The left hip joint appears intact. There is marked type ossification about both proximal femurs. Chronic deformity of the sacroiliac joints is noted. Anomalous sacral formation is identified. This exam is suboptimal for evaluation of osteomyelitis. Contrast material is noted in the bladder.
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Marked deformities of the pelvis and proximal femurs. If there is suspicion for osteomyelitis, cross-sectional imaging such as MRI or CT should be considered.
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Generate impression based on findings.
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19 year-old female with pain status post trauma. Evaluate for injury. No joint effusion or significant soft tissue swelling is identified. No evidence of fracture or malalignment in the left knee.
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No evidence of fracture or malalignment.
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Generate impression based on findings.
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67-year-old male with pain, weakness. Known bony metastases from prostate cancer. Evaluate for interval change. The bones are diffusely demineralized.Pelvis: Innumerable, diffuse small sclerotic bone lesions in the lower lumbar spine, pelvis, and femora are compatible with stated history of metastatic prostate cancer appearing significantly progressed since 2/19/14.Right hip: Diffuse sclerotic osseous metastases have progressed. No evidence of fracture or malalignment.Left hip: Diffuse sclerotic osseous metastases have progressed. No evidence of fracture or malalignment.Right femur: Diffuse sclerotic osseous metastases in the proximal femur have progressed. No evidence of fracture or malalignment.Left femur: Diffuse sclerotic osseous metastases in the proximal femur have progressed. No evidence of fracture or malalignment.
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Progression of skeletal metastases without evidence of acute fracture or malalignment in the pelvis, hips or femora.
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Generate impression based on findings.
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Three day old twin 33 week gestational age patient with increased respiratory distress. History of pneumothorax.VIEWS: Chest and abdomen AP (two views) 01/25/15, 1106 Endotracheal tube tip is above the thoracic inlet. Feeding tube tip is in gastric body. Umbilical venous line tip is at junction of umbilical and left portal veins.Small to moderate right pneumothorax is present. Air is seen laterally inferiorly and medially. Mediastinum is slightly shifted to the left. Hazy opacities are present bilaterally. Cardiothymic silhouette is normal.Bowel gas pattern is disorganized. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is present.
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Small to moderate right pneumothorax. Disorganized bowel gas pattern.
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Generate impression based on findings.
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Arm injury.EXAMINATION: Left elbow lateral (one view) 01/24/15 The elbow is slightly obliquely positioned. No joint effusion is present. No definite fracture is identified.
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No definite fracture.
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Generate impression based on findings.
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Pain in arm. Left humerusEXAMINATION: Left humerus AP/lateral (two views) 01/24/15 A buckling transverse fracture of the medial proximal humeral metaphysis is seen.
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Fracture of proximal humerus.
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Generate impression based on findings.
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Vomiting. History of chronic lung disease.EXAMINATION: Abdomen AP (one view) 01/24/15 Motion artifact is present and precludes evaluation for small free peritoneal air and pneumatosis intestinalis.Mildly dilated bowel loops are present. Bowel gas pattern is disorganized.
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Disorganized gas pattern.
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Generate impression based on findings.
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69-year-old male status post L3 to L5 surgery. Bilateral rods and pedicular screws affix L3-L5. Intervertebral spacer devices are noted at L3-4 and L4-5. No evidence of hardware complication at this time. No evidence of fracture or malalignment in the lumber spine. Vascular calcifications are noted in the abdomen.
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L3-L5 orthopedic hardware without evidence of complication.
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Generate impression based on findings.
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81-year-old female status post fall with right ankle pain. Rule out fracture. The bones are diffusely demineralized, limiting sensitivity for fracture. There is mild soft tissue swelling about the distal right leg and ankle. Vascular calcifications are noted. The ankle mortise appears intact. No evidence of fracture or malalignment. No joint effusion is identified.
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No evidence of fracture.
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Generate impression based on findings.
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52 female with wrist pain. Evaluate for fracture. No definite fracture or malalignment in the left wrist. There is irregularity of the distal ulna at the articular surface. This is of uncertain clinical significance.
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No definite fracture or malalignment. Irregularity of the distal ulna at the articular surface is of uncertain clinical significance.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. Mild hypoattenuation within the pons may be related to age indeterminate ischemia. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Left lens is thin, likely related to cataracts.
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1.No acute intracranial abnormality. 2.Mild hypoattenuation within the pons may be related to age indeterminate ischemia. If there is continued clinical concern for acute ischemia, MRI would be recommended.
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Generate impression based on findings.
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Mild prominence of the ventricles and sulci indicate mild volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is severe periventricular and subcortical hypoattenuation which is nonspecific but likely reflects age indeterminate small vessel ischemic disease. The distal basilar artery is appears dense and given that there is no associated territorial infarct, this is favored to represent artifact/slow flow. Hypodensity in the right thalamus likely represents an age indeterminate lacunar infarct. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. A nasal trumpet is present. Nonspecific sclerotic focus in the anterior right frontal calvarium.
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1.No acute intracranial hemorrhage.2.Severe age indeterminate small vessel ischemic disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Diffuse benign calcifications in both breasts are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable bilateral calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. 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: NSA - Screening Mammogram.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. No focal fluid collections identified in the soft tissues. An empty sella is present.
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1.No acute intracranial abnormality.2.Left mastoid air cells are clear. No focal fluid collections are present in the soft tissues surrounding the left ear.
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Generate impression based on findings.
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71 year old female with left facial weakness. There is no evidence of intracranial hemorrhage, mass or mass effect. There are scattered patchy regions of low-attenuation within the supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Mild age indeterminant small vessel ischemic disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy. Personal history of uterine cancer diagnosed in 2003. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. 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: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy. 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 heterogeneously dense, which may obscure small masses. Round marker was placed on a skin lesion overlying the left breast. A linear marker was placed on the scar overlying the right breast. Loosely grouped calcifications are present in the left upper outer quadrant. Scattered benign calcifications are present bilaterally. A lymph node projects over the left axilla. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Left breast calcifications. Comparison to outside mammogram is recommended. If the calcifications are new or the prior mammogram cannot be obtained, magnification imaging will be needed.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.
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Generate impression based on findings.
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80 year old female with head trauma. There is no evidence of intracranial hemorrhage. There are scattered regions of low-attenuation within the supratentorial white matter as well as a more focal region of low attenuation with volume loss in the left medial cerebellar hemisphere (PICA territory). There is atherosclerotic calcification of the distal internal carotid and vertebral arteries. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mucosal thickening within the posterior right ethmoid air cells. The imaged paranasal sinuses and mastoid air cells are otherwise clear. There is soft tissue swelling and hematoma overlying the right aspect of the frontal bone. The skull and extracranial soft tissues are otherwise unremarkable. There are bilateral lens implants.
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1.Soft tissue swelling and hematoma overlying the right aspect of the frontal bone without evidence of intracranial hemorrhage or skull fracture.2.Mild age indeterminate small vessel ischemic disease and a chronic left cerebellar infarct.
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Generate impression based on findings.
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There is ventricular asymmetry and effacement of the frontal horn of the left lateral ventricle which is a stable finding but is better characterized on prior MRI from 4/5/2010 and likely reflects chronic volume loss. Dilatation of the posterior left lateral ventricle is unchanged. Left posterior periventricular hypodense foci seen on prior MRI stable. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. Mild mucosal thickening of the ethmoid sinuses. The paranasal sinuses and mastoid air cells are otherwise clear.
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1.No acute intracranial abnormality.2.Stable ventricular asymmetry, likely related to history of periventricular leukomalacia.
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Generate impression based on findings.
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83 year old with known left breast cancer presents for seed localization. On review of the prior studies, there is a hypoechoic mass on ultrasound at the 5:00 position with a biopsy clip present.The procedure, risks including bleeding, mistargeting and infection, and benefits of radioactive seed placement 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 site of procedure. The left breast 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. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, an IsoAid preloaded breast localization needle was placed within the mass, adjacent to the clip. The I-125 seed was then deployed. The skin entry site was closed with a Band-Aid. A bracelet was placed on the left wrist labeled with the patient's name, MRN, number of seeds placed, and surgical date (1/26/2014).Post-procedure digital left CC and ML views revealed the percutaneously placed seed to be in the expected location adjacent to the clip and along the lateral aspect of the mass. No evidence of hematoma or other complication was present.Post seed placement instructions were given to the patient.Patient tolerated the procedure well and left the breast imaging center in stable condition. Dr. Schacht performed the procedure and was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the clip and mass to be within the specimen. The seed is noted adjacent to the tissue specimen. Dr. Jaskowiak will take an additional margin of tissue based on the first of the two images.
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Successful seed placement for the known left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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16-year-old male with desmoplastic round cell tumor status post stem cell transplant and chemoradiation, now with septic shock and altered mental status. CHEST:LUNGS AND PLEURA: New bibasilar consolidation with air bronchograms, right greater than left. The previously identified left lower lobe pulmonary nodules are not identified, possibly obscured by surrounding consolidation. The two right upper lobe pulmonary micronodules are unchanged (image 31 and 32 of series 5).MEDIASTINUM AND HILA: The esophagus is patulous and nearly completely filled with fluid. The reference right hilar lymph node now measures 12 mm in short axis (image 38, series 4), unchanged. Left upper paratracheal nodular soft tissue, may represent extension of the thymus or a lymph node, and is unchanged in size (image 14, series 4). The heart size is normal. No pericardial effusion is seen.CHEST WALL: The right upper extremity PICC and left chest wall Port-A-Cath tips terminate in the cavoatrial junction. No evidence of axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria.ABDOMEN:LIVER, BILIARY TRACT: New periportal edema is evident. The portal vein courses through the hepatic hilar mass, with attenuation of the left portal vein appearing similar to the prior exam. Minimal subhepatic ascites.SPLEEN: The spleen is normal in size and appearance.PANCREAS: Previously identified mass effect on the pancreatic body by the upper abdominal mass, is not appreciated on today's exam, perhaps related to phase of inspiration.ADRENAL GLANDS: The adrenal glands are normal in appearance.KIDNEYS, URETERS: Symmetric nephrograms, and no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: New diffuse small bowel wall thickening is now present extending from the fourth part of the duodenum to the mid/distal ileum. The esophagus, stomach, small bowel and colon are mildly distended with fluid. These findings are consistent with diffuse small bowel enteritis, perhaps infectious or inflammatory etiology. The gastrojejunostomy tube tip now terminates in the upper thoracic esophagus.The upper abdominal mass now measures 4.4 x 6.0 cm in cross-sectional dimension (image 81, series 4), previously 4.3 x 6.0 cm, and 4.9 cm in craniocaudal dimension (image 84, series 80368), previously 4.9 cm. The previously seen lower abdominal mass has been resected, without evidence of recurrence.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: New diffuse small bowel wall thickening is now present extending from the fourth part of the duodenum to the mid/distal ileum. The esophagus, stomach, small bowel and colon are mildly distended with fluid. These findings are consistent with diffuse small bowel enteritis, perhaps infectious or inflammatory etiology. The previously identified lower abdominal mass has been resected, and is without evidence of recurrence.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.New diffuse small bowel wall thickening, which may be infectious or inflammatory in etiology. Graft-versus-host disease is a differential consideration considering the patient's prior stem cell transplant.2.New bibasilar consolidation right greater than left.3.Gastrojejunostomy tube tip now residing in the upper thoracic esophagus, repositioning is recommended.4.Upper abdominal mass and reference right hilar lymph node unchanged in size.5.New periportal edema likely related to fluid status.These findings were relayed to Dr. Chong via telephone at 08:30 on 1/26/2015
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Generate impression based on findings.
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There is no evidence for intracranial hemorrhage. There are no masses, mass effect or midline shift. The cerebellar tonsils appear somewhat low lying with effacement of the CSF space of the foramen magnum although full evaluation is made difficult by artifact at the skull base. 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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No acute abnormalities. The cerebellar tonsils are somewhat low lying with effacement of the CSF space of the foramen magnum. MRI with CSF flow imaging may provide more information if clinically warranted.Findings conveyed to Dr. Crain within the emergency department via phone by Dr. Veronesi of the Radiology service at the time of this dictation.
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Generate impression based on findings.
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48 years, Female. Reason: Evaluate for megacolon and free air History: metastatic cancer with c.diff and RLQ abdominal pain. Bilateral nephrostomy tubes and nephroureteral catheters identified. IVC filter in expected position. Mild gaseous distention of the stomach and small bowel loops, which are displaced superiorly, likely due to pelvic mass seen on prior CT. Colon is not abnormally dilated. Free air cannot be excluded without erect or decubitus views, given the presence of oral contrast from prior CT creating a pseudo Rigler sign.
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1.Free air cannot be excluded on this supine radiograph, and further evaluation with erect or decubitus views can be considered if clinical concern persists. 2.Mild gaseous distention of small bowel loops without colonic distention.
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Generate impression based on findings.
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71-year-old male with a CVA. NONCONTRAST CT HEADNo evidence of acute intracranial hemorrhage. There is loss of gray white in the right insula and right basal ganglia region which is new compared to 2012 and compatible with acute ischemia. In addition, there is a hyperdense vessel in the right M2 distribution. Chronic infarcts are again noted within the right frontal, left temporal and left occipital lobes visualized on the previous head CT is stable. There is mildly increased size of the occipital horn of the left lateral ventricle representing mild ex-vacuo dilatation. The ventricles are otherwise stable. Marked periventricular and subcortical white matter hypoattenuation which is nonspecific but compatible with small vessel ischemic changes. No intra- or extra-axial fluid collection. The osseous structures are unremarkable. Mucus retention cyst in the right maxillary sinus, partially visualized but appears unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. CTA HEAD AND NECKThere is a common origin of the left common carotid artery from the brachiocephalic trunk. Atherosclerotic calcifications are visualized at the origins of the great vessels but the origins are patent.Atherosclerotic narrowing at the origin of the right internal carotid artery causes no more than 30% stenosis by NASCET criteria. Minimal atherosclerotic narrowing at the left internal carotid artery origin is seen on the order of 10-20% stenosis.Mild to moderate atherosclerosis affects the cavernous and supraclinoid ICAs. The left ICA is smaller in caliber than the right ICA which may be due to congenital differences given the smaller size of the bony carotid canal. There is an outpouching directed inferiorly from the anterior genu of the right cavernous ICA which measures 2 mm in length and 1.5 mm at its neck, which is suspicious for an aneurysm. There is an aneurysm arising from the region of the anterior communicating artery projecting superiorly and to the left. It measures up to 5 mm in length and 5 mm in width with a neck of approximately 2.5 mm. One of the M2 branches of the inferior division of the right MCA is occluded as it reaches the level of the insula which correlates with the hyperdense vessel seen on noncontrast head CT. The left PCA is of small caliber relative to the right which could be normal variation but some degree of atherosclerotic narrowing is also possible. Additional mild to moderate scattered atherosclerotic narrowing is visualized throughout the intracranial circulation. Emphysema is noted in the visualized lung apices. Degenerative changes are seen in the cervical spine.
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1.Occlusion of one of the M2 branches of inferior division of the right MCA with developing parenchymal hypoattenuation in the insula and basal ganglia compatible with acute infarction. 2.Multiple areas of chronic cortical ischemia and scattered age indeterminate small vessel ischemic disease. Mild-moderate scattered atherosclerotic disease elsewhere intracranially. 3.Anterior communicating artery region aneurysm measuring up to 5 mm. 4.Questionable 2 mm aneurysm off the right ICA anterior genu.5.Mild atherosclerotic disease at the carotid bifurcations in the neck.
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Generate impression based on findings.
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There is a large area of encephalomalacia in a right MCA distribution with a dystrophic calcification and ex vacuo dilatation of the right lateral ventricle. Volume loss within the right cerebral peduncle is likely related to Wallerian degeneration. There is 5 mm, left to right midline shift secondary to volume loss. Area of hypoattenuation in the left pons is also likely related to age indeterminate ischemia. Prominent ventricles and sulci are likely related to volume loss.There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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1.No acute intracranial hemorrhage.2.Large region of encephalomalacia in a right MCA distribution. 3.Hypodensity in the left pons may be related to age indeterminate ischemia.If there is clinical concern for superimposed ischemia, an MRI may be considered.
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Generate impression based on findings.
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Right hip pain. Possible slipped capital femoral epiphysis.VIEWS: Pelvis AP/frog leg (two views) 01/26/15 The round smooth femoral heads are well directed into normally formed acetabula. Proximal femoral physes are fused. No fracture is identified.
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Normal examination.
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Generate impression based on findings.
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7 year old female with epilepsy and VNS, cortical blindness, G-tube dependence, intellectual disability and adrenal insufficiency presenting with vomiting, listlessness, and seizures. There is no evidence of intracranial hemorrhage. There is global parenchymal volume loss with suspected thinning of the corpus callosum. There is no midline shift, herniation, or hydrocephalus. There is mild ethmoid sinus mucosal thickening. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1.No evidence of acute intracranial hemorrhage.2.Global parenchymal volume loss. Consider MRI for evaluation of the parenchyma if clinically indicated.
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Generate impression based on findings.
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29 years, Female. Reason: evaluate for obstruction and r/o free air- 29 yo w reported h/o cyclic vomiting syndrome p/w intractable vomiting, severe abdominal pain, diarrhea x1 episode, PO intolerance History: intractable vomiting, single episode diarrhea, severe abdominal pain Nonobstructive bowel gas pattern. IUD in place. Bones and soft tissues are unremarkable.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Male 30 years old; Reason: evaluation of epigastric sharp pain, h/o crohns disease ABDOMEN:LUNG BASES: Minimal dependent atelectasisLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly enlarged and edematous with peripancreatic fat stranding. There is trace fluid adjacent to the uncinate process and third part of duodenum. The findings are consistent with acute pancreatitis. There is no loculated fluid collection, small fluid seen in retroperitoneal area. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple prominent mesenteric lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple prominent perirectal lymph nodes are likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Findings compatible with acute pancreatitis.
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Generate impression based on findings.
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Female 80 years old; Reason: stage IV gastric cancer. CT for re-staging after palliative chemo. History: abd pain CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions, right greater than left. Scattered areas of atelectasis. Radiation changes in the left upper lobe.MEDIASTINUM AND HILA: Heart size is enlarged. Trace pericardial effusion.Right chest wall port terminates at the caval atrial junction.CHEST WALL: Postsurgical changes in the left breast and chest wall.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe cyst is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Arthrosclerotic disease affects the aorta. Gastrohepatic lymph node measures 1.0 x 0.8 cm previously, 1.0 x 0.7 cm (image 87/series 3)BOWEL, MESENTERY: Diffuse thickening of the gastric antrum and pylorus compatible with the patient's known history of gastric cancer There is subtle nodularity of the upper abdominal mesentery.No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic ascites. Wall thickening of the terminal ileum without obstruction of unclear etiology.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine. Grade 1anterolisthesis of L4 over L5.OTHER: No significant abnormality noted.
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1.Large gastric mass with subtle nodularity of the upper abdominal mesentery.2.Thickened terminal ileum wall.
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Generate impression based on findings.
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Male 64 years old; Reason: eval abd/pelvis for cause of secondary bacterial peritonitis, eval lungs for cause of respiratory decompensation History: tachypnea, ascites PMN >5000 CHEST:LUNGS AND PLEURA: Basilar atelectasis. Left pleural effusion. Small right pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is contracted. There is infiltration of the fat surrounding the gallbladder fossa. There is mild widening of the fissures. The paraumbilical vein appears prominent.SPLEEN: No significant abnormality notedPANCREAS: There is acute pancreatitis worst in the body and tail. There is an associated fluid collection in the lesser sac that measures 14.6 x 10.1 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is bowel wall thickening of the duodenum. An enteric tube terminates proximal to the ligament of Treitz.There are areas of bowel wall thickening involving the jejunum and ileum and ascending colon.There is nodularity of the peritoneum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is peritoneal nodularity.BONES, SOFT TISSUES: There is superior endplate height loss of the L4 vertebral body.OTHER: There is pelvic ascites.
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1.Increase in the size of the peripancreatic fluid collection.2.Basilar atelectasis/consolidation and left pleural effusion.3.Bowel wall thickening worst in the duodenum.4.Peritoneal nodularity.
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Generate impression based on findings.
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left sided headache No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion on this scan.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Biopsy proven left breast fibroadenoma. Personal history of lupus. History of ovarian cancer in two maternal aunts. Two standard digital views and tomosynthesis of both breasts and an additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable 2.2 x 3.2 cm mass with coarse internal calcification is present in the posterior depth of the medial superior left breast. Additional stable benign circumscribed masses are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable bilateral masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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64 years, Male. Reason: Evaluate for free air History: increased abdominal distention Enteric tube tip overlies the forth portion of the duodenum. Previously seen gastric distention has resolved. No definite evidence of free air. Nonspecific paucity of small bowel gas. No definite evidence of bowel obstruction. Left pleural effusion partially visualized.
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Enteric tube tip overlies the forth portion of the duodenum. No definite evidence of free air. No definite evidence of bowel obstruction. Left pleural effusion partially visualized.
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Generate impression based on findings.
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56 yo male with worsening abdominal pain in the setting of acute pancreatitis. Severely limited exam due to patient motion and exclusion of pelvis from field of view. Mild dilatation of visualized small bowel loops may reflect ileus.
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Possible ileus pattern although exam is significantly limited due to factors outlined above. Repeat radiographs with a full field of view can be considered for further evaluation if clinical concern persists.
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Generate impression based on findings.
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31-year-old man with history of ankle fracture, evaluate for extension into ankle mortise. Again seen is a minimally displaced fracture through the medial malleolus of the distal tibia with extension of the fracture line to the articular surface. Additionally, there is also a minimally displaced fragment arising from the lateral aspect of the distal tibia with oblique fracture line extending to the articular surface. Cortical step-off along the distal fibula indicates a transverse fracture of the lateral malleolus with slight impaction.Associated soft tissue swelling is noted about the ankle joint and there appears to be a joint effusion.The bones of the foot including the talus appear intact without fracture.
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Intra-articular fractures of the medial and lateral aspects of the distal tibia involving and fracture through the distal fibula.
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Generate impression based on findings.
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63-year-old male, evaluate for osteomyelitis Soft tissue swelling with foci of gas extending to the stump. Irregularity of the underlying cortex of the residual fourth and fifth metatarsals is highly concerning for osteomyelitis. Additional more chronic appearing periosteal reaction may be the sequela of chronic osteomyelitis.
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Findings consistent with osteomyelitis of the stump as described above.
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Generate impression based on findings.
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CT HEAD:The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is benign enlargement of the subarachnoid spaces adjacent to the frontal lobes bilaterally. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. CT CERVICAL SPINE:Vertebro-body heights and disk spaces are intact. There is pseudosubluxation at C2-C3, otherwise alignment is anatomic. No prevertebral soft tissue swelling. There is cortical irregularity with adjacent sclerosis along the anterior left pedicle of C2 and bilaterally at C6 which are developmental. No definite acute fractures.
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1.No acute intracranial abnormality.2.Findings of benign enlargement of the subarachnoid spaces, which usually resolve by two years of age.3.Cortical irregularity with adjacent sclerosis along the anterior left pedicle of C2 and bilaterally at C6 are likely developmental and represent asymmetric apophyseal fusion. No definite cervical spinal fracture identified.
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Generate impression based on findings.
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20 years, Female. Reason: is there stool burden or obstruction History: constipation. Nonobstructive bowel gas pattern. Normal stool burden. IUD projects over the pelvis in expected position.
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Nonobstructive bowel gas pattern. Normal stool burden.
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Generate impression based on findings.
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38 year-old male with laceration from human bite Soft tissue swelling and irregularity volar to the DIP joint. No fracture is identified. Alignment is within normal limits.
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Soft tissue swelling without fracture evident.
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Generate impression based on findings.
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slurred speech, history of CVA with residual left sided deficit No evidence of acute ischemic or hemorrhagic lesion.There is right PCA territorial encephalomalacia indicating prior ischemic infarction.No change since prior examination.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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1. Chronic right PCA territorial ischemic infarction with encephalomalacia, no change since prior exam.2. No evidence of acute ischemic or hemorrhagic lesion.Comment: Brain MRI can be considered if clinically indicated.
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Generate impression based on findings.
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Reason: r/o PE History: cp w/ hypoxia and d dimer > 20; trop 0.09; left sided cp PULMONARY ARTERIES: Extensive bilateral pulmonary emboli involving lobar, segmental, and subsegmental branches. LUNGS AND PLEURA: Basilar subsegmental atelectasis/scarring. No pleural effusions. Pleural based left lower lobe micronodule is most likely benign. MEDIASTINUM AND HILA: Heart size upper limits of normal with small amount of pericardial fluid. No visible coronary calcification. 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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Extensive bilateral pulmonary emboli involving lobar, segmental, and subsegmental branches. PULMONARY EMBOLISM: PE: PositiveChronicity: Acute.Multiplicity: BilateralMost Proximal: LobarRV Strain: Positive
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Generate impression based on findings.
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26-year-old male with pain after MVA Alignment is anatomic. No fracture or other specific findings to account for the patient's pain.
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No fracture or dislocation.
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Generate impression based on findings.
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31 years, Male. Reason: Evaluate NG placement. Lower pelvis excluded from field of view. NG tube coiled in the gastric fundus. Diffuse colonic gas is again noted and not significantly changed. Cholecystectomy clips.
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NG tube tip in gastric fundus. Persistent diffuse colonic dilatation.
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Generate impression based on findings.
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31-year-old female with pain in coccyx after falling Alignment is within normal limits. No fracture is noted.
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No fracture or dislocation
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Generate impression based on findings.
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31 years, Male. Reason: Evaluate NG tube placement. Lower pelvis excluded from field of view. NG tube tip in right mainstem bronchus. Diffuse colonic gas is again noted and not significantly changed. Cholecystectomy clips.
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NG tube tip in right mainstem bronchus. Persistent diffuse colonic dilatation.
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Generate impression based on findings.
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Reason: acute onset facial paralysis r/o stroke History: acute onset facial paralysis The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left ethmoid air cells, and sphenoid sinus and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is an extra-axial hyperdense mass measuring 10 x 14 mm in axial dimensions adjacent to the left middle frontal gyrus. It is associated with a few calcifications along its periphery
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.A small extra-axial mass adjacent to the left frontal gyrus most likely represents a meningioma.3.CT is insensitive for the early detection of nonhemorrhagic CVA.
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Generate impression based on findings.
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66 years, Male. Reason: 66yo M with h/o EtOH abuse and ?pancreatitis presenting with abd pain, tenderness on exam, and significant constipation. History: constipation, abd pain Gas filled loops of bowel compatible with generalized ileus. No calcification of the pancreas is identified.
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Gas filled loops of bowel compatible with generalized ileus.
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Generate impression based on findings.
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69-year-old female with recent fall, pain Bowel gas and stool obscures the upper pelvis. No pelvic or hip fracture is visualized. Alignment is anatomic.
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No fracture or dislocation.
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Generate impression based on findings.
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56-year-old female with pain and swelling Osteoarthritis particularly affects the patellofemoral joint. There may be a small joint effusion. No fracture or dislocation.
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Osteoarthritis and possible small joint effusion.
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Generate impression based on findings.
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Male 65 years old, evaluate interval change in hepatic abscess ABDOMEN:LUNG BASES: Small right pleural effusion with underlying compressive atelectasis. Worsening left basilar atelectasis / consolidation. Small pericardial effusion. Mild cardiomegaly. LIVER, BILIARY TRACT: Low attention collection at the hepatic dome with foci of gas density measuring 5.4 x 4.9 cm (series 3, image 20), perviously measuring 7.6 x 7.1 cm. There are two percutaneous catheters entering the right hemiabdomen. A fluid collection inferior to the right hepatic lobe measures 2.4 x 0.8 cm (series 3, image 67), previously 9.6 x 3.9 cm. Several bowel loops are adhesed/tethered to the anterior right abdominal wall with surrounding free fluid, unchanged in appearance, no associated bowel obstruction. Focus of gas density anterior to the liver, may be related to catheter placement.SPLEEN: Splenic granuloma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Indeterminate low attenuation left renal focus seen on prior MRI may represent a complex renal cyst.RETROPERITONEUM, LYMPH NODES: IVC filter noted. Mild aortic calcifications. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostatic enlargement.BLADDER: Air in the bladder; correlate with recent instrumentation.LYMPH NODES: Mildly prominent inguinal lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Decreasing fluid collections at the hepatic dome and inferior to the right hepatic lobe.2.Interval placement of two percutaneous drains.3.Worsening left basilar atelectasis / small consolidation.
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Generate impression based on findings.
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Reason: r/o ICH History: AMS The temporal horns of the lateral ventricles are mildly dilated but the sulci are not completely effaced.There are gyriform calcifications present along the medial aspects of the occipital lobes some of which involve the calcarine cortex. Additional cortical calcifications are present along the anterior aspect of the inferior vermis.The patient is status post right frontal craniotomy.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.There are gyral calcifications along the medial occipital lobes bilaterally and the inferior anterior aspect of the vermis which are nonspecific. These could represent dystrophic calcifications from prior inflammatory reaction. Please correlate with patient's clinical history.3.CT is insensitive for the early detection of nonhemorrhagic CVA.4.Mild ventriculomegaly. A comparison exam may be helpful to further evaluate for any interval change.
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Generate impression based on findings.
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Female 44 years old; Reason: Evaluate for stone History: R flank pain ABDOMEN:LUNGS BASES: Small dependent bibasilar 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: Edematous right kidney with mild right sided hydronephroureter and minimal adjacent stranding, obstructing 2 mm distal ureteral stone present. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix. PELVIS:UTERUS, ADNEXA: 3.3 x 2.9 cm left adnexal cystic lesion, most likely dominant follicle/underlying physiologic follicles but if clinically indicated further evaluation with dedicated pelvic sonography recommended. Intrauterine device present.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Minimal degenerative changes involving lower thoracic spine. Subcentimeter fat containing umbilical hernia.
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1. Mild right-sided hyronephroureter with obstructing 2 mm distal ureteral stone.2. Left adnexal cystic lesion measuring 3.3 cm, most likely physiologic but if clinically indicated further evaluation with dedicated pelvic sonography recommended.
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Generate impression based on findings.
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39-year-old male with neck pain. Status post fall Posterior rods with screws entering the C2, C3, and C4 vertebral bodies in near-anatomic alignment without evidence of hardware complication. Moderate degenerative disk disease at C3-C4 and C6-C7. No fracture.
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Orthopedic fixation in near-anatomic alignment without evidence of fracture.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable benign intramammary and axillary lymph nodes are present bilaterally. 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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16 year old male with desmoplastic round cell tumor s/p autologous stem cell rescue on 1/20 now day +5 from his transplant and acutely decompensating with hypotension. There is no evidence of intracranial hemorrhage. No intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal ethmoid sinus mucosal thickening. The imaged paranasal sinuses and mastoid air cells are otherwise clear. The skull and extracranial soft tissues are unremarkable.
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1.No intracranial hemorrhage or mass effect. If there is continued suspicion for intracranial pathology, consider MRI for further evaluation.2.Minimal ethmoid sinus mucosal thickening similar to the 12/17/14 exam is non-specific.
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Generate impression based on findings.
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31-year-old man with history of motor vehicle accident. There is a fracture of the medial malleolus extending to the articular surface with minimal inferior displacement of the distal fracture fragment. Additionally, there is a transverse fracture through the distal fibula with minimal lateral displacement of the distal fracture fragment. A fracture through the lateral aspect of the distal tibia is better seen on the subsequent CT. The talar dome appears intact. Soft tissue swelling is noted.
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Intra-articular fracture of the medial malleolus and transverse fracture of the distal fibula. Please see subsequent CT for additional characterization.
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Generate impression based on findings.
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54-year-old male with pain, trauma, evaluate for fracture There is a probably oblique fracture to the distal diaphysis of the clavicle with inferior displacement of the distal fragment. The acromioclavicular joint and glenohumeral joint appear within normal limits. Note is made of vascular stents.
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Left clavicle fracture as described above.
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Generate impression based on findings.
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80 years, Female. Reason: 80F with gastric cancer, abdominal pain. Eval for SBO. History: abd pain Nonobstructive bowel gas pattern. Right pleural effusion. Pelvic phleboliths noted.
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Nonobstructive bowel gas pattern. Right pleural effusion.
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Generate impression based on findings.
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25-year-old male with pain and discoloration There is mild soft tissue swelling about the ankle without fracture evident. Alignment is within normal limits.
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Soft tissue swelling without fracture or dislocation.
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Generate impression based on findings.
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85 years, Female. Reason: abdominal distension and emesis History: abdominal distension and emesis Dilated loops of jejunum measuring up to 3.6cm. Gas seen in non-distended colon. Early incomplete small bowel obstruction cannot be excluded.
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Dilated loops of jejunum. Early incomplete small bowel obstruction cannot be excluded.
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Generate impression based on findings.
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67-year-old male with desaturation and tachycardia. Evaluate for pulmonary embolism. PULMONARY ARTERIES: Thin linear filling defect in the superior segment of the right lower lobe which likely represents a small, nonocclusive pulmonary embolus with uncertain chronicity. The pulmonary artery is enlarged measuring up to 38 mm consistent with pulmonary arterial hypertension. No evidence of right heart strain.LUNGS AND PLEURA: Bibasilar dependent atelectasis. Tracheal and bronchial collapse consistent with tracheobronchomalacia. Moderate bronchial wall thickening consistent with bronchitis. No pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Atherosclerotic disease of the aorta with severe coronary calcifications. No hilar or mediastinal lymphadenopathy.CHEST WALL: Mild degenerative changes of the thoracic spine. Mild bilateral gynecomastia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Patient is status post cholecystectomy.
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Small, nonocclusive pulmonary embolus in the superior segment of the right lower lobe of uncertain chronicity and questionable clinical significance.The findings were discussed by telephone with Dr. Gera from the clinical service at 10:00am on 1/26/2015.PULMONARY EMBOLISM: PE: Positive.Chronicity: Indeterminate.Multiplicity: Single.Most Proximal: Segmental.RV Strain: Negative.
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Generate impression based on findings.
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82-year-old male evaluate for middle finger fracture There is dorsal dislocation and mild ulnar subluxation of the middle phalanx of the third finger relative to the proximal phalanx. No discrete fracture is visualized. Osteoarthritis affects scattered interphalangeal joints and carpometacarpal joints.
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Third finger PIP joint dislocation as described above without discrete fracture evident.
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Generate impression based on findings.
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38 year-old woman status post assault, evaluate for fracture. There is no acute fracture or malalignment. Mild soft tissue swelling is noted about the wrist.
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Mild soft tissue swelling without acute fracture or malalignment.
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Generate impression based on findings.
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92 year-old male with ataxia, altered mental status and aphasia for 16 hours. 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 mild 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. The paranasal sinuses and mastoid air cells are clear. Calvarium is intact. There is evidence of previous left cataract surgery.
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No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.
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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 extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. 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: NSD - Screening Mammogram.
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Generate impression based on findings.
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42 year-old woman with history of hand laceration, evaluate for foreign body. A 3-mm, ovoid corticated density is seen immediately volar to the head of the second metacarpal and likely represents a sesamoid bone. Significant thenar soft tissue swelling is noted. There is no underlying fracture or malalignment.
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Thenar soft tissue swelling without evidence of radiopaque foreign body.
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Generate impression based on findings.
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Reason: sickle cell disease, eval for PE, infiltrate History: tachycardia PULMONARY ARTERIES: Technically adequate examination without pulmonary embolus. LUNGS AND PLEURA: Bibasilar linear opacities consistent with atelectasis. No pleural effusions. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary calcifications. CHEST WALL: H shaped vertebral bodies consistent with sickle cell anemia. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Prominent spleen partially imaged.
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1. No pulmonary embolus. 2. Bibasilar atelectasis. 3. Osseous abnormalities consistent with sickle cell anemia. PULMONARY EMBOLISM: PE: Negative. Chronicity: 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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Respiratory distress. Ventilator dependent.VIEW: Chest AP (one view) 01/26/15, 0401 Tracheostomy and gastrostomy tubes are present.Lung volumes are large. Segmental atelectasis is present in the medial lower lobes. Streaky perihilar opacities are noted. Mild peribronchial thickening is present. Cardiothymic silhouette is normal.
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Reactive airways disease/bronchiolitis pattern.
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Generate impression based on findings.
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History of right lumpectomy for breast cancer in 1998. Patient received adjuvant radiation therapy. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. Postsurgical architectural distortion with increased density and dystrophic calcifications are again seen and progressing in a benign fashion. Stable asymmetry in the posterior right breast seen only on the MLO view may represent a normal sized intramammary lymph node.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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Postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation 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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46-year-old man with history of left knee pain status post motor vehicle accident. There is no acute fracture or malalignment. There is no knee joint effusion.
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No acute fracture or malalignment.
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