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Generate impression based on findings.
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39 year-old female with one-day history of palpable lump in the left breast adjacent to the nipple at the 4 o'clock position. Patient states breast pain for approximately 2 weeks. No prior mammograms. No injury is reported. Three standard views of both breasts were performed digitally with bilateral spot compression views and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A skin marker is noted adjacent to the left breast nipple at the site of the patient's palpable abnormality. No underlying left breast mammographic abnormality is evident. A focal asymmetry in the right upper inner breast disperses with spot compression. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. LEFT BREAST ULTRASOUND: Physical examination revealed a rubbery pea-sized mass immediately adjacent to the nipple at the 4:00 position. Targeted left breast ultrasound was performed for the palpable abnormality. A 6 x 6 x 4 mm circumscribed ovoid lesion is identified superficially, corresponding to the palpable mass. The lesion is predominantly hypoechoic with hyperechoic elements and mild associated vascularity. No posterior acoustic shadowing is noted.
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Subcentimeter lesion adjacent to the nipple seen only on ultrasound, most likely representing fat necrosis. Repeat examination in 6-8 weeks to assess for resolution was suggested to the patient. She declined this management option and prefers ultrasound-guided aspiration/ possible core biopsy to prove fat necrosis and absolutely exclude malignancy. Findings were discussed with Dr. Chaney, the ordering physician. However, the patient will resume coordination of care through her primary care physician. BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.
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Generate impression based on findings.
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67-year-old female with status post curettage of left tibia metachronous focus of giant cell tumor, complicated by fracture after biopsy. Please for metastasis. Again seen is a lucency within the proximal tibial diaphysis with adjacent cortical thickening, compatible with stated history of curettage of giant cell tumor. The bone appears to have undergone further remodeling, indicating continued interval healing. No evidence of tumor recurrence or metastasis within the tibia or fibula. On the AP view, there is lucency seen within the medial talus, which may simply reflect diffuse demineralization. However, if the patient complains of pain at this site, dedicated ankle radiographs would be recommended. Soft tissue swelling of the leg is noted, particularly at the proximal aspect, accentuated by what we believe to be a sock or stocking.
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Healing of the proximal diaphyseal fracture, as described above. We see no definite metastasis and suspect that relatively focal lucency in the medial talus is an artifact of diffuse demineralization. However if the patient complains of pain at this site, dedicated ankle radiographs would be recommended.
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Generate impression based on findings.
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22-year-old male with pain and swelling of the middle finger. Evaluate for fracture, abnormality. There is mild soft tissue swelling, particularly along the volar and ulnar aspect of the middle phalanx. We see no underlying fracture or other bony abnormality. Phalangeal alignment is within normal limits.
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Soft tissue swelling without fracture.
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Generate impression based on findings.
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36-year-old female with history of sickle cell anemia. Left hip pain status post revision total hip arthroplasty. Evaluate for bone loss medially. Evaluation is limited by streak artifact related to bilateral total hip arthroplasty devices.Components of a left total hip arthroplasty device are situated in near-anatomic alignment. There are findings indicating chronic bone infarction of the proximal femoral diaphysis, but no findings to suggest loosening of the femoral component. There is cement adjacent to the superomedial aspect of the acetabular component, as seen on prior radiographs. Lucency between the bone and acetabular component/cement also appears similar to that seen on prior radiographs. However, there is marked thinning of the medial wall of the left acetabulum, as well as a defect spanning approximately 1.5 x 1.0 cm (CC x AP dimensions). Furthermore, there is a hemispherical soft tissue mass/collection within the pelvis along the medial acetabular wall, measuring 5 x 2.5 x 5 cm (AP x ML x CC dimensions). Differential diagnosis includes acetabular fracture with adjacent hematoma, and also prosthesis loosening or particle disease with adjacent sterile fluid collection. The possibility of an abscess is also considered, for which evaluation is suboptimal given the aforementioned artifact and lack of intravenous contrast; however, the adjacent pelvic fat planes appear preserved, which would be unusual for an inflammatory process. Thin lucency surrounds the posterior of the two left acetabular screws, which may reflect loosening. Small foci of heterotopic ossification are seen lateral to the left hip joint. Given the aforementioned limitations, we see no findings to suggest a large hip joint effusion.There are two collections within the subcutaneous fat of the lateral aspect of the proximal left thigh, subjacent to the greater trochanter. The larger is inferior and measures 4.5 x 3.5 cm in transverse dimensions and 5 cm in craniocaudal dimension. The smaller superior collection measures approximately 2 x 3 cm in transverse dimensions and 3.5 cm in craniocaudal dimension. Small foci of high density are seen within the periphery of these collections, and while abscess cannot be excluded, these may simply represent postoperative hematomas/seromas. Components of a right total hip arthroplasty device are situated in near-anatomic alignment. There is thin lucency at the bone-cement interface of the proximal femoral component, which could represent loosening, although the true clinical significance of this is uncertain and we see no findings to suggest loosening of the distal femoral stem. Cement along the medial aspect of the acetabular component is seen protruding slightly into the pelvis through a defect in the medial acetabular wall. We see no mass or findings to suggest a large joint effusion, given the aforementioned limitations. There are small foci of heterotopic ossification along the medial aspect of the proximal right femur. There are also findings to suggest chronic bone infarction of the visualized right femoral diaphysis.Sclerotic foci in the remaining pelvic bones and visualized lower lumbosacral spine are seen indicating chronic bone infarction, with loss of height of the visualized lower lumbar vertebral bodies.
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1.Left total hip arthroplasty as described above, with defect of the medial acetabular wall and adjacent soft tissue mass/collection. Streak artifact prevents characterization of the collection with Hounsfield units. Differential diagnosis includes acetabular fracture with adjacent hematoma as well as loosening/particle-wear disease with formation of adjacent intrapelvic fluid collection. The possibility of abscess is also considered, although the adjacent fat planes appear maintained, which would be somewhat unusual for an inflammatory process. The nature of this collection can be further evaluated with MRI if clinically indicated. Alternatively, if there is clinical concern for infection, radiolabeled WBC scintigraphy may also be considered.2.Two soft tissue collections along the lateral aspect of the proximal thigh; while abscess cannot be excluded, these may simply represent postoperative hematomas or seromas.3.Right total hip arthroplasty, as described above.4.Chronic osseous findings of sickle cell disease, as described above.
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Generate impression based on findings.
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Male 21 years old Reason: r/o gall bladder pathology History: ruq pain LIVER: The liver measures 15.4 cm in length. There is no focal liver lesion. The portal vein demonstrates normal directional flow with peak velocity of 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 10.9 cm. There is no hydronephrosis or shadowing stones.OTHER: The spleen measures 9.6 cm in length.
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No evidence of gallstones or acute cholecystitis. No specific cause for patient's right upper quadrant pain is identified.
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Generate impression based on findings.
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Reason: lung cancer. s/p resection and chemo. On erlotinib now. pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Postoperative/postradiation changes in the right middle lobe with bronchiectasis and fibrosis not significantly changed compared to prior study. Persistent small right pleural effusion/thickening with right lung volume loss.Scattered bilateral micronodules, including 7 x 6 mm groundglass nodule in the right upper lobe (series 4 image 31) are unchanged. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Hypoattenuating thyroid nodules incompletely characterized are not significantly changed. Stable rightward mediastinal deviation and cardiac valvular calcifications.CHEST WALL: Old rib fractures in the right hemithorax.Stable sclerotic focus in the T12 vertebrae.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomyADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal scarring and renal cysts of varying density unchanged. These are further characterized on recent MRI.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and branches. Retroperitoneal surgical clips.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Subcutaneous soft tissue nodules in the abdominal wall are unchanged and likely sequela of prior medication injection.OTHER: No significant abnormality noted.
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Stable postoperative and postradiation changes in the right lung with unchanged pulmonary nodules.
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Generate impression based on findings.
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Metastatic colon cancer, evaluate and compare to prior CHEST:LUNGS AND PLEURA: Right middle lobe fissural nodule measures up to 6 mm (series 4, image 60), previously 8 mm. Additional non-reference pulmonary nodules appear stable in size over the interval. No pleural effusions. Moderate to severe centrilobular emphysema.MEDIASTINUM AND HILA: Enlarged lymph node in the AP window measures 1.6 x 1.1 cm (series 3 image 41), previously 1.4 x 1.1 cm. Trace pericardial effusion.CHEST WALL: Right chest wall Port-A-Cath tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy. Ill-defined hepatic lesions compatible with metastases. Reference anterior right hepatic lobe lesion measures 2.1 cm, previously 2.5 cm (series 3, image 104). Additional hepatic lesions appear stable to slightly decreased in size over the interval. No biliary ductal dilation. The hepatic vasculature is patent.SPLEEN: Chronically occluded splenic vein. Multiple perigastric varices are again noted.PANCREAS: Pancreatic body mass measures 3.4 x 3.1 cm (series 3, image 106), previously 2.5 x 3.1 cm.ADRENAL GLANDS: Left adrenal nodularity is unchanged.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Reference left paraaortic lymph node measures 1.9 x 1.3 cm (series 3, image 110), previously 2.0 x 1.3 cm. Reference aortocaval lymph node measures 1.7 x 1.2 cm (series 3, image 125), previously 2.5 x 1.1 cm. Additional lymphadenopathy appears similar to the prior exam.BOWEL, MESENTERY: No evidence of obstruction. No free fluid in the abdomen or pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds in the prostate.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable benign bone island in the left iliac wing, unchanged. Bilateral atrophy of the gluteus minimus muscles.
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1.Stable or decreasing hepatic metastases.2.Stable pancreatic body mass.3.Stable or decreasing lymphadenopathy in the chest, abdomen, and pelvis.4.Stable or decreasing pulmonary metastases.
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Generate impression based on findings.
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Male 59 years old; Reason: prostate cancer with bone mets compare to last bone scan History: see above Persistent abnormal osseous foci are identified at the level of T7 and T12 vertebral bodies appearing similar to prior study. Subtle focus in the right intertrochanteric hip appears similar to prior exam. Additional foci in the spine, pelvis and femur are not significantly changed. There are no new abnormal osseous foci identified.
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Stable examination with no new sites of osseous metastatic disease.
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Generate impression based on findings.
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69-year-old female with syncopal episode, evaluate for intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect, or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. No extra-axial collections are identified. Encephalomalacia within the right basal ganglia and associated ex vacuo dilatation of the right lateral ventriclar atrium is compatible with chronic infarct. 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. There is scattered mild mucosal thickening of the paranasal sinuses. Small retention cysts are present in the left maxillary and right sphenoid sinuses. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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No evidence of intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.
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Generate impression based on findings.
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Metastatic nasopharyngeal cancer treated with TFHx on 7/19/14. Neck: There are post-treatment findings in the nasopharynx, without evidence of measurable tumor in this region. There are also findings related to right neck dissection. There is interval development of ill-defined heterogeneity of the inferior right sternocleidomastoid muscle that measures approximately 10 x 15 mm in cross-section. There otherwise no significant change in the appearance of the cervical lymph nodes. For example, a right level 2A lymph node measures 8 mm in short axis, previously also 8 mm, and a right level 3 lymph nodes measure up to 3 mm in short axis, previously also 3 mm. There is a left subclavian venous catheter. The major cervical flow voids are intact. The salivary glands appear unchanged. There are patchy opacities in the lung apices, which likely represent scarring.
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1. Post-treatment findings in the neck with interval development of an infiltrative lesion in inferior the right sternocleidomastoid muscle, which may represent tumor recurrence. Otherwise, the treated lymphadenopathy elsewhere in the neck is unchanged.2. Nonspecific partial bilateral tympanomastoid opacification.
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Generate impression based on findings.
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Worst head ache of life. NONCONTRAST CT HEADNo evidence of acute intracranial hemorrhage. 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. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEADThe right A1 segment is hypoplastic and there is a dominant left ACA. The bilateral ICA and MCA arteries are within normal limits. Incidental note is made of a tortuous cervical segment of the right ICA.There is a hypoplastic right P1 segment. The left PCA and PComA demonstrate normal anatomy. There is normal variant extracranial origin of the left PICA. The vertebral-basilar, right PICA, anterior-inferior cerebellar and superior cerebellar arteries are normal. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.
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1.No evidence of acute intracranial hemorrhage or mass.2.No evidence of steno-occlusive disease, occlusion or aneurysm of the intracranial arteries.3.Incidental findings of a right sided hypoplastic A1 segment of the ACA and P1 segment of the PCA.
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Generate impression based on findings.
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Female 5 years old; Reason: mag3 renal scan - 5F with atrophied right kidney and grade 1 hydronephrosis in solitary left kidney History: assess for obstruction The angiographic phase demonstrates prompt uniform perfusion of only a left kidney. Patient is status post right nephrectomy.Sequential cortical images show a compensatory anticipated hypertrophied left kidney without focal abnormality with homogeneous uptake. Following excretory images reveal prompt excretion of radiopharmaceutical into the ureter with activity seen in the bladder all within the first 3 minutes. There is no evidence of retention or obstruction on serial imaging. Following administration of the diuretic, there was prompt washout of collecting system observed and again without evidence of obstruction. Postprocessing images show normal renal function with normal peak activity and T1/2 washout from the left collecting system of approximately 4 minutes.
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Normal renal perfusion and function of a mildly hypertrophied left kidney, with no evidence of obstruction.
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Generate impression based on findings.
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History of stage III lung adenocarcinoma. Restaging examination. CHEST:LUNGS AND PLEURA: Spiculated mass in the superior segment of the right lower lobe consistent with the patient's known malignancy measures 3.1 x 2.0 cm (series 4 image 37). There is mild adjacent pleural thickening/fluid.Subsegmental left basilar atelectasis/scarring.MEDIASTINUM AND HILA: Enlarged right hilar lymph node measures 1.2 cm in short axis (series 3 image 37). Small pericardial effusion. No visible coronary arterial calcifications.CHEST WALL: Punctate left breast calcifications.Multilevel degenerative changes affect the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Inferior right hepatic lobe lesion with peripheral nodular discontinuous enhancement and without hypermetabolism on PET is most consistent with a hepatic hemangioma. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypoattenuating renal foci too small to characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes are nonspecific.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Spiculated mass in the superior segment of the right lower lobe is consistent with the patient's known malignancy.2.Mildly enlarged right hilar lymph node.3.Small pericardial effusion.4.No specific evidence of metastatic disease in the upper abdomen. Other findings as described above.
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Generate impression based on findings.
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Male, 79 years old. RFO trigger: Multiple surgical teams. Attending physician: Dr. Eggener. No unexpected radiopaque foreign body seen. Nonobstructive bowel gas pattern.
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No unexpected radiopaque foreign body. Findings discussed with OR resident Patel at the time of the exam and with the attending physician, Dr. Eggener, via telephone on 1/26/2015 at 12:45.
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Generate impression based on findings.
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Male, 71 years old, with acute stroke, right MCA syndrome, TPA given 1/25. A hyperdense segment of one of the right M2 MCA branches is redemonstrated. When compared to the prior examination, hypodensity within the right insula and basal ganglia has become slightly more conspicuous.Encephalomalacia in the right frontal lobe is unchanged. Small regions of encephalomalacia in the left middle frontal gyrus and medial left temporal lobe are also unchanged. Patchy ventricular hypoattenuation is demonstrated elsewhere in the cerebral hemispheres compatible with age indeterminate microvascular ischemic disease.No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. No significant generalized mass-effect is seen. The ventricular system remains within normal limits for size.The osseous structures of the skull are intact. Mucosal thickening is present along the floor of the right maxillary sinus.
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1. Findings compatible with acute right MCA distribution ischemia are again seen including mild hypoattenuation within the right insula and basal ganglia.2. Scattered areas of chronic cortical ischemia and age indeterminate microvascular ischemic disease are unchanged.3. No evidence of intracranial hemorrhage.
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Generate impression based on findings.
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Reason: hx breast ca and NSCLC with left pleural effusion. s/p pleurax. assess disease vs. priro scan, placement of pleurax, and effusion History: pleural effusion LUNGS AND PLEURA: Spiculated left upper lobe mass measures 2.0 x 1.9 cm (series 5 image 31) unchanged. Numerous pleural-based nodules, with mild interval increase in reference nodule in the left major fissure now measuring 7 mm (series 5 image 41) previously 5 mm. Other pleural based nodules have also shown similar increase in size. Mildly improved left basilar interstitial opacities and a decreased loculated left pleural effusion. Interval removal of pleurX. Emphysema.MEDIASTINUM AND HILA: Increased size of small superior mediastinal lymph nodes with reference node measuring 7 mm in short axis (series 3 image 23). Limited evaluation of other mediastinal lymph nodes due to lack of intravenous contrast without gross interval change. Severe coronary arterial calcifications.CHEST WALL: Left chest port with tip in the SVC. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating focus in the hepatic dome is unchanged. Stable nonspecific mild left adrenal thickening.
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1.Stable size of spiculated left upper lobe mass.2.Interval decrease in loculated left pleural effusion, but slight interval increase in size of some of the pleural based nodules. The pleurX has been removed in the interval.3.Interval increase in size of some mediastinal lymph nodes, allowing for limitations of noncontrast technique.
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Generate impression based on findings.
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Female 71 years old; Reason: Bladder cancer. Compare to previous. 13-0311 protocol. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes. Severe calcified coronary artery disease. Calcified atherosclerotic thoracic aorta.CHEST WALL: Right chest wall portacatheter with tip in right atrium.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate bilateral hydronephroureter, similar in appearance to prior study. Ureters distended throughout their courses and terminate in right lower quadrant ileal urinary diversion. Diffuse ureteral wall thickening seen, likely reactive in etiology/related to reflux. Kinking of ureter seen near left ureteropelvic junction, coronal image 63, urine seen traversing beyond this point. Areas of renocortical scarring and atrophy of parenchyma more pronounced on left side. As seen on prior imaging is 1.2 x 0.9 cm focus of soft tissue attenuation in distal right ureter, near junction with urinary diversion, axial image 175 series 3/sagittal image 72 series 80248, unchanged in appearance when compared to April 20, 2014 CT study. Stable high-density lesion in left renal upper pole, unchanged, at site of previously seen cyst on 10/16/13 CT exam, may reflect collapsed cyst. Additional subcentimeter renal hypoattenuating lesions seen bilaterally, too small to characterize but unchanged.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes. Unchanged reference left paraaortic lymph node measuring 0.9 x 0.8 cm, image 128 series 3. Extensive aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Colonic diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Left inguinal surgical clips. Also seen is stable left hemipelvic soft tissue lesion measuring 5 x 1.3 cm.BLADDER: Status post cystectomy.BONES, SOFT TISSUES: Right-sided ostomy. Multilevel degenerative changes of spine and decreased osseous mineralization. Grade 1 anterolisthesis of L4 on L5. Again seen mild anterior wedging of T5 vertebral body.
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1. As seen on prior imaging is distal right ureteral soft tissue focus and pelvic soft tissue mass, without significant change. 2. Bilateral hydronephrosis, similar to prior study, see discussion above.
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Generate impression based on findings.
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Reason: h/o hnc and crt, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Right apical scarring, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left chest wall port with tip at RA/SVC junction.Metastases in right ninth rib and scapula unchanged. T6 lytic lesion unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Reference hepatic lesion has increased to 19 x 19 mm on image 77/121 (8 x 8 mm on prior). Other hypodense lesions are stable and are either too small to characterize or presumably represent cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Osseous metastases stable. Compression fracture with lytic L3 metastasis. Left iliac lytic lesion unchanged.OTHER: No significant abnormality noted.
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Interval increase in hepatic mass highly suggestive of metastatic disease. Osseous metastases grossly stable.
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Generate impression based on findings.
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History of bladder cancer status post radical cystectomy, evaluate for metastatic disease with delayed imaging ABDOMEN:LUNG BASES: No suspicious pulmonary nodule.LIVER, BILIARY TRACT: No focal hepatic lesion. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Punctate low attenuation focus in the pancreatic body is too small to adequately characterize.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left nephroureteral stent in place. Moderate hydronephrosis with mild cortical atrophy, similar in appearance to 7/18/2014 and compatible with chronic obstruction. The collecting system does not opacify beyond the renal pelvis on the delayed images, limiting evaluation for urothelial recurrence.RETROPERITONEUM, LYMPH NODES: Moderate calcifications of the abdominal aorta without aneurysmal dilation. Apparent filling defect in the left gonadal vein is suggestive of venous thrombosis.BOWEL, MESENTERY: Left lower quadrant ileal conduit. Surgical small bowel anastomosis in the central abdomen.BONES, SOFT TISSUES: Scoliosis and degenerative changes of the lumbar spine.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.
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1.The left collecting system does not opacify beyond the renal pelvis on the delayed images limiting evaluation for urothelial recurrence.2. No evidence of distal metastases3. Findings consistent with left gonadal venous thrombosis.4. Postsurgical changes and chronic obstruction of the left kidney, similar in appearance to prior exam. Findings text paged to x3521 at the time of dictation.
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Generate impression based on findings.
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History of relapsed AML and neutropenic fever, now presenting with word finding difficulties. Interval resolution of previously described right cerebral convexity subdural hematoma. There is no midline shift or herniation. There is unchanged non-specific patchy cerebral white matter hypoattenuation. There is unchanged punctate area of encephalomalacia in the left inferior cerebellar hemisphere, which likely represents a chronic infarct. The ventricles are unchanged in size and configuration, with a subcentimeter focus of fat within the glomus of the right lateral ventricle choroid plexus. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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Interval resolution of previously described right cerebral convexity subdural hematoma.
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Generate impression based on findings.
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50 year-old with history of cysts. Three standard views of both breasts were performed digitally 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. There are multiple masses bilaterally, including enlarged masses in the right breast. The largest of these is in the right upper inner breast at mid to posterior depth . The multiple masses seen in the left breast are either not significantly changed or decreased in size and are compatible with cysts. There are benign calcifications bilaterally, many of which represent milk of calcium. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Multiple cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains stable, bilateral screening mammogram is recommended annually. If any of the cysts are larger when the patient will have her next mammogram, then it would be reasonable to just come directly to diagnostic mammography rather than first obtaining a screening exam. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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All of the paranasal sinuses are clear as are the right mastoid air cells and middle ear cavities and there are no air-fluid levels. Opacification is noted within a few left mastoid air cells. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. Note is made of small bilateral Haller cells. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is S-shaped. Bilateral orbits and the posterior nasopharynx appear unremarkable.
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1.Opacification is noted within a few left mastoid air cells. 2.The nasal septum is S-shaped.
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Generate impression based on findings.
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Reason: Has pulmonary nodular opacity changed since Oct 2014 CT scan. She had TB in the past and I suspect she has Post TB bronchiectasis. Sputm cultures for MAI have been negative History: morning cough with expectoration LUNGS AND PLEURA: Stable scarring, volume loss and bronchiectasis in the right upper lobe. No change in multiple irregular nodular opacities with surrounding areas of scarring and bronchiectasis. No new areas of opacity. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Punctate hypodensity in the liver is too small to characterize but stable. Small presumed left renal cyst.
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Stable scarring, volume loss and bronchiectasis in the right upper lobe. No change in multiple irregular nodular opacities with surrounding areas of scarring and bronchiectasis. No new areas of opacity. These findings are suggestive of atypical mycobacterial infection. Connective tissues disorders such as Wegener granulomatosis may appear similarly. The findings would be atypical for malignancy, though continued follow up is recommended to exclude growth.
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Generate impression based on findings.
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Assess vasculature prior to kidney transplant ABDOMEN:LUNG BASES: Cardiomegaly and small pericardial effusion.LIVER, BILIARY TRACT: No intrahepatic ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys with nonobstructive calcifications. Chronic renal transplant in the right iliac fossa with dystrophic calcifications.RETROPERITONEUM, LYMPH NODES: The abdominal aorta and iliac arteries are normal in caliber. There is moderate calcification of the right external iliac artery just central to the aforementioned chronic renal transplant. Otherwise, minimal vascular calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous sclerosis likely reflects renal osteodystrophy.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.
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The abdominal aorta and iliac arteries are normal in caliber. There is moderate calcification of the right external iliac artery just central to the chronic renal transplant. Otherwise, minimal vascular calcifications.
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Generate impression based on findings.
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Chronic nasal congestion; possible right sided nasal polyp. There is opacification of the inferior anterior nasal cavity, left greater than right. There is minimal opacification of the maxillary sinuses and infundibula bilaterally. The paranasal sinuses are otherwise essentially clear. There is slight nasal septal deviation to the right. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.
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1. Nonspecific opacification of the anterior nasal cavity, which may represent polyposis or secretions related to rhinitis.2. No evidence of acute sinusitis.
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Generate impression based on findings.
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Male 29 years old; Reason: Is there a entero-vesicular fistula? Pt w fistulizing Crohn's disease History: above No evidence of fistula or urinary leak. Bladder emptied promptly with un-clamping Foley.
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No evidence of fistula or urinary leak.
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Generate impression based on findings.
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There are multiple small foci of T2 hyperintensity in the white matter, primarily in subcortical white matter locations, not associated with mass effect, restricted diffusion, or susceptibility abnormality. Similar appearing lesions are also present within the left caudate body and right thalamus. The ventricles and sulci are normal in size. Incidental note is also made of numerous dilated perivascular spaces throughout the supratentorial brain, a finding which can be seen in this patient's age group. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is unremarkable. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.
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Chronic small vessel ischemic disease.
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Generate impression based on findings.
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Prior asymmetry in the left breast. History of left breast surgeries for abscess drainage. History of breast carcinoma in maternal cousin. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear scar markers overlie the left breast. Previously described asymmetry in the inferior medial left breast is not evident. Benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: r/o lesion, source of hemoptysis History: hemoptysis LUNGS AND PLEURA: Very mild nonspecifc bronchial wall thickening. No evidence of pulmonary hemorrhage.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Mild bronchial wall thickening which is nonspecific but most commonly seen in asthma or bronchitis. No evidence of pulmonary hemorrhage.
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Generate impression based on findings.
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51 years, Male. Reason: Patient w/ N/V, eval for obstruction History: abdominal distension Nonobstructive bowel gas pattern. No evidence of free air. Abdominal distention noted, which may correlate with ascites seen on prior CT.
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No evidence of free air or obstruction.
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Generate impression based on findings.
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33 year old female for lumbar puncture by the clinical service. C-arm fluoroscopy was used by the clinical service for image-guided lumbar puncture. One spot image was obtained, which demonstrates the lumbar puncture needle projected over the L4 vertebral body. FLUOROSCOPY TIME: 0.39 minutes
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C-arm fluoroscopy used by the clinical service for lumbar puncture.
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Generate impression based on findings.
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Left facial mass. There is a well-circumscribed lesion in the subcutaneous tissues in the left oral commissure region that measures up to 15 mm, although assessment is limited by dental streak artifact. There is an air-filled compartment with a few bubbly secretions in the lower right tracheoesophageal groove that measures up to 4 cm in length. The airways are patent. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There are right maxillary alveolus periodontal lucencies. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1. A well-circumscribed lesion in the subcutaneous tissues in the left oral commissure region that measures up to 15 mm may represent an inclusion cyst, although other etiologies are not excluded and assessment is limited by dental streak artifact. An ultrasound or MRI with the use of a microscopy coil may be useful for further evaluation, if clinically warranted. 2. An air-filled compartment with a few bubbly secretions in the lower right tracheoesophageal groove that measures up to 4 cm in length may represent an esophageal and perhaps less likely a tracheal diverticulum. An esophagogram may be useful for further evaluation, if clinically warranted.
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Generate impression based on findings.
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63 years, Male. Reason: assess NJT position History: J-tube clogged. Lower pelvis excluded from field of view. Distal esophageal stent is again noted. Coaxial feeding tube is coiled multiple times in the stomach with tip in the 3rd portion of the duodenum. Nonobstructive bowel gas pattern. Small left pleural effusion and partially visualized left chest tube. Please see same day chest radiograph report for additional findings.
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Enteric tube tip in the 3rd portion of the duodenum.
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Generate impression based on findings.
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70 year-old female with decreased range of motion There is marked glenohumeral joint space narrowing and osteophyte formation, consistent with severe osteoarthritis. No fracture or dislocation.
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Severe glenohumeral osteoarthritis.
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Generate impression based on findings.
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Reason: 58 yo male with history of AML; pre-allo SCT evaluation History: evaluate for resolution of prior pneumonia. LUNGS AND PLEURA: Mild-moderate right pleural effusion has increased since the prior study. Consolidation in the superior segment of the right lower lobe appears similar to the prior study allowing for differences in technique. Nodular pleural based opacity in the left upper lobe is unchanged. Mild centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. No new lymphadenopathy. Severe coronary calcifications. Normal heart size without pericardial effusion. Right PICC tip in RA.CHEST WALL: Stable thoracic spine degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Mild-moderate right pleural effusion is increased since the prior study, but remains decreased in comparison to 12/12/14.2.Consolidation in the superior segment of the right lower lobe is not significantly changed compared with recent prior studies. Nodular pleural based opacity in the left upper lobe is unchanged. These findings are presumably related to infection.
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Generate impression based on findings.
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History of chest wall angiosarcoma, evaluate for recurrence CHEST:LUNGS AND PLEURA: Left hemithorax postsurgical changes and volume loss. Scattered pulmonary micronodules without suspicious pulmonary nodule.MEDIASTINUM AND HILA: No lymphadenopathy. Mild to moderate coronary artery calcifications.CHEST WALL: Increasing hyperattenuating pleural thickening in the upper left hemithorax measuring 9 mm in maximal thickness, previously 5; may be chronic in etiology. There is minimal residual fluid along the inferior margin of the chest wall measuring 3.0 cm x 0.7 cm (series 3, image 75). Right breast prosthesis.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Incompletely characterized low attenuation renal foci, unchanged from the prior exam.RETROPERITONEUM, LYMPH NODES: Mild calcification of the aorta without aneurysmal dilation. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the lumbosacral spine.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Postoperative changes in the left chest wall, including increasing hyperattenuating pleural thickening in the upper left hemithorax measuring 9 mm in maximal thickness, previously 5; may be chronic in etiology. 2.No definite evidence of disease recurrence or metastasis.
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Generate impression based on findings.
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46 years, Male. Reason: r/o obstruction, free air History: worsening distention, pain. Lower pelvis excluded from field of view. Diffuse colonic distention with a paucity of visualized small bowel gas. Favor colonic ileus as etiology of findings given that no evidence of rectal obstruction was seen on recent prior CT. No free air on decubitus view.
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Findings consistent with colonic ileus as described above. No free air.
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Generate impression based on findings.
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58 year old female who felt a small lump in the submental area which has since resolved but is now tender There is no evidence of mass lesions. Minimally prominent left level Ib lymph node. The thyroid is obscured by artifact but no large lesions are suspected. The submandibular and parotid glands are normal. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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1.No evidence of mass or significant lymphadenopathy.2.Slightly prominent left submental lymph node which appears to have a normal fatty hilum and is not pathologically enlarged by CT criteria. Correlation with physical exam findings is suggested.
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Generate impression based on findings.
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Female 44 years old Reason: Subject participating in research study. Evaluate for lung disease History: History of rheumatoid arthritis. LUNGS AND PLEURA: Three benign appearing micronodules are present in the left lower lobe, the largest of which measures 7.8 x 5.4 mm (series 4, image 65). Two benign appearing micronodules are present in the right lung, the largest in the right lower lobe which measures 4.5 x 2.9 mm (series 4, image two). There is subpleural reticular opacities in the right anterior superior lung which is likely secondary to post-radiation fibrosis. Left lower lobe granuloma likely secondary to prior infection. No focal lung opacity or pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Posttreatment changes in right breast. Surgical clips in the right axilla. No evidence of bony metastasis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Scattered bilateral benign appearing micronodules. In a patient with a history of breast cancer, recommend follow-up in 6-12 months. 2. No reliable evidence of rheumatoid lung disease. Subpleural reticular opacities in the right upper lobe likely secondary to post-radiation fibrosis.
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Generate impression based on findings.
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Male, 58 years old, history of AML, pre-allo stem cell transplant. The frontal sinuses are clear. Mild mucosal thickening or secretions are evident along the left frontoethmoidal recess. Minimal scattered thickening is seen through the ethmoid air cells. The sphenoid sinuses are clear and the sphenoethmoidal recesses are unobstructed. The maxillary sinuses are clear. The right maxillary outflow pathway is unobstructed. The left maxillary outflow pathway is not well seen and may be congenitally narrow. The walls of maxillary sinuses are thickened, right side more than left, suggestion prior chronic inflammation. The nasal septum is intact and deviates gently towards the left. The turbinates are within normal limits. The mastoid air cells and middle ear cavities are clear.
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No evidence of significant active sinus inflammation.
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Generate impression based on findings.
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49 year-old female with right lower rib pain post battery Radiopaque markers were placed over the lower chest wall at the site of the patient's pain. No underlying rib fracture is identified. The lungs are clear.
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No rib fracture identified.
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Generate impression based on findings.
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Reason: aneurysm, abnormality History: right sided headache Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.Atherosclerotic calcifications are present along the distal internal carotid arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The anterior communicating artery is medium sized. The posterior communicating arteries are tiny. There is infundibulum on the left half of the anterior communicating arteryCT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a small left maxillary sinus with thick walls and some mucosal thickening suggesting silent sinus syndrome. 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 aneurysm.2.No evidence for cerebral vascular occlusive disease3.Silent sinus syndrome involving the left maxillary sinus.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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44 year-old male with ulcer, evaluate for osteomyelitis There is marked soft tissue swelling about the middle finger with foci gas adjacent to the cortex at the volar aspect of the DIP joint. The underlying cortex is indistinct, highly suspicious for osteomyelitis. Soft tissue swelling also extends along the dorsum of the hand.
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Findings highly suspicious for osteomyelitis involving the third finger as described above.
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Generate impression based on findings.
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This patient has a new diagnosis of small cell lung CA; evaluate for brain metastases. 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.Atherosclerotic calcifications are present along the distal internal carotid arteries.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.No evidence for brain metastases. Please note that MRI is more sensitive in detecting brain metastases than CT.
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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. Enhancing focus in the left high convexity is thought to represent a vessel or small developmental venous anomaly (4/23). No definite abnormal enhancing lesions to suggest metastases. Minimal periventricular and subcortical hypoattenuation nonspecific but may be related to indeterminate small vessel ischemic disease. 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 evidence of intracranial metastases.2.Minimal periventricular and subcortical hypoattenuation is nonspecific but may be related to age indeterminate small vessel ischemic disease.
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Generate impression based on findings.
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Reason: evaluate ILD History: Doe fibrosis cough LUNGS AND PLEURA: Extensive bilateral interstitial disease with a severe honeycomb pattern and traction bronchiectasis indicative of fibrosis. Distribution is somewhat peripheral and basilar predominant, with more extensive involvement of the left lung.Mild groundglass opacity is present at the lung bases.No significant airtrapping on the expiration scan.Nodular subpleural opacity in the left upper lobe (series 4/70) is most likely secondary to fibrosis but continued follow-up is recommended to confirm stability.Small calcified nodule posteriorly at the left base, compatible with a healed granuloma.MEDIASTINUM AND HILA: Moderately large prevascular and paratracheal lymph nodes measuring up to 10 mm in short axis diameter, most likely reactive.Moderate coronary artery calcification.No pericardial effusion.Patulous esophagus.CHEST WALL: Surgical clips in the right axilla.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis.
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Extensive interstitial fibrosis with honeycombing and traction bronchiectasis, compatible with UIP except for a slightly atypical distribution.
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Generate impression based on findings.
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Multiple myeloma following chemotherapy, last 1/21/15.RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion grossly demonstrates numerous lytic lesions throughout the visualized skeleton most notably involving the skull and pelvis. Healing fracture deformities involve multiple bilateral anterior ribs, right greater than left. Scarlike opacities are seen in the right middle lobe and left lingula. Right chest Port-A-Cath with tip in the SVC.Today's PET examination demonstrates multiple mild to moderately hypermetabolic foci (SUV max = 4.1) involving bilateral anterior ribs, right more numerous than left. Given the configuration and distribution of these lesions they are compatible with benign activity from healing rib fractures rather than tumor activity. On CT portion these correspond with sclerotic healing rib fractures as well.Otherwise no suspicious FDG avid lesion to indicate tumor activity currently. None of the lytic lesions on CT (which are not involved with fractures) demonstrate significant FDG accumulation.
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1.No FDG avid tumor currently.2.Multiple bilateral anterior rib fractures.
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Generate impression based on findings.
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Male 76 years old; Reason: 76 y.o. Male with HPT. Please assess for parathyroid adenomas History: HPT There is physiologic distribution of the radiopharmaceutical. On the delayed images there is a discrete focus of persistent activity in the region of the inferior pole of the left thyroid lobe. This correlates with the nodule seen on recent thyroid ultrasound. The right thyroid lobe appears to measure 4.2 cm and the left lobe 4.4 cm in length.
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Findings compatable with a parathyroid adenoma overlying the inferior pole of the left thyroid lobe, correlating as well with the ultrasound
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Generate impression based on findings.
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82 year old female with history of metastatic uterine cancer, SBO. Failed multiple trials of NG tube clamping and presents with abdominal pain. Scout radiograph showed a nonobstructive bowel gas pattern and cholecystectomy clips. Spot images obtained immediately following patient ingestion of contrast material demonstrated expected transit of barium through the esophagus and into the stomach and proximal small intestine without evidence of gastric outlet obstruction. Transit time to the colon was 1 hour and 20 minutes. Fluoroscopic evaluation demonstrated convergence of several small bowel loops in the left lower quadrant into a triangular configuration upon compression; findings are compatible with non-obstructive adhesions. No stricture or evidence of small bowel obstruction. Normal mucosa was seen throughout the small bowel, without ulcers, sinus tracts, fistulae, or other evidence of active inflammation. No separation of bowel loops was present to suggest fibrofatty proliferation. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 7:43 mm:ss
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1.Non-obstructive left lower quadrant adhesions without evidence of gastric outlet or small bowel obstruction. 2.Normal terminal ileum. No signs of active small bowel inflammation.
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Generate impression based on findings.
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Female 71 years old; Reason: history of diverticulitis, concern for diverticular abscess History: LLQ pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable subcentimeter anteriorly located hepatic hypoattenuating focus, too small to characterize, image 37 series 4. Common bile duct measures upper limits of normal at 6 mm with distal tapering seen, minimal intrahepatic biliary duct prominence, appearance stable from prior study. Possible focal fatty infiltration seen near falciform ligament.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic aorta.BOWEL, MESENTERY: Extensive left-sided colon diverticulosis with the distal descending clonic wall thickening and adjacent fat stranding seen, appearance compatible with acute diverticulitis. Best seen on image 85 series 4 is small paracolic/ fluid and air containing collection, structure measures 1.8 x 1.4 x 1 .4 cm, image 85 series 4, surrounding induration seen. Underdistended distal gastric body, making evaluation for wall thickening suboptimal.PELVIS:UTERUS, ADNEXA: New small pelvic free fluid. Calcified fibroid uterus.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease of spine, most pronounced at L5/S1, grade 1 anterolisthesis of L4 on L5, levoscoliosis seen. Decreased osseous mineralization.
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1. Findings compatible with acute diverticulitis with small paracolic fluid and air containing collection, abscess formation related to localized perforation favored based on appearance (coronal image 72), although an inflamed diverticulum another differential consideration. Findings discussed with Dr. Weiss at 2:45 p.m. on 1/26/15. 2. New small pelvic free fluid, likely reactive.
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Generate impression based on findings.
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14-year-old male with history of bladder exstrophy, neurogenic bladder, augmentation ileocystoplasty and stone removal. BLADDER Wall Thickness: Unable to assess. Contents: Collapsed. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: The cortical echogenicity of the right kidney has increased. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 6.1 cm Left: 7.3 cm Mean for age: 10.0 cm Range for age: 8.5 - 11.1 cmADDITIONAL OBSERVATIONS: A 5-mm shadowing echogenic focus in the inferior pole of the right kidney is consistent with a non-obstructing renal stone.
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1.Increased right renal cortical echogenicity suggests medical renal disease.2.Nonobstructing 5-mm stone in the inferior pole of the right kidney.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469
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Generate impression based on findings.
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History of base of tongue and breast cancers. Now with enlarging left lower lobe pulmonary nodule. Evaluate for malignancy/restaging.RADIOPHARMACEUTICAL: 10.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates an approximately 1 cm left lower lobe pulmonary nodule. Adjacent surgical material is noted. Areas of atelectasis or scarring is seen elsewhere bilaterally. Trace pericardial effusion or thickening is noted. Multiple surgical clips are seen in the left breast. Extensive atherosclerotic calcifications are noted. Hypodense bilateral renal lesions are likely cysts.Today's PET examination demonstrates a markedly hypermetabolic focus corresponding to the left lower lobe pulmonary nodule (SUV max = 8.4). This is very suspicious for malignancy either a primary lung cancer or metastatic disease.No additional suspicious FDG avid lesion is identified elsewhere.
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1.Markedly hypermetabolic left lower lobe pulmonary nodule is very suspicious for tumor, either primary lung cancer or metastatic disease.2.No suspicious FDG avid lesion elsewhere in the neck, chest, abdomen or pelvis.
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Generate impression based on findings.
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Male 56 years old; Reason: Pancreas cancer please assess and compare to previous scan and provide index lesion measurements for RECIST CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change. Scattered micronodules, nonspecific. Right apical bullous disease. Small dependent bibasilar atelectasis. MEDIASTINUM AND HILA: Mild calcified coronary artery disease.CHEST WALL: Right chest wall portacatheter with tip in right atrium. ABDOMEN:LIVER, BILIARY TRACT: Biliary stent present with small pneumobilia seen in left hepatic lobe. New and enlarging hepatic metastases seen, with innumerable lesions now present. Reference right hepatic lesion measures 1.7 x 1.7 cm on image 21 series 3, previously measured 1.1 x 0.9 cm. New portal vein thrombus, near portosplenic confluence, image 105 series 3, possible small thrombus extending into SMV at this level as well.SPLEEN: No significant abnormality noted.PANCREAS: Mildly increased prominence of ill-defined lesion involving pancreatic head and uncinate process, measuring approximately 5.3 x 2.3 cm (measurements difficult due to ill-defined margins), image 112 series 3, previously measured 5 x 2 cm. Again seen dilatation of pancreatic duct, measuring up to 6 mm. Increasing soft tissue abutment of SMA, measuring approximately 180 degree circumference, with mild luminal narrowing posteriorly. Periceliac soft tissue haziness, likely reflecting neoplastic involvement. Again seen abutment of the IVC and second/third portions of duodenum by pancreatic mass with possible involvement.ADRENAL GLANDS: Stable bilateral adrenal thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance with multilevel degenerative disease seen.
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1. New and enlarging hepatic metastases, new portal venous thrombosis. 2. Increased prominence of ill-defined pancreatic head/uncinate mass with increasing mass effect on adjacent vasculature as above.Findings discussed with research nurse Kenisha at 3:25 p.m. on 1/26/15.
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Generate impression based on findings.
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Acute visual field deficit. There is a partially empty sella. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is possible flattening of the optic nerve discs. There are bubbly secretions within the left sphenoid sinus. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. Partially empty sella and possible flattening of the optic nerve discs may indicate pseudotumor cerebri.2. Bubbly secretions within the left sphenoid sinus may represent acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Female 48 years old Reason: Patient has a TIPS with stents, possible stent clog History: fluid overload LIMITED ABDOMENLIVER: The liver measures 19.1 cm in length. Heterogeneous and coarsened hepatic echotexture. No focal hepatic lesion. BILIARY TRACT: No cholelithiasis. No biliary dilatation.PANCREAS: The pancreas is largely obscured by bowel gas.SPLEEN: Spleen measures 20.6 cm. KIDNEY: The right kidney measures 11.8 cm. The left kidney measures 7.3 cm. There is no hydronephrosis.OTHER: No ascites.
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Suboptimal evaluation of TIPS. The proximal portal venous portion was interrogated and is patent. The hepatic venous end is obscured. No ascites evident.
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Generate impression based on findings.
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Male 70 years old; Reason: patient with a history of MS and bladder cancer now with tenderness in his left testicle History: left testicular discomfort RIGHT TESTIS: Right testicle measures 4.0 x 1.7 x 2.6 CM . Echotexture is moderately heterogeneous. Within its anterior aspect, there is a hypoechoic lesion measuring 8 x 6 mm. LEFT TESTIS: Left testes measures 4.9 x 1.9 x 2.8 cm. There are dilated rete testesRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.
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Abnormal scrotal ultrasound involving the right testicle which has heterogeneous parenchymal echotexture and a focal hypoechoic lesion. The imaging features are not entirely specific and include infection. However, neoplastic involvement is not entirely excluded and a follow sonogram in 4 to 6 weeks is suggested.
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Generate impression based on findings.
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History of left lumpectomy 11/2010 for invasive mammary carcinoma with squamous differentiation. Patient received radiation and chemotherapy. Occasional bilateral breast pain. Three standard views of both breasts were performed digitally with right breast spot compression views and rolled views (13 total images) 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. A focal asymmetry is noted in the posterior inferior right breast, at the 6:00 position, which persists on spot compression images and rolled views. Post surgical changes in the left breast upper outer quadrant are without significant interval change. No dominant mass, suspicious microcalcifications, or suspicious areas of architectural distortion are present in the left breast. RIGHT BREAST ULTRASOUND
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Indeterminate 11 mm right breast mass. Ultrasound-guided biopsy is recommended. Findings were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.
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Generate impression based on findings.
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Male 57 years old; lumbar sensory radiculopathy, evaluate for lumbar plexus abnormality ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Right hepatic lobe low attenuation focus is too small to further characterize. Minimal intrahepatic biliary ductal dilation status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis. Multilevel lumbosacral fusion construct and stabilization rods with associated extensive ankylosis.PELVIS:PROSTATE/SEMINAL VESICLES: Prostatic calcifications.BLADDER: Right anterolateral bladder wall thickening is suspicious for underlying neoplasm. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis. Multilevel lumbosacral fusion construct and stabilization rods with associated extensive ankylosis. Extensive been hardening artifact severely limits evaluation of the spine.
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1.Extensive beam hardening artifact severely limits evaluation of the spine. Recommend dedicated spine imaging study for further evaluation of patient's symptoms.2.Right anterolateral bladder wall thickening is suspicious for underlying neoplasm. Correlate with cystoscopy.
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Generate impression based on findings.
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Trouble breathing. History of right diaphragmatic hernia.VIEW: Chest AP (one view) 01/26/15, 1512 Postoperative changes are seen in the right diaphragm. Right lung volume is slightly less than expected for normal. Mild peribronchial thickening is noted. Cardiothymic silhouette is normal.
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Bronchiolitis/reactive airways disease pattern.
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Generate impression based on findings.
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67-year-old female with history of metastatic breast cancer with diffuse bony metastases, now with shoulder pain. Please evaluate for metastatic disease. The bones appear demineralized, which may reflect osteopenia. No focal lesion is identified to suggest metastasis to bone. Tiny osteophytes are noted at the acromioclavicular joint.Surgical clips are seen in the right axilla. A right central venous catheter is partially imaged. Prominence of the right hilum may reflect lymphadenopathy.
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No focal lesion to suggest metastasis to bone. If further evaluation is clinically indicated, MRI or skeletal scintigraphy may be considered.
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Generate impression based on findings.
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55-year-old female with left knee effusion and tenderness after twisting left knee and falling directly onto knees. Evaluate for fracture. Left knee: Moderate osteoarthritis affects the left knee, appearing similar to the prior study. We see no fracture. In particular, no patellar fracture is identified. Alignment is within normal limits.Right knee: Relatively mild osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis, as above, without evidence of fracture.
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Generate impression based on findings.
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51-year-old with diffuse right breast pain. 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Previously noted focal asymmetry in the right breast near 12 o'clock does not appear significantly changed. Normal-sized lymph nodes project in each axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Clinical correlation is also recommended for the patient's breast pain. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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57-year-old female with pain in knees. Evaluate for arthritis, RA progression. Right hand: Mild osteoarthritis affects the DIP joints. Slight widening of the scapholunate interval is again noted. We see no erosions or specific radiographic findings of rheumatoid arthritis.Left hand: Mild to moderate osteoarthritis affects the DIP joints. Mild scapholunate widening is noted. Shortening of the fourth metacarpal is nonspecific, but may be seen in patient's with juvenile idiopathic arthritis.Right knee: Mild osteoarthritis and small joint effusion appear similar to the previous study.Left knee: Small joint effusion. The left knee otherwise appears normal for age.
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Arthritic changes as described above appear predominately degenerative. Small bilateral knee joint effusions, without specific radiographic features of rheumatoid arthritis.
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Generate impression based on findings.
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28-year-old female with pain, reduced range of motion, evaluate elbow fracture There is a comminuted fracture of the coronoid process of the ulna with mild volar displacement of the fracture fragments. No fragments have migrated posteriorly within the joint. The remainder of the proximal ulna is intact. The proximal radius and distal humerus are intact. Evaluation of the supporting structures of the elbow is limited as the elbow is held in flexion. The biceps and triceps tendons appear intact. The medial and lateral supporting structures are not well visualized. There is edema within the soft tissues dorsal to the proximal ulna.
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Coronoid process fracture as described above.
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Generate impression based on findings.
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Reason: history of right breast cancer with +axillary lymph nodes, initial staging exam History: none Limited examination due to patient motion artifact. CHEST:LUNGS AND PLEURA: 5 mm micronodule in the right mid lung (series 5 image 37). Calcified micronodules in the right lung base. No pleural effusions. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion or visible coronary calcification. CHEST WALL: Asymmetric soft tissue in the right breast may represent the patient's known malignancy. Mildly enlarged right axillary lymph nodes, with reference node measuring 10 mm in short axis (series 3 image 39). ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: 1.8 cm enhancing lesion in the hepatic dome (series 3 image 64) is nonspecific and incompletely characterized. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent nonspecific gastrohepatic lymph nodes. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes affect the thoracolumbar spine. No discrete suspicious osseous lesions. OTHER: No significant abnormality noted.
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1. Right breast mass and enlarged right axillary lymph node consistent with the patient's known malignancy. 2. Limited pulmonary examination due to respiratory motion artifact. Scattered nonspecific micronodules, for which continued follow up is recommended. 3. Enhancing lesion in the hepatic dome is nonspecific, differential considerations include both benign etiologies and metastasis. Dedicated liver protocol CT or MRI recommended. 4. Borderline enlarged gastrohepatic lymph nodes.
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Generate impression based on findings.
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15-year-old male with long-standing cough with liquids, assess for respiration.EXAMINATION: Oropharyngeal motility study 1/26/2015 Beth Harrison, speech and language therapist, supervised the examination.59 seconds of fluoroscopy was used.PRESENTATION: The patient was presented with thin liquids via an open cup, straw and open bottle. Additionally, half-strength and three-quarter strength nectar thickened liquids were presented via an open bottle with a rim. Finally, table purée and barium covered crackers were presented via spoon.RESULTS: Oral deficits, including oral residual, premature spillage, spillage of oral residue with swallowing and decreased rotary mastication were noted. Decreased bolus control with thin liquids and half-strength nectar thickened liquids was apparent. Residue from oral phase spilled into the pharynx with penetration after swallowing. Penetration with thin liquids and half-strength nectar thickened liquids was evident, without cough. No aspiration was seen. The patient tolerated thin liquids via a single small cup sip as well as table purée and solids.
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Penetration with thin and thickened liquids without cough or aspiration.Please see the speech and language therapist's report for feeding recommendations.
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Generate impression based on findings.
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Esophageal mass. Initial staging esophageal cancer.RADIOPHARMACEUTICAL: 13.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 116 mg/dL. Today's CT portion grossly demonstrates a large distal esophageal mass. A smoothly marginated pleural based right upper lobe pulmonary nodule measures just over a centimeter. Linear atelectasis or scarring seen in the left lower lobe. The left kidney is markedly atrophic.Today's PET examination demonstrates a large markedly hypermetabolic distal esophageal mass (SUV max = 32.1), compatible with esophageal cancer. Several immediately adjacent hypermetabolic paraesophageal and perigastric lymph nodes are suspicious for adjacent lymph node metastases.Otherwise no suspicious FDG avid lesion elsewhere to indicate more distant metastatic disease. The small smoothly marginated right upper lobe pulmonary nodule demonstrates no appreciable FDG accumulation (SUV max = 1.5). This may be benign although non-FDG avid tumor cannot be entirely excluded.
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1.Large markedly hypermetabolic distal esophageal mass, compatible with esophageal cancer.2.Several hypermetabolic immediately adjacent paraesophageal/perigastric lymph nodes are suspicious for adjacent lymph node metastases.3.No evidence of more distant FDG avid metastatic disease. A right upper lobe pulmonary nodule is not FDG avid and may be benign although comparison with outside prior or follow-up chest CTs should be considered to assure stability.
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Generate impression based on findings.
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Reason: evaluate for changes in ILD recent worsenning doe History: worsejing DOE , hypoxemia LUNGS AND PLEURA: Lower lung zone predominance subpleural reticulation with mild honeycombing is unchanged.As on prior there is little groundglass opacity and lung volumes are small with traction bronchiectasis indicating architectural distortion.No significant airtrapping noted.MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes measure near upper normal in size.No significant coronary calcifications are noted.CHEST WALL: Endplate depression of a lower thoracic vertebral body is unchanged. Degenerative abnormalities associated with the sternomanubrial joint also stable.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Post op change involving stomach. Stable nonspecific hepatic hypodensities. Small hiatal hernia.
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Stable severity and distribution of pulmonary fibrosis in a pattern suggestive of UIP.
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Generate impression based on findings.
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65-year-old female, preoperative evaluation There is severe joint space narrowing with subchondral sclerosis and subchondral cysts affecting the left hip. Marked degenerative arthritic changes also affect the lower lumbar spine, SI joints and to a lesser extent, the right hip. A generator device is present in the posterior right soft tissues.Note is made of a right lower quadrant ileostomy.
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Severe osteoarthritis, as above.
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Generate impression based on findings.
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37 years, Female. Reason: Abdominal distension, TTP, no BM in 9 days. Evaluate for obstruction. History: As above Non obstructive bowel gas pattern. Greater than average stool burden. Pelvic phleboliths are noted. Foley catheter partially visualized. Redemonstration of osseous abnormality. Please see recent pelvis radiograph report for more details.
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Non obstructive bowel gas pattern. Greater than average stool burden.
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Generate impression based on findings.
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Mucosal thickening is found throughout all paranasal sinuses which obstructs the ostiomeatal units, the sphenoethmoidal recesses, and the frontoethmoidal recesses. There is a small superimposed air-fluid level on the right. Several ethmoid air cells are completely opacified. Note is made of bilateral Haller cells. Bilateral mastoid air cells and middle ear cavities are clear. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is midline. Bilateral orbits and the posterior nasopharynx appear unremarkable.
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Mucosal thickening is found throughout all paranasal sinuses which obstructs the ostiomeatal units, the sphenoethmoidal recesses, and the frontoethmoidal recesses. There is a small superimposed air-fluid level on the right.
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Generate impression based on findings.
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Reason: eval for mass History: right sided headache for 2 days 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 a left sided maxillary sinus mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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No evidence for acute intracranial hemorrhage, mass effect or edema.
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Generate impression based on findings.
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71-year-old female with right humerus a pathologic fracture, status post intramedullary rod. Evaluate for healing. An intramedullary rod and screw device affixes a pathologic fracture through a lytic lesion of the mid humeral diaphysis in near-anatomic alignment. There is no evidence of hardware complication. Small amount of callus formation is seen along the medial aspect of the fracture, suggesting early healing.
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Orthopedic fixation of a pathologic humerus fracture, as described above.
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Generate impression based on findings.
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Male 63 years old; Reason: possible metastatic prostate or testicular cancer (unknown etiology), help determine risk of fracture History: back pain, R hip and leg pain There are multiple abnormal osseous foci noted throughout the ribs, spine, pelvis, bilateral femuri, most prominent in the pelvis, which given recent axial imaging correlate with the diffuse mixed sclerotic and lytic lesions consistent with known extensive metastatic disease. The largest of these lesions is located in the left sacrum and is most concerning for impending fracture when compared with CT study given complete loss of the posterior wall.
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Extensive osseous metastatic disease as described above. Lesion in the left sacrum is most concerning for impending fracture given findings on CT.Findings were discussed with Dr. Katelyn Good at 4:30 p.m. on 1/26/2015.
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Generate impression based on findings.
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Reason: pe? History: sob, tachypnea, h/o ovarian cancer PULMONARY ARTERIES: Mildly limited examination due to motion artifact. No pulmonary embolus.LUNGS AND PLEURA: Basilar predominant dependent ground glass opacities likely secondary to examination performed in the expiratory phase. Scattered micronodules grossly unchanged. No new suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Mediastinal, retrocrural, and precardiac lymphadenopathy not significantly changed allowing for differences in technique. Small hiatal hernia. Severe coronary calcification. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left hepatic lobe hypoattenuating lesion incompletely characterized. Gastrohepatic lymphadenopathy partially imaged.
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1. No pulmonary embolus or other acute abnormality to account for the patient's symptoms.2. Limited pulmonary examination due to examination performed in the expiratory phase, without new pleural effusion or airspace opacity.3. Thoracic and abdominal lymphadenopathy and hepatic metastasis without acute interval change, incompletely imaged on this examination.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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Male 64 years old; Reason: r/o PE History: SOB The comparison chest radiograph performed on 1/25/2015 demonstrates bilateral pleural effusions and atelectasis with near complete left lower lobe collapse. The ventilation images show lung volumes and inhomogeneous distribution of radiotracer and little change on washout images, however this is incomplete as described above. The perfusion images show at least 3 moderate defects in the right lung specifically in the anterobasal segment of the right lower lobe, as well as the anterior and posterior segments of the right upper lobe. Considering the plain film findings and incomplete ventilation images this would be considered an intermediate probability scan.
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Within the limitations described above and the combined constellation of findings, this is intermediate probability scan for pulmonary embolism.
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Generate impression based on findings.
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59-year-old female with persistent shoulder and neck pain after lifting Left shoulder: The bones are demineralized. There are osteophytes along the inferior glenoid, consistent with mild to moderate osteoarthritis. A band of sclerosis along the humeral neck and small cortical step-off likely are due to prior fracture.Cervical spine: Alignment is anatomic. There is no significant degenerative disk disease or neuroforaminal narrowing.
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Degenerative and posttraumatic changes of the shoulder as described above without acute abnormality evident.
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Generate impression based on findings.
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48-year-old with history of breast cancer status post left mastectomy. Three standard views of the right breast and spot magnification views were performed digitally 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. There are clustered calcifications of suspicious morphology in the right upper outer breast at posterior depth. These measure up to 14 mm in diameter. No dominant mass or areas of architectural distortion in the right breast. Benign calcifications are again noted elsewhere in the right breast.ULTRASOUND
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Suspicious clustered calcifications in the right upper outer breast for which stereotactic biopsy is recommended. Findings and recommendations were discussed with the patient. She will be following up with Dr. Hahn later today.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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Male 60 years old; Reason: metastatic colon cancer History: baseline scan pre-chemotherapy CHEST:LUNGS AND PLEURA: New small to moderate right pleural effusion. Biapical bullous changes. 4 mm right upper lobe lung nodule, image 95 series 7, not definitely seen on prior study. MEDIASTINUM AND HILA: Multiple small subcentimeter mediastinal lymph nodes. Moderate calcified coronary artery disease.CHEST WALL: Right chest wall portacatheter with tip near cavoatrial junction. ABDOMEN:LIVER, BILIARY TRACT: Percutaneous centrally located biliary drainage catheter. New from prior study is heterogeneous soft tissue attenuation involving left hepatic lobe particularly lateral segment with small to moderate intrahepatic biliary duct dilatation, exact measurements difficult due to ill-defined appearance, component measuring approximately 6.1 x 3.9 cm, image 83 series 701. Left portal vein branches not well seen, worrisome for underlying portal venous thrombosis. Upper abdominal/periportal lymphadenopathy. Reference portacaval lymph node measuring 2.9 x 1.4 cm, image 99 series 701, previously measured 1.9 x 0.7 cm. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided renal cyst. Incidentally seen retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Extensive aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Right-sided ostomy. Mesenteric induration/nodularity seen, particularly in left abdomen, and underlying peritoneal carcinomatosis not entirely excluded. Increasing presacral soft tissue attenuation, measuring up to 2.8 cm, previously measured 2.1 cm.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged calcification-containing prostate gland, measuring up to 5.2 cm.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Visualized osseous structures stable in appearance, including subcentimeter proximal right femoral sclerotic focus. Multilevel degenerative changes of spine. New ascites.
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1. Marked ill-defined heterogeneity involving left hepatic lobe as above, suspicious for metastatic disease. Associated intrahepatic biliary duct dilatation, left portal vein branches not well seen, worrisome for underlying portal venous thrombosis. Upper abdominal lymphadenopathy. 2. New ascites. Mesenteric induration/nodularity seen, particularly in left abdomen, and appearance worrisome for underlying peritoneal carcinomatosis. 3. Increasing presacral soft tissue thickening.4. New right pleural effusion and right upper lobe micronodules, not definitely seen on prior study, nonspecific, given these findings underlying metastatic disease not entirely excluded.
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Generate impression based on findings.
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Abdominal pain and acute pancreatitis with shortness of breath and shock, evaluate for pancreatic necrosis and abscess CHEST:LUNGS AND PLEURA: Respiratory artifact limits evaluation of the lungs. Bilateral pleural effusions with overlying compressive atelectasis.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.CHEST WALL: Catheter tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Increasing perihepatic ascites. Status post cholecystectomy.SPLEEN: The splenic vein is attenuated but patent.PANCREAS: Diffusely enlarged pancreas with extensive peripancreatic and mesenteric edema / free fluid, overall increased from the prior exam. No discrete loculated fluid collections. There is heterogeneous parenchymal enhancement on arterial and portal venous phases without areas of frank necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Incompletely characterized hypoattenuating renal lesions. Nonobstructive renal stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube in the stomach. Midabdominal small bowel with nonspecific wall thickening. No pneumatosis or pneumoperitoneum. Increasing ascites.BONES, SOFT TISSUES: Mild anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter in the bladder.
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1.Findings consistent with acute pancreatitis with heterogeneous parenchymal enhancement but no frank parenchymal necrosis.2.Increasing ascites.3.Nonspecific small bowel wall thickening reflects enteritis of uncertain etiology, correlation with patient's clinical history recommended.4.Bilateral pleural effusions.
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Generate impression based on findings.
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8 year-old female with left lower quadrant abdominal mass, evaluate stool burden.VIEW: Abdomen AP (one view) 1/26/2015 A moderate amount of feces is distributed throughout the colon, with desiccated feces present within the rectum. The bowel gas pattern is nonobstructive.
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Moderate stool burden with desiccated feces within the rectum.
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Generate impression based on findings.
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Purulent rhinorrhea, sinus tenderness, and resistant to antibiotic therapy. There is new diffuse opacification and mucosal thickening of the paranasal sinuses including the bilateral maxillary sinuses, frontal sinuses, ethmoid sinuses and sphenoid sinus. There is also partial opacification of the nasal cavity with bubbly secretions. There is partial opacification of the bilateral mastoid air cells with fluid. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.
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1. Diffuse paranasal sinus and nasal cavity opacification suggests rhinosinusitis, perhaps bacterial and/or fungal.2. Bilateral mastoid air cells fluid may indicated mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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73 old female status post left TKA Hardware components of a total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Drain, gas and surgical staples in the soft tissues reflect recent surgery. Extensive bone infarctions within the distal femur and proximal tibia are again visualized.
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TKA, as above.
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Generate impression based on findings.
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14-year-old male with right gunshot wound Two K wires affix the comminuted fracture about the MCP joint of the thumb. Status-post amputation of the fifth finger at the PIP joint. Multiple foci of metallic artifact within the first and fifth fingers are consistent with prior gunshot wound. There is adjacent soft tissue swelling.
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Orthopedic fixation and postoperative changes as described above.
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Generate impression based on findings.
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Acute visual field deficit. There is a partially empty sella. The cerebellar tonsils are mildly low-lying. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There appears to be flattening of the optic nerve discs. There are bubbly secretions within the left sphenoid sinus. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. The constellation of findings, including a partially empty sella and flattening of the optic nerve discs, indicate pseudotumor cerebri.2. Bubbly secretions within the left sphenoid sinus may represent acute sinusitis.Findings discussed with Debra Conti at 4:30 PM on 1/26/15.
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Generate impression based on findings.
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Colorectal cancer status post chemoradiation 2001. Restaging for new baseline.RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates a large destructive hypermetabolic manubrial lesion (SUV max = 13.1), consistent with an osseous metastasis.A small left upper paratracheal hypermetabolic lymph node (SUV max = 5.4), consistent with additional metastatic disease.Abnormal FDG accumulation involving right pleural effusion (SUV max = 6.5), very suspicious for pleural tumor seeding.Large left hepatic hypermetabolic mass (SUV max = 15.8), indicates liver metastatic disease.Multiple hypermetabolic abdominal lymph nodes seen in the celiac axis and retroperitoneum (SUV max = 13.5), indicate additional metastatic disease.Multiple hypermetabolic soft tissue foci involving bowel and mesentery (SUV max = 7.9), indicates carcinomatosis.A small hypermetabolic lesion at the level of the rectum (SUV max = 7.2), very suspicious for additional tumor activity.
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1.Extensive hypermetabolic metastatic disease in the chest, abdomen, and pelvis including osseous, hepatic, and lymph node metastases as well as carcinomatosis and likely right pleural tumor seeding.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately.
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Generate impression based on findings.
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20 year-old female with injury, pain and swelling. No definite fracture line is identified. No ankle joint effusion is present. There is focal bony prominence at the plantar aspect of the proximal fifth metatarsal with questionable linear lucency, which in the correct clinical context could represent a stress fracture or even acute fracture of the base of the fifth metatarsal.
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Focal bony prominence and questionable lucency of the fifth metatarsal base may represent stress fracture or acute fracture in the appropriate clinical context. Dedicated right foot radiographs are recommended for further evaluation.
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Generate impression based on findings.
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68-year-old female with severe pain in the left big toe. Assess for fracture. The bones appear slightly demineralized. Hammertoe deformities of the lesser toes are present. No fracture or malalignment is evident.
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No fracture or other findings to account for severe great toe pain.
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Generate impression based on findings.
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There is mild ventricular asymmetry, similar to the prior CT with anterior displacement of the right choroid relative to the left. Within the atrium of the right ventricle, there is no abnormal enhancement, mass or cystic lesion. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Mild rightward deviation of the nasal septum.
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1. No acute intracranial abnormality.2. Within right lateral ventricle at the site questioned on prior CTA, no concerning lesion is present.
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Generate impression based on findings.
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Metastatic adenoid cystic carcinoma status post cis/navelbine and palliative radiotherapy. There is interval decrease in size of the hyperattenuating left tongue base mass that crosses the midline and extends into the left oral tongue and into the left tonsillar fossa, now measuring up to approximately 35 mm, previously 45 mm. Furthermore, the mass appears to be more hypoattenuating centrally, which suggests necrosis. There has also been interval decrease in size of the cervical lymphadenopathy. For example, a right level 2A lymph node measures 7 mm in short axis, previously 11 mm, a right level 3 lymph node measures 6 mm, previously 12 mm, and a left level 2A lymph node measures 4 mm in short axis, previously 13 mm. Likewise, the partially imaged upper mediastinal lymphadenopathy has decreased in size. A lesion within the right manubrium also appears to less conspicuous. The thyroid and major salivary glands are unchanged. There is a right internal jugular venous catheter. The imaged intracranial structures are unremarkable. The majority of the nodules in the partially-images lungs appear to have decreased in size. However, there is a new area of ground glass opacification in the right lung and the right pleural effusion has increased in size.
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1. Interval decrease in size of the mass centered within the left tongue base with extension into the left lateral floor of mouth and right tongue base and left tonsillar fossa.2. Interval decrease in size of the bilateral neck and partially imaged upper mediastinal lymphadenopathy. Please refer to the separate chest CT report for additional details.3. The majority of the metastases in the partially-images lungs appear to have decreased in size. However, a new area of ground glass opacification in the right lung and the right pleural effusion has increased in size. Please refer to the separate chest CT report for additional details.4. The metastasis within the right manubrium appears less conspicuous.
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Generate impression based on findings.
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68-year-old female with 6 weeks of right lower quadrant pain. The right hip appears normal for age. No fracture or malalignment is evident. There are ovoid calcific densities overlying the right pubic bone that we suspect were present on prior lumbar spine radiographs from 2007 and hence are of doubtful clinical significance, perhaps representing injection granulomas in the overlying gluteal musculature. Mild osteoarthritis affects the right sacroiliac joint.
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Mild osteoarthritis of the right sacroiliac joint and other findings as described above. If further imaging is clinically indicated, CT of the abdomen and pelvis may be considered.
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Generate impression based on findings.
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Male, 51 years old, with altered mental status. Grey-white differentiation is preserved. No evidence of parenchyma edema or mass effect seen. Mild patchy white matter hypoattenuation in the right frontal lobe is seen, a nonspecific finding. A cystic structure within the left basal ganglia may represent a dilated perivascular space. No evidence of any intracranial hemorrhage or abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.The osseous structures of the skull are intact. No significant paranasal sinus inflammation is detected.
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No acute intracranial abnormality.
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Generate impression based on findings.
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97-year-old female status post fracture, evaluate for bone healing Splint material obscures underlying osseous detail. Intramedullary rods affix the distal ulna and proximal radius fractures in near-anatomic alignment.
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Orthopedic fixation of both bone forearm fracture in near-anatomic alignment.
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Generate impression based on findings.
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Male 54 years old; Reason: Evaluate for re-development of fluid collection in the abdomen from an anastomotic leak, Ct last week History: fatigue, abdominal pain, cramping, diaphoresis, nausea and dry heaves ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Perfusion artifact in the right hepatic lobe likely due to subsegmental occlusion of a branch of the right portal vein, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes from a right hemicolectomy with reaccumulation of fluid in the surgical bed with gas pockets within the mesentery. It measures at least 4.0 x 3.8 cm (image 75/series 3) compatible with an abscess.There is inflammation extending cephalad toward the liver. The genesis of which may be from the surgical margin in the transverse colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Developing fluid collection in the area of prior drainage. This is suspicious for recurrent abscess. Possibly due break down of the anastomosis.2.Findings discussed with Michele Rubin and the Interventional radiology resident (Dr. Finkle) at the time of this report.
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Generate impression based on findings.
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Female 63 years old; Reason: Pt with newly diagnosed ampullary carcinoma at OSH. Need staging and evaluation for resectability before tumor board on 1/27 (pancreas protocol) History: ampullary carcinoma ABDOMEN:LUNGS BASES: Extensive respiratory motion artifact, making assessment suboptimal. Mild cardiomegaly.LIVER, BILIARY TRACT: Biliary stent present with moderate pneumobilia. Patent portal veins. Patent splenic vein and SMV.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate right sided hydronephrosis, likely secondary to enlarged fibroid uterus. Subcentimeter hypoattenuating renal lesions most likely cysts.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal and upper abdominal lymph nodes. Patent celiac and superior mesenteric arteries. BOWEL, MESENTERY: Ill defined soft tissue density seen in region of ampulla, measuring approximately 3.2 x 2 .4 cm, image 55 series 91. Mild gastric distention with underdistended pylorus and proximal duodenum seen, possible mucosal enhancement noted, image 45 series 80613, correlation with patient's clinical history to exclude underlying enteritis recommended.PELVIS:UTERUS, ADNEXA: Enlarged lobulated heterogeneous dystrophic-calcification containing soft tissue mass, centered in right lower abdomen, appears to be enlarged fibroid uterus, measures approximately 16.8 x 12.3 cm on transaxial imaging. BLADDER: Distended bladder, mass effect on dome of bladder secondary to enlarged fibroid uterus. BONES, SOFT TISSUES: Subcentimeter fat containing umbilical hernia.
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1. Ill defined soft tissue attenuation seen in region of ampulla, may reflect patient's known ampullary carcinoma. 2. Mild gastric distention with underdistended pylorus and proximal duodenum seen, possible mucosal enhancement noted, correlation with patient's clinical history to exclude underlying enteritis recommended.3. Markedly enlarged fibroid uterus.4. Right sided hydronephrosis, likely secondary to enlarged fibroid uterus.
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Generate impression based on findings.
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20 year-old female with right foot pain. Patient fell down stairs two weeks ago and has pain and swelling along the medial side of the foot. Technologist notes that pain is located along the medial aspect of the foot. We see no findings to account for medial foot pain. There is sclerosis of the proximal diaphysis of the fifth metatarsal, which could represent a healed fracture.
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No findings to account for medial foot pain.
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Generate impression based on findings.
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Bilateral hip pain Two views of the left hip are provided. Tiny osteophytes indicate minimal osteoarthritis, appearing similar to the prior study accounting for slight positional differences. There is slight prominence of the anterolateral aspect of the femoral head/neck junction, which can be associated with femoroacetabular impingement in the correct clinical context.Two views of the right hip are provided. Minimal osteoarthritis affects the hip. There is slight prominence of the anterolateral aspect of the femoral head/neck junction, which can be associated with femoroacetabular impingement in the correct clinical context. Sclerotic foci in the femoral head and neck likely represent benign bone islands.
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Minimal osteoarthritic changes of the hips and other findings as above.
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Generate impression based on findings.
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Female 50 years old; Reason: r/o SBO History: persistent N/V, no flatus Contrast extravasation description:Supervising radiologist: Dr. ShethMinor or major extravasation: MinorContrast type: 120 cc of Omnipaque 350 were administered. Amount extravasated: 18 ccLocation of extravasation: Right antecubital fossaSigns and symptoms: Localize swelling around the right antecubital areaTreatment given: Cold compressDischarge instructions given: YesABDOMEN:LUNG BASES: Focal right basal atelectasis/scar.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Fat attenuation lesion within the pancreatic body measuring 1.1 x 0.6 cm at the appearance of pancreatic lipoma versus focal fat. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes do not meet CT criteria for enlargement.BOWEL, MESENTERY: Oral contrast passes to the mid/distal small bowel without evidence of obstruction. The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is a 3.0 x 2.4 cm cystic right adnexal lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Contrast extravasation as detailed above.2.No evidence of small bowel obstruction. No specific cause for patient's symptoms is identified.3.3.0 cm cystic right adnexal lesion.
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Generate impression based on findings.
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No evidence of acute intracranial hemorrhage. No focal mass effect, midline shift or herniation. 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 evidence of acute intracranial hemorrhage or mass. If there is continued suspicion for intracranial pathology, consider MRI for further evaluation.
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Generate impression based on findings.
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Female 57 years old; Reason: r/o appendicitis History: RUQ/RLQ abd pain 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:ABDOMEN:LUNG BASES: Airspace opacities with a tree in bud appearance in the right middle lobe with associated micro-nodules. Scout image demonstrates cavitating right upper lobe mass, consistent with mycetoma and these findings are better evaluated on recent CT chest. Trace pericardial fluid.LIVER, BILIARY TRACT: Mild prominence of the proximal common bile duct. No CT evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate non obstructing left lower pole calculi, new compared to prior PET/CT.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the right lower quadrant and is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of appendicitis.2.Mild prominence of the common bile duct. Consider right upper quadrant ultrasound for further evaluation as CT is insensitive for the detection of gallstones.3.Right middle lobe opacities are suggestive of infection and are better evaluated on recent CT chest.
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