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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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prior history of SAH with clipping There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is evidence of prior aneurysm clipping of the A2 segment of ACA with associated encephalomalacia in the bilateral anterior frontal lobes. Hypoattenuations within the anterior limb of the left internal capsule do not show any evidence of interval change. There is no evidence of acute intracranial hemorrhage or mass. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear.
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1. Stable prior surgical clipping on ACA related changes since prior exam.2. No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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63 years, Female. Reason: rule out free air History: severely tender w/ rebound and guarding Mildly prominent loops of small bowel are seen in right hemipelvis. No evidence of free air. Please refer to recent CT report.
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Mildly prominent loops of small bowel are seen in right hemipelvis. No evidence of free air.
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Generate impression based on findings.
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15-year-old male with left hip painVIEWS: Pelvis AP/frog leg (two views) 01/26/15 Residual contrast is seen within bilateral ureters. Foley catheter is present. Gas distended bowel loops in the right hemipelvis.No acute fracture or malalignment is evident. Right coxa valga.
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Right coxa valga. No acute fracture or malalignment is evident.
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Generate impression based on findings.
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left side weakness No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion on this scan.
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Generate impression based on findings.
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Female, 33 years old.Multiple surgical teams. Correct count. Bilateral nephroureteral tubes. Enteric tube tip overlies the fundus. Esophageal temperature probe present. Right abdominal drain is noted. Surgical clip overly the sacrum, which was seen on prior CT. No unexpected radiopaque foreign body.Intraperitoneal free air likely from recent surgery. Mild prominence of transverse colon.
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No unexpected radiopaque foreign body. Intraperitoneal free air likely from recent surgery. Findings discussed with Dr. Tenney by phone 1/26/2015 at 21:15.
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Generate impression based on findings.
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syncopal episodes on admission with persistent headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion on this scan.
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Generate impression based on findings.
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Traumatic little finger amputation. Can move digit. No bone protrusion. Bone involvement?VIEWS: Left hand PA/lateral/oblique (3 views) 01/27/15 The soft tissues of the distal phalanx of the little finger have been amputated at the level of the tuft. The tuft appears to protrude. No bone defect is identified.
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Soft tissue amputation with no fracture.
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Generate impression based on findings.
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15-year-old female with history of headache x 3 months and vomiting. Evaluate for intracranial mass. The ventricular system appears smaller than expected, however this may be a normal variant. Basal cisterns are patent. There are no areas of abnormal attenuation or pathological enhancement. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There is no extraaxial fluid collection. There is a partially-imaged small retention cyst in the right maxillary sinus. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. No acute intracranial abnormality, or definite enhancing mass lesion.2. The ventricular system appears somewhat diminutive, which may be seen in the setting of pseudotumor cerebri. However, no other CT evidence of pseudotumor is identified. Given the stated history of chronic headaches, non-urgent MRI follow-up may be considered for further characterization if clinical concern persists.Findings were relayed to ED via stat consult system and acknowledged on 1/27/15 at 10:36am.
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Generate impression based on findings.
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Toe bruised and crooked.VIEWS: Left foot AP left second toe oblique/lateral (3 views) 01/26/15 Soft tissue swelling surrounds the proximal phalanx of the second toe. A Salter II fracture of the proximal phalanx is identified. The metaphyseal fragment is large. Minimal medial displacement is seen and there is lateral angulation of the distal fracture fragment.
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Fracture of proximal phalanx of second toe.
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Generate impression based on findings.
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15-year-old male with left thigh swellingVIEWS: 1-mm CT axial scans of the lower abdomen and pelvis were obtained following intravenous administration of contrast without immediate complication. Postcontrast imaging performed as well as coronal and sagittal reconstructions.IV Contrast: 80mL of Omnipaque 300, rate 1.3 mL/sec Foci of gas is present around the left femoral neck. Redemonstrated is a fluid collection extending from the inferior pelvis along the left obturator muscle into the medial compartment of the thigh. There is extensive tissue swelling with subcutaneous fat stranding is present circumferentially in the upper and lower thigh, particularly in the medial femoral compartment. This process abuts the left femoral neck with a small amount of hypoattenuation surrounding the left femoral neck. Stranding of the left gluteal fat planes with overlying skin thickening is again seen. No osseous erosions to suggest osteomyelitis. Probable subchondral cyst is seen in the posterior aspect of left femoral head and neck junction. Small amount of air within the bladder likely due to Foley catheter manipulation. The bladder is distended and within normal limits. There is a small amount of free fluid within the pelvis. No evidence of bowel obstruction. Severe levoscoliosis of the thoracolumbar spine and diffuse muscular atrophy consistent with paraplegia.
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1.Extensive soft tissue swelling with extension inferiorly particularly in the medial femoral compartment concerning for abscess.2.Foci of gas around the left femoral neck may reflect recent joint aspiration. Small amount of fluid surrounds the left femoral neck.3.Cellulitis overlying the inferior pubic ramus. 4.Small amount of free fluid in the pelvis.
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Generate impression based on findings.
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Male 61 years old; Reason: 61 yo M with complicated UTI, eval for stones/masses History: renal protocol, abnormal US ABDOMEN:LUNG BASES: Heterogeneously enhancing right pleural-based, right parenchymal and right hilar masses suspicious for metastatic deposits. There is distal atelectasis. The right hilar mass encases the hilar vessels and lower lobe bronchi and are incompletely evaluated on this study. 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: There is a 6.0 x 6.1 cm hypo enhancing, infiltrating mass replacing most of the upper pole of the left kidney. The left renal vein is patent.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes do not meet CT criteria for enlargement. Multiple right lower lobe calculi. The largest measures 2.7 cm in maximum dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild arteriosclerosis of the abdominal aorta and branch vessels.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes of the right hip joint.OTHER: No significant abnormality noted.
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1.Infiltrating left upper pole renal mass suggestive of primary renal cell carcinoma with pulmonary metastatic disease. This likely represents clear-cell carcinoma however other rare variants such as collecting duct carcinoma (medullary carcinoma) could have a similar appearance.2.Right lower pole nonobstructing renal calculi.
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Generate impression based on findings.
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86 years, Male. Reason: Evaluate for stool History: constipation, poor po intake Above average stool burden. Nonobstructive bowel gas pattern.
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Above average stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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There is diffuse leptomeningeal and extensive perivascular enhancement involving the cerebrum and cerebellum. Patchy T2 hyperintensity is also present, most notable in the left frontal lobe. T2 hyperintensity involving the splenium of the corpus callosum is seen diffusely. There is also a superimposed cystic focus in the splenium which may represent a perivascular space sequela of old injury. There are additional prominent perivascular spaces within basal ganglia. There is mild enlargement of the lateral and third ventricles with more significant enlargement of the fourth ventricle.There are postsurgical changes of right frontal craniotomy. There is gyral T1 shortening corresponding to the CT finding of gyral hyperattenuation in the medial occipital lobes involving the calcarine cortex compatible with chronic mineralization. Slightly abnormal contour along the inferior vermis may represent inferior vermian hypoplasia or be related to a posterior fossa arachnoid cyst.There is no midline shift or mass effect. 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.
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1.Diffuse leptomeningeal and perivascular enhancement is nonspecific. Etiologies include granulomatous disease, including neurosarcoidosis, as well as vasculitis, with angiocentric neoplasm and infection considered less likely.2.Mild ventriculomegaly may reflect some degree of communicating hydrocephalus.3.Additional findings including a cystic region in the corpus callosum and mineralization within the occipital lobe may be unrelated to current complaints, possibly the sequelae of old injury/inflammation.
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Generate impression based on findings.
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Shoulder pain. Evaluate for fracture.VIEWS: Right clavicle AP/axial (two views), right shoulder internal/external rotation (two views) 01/26/15 The clavicle is intact and normal in appearance no fracture is identified.The humeral head is normally positioned with respect to the glenoid fossa. No fracture is identified.Two staples overlie right T1, most likely within the patient's clothes.
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Normal examinations.
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Generate impression based on findings.
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CLINICAL DATA: Age: 76 years. Sex : Male. Indication: Reason: eval abd aortic aneurysm - seen on ultrasound in ED History: left abdominal wall pain. LUNG BASES: Mild apical predominant emphysema.LIVER, BILIARY TRACT: Hypoattenuating focus in the right hepatic lobe, nonspecific but most likely benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is prominent, however there is no pancreatic atrophy or peripancreatic stranding.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole hypoattenuating renal cyst is noted.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix is within normal limits.BONES, SOFT TISSUES: Degenerative changes affect the hips bilaterally, with mild degenerative changes of the visualized spine.VASCULATURE:Marked atherosclerosis of the aorta and its branches, with several areas of ulcerated plaque noted (10/190). Common celiacomesenteric trunk is ectatic, and there is a replaced left gastric originating from the aorta.Atherosclerotic narrowing of the bilateral renal arteries, right greater than left, up to approximately 45%. The IMA is not visualized, and may be occluded.The infrarenal aorta is aneurysmal (10/206) up to approximately 4 cm.Old dissection flap is noted just inferior to the renal arteries (10/23).Left internal iliac is occluded at its origin, however is reconstituted distally by collaterals.PELVIS:PROSTATE: Prostate is enlarged.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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Marked atherosclerosis, with aneurysmal infrarenal aorta as above.
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Generate impression based on findings.
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Female 66 years old Reason: Metastatic gall bladder cancer w tachycardia and hypoxia History: Metastatic gall bladder cancer w/ tachycardia and hypoxia Study is limited by body habitus and motion artifact especially in the the lung bases. PULMONARY ARTERIES: No acute pulmonary embolism to the lobar level. Pulmonary artery size is enlarged measuring 35 mm suggestive of pulmonary arterial hypertension. No significant right heart strain.LUNGS AND PLEURA: Increased airspace opacity with air bronchograms throughout the right lung. Interval decrease in right pleural effusion and basilar atelectasis. Persistent left pleural effusion with overlying compressive atelectasis. Elevated right hemidiaphragm with marked compression of the right atrium.MEDIASTINUM AND HILA: Cardiomegaly without pericardial effusion. Central venous catheter with tip in the SVC. Nonspecific mildly enlarged mediastinal lymph nodes.CHEST WALL: Moderate degenerative changes thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. NG tube in place with tip beyond the field of view. Please refer to separate CT abdomen/pelvis from the same day for additional findings.
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1. No acute pulmonary embolism to the lobar level. 2. Interval increase in right lung air space opacities which likely represent widespread infection and/or aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Negative.
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Generate impression based on findings.
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16 year old female with sickle cell anemia now with fever, crackles and increased oxygen requirement.VIEW: Chest AP (one view) 1/27/2015 A left basilar opacity is seen with an associated small pleural effusion consistent with acute chest syndrome. The cardiothymic silhouette is enlarged. A right thoracolumbar curve is again noted. Surgical clips are present in the right upper quadrant. Gas containing bowel in the left quadrant suggests prior splenectomy.
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Left basilar opacity with associated small pleural effusion consistent with acute chest syndrome.
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Generate impression based on findings.
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55-year-old male with abdominal pain and nausea ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Nonspecific right hepatic hypodensity measures 1.8 cm, incompletely characterized by CT (series 3, image 37)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: Arterial calcifications.BOWEL, MESENTERY: Dilated small bowel loops measuring up to 4.3 cm with a small amount of interloop fluid. There is a transition point in the central abdomen (series 3, image 97) with collapsed distal ileal loops. No pneumoperitoneum. The appendix is normal.BONES, SOFT TISSUES: Posterior stabilization rods extending from T9 to L3. There is age indeterminate height loss of the L1 vertebral body. Chronic appearing deformity of the right iliac wing.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Findings consistent with a small bowel obstruction with a transition point in the central abdomen. The presence of interloop fluid raises the possibility of a developing ischemic component. No pneumoperitoneum.2. Indeterminate right hepatic lobe lesion; consider MRI as clinically warranted.
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Generate impression based on findings.
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Status post fracture.VIEWS: Right ankle AP, lateral and oblique 1/27/15 804 hours. (Three views) Subtle bone demineralization noted. No periosteal reaction or callus formation is present. Alignment is anatomic.
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Anatomic alignment of the right ankle with subtle bone demineralization.
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Generate impression based on findings.
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Tachypnea. Evaluate pneumothorax.VIEW: Chest AP (one view) 01/27/15, 0020 Right chest tube remains in place. Surgical clips and staples are again seen. Anterior right fifth and sixth ribs have been resected. A hepatic flexure of the colon and is in the right nephrectomy bed.Small right pneumothorax persists. Subsegmental atelectasis is present in both lung bases. Cardiac silhouette size is normal.
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Persistent right pneumothorax.
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Generate impression based on findings.
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Reason: 82 female with metastatic lung cancer. Now with worsening chest pain, syncope. Asses tumor progression and involvement of vessels History: chest pain LUNGS AND PLEURA: Continued increase in size of large left upper lobe mass now measuring 11.0 x 6.7 cm (series 4 image 22). It is again noted to abut the mediastinum and pleural surfaces. Tumor abuts the aorta and encases and attenuates the left subclavian artery and left main pulmonary artery. The left upper lobe branch of the left pulmonary artery is no longer visualized and may be occluded or invaded.Right middle lobe mass measures 2.2 cm in short axis (series 4 image 49) increased from 12/11/14 but appearing similar to 10/24/14. Right upper lobe mass measures 2.0 cm in short axis (series 4 image 34) previously 2.0 cm. Other smaller nodular opacities in the right lung are not significantly changed.Interval development of a small left pleural effusion.MEDIASTINUM AND HILA: Right high paratracheal lymph node measures 3.5 cm (series 3 image 10) increased from 12/11/14 when it measured 2.9 cm but similar to 10/24/14 when it measured 3.5 cm.Similarly, low right paratracheal lymph node measures 2.5 cm (series 3 image 24) increased from 12/11/14 when it measured 2.0 cm but similar to 10/24/14 when it measured 2.5 cm.Severe coronary and atherosclerotic calcification. Encasement of vasculature as described above by tumor.Severe coronary and aortic atherosclerotic calcification.CHEST WALL: Mild collapse of the superior endplate of T12 and multilevel degenerative changes again noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Continued increase in size of large left upper lobe mass and reference right middle lobe mass. The left upper lobe branch of the left pulmonary artery is no longer visualized and is likely occluded or invaded. Reference right upper lobe mass not significantly changed. 2. Increased mediastinal and supraclavicular bulky lymphadenopathy from 12/11/14 but similar in size to 10/24/14. Tumor encases and attenuates the left subclavian artery. 3. New small left pleural effusion.
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Generate impression based on findings.
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72-year-old female with history of right shoulder pain. There is no acute fracture or dislocation. Alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint.
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Osteoarthritis without acute fracture.
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Generate impression based on findings.
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Increased intracranial pressure, altered mental status No intracranial hemorrhage is identified. Again seen is areas of thickening of the cortex particularly in the frontal lobes and subcortical band heterotopia, findings which are better seen on prior MRI. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is grossly maintained. No extra-axial collections. No hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.
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1. No evidence of acute intracranial hemorrhage or mass effect. 2. Subcortical band heterotopia and pachygyria as seen on prior MRI.
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Generate impression based on findings.
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72-year-old female with history of joint pain. There is no acute fracture or dislocation. There is mild chondrocalcinosis of the triangular fibrocartilage complex. There is a 1 mm density near the second DIP joint which is nonspecific. Mild degenerative changes at the basilar joint.
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1.No acute fracture. 2.1 mm density near the second DIP joint is nonspecific. Clinical correlation is recommended.3.Other findings as above.
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Generate impression based on findings.
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Lower extremity radiculopathy. Status post fusion. Assess L5 -- S1 foramen Again seen are posterior rods with screws entering the L2 through L5 vertebrae. I see no hardware complications. Bone graft is again noted along the right lateral aspect of the lumbar spine appearing similar to that seen on the prior study. Severe degenerative disk disease affects the L5/S1 intervertebral disk space, with posterior vertebral body osteophytes that appear to result in narrowing of the neuroforamina at this level. There is also moderate degenerative disk disease at L2/3 with grade 1 retrolisthesis of L2. Mild degenerative disk disease affects the remaining lumbar levels. There is also a grade 1 anterolisthesis of L4 relative L5. Vertebral body heights are preserved. Overall, these findings appear similar to those seen on the prior study.
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Postoperative changes of lumbar spine fusion and multilevel degenerative disk disease as described above, with findings suggestive of narrowing of the L5/S1 neuroforamina, although this would be better evaluated with cross-sectional imaging.
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Generate impression based on findings.
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23 year old female assess PICC placement.VIEW: Chest AP (one view) 1/27/2015, 1:46 The right upper extremity PICC tip terminates at the level of the cavoatrial junction.Streaky bibasilar opacities suggests subsegmental atelectasis, appearing similar to the prior exam. The cardiothymic silhouette is normal. No pneumothorax or pleural effusion is seen.
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Right upper extremity PICC tip at the level of the cavoatrial junction.
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Generate impression based on findings.
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Reason: lupus cerebritis? History: perseveration, confusion. 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 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.Please note that MRI may be more sensitive in identifying cerebral lesions associated with lupus compared to CT
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Generate impression based on findings.
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Hypoxia, evaluate for pneumonia.VIEW: Chest AP (one view) 1/27/2015, 07:39 Left central line tip in the superior vena cava. The right upper extremity PICC tip is in the superior vena cava.No focal lung opacity is seen. The cardiothymic silhouette is normal. Gas-containing loops of bowel are present in the right upper quadrant, in the region of the prior liver resection.
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No focal opacity to suggest pneumonia.
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Generate impression based on findings.
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Reason: SAH History: sah, s/p coiling Compared to the prior exam the lateral ventricles remain mildly dilated but unchanged.The patient is status post embolic coil occlusion of a basilar tip aneurysm.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Right sided periventricular hypodensity associated with volume loss in the right inferior parietal lobule remains stable since the pre-procedural CT of 1/15/15.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.Ventricles remain mildly dilated but stable since yesterday.
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Generate impression based on findings.
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14 year old female with epilepsy, status post endotracheal tube placement.VIEW: Chest AP (one view) 1/27/2015, 07:56 The endotracheal tube is at the level of the thoracic inlet. Left chest wall neurostimulator device in place. The nasogastric tube tip terminates in the body of the stomach with side port below the GE junction.Multifocal air space opacities are seen in the right upper and right lower lobe, perhaps related to aspiration. The cardiothymic silhouette is normal. No pleural effusion or pneumothorax is seen.
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Right upper and left lower lobe airspace opacities may reflect aspiration, although superimposed infection is not excluded.
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Generate impression based on findings.
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8-month-old former 24 week gestational age patient with chronic lung disease and abdominal distention.VIEWS: Chest and abdomen AP (two views) 01/27/15, 0720 Tracheostomy tube tip is between thoracic inlet and carina. Feeding tube tip is at GE junction with side port in lower esophagus.Cardiothymic silhouette is mildly to moderately enlarged. Lung volumes are large with the hemidiaphragms at the 10th posterior ribs. Streaky opacities are seen bilaterally. No focal air space disease is present.A large amount of gas is seen in the upper aspect of oh left inguinal hernia. Multiple moderately dilated bowel loops are noted within the abdomen.
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Chronic lung disease. Large left inguinal hernia containing bowel and distended bowel in the abdomen raises the question of obstruction.
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Generate impression based on findings.
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There is a stable right parietal approach ventriculostomy catheter, with its tip in the right frontal horn. The ventricles and sulci are stable in within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Bilateral mastoid air cells and middle ears have cleared. The visualized portions of the paranasal sinuses are grossly clear.
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No acute intracranial abnormality. Stable ventricular system size with right-sided ventricular catheter.
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Generate impression based on findings.
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Parotid gland neoplasm CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions with overlying compressive atelectasis. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal. Trace pericardial effusion.CHEST WALL: Small amount of air in the right neck, likely postoperative.ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic hypodensities are too small to further characterize. No biliary ductal dilation. The hepatic vasculature is patent.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: Partially thrombosed right common iliac artery aneurysm measures 2.5 cm in diameter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter in collapsed bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific tiny amount of pelvic free fluid.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Postoperative changes in the right neck without evidence of disease in the chest, abdomen, or pelvis.2.Right common iliac artery aneurysm.
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Generate impression based on findings.
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45-year-old female with history of left foot injury. There is no acute fracture or malalignment. There is an accessory navicular bone, a normal variant. The soft tissues are unremarkable.
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No acute fracture or malalignment. There is an accessory navicular bone, a normal variant, although this can be associated without posterior tibialis tendon dysfunction.
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Generate impression based on findings.
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86-year-old male with remote hx of CVA, presenting with weakness and altered mental status, evaluate for intracranial hemorrhage. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The evaluation of acute ischemia is limited secondary to extensive encephalomalacia/volume loss and associated ex vacuo dilatation of the lateral ventricles in the left much greater than right middle cerebral artery territories consistent with chronic infarction. Paucity of the tissue in the midline inferior cerebellum/vermis may be secondary to developmental hypoplasia. 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. No extra-axial collections are identified. There is mild mucosal thickening of the right maxillary sinus and anterior ethmoid sinuses. There is focal medial deformity of the medial wall of the left maxillary sinus. There are partially visualized bilateral accessory maxillary ostia, less likely postsurgical. The mastoid air cells are clear. The skull and visualized soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Extensive encephalomalacia/volume loss in the left much greater than right middle cerebral artery territories consistent with chronic infarction.
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Generate impression based on findings.
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History of left lumpectomy in 2004 for intraductal and infiltrating ductal carcinoma. Patient received radiation therapy. History of breast carcinoma in daughter diagnosed at age 28 and ovarian carcinoma in mother. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear marker was placed on the scar overlying the left breast. Post-surgical architectural distortion, oil cyst formation, and dystrophic calcifications are present within the lumpectomy bed. The skin thickening is compatible with prior radiation. Benign calcifications are present bilaterally.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 diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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17 year-old female with new fever, left shoulder/chest painVIEWS: Chest PA/lateral (two views) 01/26/15, 2238 hrs Cardiothymic silhouette is top normal. Moderate to large left pleural effusion is present. Adjacent atelectasis and/or consolidation is present. Interval improvement of right pleural effusion with mild residual discoid atelectasis in the right lower lung.Slight rightward curvature of the thoracolumbar spine. Interval removal of left upper extremity PICC. Radiopaque foci in the left axilla is likely of no clinical significance. Contrast is present in the pelvicaliceal systems.
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Moderate to large left pleural effusion with adjacent atelectasis and/or consolidation.
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Generate impression based on findings.
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Reason: SDH? History: lethargy, on coumadin, recent lumbar drain 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.Periventricular and subcortical white matter hypodensities of a moderate degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses demonstrate minor opacities in the right maxillary sinus with associated wall thickening suggestive of chronic sinusitis. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of hemorrhagic cerebral infarction.3.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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20 year-old male with history of injury. There is anterior subluxation of the humeral head with respect to the glenoid. There are no acute fractures.
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Anterior shoulder dislocation without evidence of fracture.
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Generate impression based on findings.
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Female 27 years old; Reason: recent h/o soigmoid diverticulitis, still pain. eval for colonic complication. pls with IV and oral contrast History: abd pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated pericolonic induration and sigmoid wall thickening is improved from prior study. A focus of previously seen extraluminal loculated gas is not visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Mild interval improvement in sigmoid inflammatory changes as described above. No extraluminal gas or abscess collection.
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Generate impression based on findings.
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66-year-old male with metastatic pancreatic carcinoma. Evaluate disease status and compare to prior examination. CHEST:LUNGS AND PLEURA: The reference pulmonary nodules appear unchanged from the prior exam. Reference left upper lobe nodule measures approximately 1.2 x 0.7 cm, previously 1.2 x 0.6 cm on image 30 of series 6. Reference nodule in the right middle lobe measures 1.3 x 1 .4 cm, previously 1.3 x 1.4 cm on series 6; image 68.MEDIASTINUM AND HILA: Vascular calcifications of the aorta and its branches. Mild coronary artery calcifications.CHEST WALL: Right chest port with catheter tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Small low attenuation foci are unchanged and too small to characterize. Pneumobilia consistent with the patient's history of hepaticojejunostomy.SPLEEN: No significant abnormality notedPANCREAS: Postoperative appearance of prior Whipple's procedure without mass. Small amount of soft tissue density along the SMA is nonspecific but may represent post operative changes, appearing similar to the prior study. Small amount of air within the main pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative suture in the left upper quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large amount of stool noted throughout the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis is nonspecific but abnormal in a male patient.
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Stable examination without change in size of lung nodules.
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Generate impression based on findings.
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Reason: Patient has severe asthma, on optimal therapy still with severe symptoms, evaluate for bronchiectasis and ILD History: SOB, wheezing, drop in peak flow LUNGS AND PLEURA: Interval increase in primarily linear right basilar opacities consistent with scarring/atelectasis, though with some clustered nodular areas in the right lung base. Left basilar scarring/atelectasis unchanged. Mild bronchial wall thickening consistent with the clinical history of asthma. No pleural effusions. No significant air trapping on expiratory images. MEDIASTINUM AND HILA: Enlarged nonspecific multinodular thyroid with calcifications.Severe coronary arterial calcification. Mild pericardial fluid/thickening. Normal heart size.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1. Mild bronchial wall thickening consistent with the clinical history of asthma, with interval increase in primarily linear right basilar opacities consistent with scarring/atelectasis and possibly aspiration. Further follow up may be helpful as clinically warranted. 2. No evidence of interstitial lung disease or significant bronchiectasis. 3. Enlarged nonspecific multinodular thyroid with calcifications.
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Generate impression based on findings.
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Images are slightly limited by patient motion. There is scattered hyperdensity along the right anterior/inferior frontal lobe sulci consistent with acute subarachnoid hemorrhage. There are questioned foci of subtle hyperdensity within the subcortical white matter as seen at the level of the right frontal centrum semiovale on 5/25 as well as along the left caudate on 5/21 but better appreciated on 80384/37. There is an additional question sulcal hyperdensity in the left temporal occipital region on 5/16, which could represent additional subarachnoid blood products.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is moderate mucosal thickening in the right maxillary and left sphenoid sinus, as well as minimal mucosal thickening the left maxillary sinus. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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Small amount of focal right anterior/inferior frontal acute subarachnoid hemorrhage. Additional questioned left temporal occipital subarachnoid blood products as well as possible tiny rounded scattered petechial parenchymal hemorrhages.Dr. Yang discussed these findings over the telephone with Dr. Amrish Deshmukh on 1/27/2015 8:45 AM.
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Generate impression based on findings.
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Female 25 years old Reason: cholecystitis? History: RUQ pain, bedside u/s with gallstones and thickened ant wall LIVER: The liver is mildly enlarged measuring 19.7 cm in length. No focal liver lesion.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. The patient is sonographic Murphy sign negative.PANCREAS: No significant abnormalities noted.KIDNEYS: The left kidney measures 13.9 cm. The right kidney measures 13.6 cm. There is no hydronephrosis or shadowing renal stones..OTHER: The spleen measures 11.0 cm in length. No ascites.
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Cholelithiasis without gallbladder wall thickening or pericholecystic fluid.
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Generate impression based on findings.
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Male, 71 years old, with stroke status post tPA. Hypoattenuation involving the right insula and basal ganglia is again slightly more conspicuous than on the prior examination, but not significantly increased in geographic extent. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No significant mass effect is detected. Areas of encephalomalacia compatible with chronic ischemia are redemonstrated in the right frontal lobe, left middle frontal gyrus and left medial temporal lobe.
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Expected evolution of right MCA ischemia involving the insula and basal ganglia. The lesion has become more conspicuous but has not increased in geographic extent. No intracranial hemorrhage is demonstrated.
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Generate impression based on findings.
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72-year-old female with history of pain and swelling. There is mild soft tissue swelling about the medial aspect of the ankle. There is no acute fracture or dislocation. There is a small plantar calcaneal spur.
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Mild soft tissue swelling without acute fracture.
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Generate impression based on findings.
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Female 49 years old Reason: 49 year-old female with RUQ pain, evaluate etiology History: as above LIVER: The liver measures 16.5 cm in length. There is no focal liver lesion. The portal vein demonstrates normal directional flow with peak velocity is 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. No biliary dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 10.7 cm. The left kidney measures 10.6 cm. There is no hydronephrosis or shadowing renal stones.OTHER: The spleen measures 10.7 cm in length.
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Unremarkable study. 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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Female 60 years old; Reason: Eval for chronic PE History: hypoxia, pulmonary HTN The comparison chest radiograph performed on 1/26/2015 demonstrates findings compatible with COPD as well as bilateral pleural effusions with adjacent atelectasis. The ventilation images show multiple defects bilaterally on single breath and equilibrium images with abnormal retention of Xe-133 retention bilaterally during the wash-out phase. The perfusion images show multiple perfusion defects bilaterally which appear matched with the ventilation defects and less prominent compared to the ventilation images.
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Multiple matched ventilation-perfusion defects makes this a low probability scan for pulmonary embolism.
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Generate impression based on findings.
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Abdominal pain, evaluate for obstruction, diverticulitis, appendicitis ABDOMEN:LUNG BASES: Reticulonodular opacities at the right base suggest scarring / atelectasis.LIVER, BILIARY TRACT: Nonspecific hepatic hypodensities are too small to further characterize. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Incompletely characterized low attenuation renal foci.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific circumferential thickening of the gastric body and antrum. Multiple dilated small bowel loops in the right upper quadrant measure up to 3.3 cm in diameter with a transition point the right lower quadrant. There is a small amount of nonspecific free fluid in the pelvis. No pneumoperitoneum. The appendix is normal.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Small bowel obstruction with a transition point in the right lower quadrant. Small amount of free fluid in the pelvis is abnormal in a patient of this age raising the possibility of a developing ischemic component.2.Nonspecific circumferential thickening of the gastric body / antrum and mild prominence of the pancreatic duct; consider endoscopy as clinically warranted.
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Generate impression based on findings.
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Left femoral osteosarcoma, status post 3 cycles of chemotherapy. Again seen is an enhancing infiltrative mass in the left femoral neck extending from the epiphysis to the mid/proximal femoral diaphysis, now measuring 4.0 x 4.6 x 8.3 cm, previously 4.3 x 4.7 x 8.6 cm. The osseous component of the mass again appears more extensive than the soft tissue component. The acetabulum appears to be spared, without enhancement or edema. The edema in the surrounding musculature has slightly improved compared to the prior, and the periosteal reaction persists.Multiple new enhancing foci are evident in left distal metaphysis and epiphysis of the left femur, which are intrinsically T1 hypointense (T1 hyperintense on fat saturated imaging) and T2 hyperintense. Additionally, a T1 hypointense lesion is evident within the distal right lateral femoral metaphysis, with associated increased T2 signal, which is incompletely characterized. Bandlike high T2 signal is distributed along the bilateral distal femoral metaphyses at the physeal interface. These finding are worrisome for metastasis to the knees, although atypical marrow conversion is a differential consideration.
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1.Slight decrease in size of the extensive infiltrative tumor in the proximal femur.2.Abnormal signal within the left distal femoral metaphysis and epiphysis as well as the right distal metaphysis is worrisome for metastatic disease, although atypical marrow conversion is a consideration. Further evaluation with MRI of the bilateral knees and/or nuclear medicine bone scan is recommended.
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Generate impression based on findings.
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52 year old with history of right breast cancer status post mastectomy. No current complaints. Three standard views of the left breast 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Stable asymmetry in the left outer breast may be the residua of the previously noted large cyst.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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72-year-old female with history of joint pain. There is no acute fracture or dislocation. There is a small olecranon spur. There is mild chondrocalcinosis at the radiocapitellar and trochlear joints. Enthesophytes are present at the origin of the flexor tendons.
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Chondrocalcinosis and other findings as above without acute fracture.
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Generate impression based on findings.
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Reason: 64M with h/o heart transplant 06 p/w fever and SOB, L lingular infiltrate seen on CXR eval for infiltrates History: fever, malaise, SOB Reason: 64M with h/o heart transplant 06 p/w fever and SOB, L lingular infiltrate seen on CXR eval for infiltrates History: fever, malaise, SOB LUNGS AND PLEURA: Patchy air space/groundglass opacities in the left upper lobe and lingula are consistent with pneumonia and correlate with recent chest radiograph. Scattered micronodules, including 6-mm micronodule in the left lower lobe (series 5 image 40) and 7-mm micronodule right lung base (series 5 image 65). No pleural effusionsMEDIASTINUM AND HILA: Postoperative changes of heart transplantation. Nonspecific soft tissue in the anterior mediastinum measuring 1.6 cm in short axis (series 3 image 31 may be postoperative in etiology but is nonspecific. No visible coronary artery calcification.CHEST WALL: Median sternotomy. Multilevel mild degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy.
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1. Left upper lobe/lingular airspace opacities consistent with pneumonia.2. Bilateral micronodules measuring up to 7 mm, for which continued follow-up is recommended.3. Postoperative changes of heart transplantation as described above.
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Generate impression based on findings.
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Male, 92 years old, with aphasia. Image quality is slightly motion degraded. Again seen is patchy ill-defined periventricular hypoattenuation, not significantly changed. Superimposed more focal areas of hypoattenuation involving the left corona radiata are also not significantly changed.No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. No mass effect or parenchymal edema is suspected. Gray-white differentiation is grossly preserved. Heavy intracranial calcification of the ICAs is noted. The ventricular system is stable and within normal limits for size.The osseous structures of the skull are intact. The visualized paranasal sinuses and mastoid air cells are clear.
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Redemonstration of ill-defined periventricular hypoattenuation as well as superimposed more focal hypoattenuating lesions in the left corona radiata. These findings are compatible with age indeterminate ischemic disease. Accounting for slight motion degradation, there has been no significant interval change in the appearance of these findings.
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Generate impression based on findings.
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72-year-old female with history of pain. Left knee: There is no acute fracture or malalignment. There is moderate to severe chondrocalcinosis of the menisci. There is severe patellofemoral joint space narrowing. Tricompartmental osteophytes are present. Small joint effusion.Right knee: There is no acute fracture or malalignment. There is moderate to severe chondrocalcinosis of the menisci. There is severe patellofemoral joint space narrowing. Tricompartmental osteophytes are present.
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1.No acute fracture.2.Moderate to severe degenerative arthritic changes and findings suggestive of CPPD arthropathy.
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Generate impression based on findings.
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39-year-old female with left eye pain with movement, evaluate for orbital cellulitis There are findings of chronic sinusitis with severe mucoperiosteal thickening and superimposed postsurgical changes including resection of the medial left maxillary wall, nasal turbinates and anterior ethmoid air cells. There is a residual low density rim of chronic soft tissue thickening within the remaining left maxilla along the lateral aspect with an enhancing component measuring 1.6 x 0.6 cm along the orbital floor. There is destruction of the osseous orbital floor and lamina papyracea with mild extraconal fat stranding along the inferior aspect of the orbit. This enhancing component abuts the inferior rectus muscle, however the intraconal space is preserved.The residual left maxillary sinus wall is thickened. The lateral left maxillary wall is also fragmented with soft tissue infiltration extending into the retromaxillary fat. The pterygopalatine foramen is also infiltrated. Periapical lucencies are noted indicating periodontal disease and the left first second and third molars are missing.There is severe mucosal thickening in the sphenoid sinus and mild mucosal thickening in the posterior ethmoid sinuses. The right maxillary sinus is clear. The infundibulum is narrowed on the right, however there is no evidence of sinus disease in this region. No intracranial abnormalities.
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1.Findings of chronic sinusitis with sclerosis, thickening and fragmentation the left maxilla and destruction of the left inferior orbital floor. There is soft tissue thickening and enhancement along the left inferior orbital floor which is nonspecific but may be postoperative, inflammatory or infectious. A neoplastic etiology is considered less likely, but correlation with history is suggested. 2.Inflammatory stranding extends within the fat of the inferior orbit, adjacent to the inferior rectus, as well as within the retromaxillary fat.
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Generate impression based on findings.
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70-year-old female with history of remote CVA, presenting with altered mental status. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect, or significant midline shift is present. The ventricles and sulci are prominent, consistent with severe age-related volume loss. No extra-axial collections are identified. A region of encephalomalacia is present in the posterior right parietal lobe, which suggests chronic infarction. Deep to this region, in the periventricular and deep white matter of the right parietal lobe, there is additional hypoattenuation with questioned mild asymmetry in appearance of the adjacent margin of the posterior body/atrium of the right lateral ventricle.There i are scattered chronic lacunar infarcts in the bilateral cerebellar hemispheres. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent chronic small vessel ischemic changes, similar in appearance to MRI brain from 5/2014. The known right terminal internal carotid artery aneurysm is not well delineated on this exam.A large retention cyst is present in the inferior right maxillary sinus and there is trace mucosal thickening of the left maxillary sinus; otherwise, the paranasal sinuses and mastoid air cells are clear. The calvarium and visualized soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Chronic infarct in the posterior right parietal lobe. Additional hypoattenuation in the periventricular and deep white matter in the right parietal lobe exerts questioned mild mass effect in the posterior body/atrium of the right lateral ventricle. Although this hypodensity is in a similar pattern as the FLAIR abnormality on most recent MRI, superimposed recent infarct cannot be excluded. MRI may be considered if clinical concern for acute ischemia persists.
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Generate impression based on findings.
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84 years, Female. Reason: Abdominal pain, diarrhea, want to evaluate stool burden and obstructive bowel gas pattern or other abnormalities History: Abdominal pain, nausea, vomiting Nonobstructive bowel gas pattern. Average colonic stool burden. IVC filter noted in the expected location.
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Average colonic stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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CLINICAL DATA: Age: 85 years. Sex : Female. Indication: Reason: eval for SBO, etc History: abd pain. LUNG BASES: Minimal bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Moderate fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Approximately 6.5-cm right hypoattenuating renal cysts, with a smaller cyst in the left. No hydronephrosis or hydroureter.RETROPERITONEUM/LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative findings of transabdominal colectomy with end-ileostomy in the right lower quadrant. Several small bowel loops have herniated into the subcutaneous fat in the right lower quadrant ostomy site, however there is no associated free fluid or bowel wall thickening, and there is no obstruction.BONES, SOFT TISSUES: Degenerative changes affect the visualized spine, including annular calcifications and at least some disk bulge posteriorly. Bones are demineralized.OTHER:No significant abnormality noted.PELVIS:UTERUS/ADNEXA: No significant abnormality noted.BLADDER: Diverticulosis affects the remaining rectosigmoid bowel.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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Postoperative findings and right lower quadrant parastomal hernia as above, without obstruction or other significant acute abnormality.
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Generate impression based on findings.
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Reason: h/o HNC/CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Mild coronary artery calcification is present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Retained metallic retention device from prior gastrostomy, unchanged since prior studies.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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64 years, Female. Reason: eval capsule History: eval capsule; hemicolectomy last year Heavy vascular calcifications noted. Capsule projects seen in the RLQ, near the anastomotic suture line. Cannot rule out hold up at the anastomosis. Non obstructive bowel gas pattern. Surgical clip noted at LUQ. Enteric contrast seen in descending colonic diverticulum.
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Capsule projects seen in the RLQ, near the anastomotic suture line. Cannot rule out hold up at the anastomosis. Non obstructive bowel gas pattern.
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Generate impression based on findings.
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65-year-old male with history of bladder cancer status post radical cystectomy and neobladder; please evaluate for metastatic disease. The absence of intravenous and oral contrast limits evaluation of the solid organs and bowel. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Reference complex cyst in the left lower pole, is incompletely characterized, measures 5.7 x 5.0 cm, previously 6.0 x 5.2 cm (series 3, image 77). Stable mild dilatation of the left proximal collecting system. Punctate non obstructing left renal calculi.Stable, right hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Again seen is a large wide-mouthed ventral hernia containing loops of small bowel and a portion of the neobladder, without evidence of obstruction or strangulation. T9 vertebral body hemangioma. Probable bone island left iliac bone, unchanged. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystoprostatectomy, end ileostomy and neobladder formation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multilevel degenerative changes.OTHER: No significant abnormality noted
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1. Stable postsurgical changes noted in the pelvis without evidence of disease recurrence, within the limitations of a noncontrast examination.2. Stable right-sided hydroureteronephrosis and dilatation of the proximal left collecting system.
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Generate impression based on findings.
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No evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. The ventricle size does not show any significant interval change since prior exam. There is no change of ventricular shunt position, right frontal approach and the tip location at or around 3rd ventricle roof since prior exam. Bilateral small subdural fluid collections do not show significant interval change either since prior exam. Dysgenesis of the corpus callosum and periventricular white matter hypoattenuation do not show any significant interval change since prior exam. There is an unchanged hyperdense appearance of the pituitary gland, which may represent a Rathke cleft cyst, and dysmorphic sella. The paranasal sinuses and mastoid air cells are clear.
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1. No evidence of acute intracranial hemorrhage or mass. 2. No interval change of ventricular system size or ventricular catheter location since prior exam.3. No interval change in chronic bilateral subdural fluid collections since prior exam.
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Generate impression based on findings.
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FractureVIEWS: Left wrist PA/lateral (two views) 01/27/15 The fracture line is no longer visible. Callus is being incorporated into the cortex along the lateral aspect of the distal radial diaphysis. Lateral angulation is decreasing.
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Further healing and remodeling at the distal radial fracture.
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Generate impression based on findings.
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64 years, Female. Reason: s/p NGT placement - please assess location of NGT tip History: s/p NGT placement - please assess location of NGT tip The lower abdomen and pelvis are excluded from the field-of-view. Interval placement of enteric tube, with tip projecting in the mid gastric body. Partially imaged central venous catheter tip at the SVC/RA junction. Biliary drainage catheter terminates beyond the field-of-view. Nonobstructive bowel gas pattern.
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Enteric tube tip projects in the mid gastric body.
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Generate impression based on findings.
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Reason: s/p gastric band re-fill, assess for esophageal dilation Single contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. Previously seen distal esophageal dilatation is not well seen on current study. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild dysmotility with proximal escape. Gastric band is in appropriate location with angle of Phi angle measures approximately 36 degrees. Gastric pouch measures 3.0 x 2.8 x1.6 cm. No air fluid level in the pouch. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal.The duodenal bulb and sweep were within normal limits. TOTAL FLUOROSCOPY TIME: 5:25 minutes
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Gastric lap band in appropriate position. Mild esophageal dysmotility with proximal escape.
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Generate impression based on findings.
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Male, 58 years old, history of T1N2b squamous cell carcinoma HPV+ of base of tongue with metastases to the left neck s/p CRT, completed June 2011. No evidence of any mucosal tumor is seen including at the base of tongue. Note is made of mild mural irregularity along the right wall of the trachea which probably represents adherent secretions or debris. The right laryngeal ventricle is more prominent than the left, a nonspecific finding.No pathologically enlarged or morphologically suspicious lymph nodes are detected in the neck. The salivary glands and the thyroid are free of focal lesions. A small amount of air has refluxed into the parotid ducts. The cervical vessels enhance normally. No concerning osseous lesions are seen.
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No evidence of local tumor recurrence or pathologic adenopathy.
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Generate impression based on findings.
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Male 48 years old Reason: new oral cancer History: r/o lung mets LUNGS AND PLEURA: Pleural scarring in the right apex with cystic and nodular components likely secondary to prior infectious etiology. Special attention should be paid on subsequent examinations to assess stability. In the right lower lobe, there is pleural scarring and bronchiectasis likely secondary to prior infection. Bilateral calcified granulomas. No definite evidence of metastasis.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mild coronary calcifications. Multiple calcified hilar and mediastinal lymph nodes consistent with prior infection. CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Punctate calcifications in the spleen consistent with prior healed granulomatous disease. Atherosclerotic calcifications of the splenic artery.
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1. No specific evidence of lung metastasis.2. Nodular pleural thickening in the right lung apex is likely postinfectious in etiology. Recommend follow-up CT in 3 months to confirm stability. Comparison with prior outside CT studies maybe helpful.
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Generate impression based on findings.
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AMS and history of fall while on anticoagulants. Rule out ICH. No evidence of acute intracranial hemorrhage. No focal mass effect, midline shift or herniation. Mild periventricular and subcortical white matter hypoattenuation is nonspecific but compatible with small vessel ischemic changes and is unchanged. Global parenchymal volume loss is again seen, commensurate with age. No hydrocephalus. Thickening of the scalp in the occipital and right parietal regions is again seen and may be related to remote trauma. Chronic deformity of the left zygomatic arch is redemonstrated. The osseous structures of the skull are otherwise intact. Torus palatinus incidentally noted.
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No evidence of acute intracranial hemorrhage or mass effect.
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Generate impression based on findings.
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47-year-old male with persistent right lower quadrant abdominal pain that radiates to left lower quadrant. History of Crohn's disease of small bowel. Determine extent of disease activity. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 15 minutes. Fluoroscopic evaluation showed normal mucosa throughout the remaining small bowel, most of which appears to have been resected. No ulcers, sinus tracts, fistulae, or adhesions are identified. No separation of bowel loops was present to suggest fibrofatty proliferation. The neoterminal ileum and was normal in appearance with widely patent ileocolonic anastomosis. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. Patient reported mild left quadrant tenderness during the exam.TOTAL FLUOROSCOPY TIME: 2:08 minutes
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Most of small bowel appears to have been resected. Normal visualized small bowel with grossly patent ileocolonic anastomosis. No evidence of stenotic or active disease.
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Generate impression based on findings.
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17 year-old female status post laparoscopic appendectomy and IR fluid drainage now with new fever and pain for reevaluation of fluid collection ABDOMEN:LUNG BASES: Moderate to large left pleural effusion with adjacent left lower lobe and lingular atelectasis/consolidation. Right lower lobe atelectasis. No right pleural effusion. No pneumothorax. LIVER, BILIARY TRACT: No focal hepatic lesions. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: There are scattered mesenteric and retroperitoneal reactive lymph nodes.BOWEL, MESENTERY: Interval removal of a right pelvic drain. Postsurgical changes of an appendectomy are seen in the right lower quadrant with mild soft tissue stranding. Two partially organized fluid collections in the mesentery adjacent to the surgical bed measure less than 1.5 cm in diameter, decreased since the prior exam. The reference subhepatic loculated fluid collection has decreased in size now measuring 4.0 x 2.5 cm (series 5, image 65), previously 6.9 x 2.8 cm. Additional loculated fluid collections along the medial aspect of the right hepatic lobe also appear to have decreased in size in the interval. These lesions now measure 1.8 x 1.7 cm and 3.0 x 2.0 cm (series 5, image 48). An additional loculated fluid collection noted in the left paracolic gutter has also decreased in size since the prior exam now measuring 1.1 x 1.2 cm (series 5, image 65), previously 1.9 x 2.7 cm. There is interval resolution of the fluid around the greater curvature of the stomach. No evidence of obstruction.BONES, SOFT TISSUES: Collateralization is noted in the left hemithorax likely due to brisk injection.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There are scattered mesenteric and retroperitoneal reactive lymph nodes.BOWEL, MESENTERY: Interval removal of a right pelvic drain. Postsurgical changes of an appendectomy are seen in the right lower quadrant with mild soft tissue stranding. Two partially organized fluid collections in the mesentery adjacent to the surgical bed measure less than 1.5 cm in diameter, decreased since the prior exam. The reference subhepatic loculated fluid collection has decreased in size now measuring 4.0 x 2.5 cm (series 5, image 65), previously 6.9 x 2.8 cm. Additional loculated fluid collections along the medial aspect of the right hepatic lobe also appear to have decreased in size in the interval. These lesions now measure 1.8 x 1.7 cm and 3.0 x 2.0 cm (series 5, image 48). An additional loculated fluid collection noted in the left paracolic gutter has also decreased in size since the prior exam now measuring 1.1 x 1.2 cm (series 5, image 65), previously 1.9 x 2.7 cm. There is interval resolution of the fluid around the greater curvature of the stomach. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Postsurgical changes related to appendectomy.2.Interval decrease in multiple loculated and partially loculated fluid collections within the abdomen and pelvis as described above.3.Left moderate to large pleural effusion with adjacent atelectasis/consolidation.
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Generate impression based on findings.
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There are new foci of restricted diffusion in the posterior frontal right centrum semiovale, corresponding to T2 hyperintensity, compatible with acute infarctions. There is redemonstration of decreased diffusion scattered in the right frontal cortex, subcortical white matter, and centrum semiovale, which now appear more confluent. There is no longer restricted diffusion present within the right anterior caudate.Patchy foci of T2 hyperintensity in the left supratentorial white matter, without diffusion abnormality, is stable when compared to previous exam, and most compatible with chronic small vessel ischemic disease. Focal extra-axial soft tissue along the left parietal convexity, with corresponding FLAIR hyperintensity, measures up to 9 mm.There are scattered susceptibility along the right paramedian frontal lobe that are likely at least in part sulcal in location, without corresponding hyperdensity on CT, likely representing nonacute blood products, grossly similar when compared to previous exam given differences in exam technique. There is also increased prominence of the cerebral vasculature, right greater than left, consistent with collateralization secondary to Moyamoya syndrome.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. The distal right internal carotid artery flow void appears diminutive, which is unchanged. The circle of Willis flow voids are not well seen, however there are multiple tiny regional vessels along the proximal MCAs, consistent with lenticulostriate collaterals.Mild left frontal soft tissue swelling is compatible with recent trauma.
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1. New areas of acute infarct in the posterior right frontal lobe.2. Expected evolution of previously identified subacute infarctions in a deep watershed distribution on the right. 3. The distal right internal carotid artery flow void appears diminutive, similar in appearance to previous exam. Absence of normal flow voids in the circle of Willis with multiple tiny collateral vessels is consistent with known Moyamoya syndrome.5. Redemonstration of small left parietal convexity extra-axial soft tissue mass with associated FLAIR hyperintensity, which is favored to represent a meningioma.6. Mild left frontal soft tissue swelling is compatible with recent trauma.
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Generate impression based on findings.
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ABDOMEN:LUNG BASES: Interval decreased small bilateral pleural effusions, left greater than right, and associated atelectasis/consolidation. The amount of airspace opacities, particularly in the right lower lung, is greater than would normally be expected given the small amount of pleural fluid, raising the likelihood of infection/aspiration.LIVER, BILIARY TRACT: Interval removal of the right hepatic dome drain. A right subhepatic drain remains in place, with tip coiled in an approximately 8.2 x 10.3 cm (12/69) loculated fluid collection, with associated hypoattenuation of the the inferior approximately 3 cm the hepatic parenchyma. Additionally, there is a new approximately 2.6 x 2.6 x 3.3-cm hypoattenuating focus in the right posterior hepatic lobe (12/45). Given the short interval development, this is more consistent with infection than metastases.Multiple additional nodular densities near the hepatic hilum, some of which have low attenuation centrally, likely represents necrotic lymph nodes.SPLEEN: Interval decreased size of peri-splenic fluid collection.PANCREAS: Nonspecific hypoattenuating collection just superior to the head of the pancreas (12/58) measures approximately 3.5 x 4.5 cm, similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several left hypoattenuating renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nasogastric tube coiled in the gastric antrum. Right midabdominal ostomy site with enteric contrast material. Postoperative findings of right hemicolectomy.BONES, SOFT TISSUES: Anterior abdominal wound is again seen.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.Interval removal of hepatic dome drain, with one remaining drain in the subhepatic fluid collection as above. This collection may represent persistent abscess, although it is unclear to what extent the gallbladder carcinoma plays a role in this process.2.Adjacent nodular densities with central hypoattenuation could represent necrotic lymph nodes or associated small satellite abscesses.3.Right lower lung patchy consolidation, consider aspiration/infection.
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Generate impression based on findings.
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52 years remote history of moyamoya syndrome secondary to chronic cocaine usage, now presenting with new left-sided weakness. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. No extra-axial collections are identified. Hypoattenuation in the right basal ganglia, right frontal and parietal lobes is more confluent and extensive when compared to most recent CT of the head. There is an area of new oval hypodensity corresponds to new areas of diffusion restriction on the concurrent MRI, most consistent with new infarction. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent other chronic small vessel ischemic changes, and are grossly unchanged. The paranasal sinuses and mastoid air cells are clear. The calvarium is intact. Mild left frontal soft tissue swelling without underlying fracture suggests recent trauma.
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1. The hypoattenuation within the right basal ganglia, right frontal and parietal lobes is more confluent and extensive when compared to most recent head CT. In addition, there are new areas of restricted diffusion on concurrent MRI, most consistent with evolving subacute infarction with superimposed acute infarcts in a deep watershed distribution.2. No acute intracranial hemorrhage is identified.
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Generate impression based on findings.
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The cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C3-C4, there is a small central disk protrusion which approaches the ventral cord. There is mild bilateral uncovertebral hypertrophy and facet arthropathy. There is mild central spinal canal stenosis and mild left foraminal narrowing. There is also trace ligamentum flavum thickening.At C4-C5, there is a very minimal central disk protrusion with annular fissure. There is mild bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild-moderate bilateral foraminal narrowing.At C5-C6, there is a mild diffuse posterior osteophyte disk complex. There is mild bilateral uncovertebral hypertrophy and left facet arthropathy, along with ligamentum flavum thickening. There is overall moderate central spinal stenosis and moderate-severe left as well as mild to moderate right foraminal narrowing.At C6-C7, there is a trace disk bulge with mild bilateral uncovertebral hypertrophy. There is mild to moderate left greater than right foraminal narrowing as well as moderate central spinal canal stenosis. There is ligamentum flavum thickening.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There is again patchy T2 hyperintensity within the pons which is nonspecific but could relate to chronic small vessel ischemic changes, this adjusted on brain MRI. There may be subtle T2 hyperintensity along the cerebellar folia.THORACIC SPINE
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1. Exam limited due to lack of contrast as well as lack of axial imaging through the thoracic spine. Within these limitations, findings suggestive of osseous metastatic disease throughout the thoracic vertebrae with focal lesions as detailed above. No evidence of vertebral compression deformity at this time.2. Moderate spondylotic changes along the cervical spine with moderate central spinal canal stenosis at C5-C6 and C6-C7. Up to moderate-severe left foraminal narrowing at C5-C6.3. Partially visualized cerebellar abnormal signal suggestive of known leptomeningeal metastatic disease. Nonspecific pontine abnormal signal likely relating to chronic small vessel ischemic changes. Please note that spinal leptomeningeal disease cannot be assessed for due to lack of intravenous contrast.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Dysphagia, evaluate for cancer ABDOMEN:LUNG BASES: Moderate bilateral pleural effusions with overlying compressive atelectasis.LIVER, BILIARY TRACT: Scattered hepatic hypodensities are too small to further characterize.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Low attenuation left superior pole focus, likely benign.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: Suture line at the cecal base. Extensive diverticulosis of the descending and sigmoid colon without evidence of diverticulitis. Moderate stool in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.No mass or other findings to suggest malignancy.2.Bilateral pleural effusions with overlying compressive atelectasis.3.No acute abnormality in the abdomen or pelvis.
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Generate impression based on findings.
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Male 60 years old Reason: ETOH hepatitis evaluate for cirrhosis History: ETOH hepatitis LIVER: The liver measures 18.6 cm in length with diffusely hyperechoic hepatic parenchyma suggestive of fatty infiltration. There is no focal liver lesion. There is minimal nodularity of the liver capsule suggestive of early cirrhotic morphology. The portal vein demonstrates normal directional flow with peak velocity is 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 9.8 cm. The left kidney measures 11.6 cm. There is no hydronephrosis or shadowing renal stones. There is a 1.1 x 1.0 x 0.8 cm left upper pole cyst.OTHER: The spleen was not clearly identified.
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1. Fatty infiltration of the liver with minimal nodularity of the capsule suggestive of early cirrhotic morphology.2. Cholelithiasis.
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Generate impression based on findings.
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70 year-old female with history of sepsis and chronic lower extremity wounds. The bones are demineralized suggesting osteopenia.Right foot: Limited study secondary to only 2 views. There is no acute fracture. Moderate osteoarthritis affects the midfoot and Lisfranc joint. There is mild diffuse soft tissue swelling. There are radiographic findings of osteomyelitis. Scattered arterial calcifications are present.Left foot: Limited study secondary to only 2 views. There is no acute fracture. There is extensive soft tissue swelling about the dorsal aspect of the foot. Moderate degenerative disease affects the midfoot and Lisfranc joint. There are no radiographic findings of osteomyelitis. Right tibia/fibula: There is diffuse soft tissue swelling. There are no radiographic findings of osteomyelitis. Scattered arterial calcifications are present.Left tibia/fibula: There is diffuse soft tissue swelling. There are no radiographic findings of osteomyelitis. Scattered arterial calcifications are present.Right femur: Moderate to severe degenerative disease affects the knee. There are scattered arterial calcifications.Left femur: A vascular stent is noted within the medial soft tissues. There is no acute fracture. Moderate to severe degenerative disease affects the knee.
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Degenerative disease and soft tissue swelling as above without radiographic findings of osteomyelitis.
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Generate impression based on findings.
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History of metastatic bladder cancer restaging after two cycles of investigational oral drug CHEST:LUNGS AND PLEURA: Reference left upper lobe nodule measures 5 mm, previously 5 mm (series 6, image 11). Reference right upper lobe nodule measures 9 mm, previously 7 mm (series 6, image 20). No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Left hilar mass measures 3.8 x 3.2 cm, previously 2.0 x 2.0 cm (series 6, image 59). Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Delayed images opacify the collecting system and ileal conduit without evidence of disease recurrence.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. Reference left periaortic lymph node measures 1.3 x 1.3 cm (series 7, image 118), unchanged.BOWEL, MESENTERY: Right lower quadrant ileostomy. BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: Increasing and extensive pelvic lymphadenopathy. Reference left pelvic lymph node measures 8.1 x 5.8 cm (series 7, image 176), previously 4.8 x 2.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Increasing pelvic lymphadenopathy.2.Increasing right apical pulmonary nodule.3.Increasing left hilar mass.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal grandmother. Two standard digital views of both breasts and an additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable benign centimeter masses are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable benign bilateral masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Three standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A MicroMark clip is present in the central right breast. Multiple coarse benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Bilateral coarse calcifications. No mammographic evidence of malignancy. Screening mammography is most sensitive when evaluating for interval changes. If the patient submits outside mammogram, comparison will be made. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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History of right mastectomy in 2004 for infiltrating mammary carcinoma. Patient received radiation, chemotherapy and hormonal therapy. No new breast complaints. History of breast cancer in maternal grandmother. Three standard views of the left breast 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 the left breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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85 year-old female with dysphagia on purée diet. This is a limited exam done semierect and only in AP view due to patient's severely limited mobility both with standing and on the exam table.Single contrast evaluation of the esophagus showed severe motility abnormality, with absence of primary peristaltic wave and diffuse hypoperistalsis. Moderate, sigmoid-shaped dilation of the esophagus was noted. There is tapering of the distal esophagus and tightness of the gastroesophageal junction, with delay of passage of contrast noted. Eventual mild relaxation does occur allowing passage into the stomach. Small anterior mid cervical web is additionally noted, may be incidental; highly unlikely to be the primary cause of patient's symptoms.Of note, patient reported chest pain after approximately half cup of barium was ingested.TOTAL FLUOROSCOPY TIME: 3:11 minutes.
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Dilated esophagus behind a tight gastroesophageal junction. This finding is nonspecific. Stricturing from from chronic reflux esophagitis and subsequent esophageal dilatation may cause these this appearance. Achalasia is possible but would be unusual for a patient of this age. While no mass lesion is visualized, pseudoachalasia remains a diagnostic consideration, and further evaluation with endoscopy with biopsy can be considered if clinically indicated.
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Generate impression based on findings.
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65-year-old male with right swollen leg, eval for destructive process Mild osteoarthritis affects the knee. A small joint effusion is noted. Arterial calcifications are present in the posterior soft tissues. No focal lytic lesion is visualized.
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Mild osteoarthritis and small joint effusion.
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Generate impression based on findings.
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76 years, Female, Reason: Metastatic breast cancer needs re-evaluation and compare to prior scans. Measurements where applicable. History: Metastatic breast cancer needs re-evaluation and compare to prior scans. Measurements where applicable. CHEST:LUNGS AND PLEURA: Reference nodule in the right upper lobe measures 6 mm, previously 6-mm (series 5; image 34). Multiple right lower lobe subpleural nodules are overall unchanged. The reference right posterior subpleural nodule measures 6 mm, previously 6 mm (63; series 5). There is interval increase in size in a right paramediastinal pleural based nodule which measures 1.4 x 1 .3 cm, previously 1.1 x 1.0 cm (66; series 5). Multiple additional bilateral pulmonary nodules also appear slightly increased in size compared to the prior study. No new pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: Precarinal node is unchanged measuring 19 mm (series 3; image 37). Right hilar lymphadenopathy is unchanged measuring approximately 12 mm, previously 13 mm (series 3; image 37). Subcarinal lymphadenopathy and prominent cardiophrenic node are unchanged. Left chest port with tip at the cava atrial junction. Heart size is normal without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Reference right axillary lymphadenopathy measures 13 mm, previously 13 mm (series 3; image 14). Right axillary surgical clips. Status post bilateral mastectomies. Nonspecific nodules along the right chest wall are unchanged but remain suspicious for metastatic deposits. Sclerotic focus in the body of the sternum appearing similar to the prior study.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Hepatic hypodensities are too small to characterize but remain stable.SPLEEN: Small splenule. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing stone in the left lower pole. Partial duplication of the collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: 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: Mild degenerative changes of the visualized spine. Soft tissue lesion in the left S3 neural foramina is stable since 3/6/2014 and appears most consistent with a Tarlov cyst. Multiple benign appearing sclerotic lesions in the pelvis may represent bone islands. OTHER: No significant abnormality noted.
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1.No significant interval change in prior reference pulmonary nodules with slight interval increase in size of additional pulmonary nodules, with measurements provided above. No new pulmonary nodules or mass are identified.2.Persistent mediastinal, hilar and right axillary lymphadenopathy.3.Nonspecific soft tissue lesions in the right chest wall are stable and remain suspicious for metastatic deposits.4.Equivocal sclerotic focus in the body of the sternum, unchanged from prior. Further evaluation with a nuclear medicine bone scan could be considered if clinically indicated.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign calcifications are present, including arterial calcifications.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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31-year-old male with wrist injury while skiing last week On the lateral view there is a questionable nondisplaced fracture of the dorsal aspect of one of the bones of the proximal carpal row, most likely the triquetrum. We cannot confirm this on the PA or oblique views. If the patient complains of dorsal pain at this site, further evaluation with CT is recommended.
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Questionable fracture of the dorsal triquetrum. Further evaluation with CT is recommended if clinically warranted.Findings discussed with Dr. Veskovic (pager 8002) at the time of dictation.
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Generate impression based on findings.
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18 year-old intubated female with ARDSVIEW: Chest AP (one view) 01/27/15, 0237 ET tube tip is below thoracic inlet and above carina. Left subclavian catheter tip is in the superior vena cava. Right upper extremity PICC tip is at the superior cavoatrial junction. Enteric tube courses below the field-of-view.Cardiothymic silhouette is top normal. Low lung volumes. Persistent bilateral airspace opacities.
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ET tube tip is below thoracic inlet and above carina. Persistent bilateral airspace disease.
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Generate impression based on findings.
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53 year old with a left breast mass detected on screening mammogram presents for ultrasound guided biopsy. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is an irregularly-shaped hypoechoic mass measuring 12 x 7 mm at the 6 o’clock position with increased vascularity, 5 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided aspiration/core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. Attempt of aspiration with 21 G needle was performed and no fluid was obtained. Subsequently, a 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens partially sank in the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.
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Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Hip total arthroplasty primary, uncemented The right femoral head and neck have been resected. An acetabular component is affixed in near-anatomic alignment. A femoral component precursor is also situated in near-anatomic alignment. Severe osteoarthritis affects the left hip. Subsequent radiographs have been interpreted.
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Intraoperative findings of total right total hip replacement as above.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal aunt. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Leg length discrepancy.VIEWS: Right femur AP/lateral (two views) 01/27/15 Osteotomy gap measures 6.8 cm laterally. Bone formation within the osteotomy appears slightly decreased.External fixator remains in place. No lucencies are seen around the screws. Premature fusion of distal femoral physis and plate and screws device and medial aspect of distal femur are again noted.
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Increase in osteotomy gap and increase in bone formation within gap.
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Generate impression based on findings.
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54-year-old with history of left breast cancer status post mastectomy. No current complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. A few benign calcifications are noted.Benign appearing lymph nodes are projected over the right axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Pain There is slight prominence of the navicular tuberosity which was present on prior studies and could conceivably reflect old trauma, but is of uncertain current clinical significance. I see no specific findings to account for the patient's pain.
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Slight prominence of the navicular tuberosity, unchanged. Otherwise I see no specific findings to account for the patient's pain.
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Generate impression based on findings.
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Right knee pain Moderate osteoarthritis affects the knee that appears to have progressed when compared with the prior study. There is now near bone-on-bone apposition of the lateral tibiofemoral compartment on the Skier's view. There are also tricompartmental osteophytes, and a small joint effusion.Mild osteoarthritis affects the left knee as seen on the frontal views.
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Osteoarthritis.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign calcifications are present bilaterally, including arterial calcifications.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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4-year-old male with tachypnea and desatsVIEW: Chest AP (one view) 01/27/15, 0244 Right upper extremity PICC with tip in the right atrium. Gastrostomy tube is unchanged. Spica is partially visualized.Cardiothymic silhouette is normal. Complete left lower lobe collapse with left mediastinal shift. Right upper lobe opacity may reflect overlying soft tissue. No pneumothorax. Mild left curvature of the thoracic spine.
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Left lower lobe collapse.
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