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Generate impression based on findings.
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Posterior neck pain, postop day 5. Streaky foci of low density are seen within the posterior soft tissues of the neck that I suspect represents gas. Aside from minimal degenerative arthritic changes, the cervical spine is unremarkable. Note is made of impacted molars.
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Findings suggestive of gas density within the posterior soft tissues of the neck. This was relayed to Dr. Schufreider at the time of dictation. As the patient's recent surgery did not involve the neck, computed tomography is recommended for further evaluation, as I cannot exclude the possibility of a soft tissue infection.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying the right breast. Stable benign mass is present in the right upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Benign right breast mass. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Female 68 years old Reason: Eval for ascites + progression hepatic mets History: Abdominal distention, Metastatic ovarian Ca LIVER: The liver parenchyma is largely replaced by diffuse metastatic disease. A reference lesion in the left lobe measures 3.6 x 3.9 x 4.9 cm. The portal vein is patent and demonstrates normal directional flow with a velocity of 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. There is trace pericholecystic fluid. There is no biliary dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 8.6 cm. The left kidney measures 10.0 cm. There is no hydronephrosis.OTHER: Right pleural effusion. Trace abdominal ascites. Splenic granulomata.
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1. Diffuse hepatic metastatic disease and trace ascites.2. Right pleural effusion.
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Generate impression based on findings.
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Male 61 years old; Reason: Esophageal cancer, please perform per CALGB 80803 requirements. RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates distal esophageal wall thickening which is not significantly changed. There is redemonstration of a hypodense lesion in the right kidney unchanged. Small nonobstructing left renal calculus is again noted. Linear density in the left lung base is again seen. Sclerotic focus in the right femoral intertrochanteric region is unchanged. Today's PET examination demonstrates marked FDG uptake in the distal esophageal wall correlating with the wall thickening seen on CT not significantly changed from prior study with an SUV max of 17.6, previously 18.6. Again seen is a focus of increased activity in the right paratracheal region corresponding to the right paratracheal lymph node on comparison CT with an SUV max of 5.6, previously 6.4.FDG uptake in the remaining portion of the body is physiological, including the liver, spleen, kidneys, intestines and bladder.There is decreased metabolic activity in the low-attenuation lesion of the right kidney, which again likely represents a renal cyst. There is no abnormal FDG uptake in the sclerotic focus seen on CT in the right intertrochanteric region.
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Stable disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is 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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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, unchanged in pattern and distribution. Benign bilateral calcifications continue to progress in a benign fashion. Stable focal asymmetry is present in the lateral right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Benign progression of bilateral calcifications. Right focal asymmetry. 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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Reason: lung cancer and new PE s/p chemorads, ck for malignancy recurrence, look at pancreas for new primary History: PE, dyspnea CHEST:LUNGS AND PLEURA: Large left chest wall mass with extensive obstruction of the left fifth and sixth ribs, measuring approximately 4.7 x 8.2 cm, not significantly changed using comparable measurements.However there is increased lytic bone destruction compared to the previous scan.Severe emphysema and scarring are present elsewhere throughout the lungs.Interval resolution of thrombus from the right middle lobe pulmonary arteries.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes, unchanged, compatible with previous infection.Severe coronary artery calcification.CHEST WALL: Left chest wall mass as described with increased destruction of the fifth and sixth ribs.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: Small bilateral cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic and iliac atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Large stable left chest wall mass with interval progression of lytic rib destruction.
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Generate impression based on findings.
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Pain and swelling There is a comminuted intra-articular fracture of the head and neck of the second metacarpal, with approximately 30 degrees of volar angulation of the distal fracture fragment. Deformity of the fifth metacarpal neck likely represents an old healed fracture. There is swelling of the dorsal soft tissues of the hand.
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Fracture of the second metacarpal head/neck as described above.
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Generate impression based on findings.
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History of right lumpectomy in 2002 for DCIS. Patient received hormonal therapy but did not receive radiation therapy. No current 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. Scar marker overlies the right breast upper outer quadrant, with minimal underlying parenchymal scarring. Few benign calcifications are present in both breasts.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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Knee pain. Assess severity of degenerative joint disease and evaluate for other intercurrent pathology. Four views of the left knee are provided. Moderate to severe osteoarthritis affects the knee with narrowing of the medial tibiofemoral compartment and tricompartment osteophytes. The degree of osteoarthritis appears to have progressed when compared with the prior study. There is a slight varus deformity of the knee. I see no large joint effusion.Severe osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis.
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Generate impression based on findings.
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Female 56 years old; Reason: Hx of Bladder Cancer s/p cystectomy with neobladder. Eval for recurrent or metastatic disease History: See above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Fatty liver. Cholelithiasis.SPLEEN: Unchanged splenic appearance.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No renal masses. Prompt contrast enhancement and excretion.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.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: Surgical neobladder, without irregularity or abnormal enhancement.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No obstruction. Post surgical changes related to neobladder formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of recurrent or metastatic disease.
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Generate impression based on findings.
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Follow-up A side plate and screws affix a fracture of the distal fibula in near-anatomic alignment. The fracture line is less distinct than that seen on the prior study suggesting some interval healing. I see no hardware complications. I suspect that there is also a healing fracture of the "posterior malleolus" of the distal tibia. Ankle joint alignment is within normal limits.
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Healing fractures as described above.
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Generate impression based on findings.
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Reason: Eval for brain metastases History: Ovarian Ca; L-sided facial twitching The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present predominantly adjacent to the left lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin.
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1. No evidence for acute intracranial hemorrhage mass effect or edema.2. Periventricular white matter lesions adjacent to the left lateral ventricle are present these are nonspecific. Most likely there vascular related at this age3. MRI is more sensitive in the detection of brain metastases compared to noncontrast CT.
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Generate impression based on findings.
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Left knee pain. Multi-ligamentous injury. Four views of the left knee are provided. There is a joint effusion. I see no fracture or malalignment.The right knee appears normal as seen on the frontal views.There is approximately 7 degrees of valgus alignment of the knee with respect to the neutral mechanical axis. Mild osteoarthritis affects the hip.
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Joint effusion and valgus alignment of the left knee as described above.
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Generate impression based on findings.
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75-year-old with history of left breast ADH status post excisional biopsy in 2009. The patient also has history of left lumpectomy in 1996 for ILC. Three standard views of both breasts and a left laterally exaggerated were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Postsurgical volume loss, density, distortion, surgical clips and dystrophic calcifications are again noted in the left breast near the lumpectomy site. Multiple bilateral benign calcifications are also noted bilaterally elsewhere. Stable focal asymmetry in the right lower central 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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72-year-old male with history of bladder cancer, evaluate and compare to prior CHEST: LUNGS AND PLEURA: Stable bilateral pulmonary nodules, likely benign.MEDIASTINUM AND HILA: No lymphadenopathy. Moderate coronary artery calcifications. CHEST WALL:ABDOMEN:LUNG BASES: No suspicious hepatic lesions. Status post cholecystectomy.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: Stable renal cysts and additional foci too small to further characterize. Nonobstructive left renal pelvis stone. Delayed images opacify the collecting system and Indiana pouch without evidence of disease recurrence.RETROPERITONEUM, LYMPH NODES: Calcifications of the abdominal aorta and its branches without aneurysmal dilatation. No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ileal conduit. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic focus in S2; likely a benign bone island.
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1.Status post cystoprostatectomy without evidence of disease in the abdomen or pelvis.2.Stable pulmonary nodules, likely benign.
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Generate impression based on findings.
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Male 53 years old; Reason: Prostate cancer, rising PSA, assess for metastatic cancer History: none 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:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Evaluation of the bladder base is limited by streak artifact from surgical clips. Rounded fluid collection below the pubic symphysis is felt to represent a portion of the urinary bladder going into the prostatectomy bed. Circumferential wall thickening, nonspecific likely secondary to decompression, with cystitis not excluded.LYMPH NODES: Right pelvic lymph node measuring 6 mm in short axis not enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Please see same day bone scan.OTHER: No significant abnormality noted.
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1.Status post prostatectomy. No overt CT evidence of metastatic disease. Please also see same day bone scan report.
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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 mother and maternal grandmother. History of ovarian cancer in paternal aunt. 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. Round markers were placed on skin lesions the overlying the right breast.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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62 year-old female with history of multiple myeloma. The bones are demineralized.SKULL: There are innumerable lytic lesions compatible with myeloma.CERVICAL SPINE: No discrete myelomatous lesions. Vertebral body heights are preserved.THORACIC SPINE: No discrete myelomatous lesions. Mild multilevel degenerative disc disease affects the thoracic spine. Vertebral body heights are preserved.LUMBAR SPINE: No discrete myelomatous lesions. Vertebral body heights are preserved.RIBS: Right chest port with tip in the SVC. Multiple healing/healed rib fractures noted, but we see no discrete lytic lesions.PELVIS: No discrete myelomatous lesions. Mild osteoarthritis affects the hips bilaterally.UPPER EXTREMITY: There is a round lucency present in the right distal humeral diaphysis. Additional smaller lucencies are present in the right mid humeral diaphysis which may represent multiple myeloma. Similar appearing lucencies are present in the left humeral diaphysis which may represent additional myelomatous deposits. Mild degenerative arthritic changes affect the wrists bilaterally.LOWER EXTREMITY: No discrete myelomatous lesions.
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Multiple myelomatous lesions as above mostly involving the calvarium.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy. Patient has rash under both breasts. 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. A linear marker was placed on the scar overlying the left breast. Stable benign circumscribed masses are present bilaterally, including a mass with internal calcifications in the left upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable bilateral masses. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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53 year-old female with history of pain. Left knee: Mild osteoarthritis affects the left knee particularly at the patellofemoral articulation.Right knee: Mild to moderate osteoarthritis affects the right knee particularly at the patellofemoral articulation.
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Osteoarthritis as above.
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Generate impression based on findings.
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Head trauma, on Coumadin. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Unchanged sclerotic foci involving the clivus on the left and right parietal bone near the vertex which remain unchanged since 4/9/2008 and most likely benign. No destructive lesions are seen. Small subgaleal hematoma in the occipital region in the midline. Underlying calvarium is intact. Partially visualized deformity of the right medial orbital wall again seen, likely related to remote trauma.
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1. No evidence of acute intracranial hemorrhage or mass effect. 2. Small occipital subgaleal hematoma. Underlying calvarium is intact.
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Generate impression based on findings.
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Asymptomatic female with possible new subcentimeter mass in the right lower inner quadrant. Personal history of uterine carcinoma. Prior mammograms at Rush. ML and spot compression images of the right breast were obtained and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The circumscribed low density subcentimeter mass in the right lower inner quadrant persists with spot compression.No suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND
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Circumscribed mass in the right lower inner breast, most compatible with an intramammary lymph node or oil cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Right upper lobe micronodule along the fissure is unchanged (series 4 image 52). Basilar subsegmental atelectasis/scarring. No new suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Small hypoattenuating foci in the thyroid gland unchanged. No mediastinal or hilar lymphadenopathy. Moderate-severe coronary arterial calcification. Normal heart size without pericardial effusion.CHEST WALL: Severe multilevel degenerative changes of the lumbar spine appear similar to the prior study.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating hepatic foci unchanged, most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel lumbar spine degenerative changes.OTHER: No significant abnormality noted.
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No evidence of metastatic disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views 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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71 year-old male with rectal cancer, evaluate and compare to prior CHEST:LUNGS AND PLEURA: Moderate - severe centrilobular emphysema. Scattered calcified pulmonary nodules. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Calcified mediastinal and hilar lymph nodes. Moderate - severe coronary artery, thoracic aorta, and arch vessel calcification.CHEST WALL: Right chest wall port tip in the distal SVC. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions.SPLEEN: Calcified splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcification of the abdominal aorta and its branches. The infrarenal abdominal aorta is ectatic. No lymphadenopathy.BOWEL, MESENTERY: Fat-containing umbilical hernia.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Mild nonspecific symmetric posterior bladder wall thickening, slightly increased from the prior exam.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.No evidence of disease in the chest, abdomen, or pelvis.2.Nonspecific symmetric posterior bladder wall thickening, increased from prior, raises the possibility of cystitis.
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Generate impression based on findings.
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72-year-old female with history of pain. Right foot: There is a mild hallux valgus deformity. Mild osteoarthritis affects the first MTP and interphalangeal joints. There is a mild pes planus deformity.Left foot: Mild osteoarthritis affects the first MTP and interphalangeal joints. There is a mild pes planus deformity. A small ossicle is present adjacent to the navicular which may represent a normal variant or chronic trauma.
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Mild osteoarthritis and flatfoot deformity bilaterally.
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Generate impression based on findings.
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Reason: mets lung cancer, s/p 3 cycles of chemo. pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Severe centrilobular and paraseptal apical predominant emphysema.Increased soft tissue within the area of right apical scarring with a new nodular component measuring 1.2 x 0.9 cm (series 4 image 25) is highly suspicious for or a new primary neoplasm or less likely metastatic disease. Left upper lobe scarring and nodularity with reference component measuring 1.4 x 0.9 cm (series 4 image 22) not significantly changed. Right middle lobe nodular opacity abutting the pericardium (series 4 image 76) not significantly changed.No pleural effusions.MEDIASTINUM AND HILA: Small mediastinal lymph nodes stable to mildly decreased in size. No visible coronary calcifications. Normal heart size without pericardial effusion.CHEST WALL: Interval decrease in size of right axillary lymph node now measuring 10 mm in short axis (series 3 image 24) previously 20 mm. Right subpectoral lymph nodes also decreased in size.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: Unchanged nonspecific mild adrenal thickening.KIDNEYS, URETERS: Unchanged small renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Interval decrease in size of paracaval lymph node now measuring 8 mm (series 3 image 13) previously 15 mm. Other gastrohepatic and retroperitoneal lymph nodes are also smaller.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. New nodular soft tissue within the area of right apical scarring, suspicious for a new primary neoplasm.2. Interval decrease in thoracic and abdominal lymphadenopathy since the prior study.3. Unchanged left apical reference lesion.
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Generate impression based on findings.
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T12/L1: Again seen is the L1 vertebral body fracture with 50% loss of height with mild retropulsion, Mild to moderate facet hypertrophy and ligamentum flavum thickening which is similar to the recent previous MRI. Unchanged minimal spinal canal stenosis. No significant bony neuroforaminal narrowing.L1/2: Mild disk bulge and mild to moderate facet hypertrophy without significant spinal canal stenosis. Mild right bony neuroforaminal narrowing. No evidence of an underlying lucent lesion to indicate a pathologic fracture.L2/3: Mild disk bulge, moderate facet hypertrophy and ligamentum flavum thickening without significant spinal canal stenosis. No significant bony neuroforaminal narrowing.L3/4: Mild disk bulge, moderate facet hypertrophy and ligamentum flavum thickening. Mild central spinal canal stenosis. No significant bony neuroforaminal narrowing.L4/5: Redemonstration of an L5 vertebral body compression fracture with 75% loss of height and moderate retropulsion. This combined with the disc bulge, thickening of the ligamentum flavum and moderate bilateral facet arthropathy, contributes to severe spinal canal stenosis and compression of the cauda equina. The neuroforaminal narrowing is not significantly changed. No evidence of an underlying lucent lesion to indicate a pathologic fracture.L5/S1: Vacuum disc phenomenon, bilateral facet hypertrophy, and ligamentum flavum thickening without significant spinal canal stenosis or neuroforaminal narrowing. Degenerative changes are noted about the sacroiliac joints. An incompletely visualized right pelvic fluid filled structure appears to arise from the bladder and may represent a large bladder diverticulum.
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1.Compression fracture of the L5 vertebral body with 75% loss of height, moderate retropulsion and degenerative changes which causes severe spinal canal stenosis and compression of the cauda equina. Taking into account differences in technique between CT and MRI, there appears to be no significant interval change. No definite evidence of an underlying lucent lesion to indicate a pathologic fracture.2.Compression fracture of the L1 vertebral body with 50% loss of height and minimal retropulsion which causes no significant spinal canal stenosis. No definite evidence of an underlying lucent lesion to indicate a pathologic fracture.3.Additional degenerative changes of the lumbar spine are not significantly changed.4.An incompletely visualized right pelvic fluid-filled structure appears to arise from the bladder and may represent a large bladder diverticulum. Further imaging evaluation may be considered as clinically warranted.
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Generate impression based on findings.
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Female 33 years old Reason: Please evaluate for Hepatosplenomegaly, portal HTN, sarcoid involvement of the liver, spleen, pancreas, or cirrhosis History: 32 yo F with likely pulmonary and hepatic sarcoid. LIVER: The liver measures 14.2 cm in length and demonstrates a lobulated contour and heterogeneous echotexture. No measurable focal lesion is identified.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. No biliary dilatation.PANCREAS: Unremarkable appearance of the pancreatic head and proximal body. The distal body and tail are poorly visualized.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 12.3 cm. There is no hydronephrosis.OTHER: The spleen measures 12.1 cm in length.
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There is no hepatosplenomegaly. Diffusely heterogeneous hepatic echotexture which may be secondary to infiltration from patient's known sarcoidosis.
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Generate impression based on findings.
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61-year-old male with history of kidney neoplasm, reevaluate disease status following systemic therapy. CHEST:LUNGS AND PLEURA: Decreased pleural effusion, with persistent right lower lung/lung base pleural thickening and nodularity (3/72).No pleural effusion.MEDIASTINUM AND HILA: Lower right paraesophageal lymph node (3/75) measures 1.8 x 1.5 cm, unchanged. No pericardial effusion. Heart size within normal limits.CHEST WALL: No fracture or lymphadenopathy. Degenerative changes of the visualized spine.ABDOMEN:LIVER, BILIARY TRACT: The previously described 3 well marginated hypo-attenuating hepatic lesions are similar to prior in size and appearance, nonspecific and likely benign cysts. Additional small cysts are also seen. The previously described hypodense nodule, better seen on coronal images, abutting the right hepatic lobe (3/99) measures approximately 2.6 x 2.1 cm, previously measured 2.7 x 2.7 cm. Size comparison is limited due to varying technique. This may represent an exophytic hepatic lesion, and should be evaluated with MRI for more specific diagnosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland is surgically absent.KIDNEYS, URETERS: Right nephrectomy, unchanged.RETROPERITONEUM, LYMPH NODES: Reference right retrocrural lymph node (3/103) measures 11 x 8 mm, previously 14 x 9 mm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left neck base lymph node with hypoattenuating center (3/12) measures 22 x 18 mm, previously 18 x 14 mm.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5/S1 right lamina fragmentation, unchanged.OTHER: No significant abnormality noted
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1.Interval decreased right pleural effusion, with persistent right lower lung pleural nodularity suspicious for metastatic disease.2.Right perihepatic hypoattenuating nodule, may represent an exophytic hepatic nodule, and would be better evaluated with dedicated liver MRI.3.Left neck base necrotic lymph node has increased in size slightly over the interval.4.Mildly enlarged paraesophageal and retrocrural lymph nodes, unchanged.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional left MLO view 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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Bilateral calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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45-year-old female with a left breast mass detected on recent screening mammogram presents for ultrasound guided biopsy. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a circumscribed oval hypoechoic mass measuring 15 x 10 mm at the 6 o’clock position with increased vascularity, 1 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 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. 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 sank to the bottom of 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 ribbon 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. 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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71-year-old male with history of cervical stenosis. Evaluation of the lower cervical spine is limited on the lateral view due to overlying anatomy.Severe multilevel facet joint osteoarthritis appears similar to the prior study. Mild to moderate degenerative disc disease affects C4-5, but the visualized remaining disc spaces are relatively well preserved. Degenerative arthritic changes also affect the C1-2 articulation.
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Degenerative arthritic changes as described above most severely affecting the facet joints. If further evaluation for cervical stenosis is needed, MRI may be obtained.
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Generate impression based on findings.
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abdominal pain, diarrhea The scout film shows a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is no evidence of obstructing or constricting lesions. Extensive diffuse colonic diverticulosis was noted. Significant tortuosity and redundancy of the sigmoid colon was noted, with significant overlap of sigmoid colon which limits evaluation. No ulceration, edema, or mass lesion was identified. Small amounts of barium and air were refluxed into the terminal ileum.
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1.Extensive diffuse colonic diverticulosis. 2.Significant tortuosity and redundancy of the sigmoid colon was noted. 3.No specific findings to account for patient's pain.
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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. Round markers were placed on skin lesions overlying both breasts. A partially obscured 8mm mass is present in the right upper outer quadrant.No suspicious microcalcifications or areas of architectural distortion are present.
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Right breast mass. Spot compression imaging and ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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4-year-old female with fractureVIEWS: Right foot AP/lateral (two views) 01/27/15, 1003 hour The transverse fracture line through the proximal phalanx of the fourth toe is less distinct with surrounding callus formation and periosteal reaction suggestive of interval healing. Alignment is near anatomic.
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Healing fourth toe proximal phalanx fracture.
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Generate impression based on findings.
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Ventricles and sulci are prominent, indicating volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Mild scattered periventricular and subcortical T2 hyperintensities are unchanged and nonspecific but likely represent chronic small vessel ischemic disease. There is no diffusion abnormality. No extra-axial fluid collection is identified.Lenses are thin bilaterally, likely relating to prior cataract surgery. Mild mucosal thickening in the maxillary sinuses, as well as the frontal and ethmoid sinuses. The left maxillary sinus is hypoplastic. Prominent vessel in the right frontal lobe on susceptibility images may represent a small developmental venous anomaly and is unchanged from the prior study. 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.No evidence of acute infarct, mass effect or edema.2.Stable mild chronic small vessel ischemic disease and volume loss.
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Generate impression based on findings.
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10-year-old male postopVIEWS: Left foot AP/lateral (two views) 01/27/15, 1010 hour The bones appear demineralized. No acute fracture is evident. Persistent equinovarus and pes cavus deformities appear slightly improved since the prior exam. The distal phalanx of the great toe is underdeveloped.
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Persistent equinovarus and pes cavus deformities appear slightly improved since the prior exam.
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Generate impression based on findings.
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Right foot pain and dorsal swelling; chronic steroid use. The bones appear slightly demineralized. There is mild deformity of the proximal phalanx of the fourth toe likely representing a healing or healed fracture. A small well corticated ossicle adjacent to the lateral sesamoid beneath the first metatarsal head is of doubtful current clinical significance. Otherwise I see no specific findings to account for the patient's pain.
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Probable old posttraumatic changes without specific findings to account for the patient's foot pain. If there is clinical concern for stress fracture, repeat radiographs may be obtained in 10 to 14 days.
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Generate impression based on findings.
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14-year-old male with pain after falling on outstretched armVIEWS: Left wrist PA/oblique/lateral (3 views) 01/27/15, 1038 hour No acute fracture or malalignment is evident.
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Normal examination.
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Generate impression based on findings.
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Male 58 years old; Reason: hx of bladder cancer s/p radical cystectomy, evaluate for metastatic disease wtih delayed imaging History: see above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy. Couple stable sub-centimeter hypodensities are too small to accurately characterize. Stable, likely hemangioma near the falciform ligament.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral renal scarring, unchanged.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal and pelvic lymph nodes, not enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Postsurgical changes of a neobladder. Stable nonobstructing stone in the neobladder lumen.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A loop of sigmoid colon is seen within a fat containing left inguinal hernia without evidence of ischemia. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of disease recurrence or metastatic disease.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views 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. Scattered benign calcifications are present.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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62-year-old male with history of bladder, urethral, and ureteral cancer, evaluate and compare prior ABDOMEN:LUNG BASES: Basilar atelectasis. LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic lesions. Cholelithiasis.SPLEEN: Enhancing splenic nodules similar in appearance to the prior exam may represent hemangiomas.PANCREAS: Fatty replacement of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal masses. Findings consistent with chronic obstruction of the right kidney, new from 2/25/2014. Delayed images opacify the left renal pelvis, ureter, and ileal conduit without evidence of disease recurrence. There is amorphous debris in the Indiana pouch. Evaluation of urothelial recurrence in the right renal pelvis and ureter is limited secondary to poor opacification.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Arterial calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Right lower quadrant ileal conduit. Fat containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Post surgical changes without evidence of disease in the abdomen or pelvis. Please note that evaluation of the right renal pelvis and ureter is limited secondary to poor contrast opacification due to chronic obstruction.2.Hepatic steatosis.
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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 mother diagnosed at age 66 and maternal aunt diagnosed at age 80. 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. Round markers were placed on skin lesions overlying both breasts. 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: NSB - Screening Mammogram.
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Generate impression based on findings.
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38 years, Male. Reason: assess passage of capsule History: capsule in stomach Spinal fixation device and surgical clips overlying the sacrum are noted. Capsule is not identified.Nonobstructive bowel gas pattern.
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Capsule is not identified. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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History of right lumpectomy and sentinel lymph node biopsy in 2006 for IDC. Patient received radiation therapy and hormonal therapy. History of breast carcinoma in two maternal aunts. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. Stable right breast architectural distortion, skin retraction, and surgical clips are present within the lumpectomy bed and axillary region. Scattered benign calcifications are present in both breasts.No dominant mass, suspicious microcalcifications, or suspicious 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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61-year-old male with history of high-risk stage 3 colon cancer. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: Stable scattered pulmonary micronodules, with two new micronodules/intrapulmonary lymph nodes in the right upper lung (5/66) which may be followed on subsequent staging exams. No suspicious masses or consolidation. No pleural effusions.MEDIASTINUM AND HILA: Moderate atherosclerosis of the coronary arteries. Heart size within normal limits, without pericardial effusion. Scattered mediastinal lymph nodes, unchanged.CHEST WALL: Minimal degenerative change affects the visualized spine. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Postoperative findings of cholecystectomy, with persistent pneumobilia.SPLEEN: No significant abnormality notedPANCREAS: Nonspecific calcification in the pancreas tail, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypoattenuating cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Postoperative findings of right hemicolectomy, without recurrent mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small amount of fluid in the right inguinal canal.OTHER: No significant abnormality noted
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1.Postoperative findings of right hemicolectomy without evidence of recurrent or metastatic disease.2.Scattered pulmonary micronodules, with two additional micronodules/intrapulmonary lymph nodes in the right middle lobe that may be followed on subsequent exams.
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Generate impression based on findings.
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Male 32 years old; Reason: Cystic fibrosis, Lung Transplant Evaluation Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 79.3 % of peak activity (normal >70 %)1 hour: 72.0 % of peak activity (normal 30-90 %) 2 hours: 37.2 % of peak activity (normal <60 %) 4 hours: 1.8 % of peak activity (normal <10 %)
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Gastric emptying within normal limits.
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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 mother diagnosed at age 63. 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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Male 61 years old; Reason: eval possible liver mets History: HCC, pre liver \T\ Heart transplantRADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 128 mg/dL. Today's CT portion grossly demonstrates cirrhotic liver morphology. There is a hypodense lesion in the right lobe of the liver at segment 5/8 with central embolizing material consistent with posttherapy changes as noted on recent CT. Previously noted enhancing subcentimeter foci in the liver are not very well defined on current nondiagnostic CT study. Cholelithiasis without evidence of cholecystitis. Splenomegaly with an accessory splenule. Bilateral atrophic kidneys. Calcification of the SMA origin is unchanged. Left chest wall pacemaker with leads in appropriate position.Today's PET examination demonstrates decreased FDG activity in the hypodense lesion in the right lobe of the liver (SUV max 2.5) in comparison to the liver parenchyma consistent with posttherapy changes. The accessory splenic contains FDG activity similar to the adjacent spleen. There are no suspicious FDG avid foci identified.
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1. No evidence of FDG avid tumor activity.2. Please note FDG imaging is not sensitive for hepatocellular carcinoma.
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Generate impression based on findings.
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Flat feet.VIEWS: Left foot standing AP/lateral (two views), right foot standing AP/lateral (two views) 01/27/15 Bilateral planovalgus is identified. No fracture is seen.
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Bilateral pes planovalgus.
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Generate impression based on findings.
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Male 86 years old; Reason: hematuria History: hematuria ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable hemangioma in the right hepatic lobe. A couple other hypodensities are only partially visualized on prior study, but likely are cysts.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:PROSTATE/SEMINAL VESICLES: Prostatomegaly measuring up to 5.4 x 6.4 cmBLADDER: Mild circumferential thickening, likely secondary to above.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No CT identifiable cause of hematuria. Prostatomegaly with impression on the urinary bladder as described above.
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Generate impression based on findings.
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76 year old female with history of presacral mass, evaluate for abnormalities ABDOMEN:LUNG BASES: Small left Bochdalek hernia.LIVER, BILIARY TRACT: Mild intra-and extrahepatic biliary ductal dilation status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal foci too small to further characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 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: Lobulated presacral mass measures 4.3 x 2.5 cm (series 3, image 94), previously 4.5 x 2.6 cm. There is an unchanged peripheral focus of calcification. There is minimal scalloping of the S2 vertebral body without frank erosion.
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Stable presacral mass is possibly neurogenic in origin and likely benign.
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Generate impression based on findings.
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Hip pain, rule-out SCFE.VIEWS: Pelvis AP/frogleg (two views) 01/27/15 The round, smooth femoral heads are well directed into normally formed acetabula. The proximal femoral physes are almost completely fused. No fracture is identified.
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Normal examination.
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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 mother diagnosed at the age of 32. History of benign bilateral breast biopsies. Two standard digital views and tomosynthesis of both breasts and an additional left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. A linear marker was placed on the scar and a round marker was placed on a skin lesion overlying the right breast. Postsurgical architectural distortion is present in the right upper outer quadrant. Benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Postsurgical architectural distortion in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Posttreatment findings are stable. There is no evidence of mass lesions or significant cervical lymphadenopathy. Small hypodense right thyroid nodule is unchanged. Submandibular and parotid glands are atrophic with probable post-treatment changes. The major cervical vessels are patent with moderate to severe right and moderate left carotid bifurcation plaques, and moderate narrowing at the right carotid bulb. The airways are patent. The imaged intracranial structures are unremarkable. For findings in the chest, please see dedicated chest CT. Mild degenerative changes of the cervical spine with grade 1 anterolisthesis of C3 relative to C4. There is scattered moderate neural foraminal narrowing with moderate to severe bilateral neural foraminal narrowing at C3-C4
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No evidence of tumor recurrence or significant lymphadenopathy.
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Generate impression based on findings.
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Male 24 years old Reason: biliary dilation? History: conjug. hyperbilirubinemia LIVER: The liver measures 16.1 cm in length. There is no focal liver lesion. The portal vein is patent and demonstrates normal directional flow with peak velocity of 0.4 m/sec. GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 12.5 cm. There is a 1.5 x 1.4 x 1.2 cm complex right mid pole cyst which demonstrates internal complexity. A right simple cyst was noted on prior ultrasound of 2012 and while this may represent interval hemorrhage/inflammation a renal protocol CT is recommended for further evaluation. The left kidney measures 11.6 cm. Tubular hypoechoic structure at the upper/mid pole of the left kidney may represent an atypical cyst and this can be evaluated on renal protocol CT.OTHER: The spleen measures 12.2 cm.
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1. Cholelithiasis without acute cholecystitis or biliary dilatation. 2. Complex right mid pole cyst demonstrating internal complexity. While this may represent interval hemorrhage/inflammation, further evaluation with renal protocol CT is recommended. A CT scan will additionally further characterize a probable left upper/mid pole cyst with an atypical sonographic appearance.Findings discussed by myself Dr. Ward with Dr. Christian pager number 3443, 01/27/15.
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Generate impression based on findings.
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Exam is limited as exact location of oral cancer is not described, and outside imaging including potential PET scan is unavailable. In addition, treatment history is not provided. Within these limitations, there is asymmetric enhancement and soft tissue thickening along the left lateral wall of the oral cavity posteriorly, as seen on 15/17 and 81a244/29. More focal soft tissue enhancement is seen on 15/17 abutting the lateral aspect of the posterior left oral tongue, with mild localized mass effect. There is asymmetric stranding within the fat or aspect of the left masticator space and lateral to the area of asymmetric soft tissue. There is effacement of normal fat planes along the likely infiltrated left pterygoid muscles as well as the anterior aspect of the left masseter muscle at the level of the left mandibular foramen. The fat within the foramen is effaced on the left side, although the foramen/canal are significantly not enlarged. There is also questioned slight thinning of the left lateral pterygoid plate along its anterior/inferior aspect on 14/73 and 8134/97. There is additional subtle stranding within the left parapharyngeal fat. The pterygopalatine fossa and skull base foramina appear symmetric and within normal limits. There are osseous changes of the diminutive left maxillary alveolar process, adjacent to the enhancing soft tissue mass, which extends cranially along the buccal space as seen on 81244/25. There is additional cortical loss along the upper mandibular margin at the left mandibular angle and more questioned in the left posterior body.PHARYNX/LARYNX: There is relative paucity of palatine tonsillar tissue, which may be previous resection. There is slight asymmetric decreased aeration along the posterior lateral aspect of the left oral tongue. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There is a heterogeneous left level Ib lymph node which measures 1.2 cm x 2.5 cm on 15/8.OTHER: There is a focal pleural-based opacity along the lateral aspect of the right lung apex with an adjacent bleb and possible mild bronchiectasis. Please see separately dictated report for CT of the chest for further details. Degenerative disease is seen along the cervical spine, most conspicuous at C4-C5 where there is a mild to moderate central spinal canal stenosis and moderate-severe bilateral foraminal narrowing. There is extreme paucity of subcutaneous fat. There is mild scattered mucosal thickening within the paranasal sinuses.
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1. Asymmetric enhancement and irregular soft tissue consistent with known malignancy along the left lateral wall of the oral cavity extending from the maxillary to mandibular alveolar processes with associated osseous changes. Left mandibular foramen fat is effaced with suspicion for metastatic spread along the inferior alveolar nerve. Mild stranding of the fat within the adjacent fat planes along the and aspect of the left masticator space is nonspecific and may be reactive or due to early spread of tumor, although there is probable infiltration of the left muscles of mastication. Questioned additional erosion in the left lateral pterygoid plate. Skull base foramina appear symmetric and unremarkable.2. Left level Ib lymphadenopathy likely from metastatic spread of tumor.3. Right apical pleural based opacity. Please see separate CT chest report for further details.
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Generate impression based on findings.
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Known bilateral breast cysts. Personal history of CML diagnosed at age 31, now in remission. History of breast cancer in mother diagnosed 51 in maternal aunt. Three standard views of both breasts were performed digitally with spot compression images and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A subcentimeter mass in the right upper outer quadrant persists on spot compression images. Additional circumscribed masses and focal asymmetries are present bilaterally and stable or decreased in size, at least some representing cysts as demonstrated on prior ultrasounds. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND
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Right breast benign cyst. 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Reason: assess for leak low rectal mass excision site, 9cm from anal verge History: pneumoperitoneum; POD1 from mass excision There was small contained leak anterolateral to the presumed anastomotic site, measuring 1.3 x 1.0 x 0.7 cm.
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Small contained leak anterolateral to the presumed anastomotic site.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of ovarian cancer diagnosed in 1963. History of breast cancer in two paternal aunts. 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. Arterial calcifications are present.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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Male 44 years old Reason: Evaluate for gallstones, biliary dilation History: abdominal pain, increased Bili LIVER: The liver measures 17.8 cm. The hepatic parenchyma is diffusely echogenic and heterogeneous suggestive of fatty infiltration. There portal vein is patent and demonstrates normal directional flow with peak velocity 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 9.1 cm. The left kidney measures 9.4 cm. There is no hydronephrosis.OTHER: The spleen measures 9.3 cm in length.
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1. No evidence of gallstones or biliary dilatation. 2. Hyperechoic heterogeneous hepatic parenchyma suggestive of fatty infiltration.
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Generate impression based on findings.
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Two year old female with fatally abused siblings.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 1/27/2015 Normal bone mineralization and remodeling. No fracture or malalignment is evident. The adenoids are mildly enlarged. The remainder of the exam is normal.
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No fracture or malalignment. Mild adenoidal enlargement.
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Generate impression based on findings.
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Status post mandibular distraction, evaluate mandible for healing and assess airway volume. Again seen are bilateral osteotomies involving the mandibular rami with interval removal of previously seen metallic distractors. There is interval development of periosteal reaction bilaterally with 1-2-mm gap at the right and less than 1 mm on the left. Findings suggest progression of healing. Streak artifact limits evaluation. Underlying symmetric hypoplasia of the mandible as well as less severe hypoplasia of the maxilla is again noted. There is some improvement in volume of the airway at the level of the tongue base/oropharynx, for example measuring 5 to 6 mm in the AP dimension on the current study, compared to 10/3/2013 when it measured 2 to 4 mm.There is unchanged left-sided posterior plagiocephaly. The clival angle is again vertically oriented. The imaged intracranial structures are unremarkable. Paranasal sinuses are clear and improved in the interval. Mastoid air cells are clear.
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1. Status post bilateral mandibular osteotomies for distraction. There is interval progression of healing compared to 11/6/2014 with small residual lucencies.2. Improvement in airway volume at the level of the oropharynx compared to 10/3/2013.
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Generate impression based on findings.
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Male 73 years old; Reason: Pancreas cancer s/p neoadjuvant chemo please assess per pancreas protocol imaging for treatment response prior to whipple surgery and provide index lesion measurements for RECIST CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change with biapical and lingular pleural scarring seen. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with tip near cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Visualized liver without significant change, scattered subcentimeter hypoattenuating liver lesions, too small to characterize but unchanged.SPLEEN: Splenic hypoattenuating lobulated lesion, most likely a cyst with Hounsfield units of 9 seen on noncontrast imaging. Lobulated configuration of spleen medially unchanged. PANCREAS: Again visualized ill-defined pancreatic distal body/tail mass, probably without significant change accounting for differences in technique, measures approximately 7.2 x 4 cm, image 84 series 34, remeasured on prior CT exam as 7 x 4.1 cm (image 90 series 9 on prior CT study). Associated occlusion of splenic vein with multiple left upper quadrant collateral vessel formation again seen. Lateral aspect of pancreatic mass adjacent to medial spleen and mass focally abuts stomach, coronal image 57 series 83116. Portal vein and SMV patent, SMA patent. Encasement of splenic artery with associated luminal narrowing also visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys stable in appearance with bilateral renal hypodensities, several of which are too small to adequately characterize, largest compatible with a cyst and located in the right kidney, measuring 4.3 cm, image 108 series 34.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Subcentimeter retroperitoneal lymph nodes. IVC filter present. BOWEL, MESENTERY: Colonic diverticulosis without evidence of acute diverticulitis.PELVIS:Extensive beam hardening artifact from right hip with surgical hardware, making assessment of pelvic structures suboptimal.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Extensive beam hardening artifact from right hip with surgical hardware, making assessment of pelvic structures suboptimal. Ventral abdominal subcutaneous soft tissue nodularity, likely reflecting sequela from prior injections. Multilevel degenerative changes of spine with L5/S1 spondylolisthesis with underlying pars defect.
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1. No significant change from prior study as described.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of left breast cyst aspiration in 2001. History of breast cancer in mother diagnosed at age 44 and maternal cousin diagnosed in her 20s. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable asymmetries are present in the central right breast. Benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable right focal asymmetries. 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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81-year-old female with history of myeloma, no prior lytic lesions SKULL: No discrete lytic lesion.CERVICAL SPINE: Marked degenerative disk disease and facet joint osteoarthritis without discrete lytic lesion.THORACIC SPINE: Multilevel degenerative disk disease and small anterior osteophytes without discrete lytic lesion. LUMBAR SPINE: Severe degenerative disk disease and mild leftward curvature without discrete lytic lesion.RIBS: No discrete lytic lesion.PELVIS: No discrete lytic lesion.UPPER EXTREMITY: No discrete lytic lesion.LOWER EXTREMITY: No discrete lytic lesion. Osteoarthritis affects bilateral knees.
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No discrete lytic lesion. Degenerative changes as described above.
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Generate impression based on findings.
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65-year-old female with sciatic nerve and chronic back pain, rule out arthritis Lumbar spine: There is grade 2 anterolisthesis of L4 on L5 as well as degenerative disk disease and facet joint osteoarthritis affecting the lower lumbar spine.Thoracic spine: There is mild leftward curvature of the thoracolumbar spine and multilevel degenerative disk disease and anterior vertebral body osteophytes.Cervical spine: Severe degenerative disk disease with vertebral body osteophytes affects C3/4, C4/5 and C5/6.
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Grade 2 anterolisthesis of L4 on L5 and degenerative changes as described above.
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Generate impression based on findings.
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History of right nipple itching and retroareolar mass. Patient states that the mass has resolved after taking antibiotics. 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 either breast. ULTRASOUND
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No mammographic evidence of malignancy. No sonographic abnormality identified. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, which could resume in June 2015 for this patient. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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51 year-old female with fall and low back pain Vertebral body heights and disk spaces are maintained. Alignment is within normal limits. No fracture is visualized.
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No findings to explain the patient's symptoms.
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Generate impression based on findings.
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Hip painVIEWS: Pelvis AP/frogleg (two views) 01/27/15 The femoral head epiphyses are well directed into the acetabula. Alignment is anatomic. No fracture is present.A moderate amount of feces is seen in the rectosigmoid.
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Normal examination.
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Generate impression based on findings.
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39 year-old female with left hip pain Surgical clips project over the pelvis and right lower quadrant. The hip appears normal for the patient's age. The osseous structures of the pelvis are unremarkable.
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Normal exam.
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Generate impression based on findings.
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66 showed female status post TKA Hardware components of a total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Gas, drain and surgical clips in the soft tissues reflect recent surgery.
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Status post TKA in near anatomic alignment.
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Generate impression based on findings.
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Male, 69 years old, history of left cheek squamous cell carcinoma s/p Mohs, with perineural invasion. Skin thickening, subcutaneous infiltration and mild skin retraction are seen within the left cheek compatible with the history of a resected squamous cell carcinoma.A lymph node is present at the tail of the left parotid gland which measures 12 x 10 mm (image 158 series 5). Although this node is not frankly pathologic by size criteria, it is morphologically suspicious given its large area of central hypoattenuation. Additional small lymph nodes are present on both sides of the neck but these are not pathologically enlarged and show no morphologically aggressive features.The aerodigestive mucosa is unremarkable and free of focal lesions. The salivary glands and the thyroid are normal. The left IJ vein does not opacify well but otherwise the cervical vessels enhance normally. No abnormalities are detected in the lung apices. The osseous structures are free of concerning or destructive lesions.
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1. Surgical sequelae are evident within the left cheek compatible with the stated history of a resected squamous carcinoma.2. A lymph node at the left parotid tail is concerning for metastatic involvement given its abnormal central hypoattenuation. No definite additional concerning lymphadenopathy is seen.
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Generate impression based on findings.
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RUE weakness. Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.Brain CTA: The distal internal carotid arteries appear occluded and the proximal MCA are ACA arteries are small.The anterior communicating artery and the posterior communicating arteries are identified. The posterior communicating arteries are suspected to receive flow from the posterior circulation and end in the thalamotuberal arteries.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses 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.Findings are compatible with the diagnosis of Moya Moya. Please refer to MRA from 1/18/15 for additional comments.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of basal cell carcinoma diagnosed at age 48. History of breast cancer in mother diagnosed at age 55. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable asymmetry is present in the medial right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable right breast asymmetry. 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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Male 47 years old Reason: assess gall bladder for stones/ liver for fatty infiltration History: RUQ intermittent abdominal pain LIVER: The liver measures 15.4 cm in length. The hepatic parenchyma is diffusely echogenic suggestive of fatty infiltration. No focal liver lesion. The portal vein is patent and demonstrates normal directional flow with peak velocity of 0.1 m/sec.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without cholelithiasis, gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: The pancreas is largely obscured by bowel gas.KIDNEYS: The right kidney measures 13.4 cm. The left kidney measures 11.5 cm. This is no hydronephrosis.OTHER: The spleen measures 11.7 cm in length.
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1. Diffusely echogenic hepatic parenchyma suggestive of fatty infiltration. 2. No gallstones.
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Generate impression based on findings.
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32 years, Female. Reason: kidney stone History: right kidney stone Nonobstructive bowel gas pattern. Punctate calcifications seen overlying right kidney, compatible with prior CT. No large renal stone identified.
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Nonobstructive bowel gas pattern. Punctate calcifications seen overlying right kidney, compatible with prior CT. No large renal stone identified.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of ovarian cancer in maternal grandmother. History of breast cancer in two paternal aunts diagnosed at age 65 and 68. Two standard digital views and tomosynthesis of both breasts and an additional left CC view 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. Round marker was placed on a skin lesion overlying the right breast. Stable benign calcifications are present bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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49 years, Female. Reason: Evaluate for bowel distention, gas pattern, constipation, air fluid levels History: epigastric pain Heavy vascular calcification. Peritoneal dialysis catheter. Nonobstructive bowel gas pattern.
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Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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14-year-old female with headache, with lumboperitoneal shunt for pseudotumor cerebriVIEWS: Abdomen AP/lateral (two views) 01/27/15 Lumboperitoneal shunt tubing is seen without kinking or discontinuity with tip in the left lower quadrant of the abdomen. The intrathecal tip courses above the field-of-view. Codman Hakim valve setting is set to 100 mm H2O. Amorphous stool within the colon with nonobstructive bowel gas pattern.
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No evidence of shunt discontinuity or kinking.
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Generate impression based on findings.
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Female 82 years old; Reason: LLL nodule History: Lung cancer please compare to prior PET for restagingRADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 138 mg/dL. Today's CT portion grossly demonstrates scattered bilateral pulmonary nodular densities, more prominent in the lower lobes, some of which are new compared to prior PET/CT study in 6/3/2014. There is a stable left renal cyst. Patient is status post cystectomy with ileal conduit formation. There is a mass near the right vaginal wall. There are posterior pelvic masses bilaterally. There are degenerative changes of the osseous structures, including L5 pars defect with anterolisthesis. There is compression deformity of T7 and T8. There are extensive atherosclerotic calcification of the aorta and coronary arteries. There is an internal rod in the right proximal femur.Today's PET examination demonstrates FDG activity in the new left lower lobe pulmonary nodule with an SUV max of 2.2. There is an additional focus of increased FDG activity in a new pulmonary nodule also in the left lower lobe. There is moderate FDG activity in a new pleural based left upper lobe pulmonary nodule along the anterior mediastinum with an SUV max of 1.8. There is moderate FDG activity in a new lateral subpleural nodule in the left upper lobe. Previously noted FDG avid nodule in the right lower lobe has decreased in intensity compared to prior study. The other scattered nodules demonstrate mild FDG activity which are nonspecific.There is a focal uptake in the ascending colon which is nonspecific with no correlation on CT.There is FDG activity which is ringlike in appearance and nodular in the perineum near the right vaginal wall. There is increased FDG activity involving the bilateral pelvic wall masses, with the right pelvic mass having an SUV max of 11.4.Linear focus of FDG activity along the left aspect of the thoracic spine correlates with left paraspinal muscle activity.There are postsurgical changes as described above with radiotracer activity noted within a urine bag.
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1.New left upper and lower lobe pulmonary nodules with increased FDG activity are suspicious for tumor. 2.Interval decreased FDG activity of the right lower lobe lung nodule. Mild FDG activity of the remaining scattered pulmonary nodules is nonspecific, cannot exclude metastatic disease.3.Focal activity in the ascending colon is nonspecific as there is no CT correlation for a focal abnormality in this region.4.Intense FDG activity at the bilateral posterior pelvic wall masses are suspicious for tumor.5.FDG activity in the perineum near the right vaginal wall is suspicious for tumor and less likely an abscess.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Three standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, 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: NSA - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional right CC view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. A benign intramammary lymph node is present in the right upper outer quadrant and benign lymph nodes project over the axillae. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram.
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Generate impression based on findings.
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The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed prone on the fluoroscopy table. The right shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the spinoglenoid notch. Attempted aspiration yielded no fluid. Next, 3 ml of Omnipaque 240 was injected to confirm the position position of the needle. Contrast opacified the notch in the expected manner. Subsequently, a mixture of 1 ml of Kenalog and 2 ml of lidocaine was injected A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. Exposure time: 23 seconds
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Successful right spinoglenoid/suprascapular notch injection.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional left CC 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. A pacemaker generator is partially projected over the posterior central left breast.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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Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal niece. 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. Round marker was placed on a skin lesion overlying the left breast. Benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. Screening mammography is most sensitive when evaluating for interval changes. If 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: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. A percutaneously placed clip with surrounding density in the left upper outer quadrant is stable. New oil cyst is present in the medial inferior right breast. Scattered benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Stable biopsy clip with surrounding density in the left breast. Oil cyst in the right breast. 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: NSA - Screening Mammogram.
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Generate impression based on findings.
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Female 90 years old; Reason: Evaluate for abdominal pathology History: back and abdominal pain. Hx of waldenstrom, poor appetite ABDOMEN:LUNGS BASES: Increasing left lower lobe consolidation with associated traction bronchiectasis. Intraluminal bronchial fluid seen, appearance consistent with aspiration. Calcified micronodules and small lymph nodes likely sequela of prior granulomatous disease.LIVER, BILIARY TRACT: Hepatic segment 7 hypoattenuating lesion, too small to characterize but stable. Common bile duct measures up to 7 mm, likely due in part due to age-related ectasia, minimal intrahepatic biliary duct prominence. No radiopaque choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Again seen are bilateral renal hypodensities, majority compatible with simple cysts. Stable partially exophytic 6 mm left renal lesion, image 37 series 3, may be a complex cyst. No hydronephrosis. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Stable left paraaortic lymph node, measuring 1.4 x 0.8 cm, image 54 series 3. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous demineralization. Multilevel degenerative changes of spine, most pronounced at L5/S1 level.
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1. Increasing small left lower lobe consolidation with associated traction bronchiectasis and evidence of aspiration, correlation with patient's clinical history/laboratory values recommended to exclude underlying infection/aspiration pneumonia.2. Stable exam as above otherwise. No definite evidence of metastatic disease.
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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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A round marker was placed on a skin lesion overlying the right breast. A linear marker was placed on a scar overlying the left breast.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of benign 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. A round marker was placed on a skin lesion and a linear marker was placed on the scar overlying the left breast. Focal asymmetry is present in the central right breast. Scattered benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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Focal asymmetry in the central right breast. Comparison to outside mammogram is recommended. If the prior mammogram cannot be obtained or if this density is new, spot compression imaging is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.
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Generate impression based on findings.
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post coronary angioplasty/stenting severe headache Although the scan was performed without contrast enhancement, the scan is essentially postcontrast scan since prior iodine contrast infusion during the coronary procedure.No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.
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No evidence of acute ischemic or hemorrhagic lesion on this scan.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of ovarian cancer in mother. History of breast cancer in paternal grandmother. 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. Scattered benign calcifications are present.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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Male 86 years old; Reason: 86 yo newly diagnosed pancreatic ca needs full staging cap pancreatic protocol CHEST:LUNGS AND PLEURA: Unchanged large right pleural effusion with underlying compressive atelectasis. Respiratory motion artifact makes assessment suboptimal. Enlarging bilateral lung nodules noted. Lingular nodule seen measuring 5 x 5 mm, image 79 series 9, previously measured 3 x 2 mm. Enlarging pleural based right upper lobe lung nodule seen, measuring 4 x 3 mm, image 23 series 9, previously measured up to 2 mm. Previously visualized 6 mm right lower lobe lung nodule not well seen, possibly obscured by pleural fluid. Again seen left posterior and diaphragmatic pleural thickening with curvilinear calcifications, may be posttraumatic or of postinfectious/inflammatory etiology. Calcified atherosclerotic thoracic aorta. MEDIASTINUM AND HILA: Status post sternotomy, postoperative changes related to CABG seen. Left-sided cardiac device seen with leads in right atrium and right ventricle. Mild to moderate cardiomegaly. Severe calcified coronary artery disease. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, no secondary signs of acute cholecystitis.SPLEEN: Stable to mildly less pronounced peripheral hypoattenuation in relation to spleen, may represent sequela of prior subcapsular hematoma. PANCREAS: Diffuse pancreatic atrophy with ductal dilatation measuring up to 9 mm, duct appears to terminate at level of pancreatic head where there is ill-defined hypoattenuating soft tissue fullness, accurate measurements difficult due to ill-defined appearance but measures approximately 2.5 x 1.9 cm, image 59 series 8. Patent portal veins, patent splenic vein and SMV. Patent celiac, hepatic, splenic and superior mesenteric arteries. Small periportal and pancreatic peripancreatic lymph nodes, reference peripancreatic lymph node, measuring 1 x 0.9 cm, image 103 series 9, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: Extensive aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Moderate-sized sliding-type hiatal hernia. Sigmoid colon-containing left inguinal hernia without associated bowel obstruction, hernia sac measures up to 2.5 cm. No ascites. PELVIS:PROSTATE, SEMINAL VESICLES: Punctate calcification-contained prostate gland, measures up to 4.8 cm in transverse dimension. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. Mild asymmetric heterogeneous sclerosis/trabecular coarsening involving left inferior ramus, nonspecific, image 202 series 9, may reflect Paget's disease. Subcentimeter sclerotic lesion at level of ischial tuberosity, image 189 series 9, may be a bone island but indeterminate. Additional areas of indeterminate sclerosis seen, for example, in left iliac wing, image 165 series 9. Diffusely decreased osseous mineralization. Chronic posterior rib fractures.
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1. Diffuse pancreatic atrophy with ductal dilatation terminating at level of pancreatic head lesion as above.2. Increasing size of bilateral lung nodules as described, nonspecific but suspicious for metastatic disease. Large right pleural effusion with underlying compressive atelectasis.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of surgical excision of a right chest wall lipoma in 2013. History of benign left breast biopsy. Two standard digital views and tomosynthesis of both breasts and an additional left 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. Round markers were placed on skin lesions overlying both breasts. A linear marker was placed on the scar overlying the right breast. There has been interval surgical excision of a right lipoma. Surgical clips project over the right axilla. Increasing calcifications are present in the central right breast for which spot magnification imaging is recommended. Additional scattered calcifications are unchanged.No suspicious masses or areas of architectural distortion are present.
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Increasing right breast calcifications. Spot magnification imaging is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.
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Generate impression based on findings.
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Evaluate second metacarpal fracture Three views of the left hand reveal a fracture of the second metacarpal head and neck with volar angulation of the distal fracture fragment, unchanged from the previous. Note again is made of old deformity of the fifth metacarpal. Bone detail is obscured by overlying splint.
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Fracture of the second metacarpal head and neck with volar angulation of the distal fracture fragment.
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Generate impression based on findings.
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Female 77 years old; Reason: Evaluate for intra-abdominal abscess, liver abscess, biliary dilation, pleural effusions, pneumonia History: candidemia, bacteremia, hyperbilirubinemia CHEST:LUNGS AND PLEURA: Extensive emphysema. Small left greater than right pleural effusions, some mediastinal shift towards left due to underlying atelectasis. Patchy air space disease seen, particularly in the upper lobes. Right upper lobe intralobular and interlobular septal thickening, may be chronic in etiology but nonspecific. Dilatation of pulmonary arterial trunk, may be seen in setting of pulmonary hypertension. Bilateral pulmonary emboli, e.g., intraluminal eccentrically located linear thrombus seen in right upper lobe and in distal left main pulmonary arteries. Sites of possible scarring seen in upper lobes as well, including 6 mm pleural based left upper lobe focus, image 46 series 4. MEDIASTINUM AND HILA: Severe calcified coronary artery disease. Right-sided central venous catheter seen with tip near cavoatrial junction, small 8 mm focus of hypoattenuation seen alongside catheter, may reflect thrombus, image 27 series 4. Aneurysmal dilatation of ascending aorta, measuring up to 4.1 cm. Trace pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar hypoattenuating lesions, several of which measure simple fluid and most likely represent cysts. However, additional lesions are relatively hyperdense and while may be hemangiomas or complex cysts, not well assessed on this nondedicated exam. No definite enhancing nodularity seen in relation to these cystic lesions. Several lesions in the liver are too small to characterize. Dystrophic calcifications seen in liver near ligamentum teres anteriorly, may reflect sequela of prior granulomatous disease or postinfectious/inflammatory etiology. Portal veins patent. Pancreatic duct at upper limits of normal in size, measuring up to 3 mm, and common bile duct at upper limits of normal in size, measuring 6 mm. No significant intrahepatic biliary duct dilatation. No radioopaque choledocholithiasis or definite obstructing lesion delineated. Mildly prominent thickened gallbladder, nonspecific in setting of ascites, no radioopaque cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct at upper limits of normal in size, measuring up to 3 mm, and common bile duct at upper limits of normal in size, measuring 6 mm. ADRENAL GLANDS: Indeterminant left adrenal nodule measuring 9 x 9 mm, image 99 series 4. KIDNEYS, URETERS: Symmetric renal parenchymal enhancement, renal cysts present.RETROPERITONEUM, LYMPH NODES: Extensive aortobiiliac atherosclerotic disease. Multiple subcentimeter retroperitoneal/left paraaortic lymph nodes. BOWEL, MESENTERY: Right-sided ostomy seen. Percutaneous gastrostomy tube seen in gastric body. Diffuse mesenteric edema and small pelvic ascites. Upper abdominal postsurgical sequela.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Air seen in the bladder, likely related to placement of Foley catheter.BONES, SOFT TISSUES: Moderate anasarca. Diffuse decreased osseous mineralization. Moderate anasarca.
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1. Bilateral pulmonary emboli, may be chronic due to eccentric/linear configuration and dilatation of pulmonary artery trunk which may be seen in setting of pulmonary arterial hypertension but correlation with patient's clinical history recommended and dedicated CT chest using PE protocol should be pursued as clinically indicated. 2. Small left greater than right pleural effusions. Patchy air space disease seen, particularly in the upper lobes. Right upper lobe intralobular and interlobular septal thickening, may be chronic in etiology but nonspecific. Correlation with patient's clinical history/laboratory values recommended to exclude multifocal pneumonia/infectious process. 3. Mildly prominent thickened gallbladder, nonspecific in setting of ascites, no radioopaque cholelithiasis. If there is clinical concern for acute cholecystitis, further assessment with dedicated sonography recommended. 4. Possible small thrombus alongside right sided central line.5. Multiple hepatic lesions as above. 6. Indeterminant left adrenal nodule. 7. Small pelvic ascites.Findings discussed with Dr. T. Cardin at 3:42 p.m. on 1/27/15.
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Generate impression based on findings.
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9-year-old male with cough, wheezing, shortness of breathVIEWS: Chest PA/lateral (two views) 01/27/15 Cardiothymic silhouette is normal. Large lung volumes. No focal pulmonary opacities. Peribronchial thickening is suggestive of bronchiolitis/reactive airway disease. No pneumothorax or pleural effusions.
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Bronchiolitis/reactive airway disease.
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