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Generate impression based on findings.
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16-year-old male with distal fibular and tibial fractures.VIEWS: Right ankle AP lateral and oblique (3 views) 1/27/2015 Overlying cast material obscures fine bone detail. A plate and screw device affixes the distal fibular fracture in near-anatomic alignment, without evidence of hardware complication. Mild periosteal reaction along the tibial fracture line, appears slightly increased.
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Distal fibular and tibial fractures as above.
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Generate impression based on findings.
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51 year-old female with ESRD. Secondary hyperparathyroidism. Three foci of increased radiotracer activity, two on the right and one on the left, are seen in the region of the thyroid gland on early SPECT imaging. Delayed SPECT images are unremarkable with complete washout of the radiotracer from the thyroid bed. While this may represent physiologic activity, atypical parathyroid hyperplasia is also a diagnostic consideration.
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Three foci of increased radiotracer activity without delayed washout, two on the right and one on the left, which may be due to atypical parathyroid hyperplasia. Suggest correlation with ultrasonographic study.
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Generate impression based on findings.
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12-year-old female with hip painVIEWS: Left hip frog leg/axiolateral (two views) 01/27/15, 1229 No acute fracture or malalignment is evident. The femoral head is smooth, round and well seated within the acetabulum.
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Normal examination.
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Generate impression based on findings.
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8-year-old male status post resection of osteochondroma from left forearmVIEWS: Left knee AP/lateral (two views), left wrist PA/lateral (two views) 01/27/15 Multiple exostoses arising from the distal femoral and proximal tibial and fibular metaphyses without significant change. No fracture is evident. No joint effusion is present.Exostosis arising from the ulnar aspect of the radius is again seen without evidence of fracture. The ulna is foreshortened. Shortened fourth and fifth metacarpals with concavity and broadening of the metaphyses.
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Multiple exostoses without evidence of fracture. Post surgical changes to the left forearm without evidence of fracture.
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Generate impression based on findings.
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Bilateral knee stiffness.VIEWS: Right knee AP/lateral (two views), left knee AP/lateral (two views) 01/27/15 The knees are normal in appearance. No fracture is identified. Ossification centers of the femoral and tibial epiphyses are present.
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Normal examinations.
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Generate impression based on findings.
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45 year-old female with pain, rule out fracture Left upper extremity: The humerus is intact. There is an oblique fracture through the olecranon process with approximately 5 mm separation of the proximal fracture fragment. Surgical clips are present within the soft tissues.Wrist: No fracture or malalignment. Arterial calcifications are noted in the soft tissues.
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Olecranon process fracture as described above.
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Generate impression based on findings.
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38 year-old male with gastric retention of capsule. Capsule with food retained in the stomach and capsule retained x 8 hours. Assess for gastric motility. 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: 42.4 % of peak activity (normal >70 %)1 hour: 10.1 % of peak activity (normal 30-90 %) 2 hours: 2.3 % of peak activity (normal <60 %)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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Reason: evaluation preoperatively chest/goiter location History: evaluation preoperatively chest/goiter location LUNGS AND PLEURA: Scattered micronodules, some calcified. No suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Heterogeneous mass arising from the left lobe of the thyroid is compatible with the patient's known goiter, measuring up to 6.2 x 4.8 cm in axial dimension (series 3 image 15). This extends into the mediastinum approximately 5 cm inferior to the thoracic inlet. There is marked rightward deviation and compression of the trachea which is narrowed to 5 mm.Incidentally noted filling defects in lobar branches of the right pulmonary artery (series 3 image 47) are consistent with acute pulmonary emboli, the complete extent of which is not assessed on this non-dedicated examination. The main pulmonary artery is enlarged measuring 3.5 cm. There is equivocal mild enlargement of the right ventricle. Mild coronary artery calcification. Mild cardiomegaly without pericardial effusion.CHEST WALL: Substernal goiter as aboveUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Mild nonspecific adrenal gland thickening. Hepatic granulomata.
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1. Acute pulmonary emboli involving lobar and segmental branches of the right pulmonary artery. Enlargement of the main pulmonary artery with possible mild right heart strain. 2. Substernal goiter as described above with associated tracheal deviation and narrowing.These findings were discussed with Sarah Gaines pager 3344 at the time of dictation.
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Generate impression based on findings.
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Shortness of breath and tachypnea, evaluate for worsening ovarian cancer ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Ill-defined left hepatic lobe lesion measures 3.5 x 3.4 cm (series 3, image 30), previously 3.8 x 3.6 cm.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: Reference gastrohepatic lymph node conglomerate encases the common hepatic artery and measures 4.3 x 3.6 cm (series 3, image 32), previously 4.4 x 3.4 cm. Adjacent large gastrohepatic lymph node conglomerate appears stable in size over the interval.BOWEL, MESENTERY: Reference omental soft tissue mass measures 8.4 x 2.2 cm (series 3, image 44), previous of 7.9 x 2.8 cm. a second reference mesenteric soft tissue mass is located inferior to the transverse colon and measures 3.6 x 2.5 cm (series 3, image 55), producing 4.2 x 2.2 cm. Additional mesenteric lymphadenopathy appearing similar to prior.BONES, SOFT TISSUES: Chronic height loss of the L1 and L2 vertebral body superior endplates. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. Reference right external iliac lymph node measures 2.1 x 1.2 cm (series 3, image 104), previously 2.5 x 1.4 cm. Reference left external iliac lymph node measures 1.9 x 1.2 cm (series 3, image 104), previously 1.9 x 1.2 cm.BOWEL, MESENTERY: Mesenteric soft tissue mass in the pelvis appears similar to the prior.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Lymphadenopathy and peritoneal soft tissue metastases with variations in reference measurements as above. No evidence of disease progression. 2.No acute abnormality in the abdomen or pelvis.
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Generate impression based on findings.
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32-year-old female with history of left shoulder pain. There has been resorption of the distal clavicle which we suspect is related to the patient's hyperparathyroidism, however post traumatic osteolysis is also a differential consideration. There is also a minimally displaced fracture through an expansile lesion at the the posterior aspect of the left fourth rib. This lesion may represent a brown tumor.
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Findings compatible with hyperparathyroidism including a minimally displaced pathologic fracture of left fourth rib fracture through what we suspect may be a brown tumor as well as resorption of the distal clavicle.
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Generate impression based on findings.
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53-year-old male with history of prostate cancer, rising PSA. Assess for metastatic disease. Increased radiotracer activity in the left aspect of the T10 vertebral body is compatible with metastasis. Foci of increased activity are also seen in the left lateral ribs 5, 7, and 9. Only the ninth rib is visualized on today's CT exam, and no definite CT correlation is seen. Rib lesions therefore also favor metastatic disease over healing rib fractures.
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Findings compatible with T10 metastasis. Additional left rib metastases are likely present as well.
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Generate impression based on findings.
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35-year-old male with shoulder pain radiating down left arm Shoulder: The osseous structures appear within normal limits for the patient's age. There is no fracture or malalignment.Cervical spine: Vertebral body heights and disk spaces are maintained.
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No specific findings to account for the patient's pain.
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Generate impression based on findings.
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70 year-old male with history of lumbar decompression, worsening back pain Severe degenerative disease affects L5/S1. Moderate degenerative disk disease affects L4/L5 and L2/L3. There is grade 1 anterolisthesis of L4 on L5 which appears similar on flexion and extension views.
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Degenerative disk disease and anterolisthesis of L4 on L5, without evidence of instability.
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Generate impression based on findings.
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20 year-old male, follow-up exam A side plate with screws affixes the base of the first metatarsal, medial and middle cuneiforms as well as the navicular bone without evidence of hardware complication. Two screws transverse the base of the proximal first phalanx. Two K wires affix each of the second, third, fourth, and fifth metatarsal head fractures. The bones of the foot and ankle are diffusely demineralized, likely due to disuse. No ankle fracture or dislocation.
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Orthopedic fixation as described above in near-anatomic alignment.
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Generate impression based on findings.
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22-year-old male with hip subluxationVIEWS: Pelvis AP/frog leg (two views) 01/27/15, 1141 hour Bilateral coxa valga is unchanged. There is minimal, 30%, uncovering of the femoral heads bilaterally. The femoral heads are well seated in the acetabula. No acute fracture or malalignment is evident.
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Bilateral coxa valga without acute fracture or malalignment.
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Generate impression based on findings.
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59-year-old with history of right breast LCIS. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. A few scattered benign calcifications are noted. Biopsy clip in the right central breast unchanged in position. Stable intramammary lymph node in the right upper outer quadrant. Stable asymmetry in the right retroareolar region.Benign appearing lymph nodes are projected over both axillae.
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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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55-year-old female with bilateral knee pain Knees: There is mild sharpening of the tibial spines bilaterally indicating minimal osteoarthritis. No joint effusion.Ankle: The distal fibular fracture line is longer visualized, indicating healing. Alignment is anatomic.
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Minimal osteoarthritis and healed distal fibula fracture.
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Generate impression based on findings.
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Chest tube removal. Five day old former 31 week gestational age patient with pneumothorax.VIEW: Chest AP (one view) 01/27/15, 1307 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is distal to GE junction and not included in image. Umbilical venous line tip is in right atrium.Right chest tube has been removed. No pneumothorax is present. Small subcutaneous emphysema persists.Cardiothymic silhouette is normal. Lung volumes are large. Minimal granular opacities are seen bilaterally.
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No pneumothorax after chest tube removal.
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Generate impression based on findings.
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44-year-old male with history of chronic low back pain. Moderate degenerative disc disease affects L5-S1. There is no evidence of spondylolisthesis.
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Degenerative disc disease at L5-S1.
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Generate impression based on findings.
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Fracture.VIEWS: Left forearm AP/lateral (two views) 01/27/15 Cast has been removed. The both bones fracture of the mid forearm is in near anatomic alignment. Callus formation surrounds the fractures of the distal and mid ulna and radius.
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Continued healing of both bones fracture.
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Generate impression based on findings.
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50 year-old female with history of right thumb swelling. There is perhaps mild soft tissue swelling about the thumb, but there is no evidence of acute fracture or dislocation.
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Soft tissue swelling without fracture.
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Generate impression based on findings.
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87 year-old male with history of bladder cancer, evaluate and compare prior ABDOMEN:LUNG BASES: Scattered micronodules, some calcified, measuring up to 5 mm in the right middle lobe.LIVER, BILIARY TRACT: No focal hepatic lesions. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal masses. Delayed images opacified the collecting systems without evidence of disease recurrence. The left collecting system is duplicated. The right collecting system is partially duplicated.RETROPERITONEUM, LYMPH NODES: Calcifications of the abdominal aorta and its branches without aneurysmal dilation. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Indiana pouch and ileal conduit in the right lower quadrant.BONES, SOFT TISSUES: Degenerative changes without suspicious osseous lesions.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Moderate stool in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.
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Postsurgical changes without evidence of disease recurrence.
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Generate impression based on findings.
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Male 78 years old; Reason: s/p OLT with recurrent HCV, also with HBV, eval for radiographic evidence of cirrhosis and portal HTN History: s/p OLT ABDOMEN:LUNG BASES: Coronary artery and valvular calcifications. Bibasilar atelectasis and trace left pleural effusion with adjacent compressive atelectasis.LIVER, BILIARY TRACT: Status post liver transplant. Numerous portosystemic collaterals. Lobulated hypodensity surrounding the hepatic hilum, decreased from prior exam, could represent postoperative seroma/lymphocele or other benign etiology. No suspicious hepatic lesions. Patent transplant vasculatureSPLEEN: No significant abnormality noted.PANCREAS: 1 cm hypodense lesion in the uncinate process, likely a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval enlargement of right renal cysts.RETROPERITONEUM, LYMPH NODES: Tortuous, ectatic aorta with mild/moderate calcification.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple fat-containing ventral hernias.OTHER: No significant abnormality noted.
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1.No suspicious hepatic lesions.
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Generate impression based on findings.
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56 year old male with history of stage III colon cancer. Evaluate for disease recurrence. CHEST:LUNGS AND PLEURA: Unchanged left major fissure intra-pulmonary lymph node, without new suspicious nodules or masses. No consolidation, and no pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes affect the visualized spine.ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe hypodensity (3/126) has ill-defined margins, and has increased in size over the interval to 2.7 x 2.3 cm, previously approximately 1 cm. Additional small cyst is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suture line in the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged, up to approximately 4.4 x 5.8 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Inferior right hepatic lobe hypoattenuating focus has increased in size, and given the patient's history is most consistent with metastatic disease.
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Generate impression based on findings.
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Reason: hx of tonsil ca, s/p CRT 12/13, eval for dz. compare to previous History: as above CHEST:LUNGS AND PLEURA: Scattered micronodules, compatible with previous infection.Mild upper zone emphysema.No suspicious nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No visible coronary artery calcifications.No pericardial effusion.CHEST WALL: Mildly enlarged axillary lymph nodes with fatty hila consistent with a benign etiology.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastatic disease and no significant change.
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Generate impression based on findings.
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1-year-old female for evaluation of pneumoniaVIEWS: Chest AP (one views) 01/27/15 , 1232 hour Tracheostomy tube is in place. Cardiothymic silhouette is moderately enlarged. Bibasilar opacities may represent atelectasis and/or consolidation. No pleural effusion or pneumothorax.
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Bibasilar atelectasis and/or consolidation.
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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: Unchanged calcified right upper lobe subpleural nodule (series 7 image 42). Additional smaller calcified micronodules are also unchanged.A triangular shaped smoothly marginated nodule along the left major fissure (series 7 image 40) measures slightly larger than previous which is likely partially due to differences in orientation and is most compatible with an intrapulmonary lymph node.No pleural effusions.MEDIASTINUM AND HILA: Calcified right hilar and subcarinal lymph nodes consistent with prior granulomatous disease. No new lymphadenopathy. No visible coronary calcification. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No specific evidence of metastatic disease.2.Calcified pulmonary nodules and lymph nodes consistent with prior granulomatous disease. Smoothly marginated nodule along the left major fissure is most compatible with an intrapulmonary lymph node.
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Generate impression based on findings.
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CLINICAL DATA: Age: 56 years. Sex : Male. Indication: Reason: iliac aneurysm` History: same. LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating focus in the right inferior liver parenchyma, likely a cyst but too small to characterize.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.VASCULATURE: Redemonstration of aortobiiliac stent, with additional stent graft in the right common, internal and external iliac arteries. The right common iliac aneurysm sac, which has been excluded by graft material, appears thrombosed and does not fill with contrast. The aneurysm sac measures approximately 2.7 cm, unchanged from prior when using the same measurement technique.Stable celiac trunk dissection flap, which extends into the proximal splenic artery.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: Post operative findings of cystectomy and neobladder construction, with persistent distention of the neobladder.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.Aortobiiliac stent graft, with thrombosed right common iliac artery aneurysm as above.2.Stable postoperative findings of cystectomy/neobladder construction.
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Generate impression based on findings.
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Worsening fatigue, metastatic pancreatic cancer CHEST:LUNGS AND PLEURA: Innumerable pulmonary metastases, increased from prior. Reference right apical nodule measures 1.3 cm (series 5, image 20), previously 0.8 cm. Reference right lower lobe pulmonary nodule measures 1.1 cm (series 5, image 62), previously 0.7 cm. Small pleural effusions, right greater the left.MEDIASTINUM AND HILA: No lymphadenopathy. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly. The splenic vein is patent.PANCREAS: Status post Whipple procedure.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Significant increase in infiltrative abdominal lymphadenopathy. Reference aortocaval lymph node mass measures 6.2 x 4.7 cm (series 3, image 102), previously 4.0 x 2.8 cm. there is mass effect upon the IVC, which is deviated posterolaterally. Tumor encases the celiac axis, SMA and SMV.BOWEL, MESENTERY: Large amount of ascites. Lateral to the right hepatic lobe is a rind of soft tissue, new from the prior exam suspicious for peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. Comparison measurements are difficult to make given extensive ascites. Reference left external iliac lymph node measures 1.4 x 0.9 cm (series 3, image 172), previously 1.7 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Total left hip arthroplasty.
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1.Pulmonary metastases increasing in size and number.2.Increasing disease in the abdomen and pelvis with new peritoneal carcinomatosis and increasing lymphadenopathy.3.Bilateral pleural effusions.
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Generate impression based on findings.
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72 year-old female status post wide excision of right chest wall desmoid type of fibromatosis in September 2012 presents for diagnostic mammogram. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A scar marker overlies right lower inner quadrant. Multiple surgical clips identified in the right upper inner quadrant at posterior depth. Few 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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Posttreatment changes in the right neck from prior right neck dissection. There is been interval right parotidectomy with new surgical clips and residual mildly enhancing tissue within the resection bed, likely representing postsurgical scar. No focal enhancing lesion is evident to suggest residual or recurrent disease. There is no evidence of significant cervical lymphadenopathy. The right submandibular gland is absent, otherwise the thyroid and left parotid glands are normal. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. Ventricular prominence are similar to prior exams. The imaged portions of the lungs are clear. Mild opacification and mucoperiosteal thickening of the left maxillary sinus likely represents the sequela of chronic sinusitis. Punctate pulmonary granulomas.
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1.Postsurgical changes of right parotidectomy without definite evidence of residual or recurrent tumor. 2.No significant cervical lymphadenopathy.3.Findings of chronic left maxillary sinus disease.
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Generate impression based on findings.
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Reason: 84 yo F with COPD, new restriction on PFTs, eval History: COPD LUNGS AND PLEURA: Image quality is limited by severe respiratory motion artifact.Focal small areas of interstitial opacity compatible with scarring and subsegmental atelectasis are largely obscured by motion artifact but likely unchanged.No large emphysematous bullae are visible.MEDIASTINUM AND HILA: Marked collapse of the distal trachea and main bronchi consistent with tracheobronchomalacia.Asymmetric heterogeneous thyroid enlargement.Multiple calcified mediastinal lymph nodes compatible with previous infection.Mild coronary artery calcification.Mild enlargement pulmonary artery.No pericardial effusion.CHEST WALL: Marked kyphoscoliosis with associated degenerative disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Multiple calcified granulomata in the spleen consistent with previous infection. Intrahepatic ductal dilation, unchanged.
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1.Limited examination due to respiratory motion artifact.2. Severe tracheobronchomalacia with almost complete collapse of the central airways on expiration.
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Generate impression based on findings.
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39-year-old female with history of pain. Left fifth toe: A lucent band separates the middle and distal phalanges of the fifth toe which we suspect represents a fracture through a prior coalition of these two bones. The fracture margins are relatively indistinct which may represent the resorptive phase of healing. There is soft tissue swelling about the toe. Femur: There is patchy sclerosis of the distal femoral metaphysis indicating prior bone infarction. The femoral head is unremarkable. There are surgical clips projecting over the pelvis.
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1.Left fifth toe fracture as above.2.Prior bone infarction of the right femur.
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Generate impression based on findings.
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Male 56 years old Reason: fever ,chills, pain, s/p transplant History: fever, RENAL TRANSPLANT: LOCATION: Right iliac fossaPERI TRANSPLANT TISSUES: No peri transplant fluid collection.KIDNEY: No significant abnormality noted. No hydronephrosis.COLLECTING SYSTEM/URETER: 1.3 x 1.4 x 1.4-cm renal cyst.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels.OTHER: No significant abnormality notedThere is a brisk systolic upstroke and normal diastolic flow.Peak systolic velocities are as follows.Right iliac artery: 1.3 m/secAnastomosis: 3.0 m/sRenal artery Proximal: 1.5 m/sec Mid: 1.3 m/sec Distal: 1.2 m/sec The intrarenal resistive indices are normal measuring 0.58 to 0.79The renal vein is color Doppler patent
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Unremarkable appearance of the renal transplant.
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Generate impression based on findings.
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47 years, Female. Reason: concern for free air History: r/o free air Nonobstructive bowel gas pattern. No evidence of free air.
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Nonobstructive bowel gas pattern. No evidence of free air.
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Generate impression based on findings.
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44-year-old male with history of T9 a multicystic mesothelioma on observation, evaluate EOD, compared to previous. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left pelvis reference hypodense lesion (3/164) is unchanged in size when using the same measurement technique, 17 x 14 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Reference right pelvis hypoattenuating lesion superior portion measures 34 x 17 mm, unchanged (3/175). Right pelvis reference lesion inferior portion (3/179) measures 30 x 24 mm, previously 29 x 23 mm.
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Reference hypodense lesions in the pelvis are stable in size over the interval. Non-reference lesions are also grossly unchanged.
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Generate impression based on findings.
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Reason: preoperative examination for lung resection History: lung nodule CHEST:LUNGS AND PLEURA: Persistent masslike consolidation in the right upper lobe measures up to 3.5 x 2.2 cm in axial dimension (series 4 image 37), with associated peribronchial thickening and surrounding groundglass opacity. There is improved aeration since the prior outside CT in December 2014. An adjacent small nodular component measures 6 mm (series 4 image 34). No pleural effusions.MEDIASTINUM AND HILA: Enlarged mediastinal lymph nodes. Pre-carinal lymph node measures 1.2 cm in short axis (series 3 image 35) correlating with hypermetabolic lymph node in recent PET CT. Moderate coronary arterial calcification. Normal heart size without pericardial effusion.CHEST WALL: No suspicious osseous lesions. Degenerative changes affect the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic hypodensities, some cysts, others too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No suspicious osseous lesions. Degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted.
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1. Left upper lobe masslike consolidation and adjacent nodularity is consistent with the patient's known tumor. Improved aeration since the prior outside CT. 2. Mediastinal lymphadenopathy correlates with increased metabolic activity on recent PET CT. 3. No evidence of metastatic disease in the upper abdomen.
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Generate impression based on findings.
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50-year-old female with history of malunion and chronic osteomyelitis. There is diffuse soft tissue swelling. There is a large soft tissue defect along the lateral aspect of the lower leg/ankle. There is deformity of the underlying fibula indicating a healing/healed fracture with the fracture fragments in near anatomic alignment. Although the ulcer approaches the lateral aspect of the fibula, we see no frank osteolysis to confirm acute osteomyelitis. Additionally, there is a larger soft tissue defect along the medial aspect of the lower leg/ankle. There is an adjacent deformity of the distal tibia compatible with old fracture and chronic osteomyelitis with multiple rounded densities within the distal tibia presumably representing antibiotic cement. There is a defect within the lateral aspect of the distal tibia which may represent a chronic cloaca or surgical defect. Additionally, there is an intra-medullary lucency with sclerotic margins which is compatible with chronic osteomyelitis. Although the aforementioned skin ulcer approaches and possibly contacts the tibia, the margins of the medial tibia appear sharp arguing against acute osteomyelitis.Moderate osteoarthritis affects the ankle, midfoot, and knee. Round lucent defects within the distal tibial diaphysis likely represents prior orthopedic fixation.
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Soft tissue ulceration, findings compatible with chronic osteomyelitis, and healing/healed fractures as described above. If there is strong clinical concern for acute osteomyelitis, MRI may be considered.
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Generate impression based on findings.
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78-year-old woman with a diagnosis of bladder cancer, evaluate and compare to the prior examination ABDOMEN:LUNG BASES: No significant abnormality noted. Chronic deformity of several lower right ribs.LIVER, BILIARY TRACT: Scattered subcentimeter hypodensities are too small to further characterize. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Small enhancing lesion in the pancreatic head is nonspecific. Mildly prominent main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Low attenuation renal foci are incompletely characterized by CT. Delayed images opacify the collecting system and ileal conduit. There is no evidence of urothelial recurrence in the renal pelvis or ureters. There is a filling defect within the ileal conduit bowel loop measuring approximately 6 mm (series 9, image 93 and series 80896, image 50), which may represent a fold within the bowel loop. Special attention should be paid to this region on subsequent exams.RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 1.3 x 0.8 cm (series 7, image 31)BOWEL, MESENTERY: Right lower quadrant ileal conduit. Parastomal hernia containing a loop of colon without complication.BONES, SOFT TISSUES: Scoliosis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.No evidence of disease in the abdomen or pelvis.2.Filling defect within the ileal conduit bowel loop measures approximately 6 mm and may represent a fold within the bowel loop. Special attention should be paid to this region on subsequent exams.3.Small enhancing lesion the pancreatic head with mild dilatation of the main pancreatic duct; consider MRCP as clinical warranted.
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Generate impression based on findings.
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Male 46 years old; Reason: pt with a history of ureter cancer, s/p chemothearpy. please assess for disease progression History: hx ureter cancer CHEST:LUNGS AND PLEURA: Innumerable metastasis bilaterally difficult to compare. The index lesions are as follows:Right upper lobe paramediastinal lesion: 1.7 x 1.4 cm (6:31) compared to 2.4 x 1.8 cmLeft upper lobe: 2.0 x 1.2 cm (6:36) compared to 2.3 x 1.3 cm (5:30). MEDIASTINUM AND HILA: Port-A-Cath tip at the cavoatrial junction. Interval increase in right hilar node measuring 2.3 x 2.3 cm (4:36), previously 1.9 x 2.4 cm (3:34)CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Right retrocrural lymph node measures 1.2 x 1.1 cm (4:89). This previously 1.3 x 1.4 cm (3:84). Other adenopathy around the aorta is unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left external iliac lymph node measures 8 x 7 mm, previously 8 x 9 mm (4:173).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Mixed response, with reference lesions measured above.
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Generate impression based on findings.
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91-year-old female with history of distal radius and ulnar fractures. Evaluation of the bones is limited due to overlying cast material. The previously seen distal radius and ulnar styloid fractures are barely visible. Alignment is near-anatomic.
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Distal radius and ulnar fractures are poorly visualized due to overlying cast material, but alignment is anatomic.
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Generate impression based on findings.
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61-year-old male with history of C5/6 pain. Moderate to severe degenerative disc disease affects C5-6 with anterior and posterior osteophytes. There are anterior and posterior osteophytes projecting from C3-6. There is minimal retrolisthesis of C5 on C6. There appears to be multilevel neuroforaminal narrowing including C5-6 although this may in part be secondary to patient positioning and could be better evaluated with cross-sectional imaging.
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Degenerative disc disease and neuroforaminal narrowing as described above. If patient care warrants further imaging, MRI may be obtained.
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Generate impression based on findings.
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44 year old female with worsening neck pain and gas in soft tissues on x-ray. History of cervical cancer status post recent pelvic exenteration in cystectomy and ileal conduit CT HEAD:The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Leftward deviation of the nasal septum.CT NECK:Findings on prior radiograph correspond to epidural air within the cervical spine, most prominently extending between C1 to C4 and exiting into the right paraspinal and posterior subcutaneous of the neck at C1, tracking along fascial planes. There is no associated soft tissue stranding or lymphadenopathy to suggest infection. A small focus of epidural air is seen at T3. No focal fluid collections.There is no evidence of mass lesions. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged portions of the lungs are clear. A right internal jugular catheter is partially visualized.
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Multiple foci of air in the epidural space in the cervical spine extending into the right paraspinal tissues of the neck are likely related to recent epidural catheter. No findings to suggest soft tissue infection within the neck. If there are focal neurologic deficits and suspicion of epidural hematoma, an MRI may be considered.
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Generate impression based on findings.
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54-year-old female with history of bilateral knee pain. Left knee: Moderate to severe osteoarthritis affects the knee with near bone-on-bone apposition in the medial compartment. There is a slight varus deformity. There is perhaps a small joint effusion.Right knee: Moderate to severe osteoarthritis affects the knee with near bone-on-bone apposition in the medial compartment. There is a slight varus deformity. There is perhaps a small joint effusion.
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Osteoarthritis as above.
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Generate impression based on findings.
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Male 51 years old Reason: known partial portal vein thrombosis, rule out extension of clot in setting of new onset encephalopthy History: as above LIMITED ABDOMENLIVER: The liver measures 20.1 cm in length and demonstrates cirrhotic morphology. The main portal vein is patent and demonstrates normal directional flow.BILIARY TRACT: There is no biliary dilatation. The gallbladder is contracted.PANCREAS: The pancreas is largely obscured by bowel gas.SPLEEN: The spleen measures 17.2 cm in length. RIGHT KIDNEY: The right kidney measures 10.1 cm. The left kidney measures 9.7 cm. There is no hydronephrosis.
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1. The main portal vein is patent with normal directional flow.2. Cirrhotic liver morphology.
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Generate impression based on findings.
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Reason: patient with a history of urothelial cancer, please assess for disease progression. **PLEASE NOTE:CT UROGRAM, 3D IMAGING, DELAYED VIEWS** History: history of urothelial cancer LUNGS AND PLEURA: No suspicious nodules or masses. Basilar subsegmental atelectasis. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild coronary arterial calcification. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. See separately dictated CT of the abdomen and pelvis for description of abdominal findings.
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1. No evidence of thoracic metastatic disease. 2. See separately dictated CT of the abdomen and pelvis for description of abdominal findings.
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Generate impression based on findings.
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Male 39 years old; Reason: hyperparathyroidism, eval for adenoma History: hypercalcemia There is physiologic distribution of the radiopharmaceutical. There is a discrete focus of persistent radiotracer activity on delayed images inferior to the right thyroid lobe which correlates with the solid hypoechoic lesion noted on same day ultrasound study.The right thyroid lobe appears to measure 4.2 cm and the left lobe 4.3 cm in length.
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Findings consistent with parathyroid adenoma inferior to the right thyroid lobe.
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Generate impression based on findings.
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History of left breast DCIS status post lumpectomy 3/2014 followed by radiation. 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. Post surgical changes are present in the left upper outer breast, with architectural distortion, increased density, and surgical clips. Benign appearing calcifications are stable in both breasts. No dominant mass, suspicious microcalcifications, or suspicious areas of architectural distortion are seen in either breast.
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Post-surgical changes. 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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Status post bilateral VDRO procedures.VIEW: Pelvis AP (one view) 1/27/2015 Overlying cast material obscures fine bone detail. Plate and screws devices affix the bilateral osteotomies of the proximal femurs, in unchanged alignment. The femoral heads are well directed into the acetabula. The left acetabulum is dysplastic. Small to moderate feces in the rectosigmoid colon.
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Bilateral VDRO procedures, with femoral heads well directed into acetabula.
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Generate impression based on findings.
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27-year-old male with acute myeloid leukemia for evaluation prior to bone marrow transplant. LUNGS AND PLEURA: The left pleural effusion has resolved. Scattered pulmonary micronodules are again seen (image 24, 37, 63, 66, 73, 85 of series 5), which overall, are not significantly changed from the prior examination. However, the left upper lobe pulmonary nodule has significantly decreased in size, now measuring 3 mm (image 50, series 5), previously 10 mm. No focal airspace opacity is seen.MEDIASTINUM AND HILA: The right upper extremity PICC tip terminates in the SVC. The heart size is normal as is the caliber of the great vessels. No mediastinal or hilar lymphadenopathy is present.CHEST WALL: There is no evidence of axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria.UPPER ABDOMEN: No significant abnormality noted.
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1.Marked interval decrease in size of the dominant left lower lobe pulmonary nodule suggesting an inflammatory or infection etiology, with the remaining scattered pulmonary micronodules unchanged.2.Resolution of the left pleural effusion.3.No focal airspace opacity to suggest active infection.
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Generate impression based on findings.
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Male 39 years old Reason: history of ALL s/p allogeneic stem cell transplant, consider epididymitis History: right testicular pain RIGHT TESTIS: The right testis measures 4.3 x 2.5 x 2.9 cm. There is a solid, vascular, 0.7 x 0.5 x 0.8 cm well-circumscribed hypoechoic lesion centrally within the inferior right testis. A neoplastic origin should be considered as primary testicular neoplasm or leukemic infiltrate could have this appearance. Infection is felt much less likely.LEFT TESTIS: The left testis measures 4.0 x 2.0 x 3.0 cm.RIGHT EPIDIDYMIS: The right epididymis measures 0.8 x 0.8 x 2.2 cmLEFT EPIDIDYMIS: The left epididymis measures 0.7 x 0.8 x 3.9 cmOTHER: No significant abnormalities noted.
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Right testicular mass. A neoplastic origin should be considered as primary testicular neoplasm or leukemic infiltrate could have this appearance. Infection is felt much less likely.
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Generate impression based on findings.
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55-year-old male with history of urothelial cancer, evaluate and compare to prior CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules without suspicious nodules or masses.MEDIASTINUM AND HILA: No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral caliectasis appears slightly increased compared to the prior exam. No renal masses. Delayed images opacified the collecting systems without evidence of urothelial recurrence.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 1.0 x 0.7 cm (series 6, image 129), unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy. Penile prosthesis.BLADDER: Status post cystectomy with continent neobladder.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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1.Postsurgical changes without evidence of disease in the abdomen or pelvis.
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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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68-year-old female status post lung transplant. PTLD small bowel.RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 115 mg/dL. Today's CT portion grossly demonstrates a large anterior mediastinal mass. Severe volume loss of the native right lung, with likely compensatory overinflation of the left transplanted lung. Streaky opacities suggestive of scarring/fibrosis is seen left of the anterior junction line, though superimposed infection cannot be excluded. There are cholecystectomy clips and calcified splenic granulomata are noted in the upper abdomen. Dense calcifications of the abdominal aorta and its branches are present.Today's PET examination demonstrates markedly FDG-avid large anterior mediastinal mass (SUV max 13.6), compatible with tumoral involvement of a conglomerate lymph node mass. A focus of decreased activity within the mass suggests a central necrotic component. Two foci of increased activity in the right pericardium/diaphragmatic pleura with subtle CT soft tissue nodularity in this area may represent additional lymph node involvement. An additional mildly hypermetabolic focus at the left diaphragmatic edge without definite CT correlation may also represent tumor involvement.In the abdomen, markedly hypermetabolic foci corresponding to multiple bowel loops, two in the left upper quadrant (small bowel), one in the right pelvis (ascending colon), and one in the left low pelvis (sigmoid colon), are compatible with stated history of bowel involvement of PTLD. A mesenteric lymph node in the mid pelvis, just left of midline demonstrates mild FDG activity, suspicious for additional tumor involvement. Additional foci of mildly hypermetabolic activity in the anterolateral left abdominal wall as well as in the midline in the anterior abdominal wall, both with subtle soft tissue thickening, may represent iatrogenic injection sites and less likely lymphomatous involvement.Mild FDG avidity of the pituitary gland may represent pituitary adenoma.
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1.Anterior mediastinal conglomerate lymph node mass with central necrosis demonstrates markedly hypermetabolic activity, compatible with lymphomatous involvement.2.At least 4 foci of hypermetabolic activity associated with bowel loops (small bowel, ascending colon, sigmoid colon) are compatible with stated diagnosis of PTLD involvement of bowel.3.Additional right pericardial/diaphragmatic pleural FDG avid foci as well as pelvic mesenteric lymph node, some of which have no CT correlation, may represent additional lymphomatous involvement.4.Pituitary hypermetabolic activity may represent pituitary adenoma.
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Generate impression based on findings.
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59-year-old female with right fifth digit nondraining ulcer and diffuse erythema. There is a possible soft tissue defect along the radial aspect of the fifth finger but we see no findings to suggest osteomyelitis. We see no subcutaneous gas. Mild osteoarthritis affects the hand and wrist. Small peri-articular ossicles are likely of no current clinical significance.
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1. 5th finger ulcer without evidence of osteomyelitis. 2. Osteoarthritis, as above.
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Generate impression based on findings.
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72-year-old with history of right breast cancer status post mastectomy and reconstruction. No current complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Numerous scattered calcifications are again noted in the left breast, not significantly changed. Stable asymmetry in the left outer breast.Benign appearing lymph nodes are projected over the left axilla.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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9-week-old female with increased bradycardia and desaturationsVIEWS: Chest and abdomen AP (two views) 01/27/15 , 1418 ET tube tip is above the thoracic inlet. Left chest tube is in place. NG tube terminates in the stomach. Nonobstructive bowel gas pattern.Complete opacification of the right hemithorax. Left lower lung opacity. Cardiac silhouette cannot be evaluated.Diffuse soft tissue edema is present.
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Reaccumulation of right pleural effusion is likely.
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Generate impression based on findings.
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30 year-old male with previous facial fractures, evaluate resolution There is a lucency through the right body of the mandible representing a nondisplaced fracture which is similar in orientation to the prior exam. There is a small amount of callus and the fracture line may be slightly less distinct, indicating healing. Multiple additional linear lucencies correspond to screw tracks. The fracture extends to the apex of a right mandibular canine tooth which contains an apparent implant/fixation screw, similar to the prior exam. A nondisplaced fracture through the left subcondylar mandible is unchanged in appearance and healed. No new fractures are identified.Mild mucosal thickening of the anterior ethmoid sinuses is slightly improved. The sphenoid sinuses and mastoid air cells are clear. Minimal mucosal thickening extends to the right frontal sinus. No intracranial abnormalities are seen. The orbits are within normal limits.
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1.Healing right mandibular body fracture.2.Healed left mandibular subcondylar fracture.
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Generate impression based on findings.
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Stigmata of agenesis of the corpus callosum are again noted. There is bilateral colpocephaly, with slight increased caliber of the atrium and occipital horn bilaterally since the previous exam. For example, on coronal images, the left atrium measures 2.3 cm in width as compared to previous 1.6-cm. At the same level, the biparietal width is currently 14.4 cm as compared to previous 11.9 cm. The temporal horns are stable in size. The third ventricle is stable in size measuring approximate 14 mm. The fourth ventricle is again nondilated and is stable. The anterior subarachnoid space has decreased since the previous exam, consistent with expected resolution of benign enlargement of subarachnoid spaces of infancy.The basal cisterns remain patent. There is no midline shift or mass effect. There are no gross areas of abnormal T2 signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is moderate-severe right and mild/moderate left mastoid air cell opacification, as well as probable fluid in the right middle ear. There is mild mucosal thickening in the sphenoid sinuses bilaterally.There is prominence of the cerebral aqueduct. CSF flow imaging was inadvertently obtained and demonstrate slightly asynchronous biphasic flow across the foramen magnum, ventrally versus dorsally. Biphasic flow is also visualized in the aqueduct and the fourth ventricle. Incidental note is made of trace prominence of the central spinal canal within the cervical spinal cord on the sagittal FIESTA images, but likely within limits of normal. The remainder of the midline structures and craniocervical junction are within normal limits.
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1. Slight interval increase in caliber of measurements of colpocephaly with complement increased in size, although overall ventricular caliber is similar including stable temporal horns. Nondilated fourth ventricle is unchanged, with conspicuous prominence of the cerebral aqueduct.2. Expected resolved benign enlargement of subarachnoid spaces of infancy.3. Redemonstration of stigmata of complete agenesis of the corpus callosum.4. Moderate-severe right and mild/moderate left mastoid air cell fluid opacification, with probable fluid in the right middle ear. Please correlate clinically.
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Generate impression based on findings.
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Male 51 years old Reason: evaluate for cholecystitis History: Abdominal pain, hx gallstones/biliary colic LIVER: The liver measures 21.9 cm in length. Hyperechoic hepatic parenchyma suggestive of fatty infiltration. The hypoattenuating segment 6 lesion identified on prior CT is not visualized on today's study. Hepatic granuloma. The main portal vein is patent and demonstrates normal directional flow. GALLBLADDER, BILIARY TRACT: Small gallstone within the gallbladder without gallbladder wall thickening or pericholecystic fluid to suggest acute cholecystitis.PANCREAS: The pancreatic head is unremarkable. The body and tail are poorly visualized.KIDNEYS: The right kidney measures 12.9 cm. The left kidney measures 12.4 cm. There is no hydronephrosis.OTHER: The spleen measures 12.4 cm.
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1. Cholelithiasis without acute cholecystitis.2. Fatty infiltration of the liver.
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Generate impression based on findings.
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Male, 27 years old, history of adenoid cystic carcinoma of the left external auditory canal, parotid and temporal bone, status post CRT. Postoperative findings are redemonstrated including left parotidectomy, resection of the bony and cartilaginous external auditory canal, and resection of the middle ear structures and part of the mastoid temporal bone. The bony defect has been partially filled with synthetic bone graft material.A temporalis flap is also been created and used to bridge the soft tissue surgical defect. This may account for the somewhat heterogeneous enhancing tissue which is seen within the surgical bed. This tissue is perhaps somewhat less bulky than on the prior examination but overall very similar in appearance.Additional treatment related findings are seen including infiltration of the fascial planes and thickening of platysma. A left neck dissection has also been performed. No pathologically enlarged or aggressive appearing lymph nodes are seen on either side of the neck. The residual salivary glands are free of focal lesions as is the thyroid. Cervical vessels enhance normally. No new or concerning osseous lesions are detected.
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Extensive postoperative and treatment related findings are redemonstrated. Heterogeneously enhancing soft tissue in the left parotidectomy bed appears slightly less bulky but overall very similar in appearance to the prior exam and probably represents the presence of the soft tissue graft.No definite findings are seen to suggest locally recurrent tumor or new adenopathy in the neck.
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Generate impression based on findings.
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Weakness, drooling, tingling of tongue No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Again seen is encephalomalacia involving the right frontal, inferior parietal, and superior temporal lobes consistent with prior infarct. 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. Calvarium is intact.
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1. No evidence of acute intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Chronic right middle cerebral artery territory infarct.
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Generate impression based on findings.
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Pubic ramus fracture.VIEW: Pelvis AP (one view) 01/27/15 Fractures of the right pubic bone and right inferior pubic ramus are again seen. Alignment is anatomic. The fracture lines are less distinct.
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Healing fractures of right pubic bone and right inferior pubic ramus.
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Generate impression based on findings.
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43-year-old female, rule out myeloma or compression fracture Thoracic spine: The bones are slightly demineralized, but we see no focal myelomatous lesions. There is mild multilevel degenerative disease without compression fracture.Lumbar spine: Again seen is a compression fracture of the L1 vertebral body appearing similar to the prior exam dated 2/25/14. Poorly defined lucency within the posterior aspect of the L5 vertebral body may represent a myelomatous lesion, appearing similar to the prior exam. Mild degenerative disk disease affects the lower lumbar spine.
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Chronic L1 compression fracture and possible L5 myelomatous lesion appearing similar to the prior exam.
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Generate impression based on findings.
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Female 71 years old Reason: 71F admitted with UTI and AMS who has h/o renal cyst and current flank pain. History: flank pain on R, renal cyst RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 13.2 cm. There is a solid exophytic mass measuring 4.5 x 4.4 x 4.6 cm arising from the lower pole of the left kidney. This has increased compared to prior remote ultrasound 03/31/12 where it measured 2.2 x 3.6 x 2.8 cm. There is a central hypoechoic renal cyst.OTHER: The bladder is nondistended.
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Solid exophytic mass arising from the left kidney, increased in size compared to a remote study from 2012. Renal protocol CT is recommended for further evaluation.Findings discussed with Dr. Stier by myself Dr. Ward 01/27/15.
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Generate impression based on findings.
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Hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple bilobar subcentimeter low attenuation foci; favor benign etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 0.5 cm nonobstructing left renal calculus; new since 2005. Multiple bilateral benign-appearing cysts. A number of these cysts have increased in size when compared to 2005 but still maintain a benign morphology without evidence for enhancement or complexity.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Nonobstructing 0.5-cm left renal calculus; new since 2005. Multiple bilateral benign-appearing cysts; a few have increased in size since 2005 but maintain benign morphology without evidence for enhancement or complexity. No worrisome mass or acute inflammatory process.
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Generate impression based on findings.
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History of tonsillar cancer, status post chemoradiation 12/13. Streak artifact emanating from dental amalgam obscures surrounding structures. Within this limitation, there is no residual or recurrent measurable oropharyngeal tumor. Treatment-related findings are seen including mild infiltration of the fascial planes and a thin retropharyngeal effusion. Salivary glands and thyroid are unremarkable. The cervical vessels are patent. Scattered subcentimeter lymph nodes are seen. No pathologic adenopathy is detected in the neck by size criteria. Emphysema is seen in the lung apices. No destructive osseous lesions are evident. Moderate multilevel degenerative changes again seen in the cervical spine. Visualized brain parenchyma is unremarkable. Paranasal sinuses and mastoid air cells are clear.
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No measurable residual or recurrent oropharyngeal tumor or significant cervical lymphadenopathy.
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Generate impression based on findings.
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Evaluate mandible distraction Again seen is an external fixation device with screws entering the anterior aspect of the mandible as well as the calvarium. Also again seen are osteotomies of the mandibular rami. On the left, the osteotomy margins appear less distinct than on the prior study, suggestive some interval healing. On the right the osteotomy appears similar to that seen on the prior study accounting for slight positional differences.
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Orthopedic fixation of mandibular distraction surgery with findings suggestive of some interval healing of the osteotomy on the left.
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Generate impression based on findings.
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35-year-old female with lumbar back pain and radiculopathy There is minimal leftward curvature of the lumbar spine. Moderate disk space narrowing is noted posteriorly at L5/S1. The vertebral body heights are preserved. Linear metallic densities in the pelvis presumably reflect a sterilization procedure.
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L5/S1 degenerative disk disease.
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Generate impression based on findings.
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61-year-old female, evaluate for progression of osteoarthritis Right knee: Severe osteoarthritis affects the knee with near bone-on-bone apposition of the medial compartment as well as tricompartmental osteophytes, perhaps progressed slightly from the prior exam. A 2cm loose body noted along the posterior aspect of the joint appears slightly larger than on the prior exam. Mild varus deformity of the knee.Left knee: Moderate to severe medial joint space narrowing with tricompartmental osteophytes consistent with osteoarthritis that has progressed slightly from the prior exam. Mild varus deformity of the knee.
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Osteoarthritis of both knees, progressed compared with the prior exam.
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Generate impression based on findings.
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Male 83 years old; Reason: metastatic Prostate cancer, evaluation of disease during treatment with investigational therapy. Please complete PCWG form. Increased activity in the right calvarium is nonspecific and unchanged. There is new focal activity in the right eighth rib at the costochondral junction which is difficult to correlate on CT in this region and more likely represents a fracture.Foci of increased activity in the basilar joints of both hands and in both feet are most likely degenerative in etiology.
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1. New focus of activity in the right eighth rib more likely represents a fracture, and less likely tumor activity. 2. No new suspicious osseous foci to suggest new metastatic disease.
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Generate impression based on findings.
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6-year-old female status post fall/head trauma. A punctate hyperdensity is located in the right frontal lobe, which is favored to represent a small intraparenchymal calcification. There is no associated edema, mass effect, or significant midline shift. The ventricles and basal cisterns are normal in size and configuration. The imaged paranasal sinuses and mastoid air cells are clear. Small right frontal subgaleal hematoma, measuring up to 7 mm in diameter, without underlying calvarial fracture.
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1. Punctate hyperdensity in the right frontal lobe, which is favored to represent small intraparenchymal calcification. There is no edema, mass effect, or midline shift.2. Small right frontal subgaleal hematoma, without underlying calvarial fracture.
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Generate impression based on findings.
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Male 70 years old Reason: please ultrasound the chest hematoma at site of subclavian balloon pump History: hematoma at site of subclavian, with fever Circadian balloon pump wire is identified in the right anterior chest wall without evidence of fluid collection.
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No evidence of fluid collection surrounding the subcutaneous portion of the balloon pump.
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Generate impression based on findings.
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Male 62 years old Reason: abdominal pain with early satiety History: abd pain LIVER: The liver measures 17.8 cm in length and is heterogeneously hyperechoic consistent with chronic liver disease. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0 .4 m/sec.GALLBLADDER, BILIARY TRACT: No gallstones or biliary dilatation.PANCREAS: Solid hypoechoic well-circumscribed mass within the pancreatic head measuring 2.3 x 1.3 x 1.6 cm requires further evaluation with pancreatic protocol CT.KIDNEYS: The left kidney measures 11.4 cm. The right kidney measures 12.8 cm. There is no hydronephrosis. Hypoechoic left renal lesion measuring 1.5 cm in maximum dimension suggestive of a renal cyst.OTHER: No significant abnormalities noted.
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1. Heterogeneously hyperechoic hepatic parenchyma consistent with chronic liver disease.2. Solid hypoechoic pancreatic mass requires further evaluation with pancreatic protocol CT.Findings discussed by myself Dr. Ward with Dr. Singh 01/27/15 at 3:51 p.m.
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Generate impression based on findings.
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Hip pain Two views of the right hip show severe osteoarthritis of the hip. Geographic lucency within the superomedial aspect of the acetabulum presumably represents a large degenerative cyst.The AP view of the pelvis reveals the aforementioned severe right hip osteoarthritis. Moderate osteoarthritis affects the left hip. Brachytherapy pellets overlie the expected location of the prostate gland. Degenerative arthritic changes affect the visualized lower lumbar spine.
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Osteoarthritis and other findings as described above.
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Generate impression based on findings.
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Colon cancer and chemotherapy, evaluate and compare to prior CHEST:LUNGS AND PLEURA: Right perihilar nodule measures 0.8 x 0.8 cm (series 5, image 37), previously 0.8 x 0.8 cm.Scattered pulmonary micronodules are stable. No pleural effusions.MEDIASTINUM AND HILA: No lymphadenopathy. Minimal coronary artery calcifications.CHEST WALL: Right chest wall Port-A-Cath tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases. Reference segment 4 lesion measures 2.0 x 1.9 cm (series 3, image 95), previously 2.2 x 1.5 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral low attenuation renal foci incompletely characterized by CT.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: Status post sigmoid resection.BONES, SOFT TISSUES: No significant abnormality noted.
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Stable exam without significant interval change in reference measurements or new sites of disease.
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Generate impression based on findings.
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29-year-old male with pain to dorsal foot and third toe after injury yesterday Diffuse soft tissue swelling without fracture evident. Alignment is within normal limits.
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Soft tissue swelling without fracture.
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Generate impression based on findings.
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11 year old female with Blount's disease status post osteotomy.VIEWS: Left tibia/fibula AP and lateral (two views) 1/27/2015 A new osteotomy is seen through the proximal tibial diaphysis and an external fixation device is in place. Skin staple lines are present in the lower leg. Reticulation of the subcutaneous fat likely reflects edema.
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Postsurgical changes related to osteotomy and external fixation as above.
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Generate impression based on findings.
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Reason: 69 y/o M with dysphagia, compare to prior esophagram which noted stricture (on Plavix for recent drug eluting stent so hoping to delay endoscopy) Scout radiograph of the chest showed increased interstitial opacities predominantly lung bases compatible with history of pulmonary fibrosis.Fluoroscopic evaluation of esophageal peristalsis demonstrated mild to moderate hypomotility with proximal escape. Liquid contrast passed freely into stomach. Double contrast evaluation of the esophagus and gastric cardia/fundus showed re-demonstration of esophageal stricture measuring 3 cm in length and 1cm in diameter and proximal diverticulum measuring 1.4 x 0.5 cm. There is mild dilatation of proximal esophagus (2.1 cm in diameter). Barium pill (13 mm) does not pass the stricture.There were thick linear filling defects at the distal half of the esophagus, which may represent varices.During the exam, there was mild provoked gastroesophageal reflux. TOTAL FLUOROSCOPY TIME: 7:37 minutes
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1.Mild to moderate hypomotility of the esophagus with proximal escape. 2.Esophageal stricture. Esophageal diverticulum and mild dilatation proximal to the stricture. 3.Barium pill does not pass the stricture, but liquid contrast passed freely.4.Mild provoked gastroesophageal reflux. 5.Thick linear filling defects at the distal half of the esophagus, which may represent varices.
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Generate impression based on findings.
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Reason: cognitive impairement/dementia History: cognitive impairement/dementia The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a mild degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses demonstrate partial opacification of the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.
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1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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49 year old female status post fall, complaining of right forearm pain Wrist: There is a poorly defined fracture extending across the distal radial metaphysis with early callus formation along the medial aspect of the fracture. Fracture fragments are in near-anatomic alignment. There is no evidence of extension to the articular surface.Forearm: The aforementioned distal radius fracture is again visualized. The proximal radius and ulna are intact.
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Distal radius fracture as described above. Findings text paged to Debra Conti (pager 6193) at the time of dictation after attempts were made to discuss by phone.
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Generate impression based on findings.
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4-year-old male with pain and swelling in the right second and third digits.VIEWS: Right hand PA lateral and oblique (3 views) 1/27/2015 Diffuse mild soft tissue swelling of the index and ring fingers is evident, but no underlying fracture or malalignment is seen.
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Mild soft tissue swelling of the second and third digits without fracture.
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Generate impression based on findings.
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GIST CHEST:LUNGS AND PLEURA: Stable micronodules. Stable calcified pleural plaques.MEDIASTINUM AND HILA: Triple vessel coronary calcifications again noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously noted hypervascular focus within segment two of the liver is less conspicuous on the current examination and difficult to clearly identify. Previously mentioned peripheral segment 5 hypervascular focus not appreciated on current examination. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable omental infarctBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Previously described enhancing foci within the liver not appreciated on current examination. No evidence for acute, metastatic, or inflammatory process.
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Generate impression based on findings.
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The frontal sinus and frontoethmoidal recesses are clear. There is mild mucosal thickening involving the bilateral anterior and posterior ethmoid air cells. There is mild mucosal thickening involving the bilateral maxillary sinuses, particularly along the superior aspect of the left maxillary antrum, with small polyps versus mucous retention cysts. Right-sided concha bullosa. There is opacification involving the right middle meatus. There is also opacification adjacent to the left middle turbinate including narrowing of the middle meatus. There is partial opacification involving the left maxillary infundibulum. The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is leftward nasal septal deviation with small left nasal septal spur. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Visualized brain parenchyma is unremarkable.
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1. Mild mucosal thickening involving the paranasal sinuses as described above.2. Lobulated areas of opacification adjacent to the anterior aspects of the bilateral middle turbinates, left worse than right, which may be related to polyposis.
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Generate impression based on findings.
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Left breast lumpectomy in 2014. History of chemotherapy and radiation. 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. Scar markers overlie the left upper outer breast and right axilla. Post surgical changes are present in the left upper outer breast, with architectural distortion, increased density, and surgical clips. Few scattered benign appearing calcifications are present in the left breast.No dominant mass, suspicious microcalcifications, or suspicious areas of architectural distortion are seen in either breast.
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Left breast post surgical changes. 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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Male 54 years old; Reason: Stem cell transplant patient with BK viurea. Hx of recurrent e.coli bacteremia. Need CT to rule out stone formation History: dysuria The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: 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 hydronephrosis or hydroureter. No renal or ureteric calculi.RETROPERITONEUM, LYMPH NODES: Diffuse infiltrative process throughout the retroperitoneum, most prominent in the pelvis. The appearance is predominantly nonspecific bland fluid without loculation. 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: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.No evidence of renal or ureteric stones.2. Diffuse infiltrative process throughout the retroperitoneum, most prominent in the pelvis. The appearance is predominantly nonspecific bland fluid without loculation.
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Generate impression based on findings.
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There is no evidence of intracranial hemorrhage. No enhancing mass is identified. There is redemonstration of encephalomalacia/volume loss involving the left frontal lobe middle fontal and precentral gyri, left angular gyrus, precuneus and cuneus, as well as ex vacuo dilatation of the left lateral ventricle, suggestive of chronic infarct with addition confluent surrounding hypoattenuation. The gray-white matter differentiation is maintained on the right. There is mild prominence of the sulci and ventricles on the right, which may be related to mild age-related atrophy. There is no mass or significant midline shift. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1.Redemonstration of findings suggestive of chronic infarctions in portions of the left middle cerebral artery territory and left posterior cerebral artery territories. 2.CT is insensitive for the early detection of non-hemorrhagic acute infarct.3. No evidence for acute intracranial hemorrhage, enhancing mass, or mass effect.
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Generate impression based on findings.
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44 years, Male. Reason: Patient with continued abdominal pain, want to evaluate for obstruction/fluid air levels/ perforation History: Abdominal pain Nonobstructive bowel gas pattern. No evidence of free air.
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Nonobstructive bowel gas pattern. No evidence of free air.
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Generate impression based on findings.
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14 month old female with increased laxity of the hips.VIEWS: Pelvis AP and frog leg lateral (two views) 1/27/2015 The femoral heads are well directed into the acetabula bilaterally. The acetabular angles are normal. Bilateral coxa valga deformities are noted. There is a large umbilical hernia.
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Bilateral coxa valga deformities without evidence of subluxation or dislocation.
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Generate impression based on findings.
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89-year-old male with right lower lobe nodule.RADIOPHARMACEUTICAL: 14.1 5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 81 mg/dL. Today's CT portion grossly demonstrates moderate to severe cardiomegaly, moderate left and small right pleural effusions with compressive atelectasis at the lung bases, mildly atrophic kidneys, dense vascular calcifications of the thoracic and abdominal aorta and its branches with aneurysmal dilatation of the distal abdominal aorta immediately proximal to the bifurcation, measuring 3.8 cm in AP dimension. Displaced intimal calcifications at this level also raises question of focal dissection, though evaluation is limited due to lack of intravenous contrast.A right lower lobe nodule with questionable spiculation adjacent to and inseparable from the right inferior pulmonary vein appears similar to that seen on the previous two studies. Subtle ground glass opacities in the right middle lobe are newly identified.Today's PET examination demonstrates moderately hypermetabolic right lower lobe nodule adjacent to the inferior right pulmonary vein (SUV max 5.6), highly suspicious for primary lung malignancy. Small mildly FDG avid foci in the bilateral hila are additionally noted (SUV max 2.5). This is nonspecific, though given symmetry, benign/granulomatous process is favored; however ipsilateral right hilar lymph node metastases cannot be entirely excluded. Mildly hypermetabolic foci in the right middle lobe correspond with groundglass opacity seen on CT, and likely represent inflammatory changes.Additional mediastinal foci of hypermetabolic activity are associated with the thoracic aortic walls, which demonstrates extensive calcification. These foci therefore likely reflect inflammation related to atherosclerotic disease.Mild FDG activity lateral to the greater trochanter of right femur may represent bursitis.
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1.Moderately hypermetabolic right lower lobe nodule, highly suspicious for primary lung malignancy.2.Symmetric hilar FDG-avid foci favor benign/granulomatous process, though ipsilateral right hilar metastases cannot be entirely excluded.3.3.8-cm abdominal aortic aneurysm with findings raising question of focal dissection.
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Generate impression based on findings.
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Reason: rule out tonsillar abscess. Current everyday smoker History: pain and tenderness with swallowing CT neck:There is a soft tissue mass in the left oro pharyngeal mucosal space at the expected location of the oropharyngeal adenoids which measures 26 x 22 mm axial dimensions and extends up to the level of the soft palate and down to the level of the hyoid bone. It has septated cystic lesions associated with it. This mass is not depicted on prior brain MRI from 8/28/15.The left jugulodigastric node measures 18 x 8 mm axial dimensions.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. Atherosclerotic calcifications are present at the carotid bifurcations. Atherosclerotic calcifications are present at the carotid bifurcations.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are endplate osteophytes and uncovertebral osteophytes present at C5-6 and at C6-7 which narrows the neural foramina bilaterally.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild to moderate degree are present.No abnormal enhancing mass lesions are appreciated intracranially. No acute 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.There is a left-sided oropharyngeal mass present. One possibility is that this represents a tonsillar abscess with reactive adenopathy. The possibility that this represents a neoplastic process cannot be excluded on this exam though. It is not depicted on a prior brain MRI from 8/28/15. Please correlate with clinical history and evaluation.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.
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Generate impression based on findings.
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12 year old female with history of rhabdomyosarcoma of the pelvis, now with pelvic pain.VIEWS: Abdomen supine and upright (two views) 1/27/2015 The bowel gas pattern is nonobstructive. A moderate stool burden is distributed throughout the colon, slightly improved from the prior examination. No pneumoperitoneum, portal venous gas or pneumatosis intestinalis is evident.
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Nonobstructive bowel gas pattern and improved moderate stool burden.
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Generate impression based on findings.
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Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: Bilateral small mucosal retention cysts are unchanged. The ostiomeatal units are clear although the infundibulum remain narrowed by bilateral Haller cells, partially opacified on the left.Posterior ethmoids: Mild mucosal thickening of the right posterior ethmoid air cells.Sphenoid sinus: There is a stable appearance of the small mucosal retention cyst in the left sphenoid sinus. There is been interval improvement of mucosal thickening within the sphenoid, and the opacification of the sphenoethmoidal recesses has resolved.There is minimal leftward nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Note is again made of a torus palatini. The previously described lymphadenopathy is not well appreciated on today's exam.
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1. Stable scattered small mucus retention cysts in the bilateral maxillary and left sphenoid sinuses.2. Previously described cervical lymphadenopathy is not appreciated on this exam.
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Generate impression based on findings.
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Reason: s/p MALS 2 weeks ago, no w/ N/V, imaging shows dilated duo, eval for SMA syndrome History: n/v, D1/D2 dilation. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Small transient hiatal hernia was noted. The esophagus and stomach were otherwise morphologically normal.There was extensive to-and-fro peristalsis of proximal duodenum consistent with SMA syndrome (e.g., video series 12). On two occasions peristalsis overcame the obstruction and contrast entered the distal duodenum and jejunum. There was delayed emptying of the duodenum.TOTAL FLUOROSCOPY TIME: 4:06 minutes
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1.Findings consistent with SMA syndrome.2.Normal motility of the esophagus and stomach.3.Possible small transient hiatal hernia.
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Generate impression based on findings.
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Male 53 years old Reason: 53M with hx right ureteral injury, now status post ureteral stent removal with right flank pain, assess for hydro History: 53M with hx right ureteral injury, now status post ureteral stent removal with right flank pain, assess for hydro RIGHT KIDNEY: The right kidney measures 11.3 cm. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 11.9 cm. There is minimal hydronephrosis.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.
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Minimal left hydronephrosis. No evidence of right hydronephrosis.
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Generate impression based on findings.
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9-year-old female with stool impactionVIEWS: Abdomen AP (one views) 01/27/15, 1453 hour Small amount of desiccated stool is noted within the rectum. Nonobstructive bowel gas pattern. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas.
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Small stool burden.
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Generate impression based on findings.
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There is redemonstration of postoperative changes from bilateral antrostomies.Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is trace mucosal thickening in the right maxillary sinus with a focal polyp or mucosal retention cysts along the floor. There is also a tiny mucosal retention cyst in the left maxillary sinus. The antrostomies are widely patent.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is mild to moderate rightward nasal septal deviation with a 3-mm rightward directed bony spur. The right middle turbinate is slightly diminutive in size as compared to the left which may be post-surgical nature. The nasal turbinate morphology is otherwise within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.Mild degenerative changes are seen involving both temporomandibular joints. Postoperative changes are also suggested along the right mastoid, with probable partial mastoidectomy. There is slight thickening of the right tympanic membrane. The right middle ear ossicles are not visualized and may be surgically versus developmentally absent or possibly chronically eroded. There is redemonstration of focal prominence of the right lateral extra-axial space which may relate to subdural effusion/hygroma.
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No significant interval change in appearance of paranasal sinuses. Postoperative changes as detailed above.
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Generate impression based on findings.
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83-year-old male with history of disseminated prostate cancer. Investigational therapy. CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule with associated scarring (5/41) measures 7 mm, previously 9 mm.Reference right lower lobe nodule adjacent to the fissure (5/45) measures approximately 5 mm, previously 6 mm.Right lower lobe reference nodule (5/80) measures 7 mm, unchanged.MEDIASTINUM AND HILA: Reference pretracheal lymph node (3/21) measures 14 x 10 mm, previously 16 x 13 mm. Additional small mediastinal lymph nodes are similar to prior.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph node (3/178) is unchanged in size, measuring 6 mm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Subtle interval decrease in size of the previously described lung lesions and lymph nodes, as above. No new evidence of metastatic disease.
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Generate impression based on findings.
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Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Relatively stable pulmonary metastatic nodules. Reference left upper lobe nodule best seen on image 24 series 4 measures 1.1 x 1 cm. Left lower lobe reference nodule best seen on image 43 of series 4 measures 1.1 x 1.2 cm.Interval increase in size of right pleural-based metastatic mass associated with rib destruction best seen on image 32 series 3 now measuring 4.8 x 3.3 cm; in retrospect, this lesion measured 1.2 x 0.4 cm on 8/14/2014.MEDIASTINUM AND HILA: Interval increase in bilateral hilar metastatic adenopathy. Reference right hilar lymph node best seen on image 51 of series 3 now measures 3.1 x 4.1 cm; this is in comparison to 3.3 x 2.8 cm on 8/14/2014.CHEST WALL: Destructive lytic lesions involving bilateral ribs are relatively stable.ABDOMEN:LIVER, BILIARY TRACT: Significant interval increase in size and confluence of bulky bilobar hepatic metastases. The reference segment 8 lesion best seen on image 67 of series 3 now measures 2.5 x 2.2 cm; this is in comparison to 1.3 x 1.4 cm on 8/14/2014. The additional reference segment 8 lesion best seen on image 84 series 3 now measures 5.8 x 6.7 cm; this is in comparison to 6 x 5.5 cm on 8/14/2014. The reference segment 2/3 lesion best seen on image 119 of series 3 now measures 7.8 x 5.9 cm; this is comparison to 4.1 x 3.6 cm on 8/14/2014.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrectomy site clear. Stable left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Slight interval increase in size and soft tissue component of multifocal lytic bony lesions.OTHER: No significant abnormality noted.
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Metastatic disease progression manifest by interval increase in size of bilateral hilar adenopathy, right pleural-based metastatic mass and significant interval increase in extensive bilobar bulky hepatic metastases. Slight interval increase in severity of pelvic lytic bony metastatic lesions.
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Generate impression based on findings.
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Male 58 years old with HCV cirrhosis. LIVER: The liver measures 15.9 cm in length. Coarsened hepatic echotexture compatible with history of liver cirrhosis. Stable appearance of an anechoic cyst in the right hepatic lobe which measures 1.8 x 0.8 x 0.6 cm, allowing for differences in imaging technique. The portal vein demonstrates normal directional flow with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Adenomyosis of the gallbladder is again noted.PANCREAS: The pancreas is largely obscured by bowel gas.KIDNEYS: The right kidney measures 9.0 cm. The left kidney measures 11.0 cm. There is no hydronephrosis.OTHER: The spleen measures 9.5 cm.
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Cirrhotic liver morphology. Unchanged simple cyst.
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