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Generate impression based on findings.
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Female, 72 years old, chronic sinusitis treated medically with worsening left facial pain and headaches. The frontal sinuses and frontoethmoidal recesses are opacified with progression on the right. The right sided ethmoid air cells are also opacified similar to prior. The right maxillary sinus is completely opacified with progression. In each case, the sinuses are opacified with hyperattenuating material. The right sphenoid sinus is clear.Evidence of endoscopic sinus surgery is seen on the left with resection of the uncinate process, the middle and superior turbinates, and most of the left-sided ethmoid air cells. The maxillary outflow pathway is widely patent. There remains some soft tissue thickening along the residual ethmoid wall and into the left sphenoid sinus similar to prior.Polypoid soft tissue thickening seems to protrude from the ethmoid air cell complex into the right upper nasal cavity with slight leftward deviation of the nasal septum. This soft tissue is also hyperdense. The septum itself remains intact. The right sided turbinates are present and appear similar to the prior examination.
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Multiple areas of sinus and sinus ostia opacification are redemonstrated with some progressive opacification as discussed above. The material filling the sinuses is hyperdense similar to prior which may reflect inspissated secretions or fungal elements.Polypoid soft tissue seems to project from the right ethmoid region into the right nasal cavity with slight leftward deviation of the nasal septum. Again, findings are not significantly changed.Redemonstration of findings related to endoscopic sinus surgery on the left. The neo-antrum remains widely patent.
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Generate impression based on findings.
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Asymptomatic woman presents with prior mammogram showing "calcium deposits." 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. Few scattered benign-appearing calcifications are noted. No dominant mass, suspicious microcalcifications or areas of architectural distortion is seen in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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Female 58 years old; Reason: h/o marginal cell lymphoma and lupus c/b leukocytoclastc vasculitis on immunosuppressants, restaging lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heart borderline in size. 1.5-cm left-sided hypoattenuating thyroid nodule. Small anterior mediastinal soft tissue attenuation, similar to prior study, may reflect residual thymic tissue. Small mediastinal lymph nodes. For example, lymph node in posterior mediastinum demonstrates interval decrease in size, measuring 6 x 6 mm, image 37 series 4, previously measured 13 x 9 mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval improvement in wedge-shaped area of hypoattenuation involving anterior aspect of medial segment of left hepatic lobe, again suggestive of focal fatty infiltration given its geographic margins. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Stable subcentimeter retroperitoneal and iliac lymph nodes.BOWEL, MESENTERY: Again seen is small bowel containing ventral abdominal hernia without evidence of associated bowel obstruction. Angulated appearance of some of the small bowel loops located in the lower abdomen and pelvis may reflect underlying nonobstructing adhesions. Scattered colonic diverticula without evidence of acute diverticulitis. Underdistended stomach, making assessment for underlying wall thickening suboptimal. Small hiatal hernia.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Surgical clips seen in region of postoperative bed. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical sequela involving ventral abdominal wall. Multilevel degenerative changes of spine, thoracic kyphosis seen. Mild anterolisthesis of L4 on L5.
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1. No pathologically enlarged adenopathy.2. Left-sided thyroid nodule.
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Generate impression based on findings.
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64 year old female with history of recurrent UTIs, dysuria, left flank pain. Obesity, hypertension. The superior most portion of the hepatic dome is not included on this exam.ABDOMEN:LUNG BASES: Left lower lobe reference pulmonary nodule (4/9) measures 5 mm, unchanged. Mild bibasilar atelectasis, likely this exam was obtained in expiratory phase. Moderate coronary artery calcifications. No pericardial effusion.LIVER, BILIARY TRACT: Cholecystectomy. Unchanged hepatic steatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydroureter. No appreciable collecting system stone. Limited evaluation of the distal ureter/bladder due to right hip prosthetic material.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. Appendix within normal limits.BONES, SOFT TISSUES: Fat-containing ventral and spigelian hernias.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Limited evaluation of the pelvis due to metallic artifact.BLADDER: Limited evaluation the bladder due to metallic artifact.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate/grade 2 anterolisthesis of L4 on L5, unchanged.OTHER: No significant abnormality noted
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1.No hydronephrosis or hydroureter.2.Degenerative changes of the lumbar spine with anterior listhesis as above.3.Left lower lobe pulmonary nodule, unchanged.
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Generate impression based on findings.
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17 year-old female with effusion, status post left chest tubeVIEW: Chest AP (one view) 01/27/15 , 1527 hour Interval placement of left-sided chest tube. Residual contrast is noted in the abdomen.Cardiothymic silhouette is normal. Interval decrease in left pleural effusion. No pneumothorax. Retrocardiac opacity and right lower lung discoid atelectasis persists. Slight rightward curvature of the thoracolumbar spine persists.
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Moderate pleural effusion with adjacent atelectasis and/or consolidation.
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Generate impression based on findings.
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The lateral and third ventricles ventricles as well as the frontal greater than parietal sulci are prominent, which is nonspecific but may relate to areas of mild volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There are T2 hyperintense non-enhancing structures within the pineal gland, likely representing small cysts which may be within the normal spectrum. There is no definite narrowing of the cerebral aqueduct. There is an incidental mega cisterna magna. The remainder of the midline structures and craniocervical junction are within normal limits. There is moderate right and minimal left mastoid air cell fluid opacification. There is prominence of the palatine tonsils as well as the nodes of Rouviere bilaterally which may relate to hypertrophied lymphoid tissue in a patient of this age. There is mild mucosal thickening in the right maxillary sinus.
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1. No acute intracranial abnormality. Mild volume loss suspected.2. Incidental tiny pineal cysts without significant mass-effect.
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Generate impression based on findings.
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49-year-old male with new tongue cancer. Evaluate for regional/distant disease.RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 97 mg/dL. Today's CT portion grossly demonstrates soft tissue mass at the base of the right tongue, compatible with stated history of new tongue cancer. Sclerotic lesion is seen in the proximal right clavicle. Soft tissue mass of unclear origin is also noted in the right axilla. Calcified prevascular lymph nodes are compatible with prior granulomatous disease. Valvular calcifications are additionally noted, likely mitral. Incidental note is made of prostatic calcification. Streaky paramediastinal opacities in the upper lobes may represent posttreatment changes; correlate for history of radiation therapy. Right lower lobe focal branching opacity may represent focally dilated bronchioles, as seen on outside diagnostic CT.Today's PET examination demonstrates markedly hypermetabolic right base of tongue soft tissue mass (SUV max 16.7), compatible with stated history of primary tongue cancer. Two mild to moderately hypermetabolic right level II/III lymph nodes are suspicious for regional lymph node metastases (SUV max 5.3). Right proximal clavicle sclerotic lesion demonstrates moderate hypermetabolic activity, highly suspicious for osseous metastasis.An additional right axillary soft tissue lesion of unclear origin demonstrates internal FDG avid focus. While this may represent a right axillary lymph node metastasis, soft tissue appearance is atypical, and may represent additional benign or malignant tumor.No other significantly FDG avid lesion is identified to suggest additional tumor activity.
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1.Markedly hypermetabolic right base of the tongue soft tissue mass, compatible with known tongue cancer.2.Right cervical hypermetabolic lymph nodes, suspicious for regional metastases.3.Moderately hypermetabolic sclerotic lesion of the right clavicle, suspicious for additional metastases.4.Soft tissue mass in the right axilla of unclear origin; may represent tumoral involvement of right axillary lymph nodes, though additional benign or malignant tumor may also be considered.
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Generate impression based on findings.
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Reason: evaluate for tumor/mass History: hoarseness, pooling of secretions in hypopharynx; possible pyriform sinus cancer LUNGS AND PLEURA: 2.7 x 2.2 cm left upper lobe mass (series 4 image 33) invades the pleura and possibly the chest wall, and is highly suspicious for primary neoplasm.Mild paraseptal apically predominant emphysema. No pleural effusions. Basilar atelectasis/scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy within the limitations of noncontrast technique. Moderate coronary calcification, as well as calcification of the aortic arch and its branches. Mild cardiomegaly without pericardial effusion.CHEST WALL: The bones appear demineralized. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. 2.7 x 2.0 cm cystic lesion adjacent to the spleen may arise from the tail of the pancreas.
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1. Left upper lobe mass invading the pleura and possibly the chest wall is highly suspicious for primary neoplasm or less likely a metastasis.2. Cystic lesion adjacent to the spleen is suspicious for a pancreatic cystic neoplasm. A dedicated contrast enhanced abdominal CT or MRI is recommended for further evaluation.
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Generate impression based on findings.
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59 years, Female. Reason: 59 yo female with hypothyroidism and persistent abdominal bloating with nausea. Please assess for signs of constipation History: abdominal bloating and fullness Average stool burden. Nonobstructive bowel gas pattern. Surgical clips overly the pelvis.
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Average stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Left shoulder pain. Left elbow pain. Three views of the left shoulder reveal so he angle R. I. some small osteophytes at the inferior glenohumeral joint. There also is some mild osteophyte at the acromioclavicular joint . No fractures or dislocations .Four views of the left elbow are unremarkable. No fractures or dislocations..
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Mild degenerative changes left shoulder. Negative left elbow exam.
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Generate impression based on findings.
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Trauma.VIEWS: Chest AP (one view), cervical spine AP and lateral (two views), pelvis AP (one view), 01/27/15 , 1523 hour The aortic arch, cardiac apex and stomach are left-sided. Cardiothymic silhouette is normal. No focal lung opacity, pleural effusion or pneumothorax is seen. Vertebral body heights and disk spaces are normal. No fracture is seen. No prevertebral soft tissue swelling is identified.The femoral heads are directed into the acetabula. No pelvic fracture is seen.
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Normal chest, cervical spine and pelvis.
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Generate impression based on findings.
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Reason: advanced squamous cell lung cancer s/p palliative RT to 2 skin lesions, need to evaluate for extent of disease/new metastases History: ulcerated skin lesions s/p RT CHEST:LUNGS AND PLEURA: Extensive left peribronchovascular soft tissue thickening and groundglass opacity is consistent with lymphangitic tumor. Multiple left pulmonary nodules. Left apical nodule measures 9 x 8 mm (series 5 image 7). Nodule in the inferior left upper lobe measures 10 x 8 mm (image 36). Mild emphysema with scattered bullae on the right with basilar predominant scarring/atelectasis. Nonspecific nodular opacity in the superior segment of the right lower lobe on series 5 image 44. MEDIASTINUM AND HILA: Multinodular thyroid.Extensive mediastinal and hilar lymphadenopathy. Enlarged subcarinal lymph node measures 11 mm in short axis (series 3 image 43). Cardiophrenic lymphadenopathy.Right chest port with tip in the cavoatrial junction. No visible coronary arterial calcification. Normal heart size without pericardial effusion.CHEST WALL: Ulcerated left supraclavicular peripherally enhancing cutaneous lesion partially imaged measures up to 3.7 x 1.8 cm in axial dimension (series 3 image 7). 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: Severe atherosclerotic calcification of the abdominal aorta with narrowing of the infrarenal aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: 10 x 9 mm cutaneous nodule along the left posterior soft tissues (series 3 image 116) is nonspecific.Soft tissue nodularity along the anterior abdominal subcutaneous tissues with a focus of gas on the right are incompletely imaged and have a more typical appearance of injection granulomata.OTHER: No significant abnormality noted.
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1.Left lung pulmonary nodules and lymphangitic carcinomatosis consistent with the patient's known malignancy. Extensive thoracic lymphadenopathy. 2.Ulcerated cutaneous left supraclavicular metastasis.3. 10 x 9 mm cutaneous nodule in left flank soft tissues is nonspecific and may also represent metastatic disease.
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Generate impression based on findings.
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Right shoulder pain Four views of the right shoulder reveal no fractures or dislocations. No significant degenerative changes.
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Negative right shoulder examination
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Generate impression based on findings.
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Patient in MVA. Upper lumbar midline tenderness. No neurologic complaints. Is there a lumbar fracture? The bones appear slightly demineralized, but I see no acute compression fracture. There are small vertebral body osteophytes and mild endplate cavities that I suspect are chronic; intervertebral disk spaces are within normal limits considering the patient's age. Calcifications within the pelvis likely reside within uterine fibroids. Mild osteoarthritis affects the left hip and pubic symphysis.
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Minimal degenerative arthritic changes without acute fracture evident.
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Generate impression based on findings.
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23-year-old male with relapsed AML, cough x 2 weeks LUNGS AND PLEURA: There is minimal bronchial wall thickening with tree in bud nodular opacities in the right upper lobe and additional nodular opacities in the left lower lobe. No focal pulmonary consolidation.MEDIASTINUM AND HILA: Left upper extremity PICC terminates in the lateral right atrium. The heart size is normal. No pericardial effusion. No significant mediastinal or hilar lymphadenopathy. The airways are patent.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: No significant abnormality is noted.
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Minimal bronchial wall thickening with tree in bud nodular opacities in the right upper lobe and additional nodular opacities in the left lower lobe likely bronchiolitis. Atypical infection may also be considered.
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Generate impression based on findings.
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There is further slight decreased prominence of intraconal fat with bilaterally. There is perhaps slight improved left greater than right exophthalmos since the previous exam. Facial subcutaneous fat is similar to perhaps minimally decreased.The extraocular muscles and optic nerves are normal in size and density. No mass is seen in the orbits within the limitations of this noncontrast exam. No bone destruction or fracture of the orbital walls is seen. There is parotid gland atrophy which is partially visualized.
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Slight further decreased orbital and stable to minimally decreased subcutaneous fat with slightly improved left greater than right exophthalmos. No evidence of orbital mass.
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Generate impression based on findings.
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History of left lumpectomy in 2011 for IDC and DCIS followed by adjuvant radiation therapy. History of ovarian cancer in sister and breast cancer in first cousin. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear scar marker overlies the left breast. The post surgical architectural distortion and skin thickening in the lumpectomy bed are stable. Focal asymmetries and calcifications in the right breast are unchanged. Benign appearing calcifications in the left breast are stable. Benign appearing lymph nodes project over the axillae.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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Lower back pain. Secondary coccygeal trauma. The sacrum appears intact. There is minimal dorsal translation of what I suspect is the second coccygeal segment with to the first coccygeal segment. I do not know if this represents a mild subluxation or simply normal anatomy for this patient. I see no discrete fracture. Mild degenerative disease affects L5/S1.
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Mild dorsal translation of the second coccygeal segment relative to the first coccygeal segment is of uncertain significance, and may either represent subluxation or normal anatomy for this patient.
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Generate impression based on findings.
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12-year-old female with leg pain.VIEWS: Tibia/fibula AP and lateral (two views) 1/27/2015 The acetabula is severely dysplastic. There is absence of the proximal and mid femur, with severe hypoplasia of the femoral metaphysis. No acute fracture or malalignment evident.
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Proximal focal femoral deficiency and acetabular dysplasia, without acute fracture or malalignment.
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Generate impression based on findings.
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Male, 82 years old, history of right mandibular ameloblastoma status post mandibulectomy with jaw pain. Findings are again seen related to right hemimandibulectomy. The resection margins remain well defined and similar in appearance to the prior examination. The right mandibular condyle is displaced anteriorly relative to the mandibular fossa. The soft tissues of the right masticator space are mildly distorted similar to prior. No evidence to suggest tumor recurrence is seen.No pathologic adenopathy is detected on either side of the neck. The cervical vessels enhance normally. A sialolith is demonstrated within the left submandibular gland with slight dilatation of the upstream ducts, not significantly changed. The remaining salivary glands and thyroid are unremarkable. No concerning osseous lesions are detected.
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Redemonstration of findings related to the right hemimandibulectomy with no evidence of recurrent primary tumor or pathologic adenopathy.
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Generate impression based on findings.
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Fatigue, chest pain CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. Centrilobular and paraseptal emphysema. No pleural effusions.MEDIASTINUM AND HILA: Moderate coronary artery and thoracic aorta calcifications. The ascending aorta measures 4 cm just superior to the coronary ostia. No evidence of acute hematoma.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonspecific hepatic hypodensities. No biliary ductal dilation.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: Moderate calcifications of the abdominal aorta, which appears ectatic. There is aneurysmal dilation of the right common iliac artery measuring up to 1.7 cm.BOWEL, MESENTERY: No bowel obstruction. Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Chronic height loss of the L2 superior endplate.PELVIS:UTERUS, ADNEXA: Pessary in the vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.
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No acute abnormality in the chest, abdomen, or pelvis on this noncontrast scan.
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Generate impression based on findings.
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CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Solitary sclerotic focus in the left sacrum, unchanged and nonspecific.OTHER: No significant abnormality noted.PELVIS:Evaluation of the pelvis is limited due to metallic artifact from right hip prosthesis.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Limited evaluation of the pelvis, without convincing evidence of metastatic disease.
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Generate impression based on findings.
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47-year-old female with history of back pain. Mild to moderate degenerative disc disease affects the mid and lower thoracic spine. We see no evidence of scoliosis. Coronal balance is within normal limits. There is approximately 2 cm of negative sagittal balance. An IUD projects over the lower pelvis.
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Degenerative disc disease and slight negative sagittal balance, but no evidence of scoliosis.
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Generate impression based on findings.
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Male 81 years old; Reason: evaluate L scrotal edema History: L scrotal edema. No testicular tenderness. RIGHT TESTIS: Heterogeneous right testis without focal lesions appearing similar to the prior exam. There is blood flow within the right testis. Right testicle measures 3.9 x 1.9 x 2.7 cm.LEFT TESTIS: Heterogeneous testis without any focal lesions appearing similar to the prior exam. Left testis measures 3.5 x 2.0 x 2.7 cm.RIGHT EPIDIDYMIS: Small epididymal cyst. The right epididymis is within normal limits. No evidence of hydrocele. LEFT EPIDIDYMIS: The left epididymis appears smaller in size than on the prior study and is not significantly hyperemic.OTHER: No significant abnormalities noted.OTHER: No significant abnormalities noted.
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1. Testes are heterogeneous bilaterally appearing similar to the prior exam. 2. Left epididymis appears smaller than on the prior study is not significantly hyperemic.
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Generate impression based on findings.
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Hoarseness, pooling of secretions in hypopharynx. Right oropharyngeal mass, particularly piriform sinuses. Neck: Absence of contrast limits evaluation for small lesions. There is mild asymmetric fullness involving the right tonsillar fossa without discrete mass. There is effacement of the bilateral piriform sinuses also without discrete underlying mass. Retropharyngeal course of the right internal carotid artery is noted.Small scattered neck lymph nodes are seen, which are not appear pathologically enlarged. Laryngeal cartilages are intact. The thyroid and major salivary glands are unremarkable. No suspicion osseous lesions are seen. Multilevel degenerative changes are seen in the cervical spine.There is a mass involving the left upper lobe. Emphysematous changes in the lung apices are seen bilaterally. Please refer to separate report for findings in the chest.Head: No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. Small right maxillary mucous retention cyst
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1. Limited evaluation without contrast. There is effacement of the bilateral piriform sinuses without definite underlying mass. There is also asymmetric thickening involving the right tonsillar fossa/right lateral oropharyngeal wall without definite underlying mass. Correlate with endoscopic findings. Otherwise, no definite neck mass is seen. If there is continued suspicion, MRI or PET could be considered. 2. No significant cervical lymphadenopathy.3. Left upper lobe lung mass. Please refer to separate CT report for findings in the chest.
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Generate impression based on findings.
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46 year old male with history of urothelial cancer now with persistent left lower extremity edema. There is diffuse reticulation of the subcutaneous fat of the thigh and leg compatible with edema. This edema becomes confluent in the anterolateral aspect of the lower thigh and then more distally along the anterolateral aspect of the leg, but we see no discrete rim enhancing fluid collection to suggest abscess formation. There is diffuse thickening of the skin. The musculature is unremarkable.There is progression of sclerosis about the femoral head and neck as well as an elongated lucent lesion within the femoral neck with sclerotic margins. Differential diagnosis includes osteonecrosis and metastatic disease. Additionally, there is an approximately 1 cm round sclerotic focus in the medial femoral condyle which may represent a metastatic deposit, although benign etiologies such as focal osteonecrosis are also considered.The left external iliac vein is markedly attenuated (narrowed) just distal to the bifurcation of the common iliac vein, appearing similar to that seen on prior studies. Adjacent lymph nodes are noted.
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1.Extensive edema of the thigh and leg of uncertain etiology.2.Progression of left femoral head/neck sclerosis with development of an elongated lucent lesion. Differential diagnosis includes progression of avascular necrosis versus metastatic disease. Additionally, there is a small focus of sclerosis within the medial femoral condyle. If patient care warrants further imaging, an MRI may be obtained to further evaluate these lesions.3.Marked attenuation (narrowing) of the left external iliac vein appears similar to that seen on prior studies and is of uncertain significance.
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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: Scattered micronodules are unchanged. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary arterial calcifications.CHEST WALL: Multilevel degenerative changes affect the thoracolumbar spine. Benign appearing sclerotic foci along the inferior endplates of the T8-9 vertebral bodies are unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe subcentimeter hypodensity unchanged and most likely benign.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: As aboveOTHER: No significant abnormality noted.
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No evidence of metastatic disease.
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Generate impression based on findings.
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C7 spinous process fracture. Evaluate for dynamic instability. There is a fracture through the spinous process of C7 with approximately 5 mm of distraction. Alignment of the remainder of the spine is within normal limits and I see no instability between the flexion, neutral, and extension views. Vertebral body heights and intervertebral disk spaces are preserved.
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C7 spinous process fracture, without evidence of spinal instability.
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Generate impression based on findings.
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Total knee arthroplasty Two portable views of the right knee reveal a total knee arthroplasty in anatomic alignment. Note is made of surgical skin staples and surgical drains.
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Total knee arthroplasty in anatomic alignment
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Generate impression based on findings.
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Pain after fall. Fracture? Moderate to severe osteoarthritis affects the left hip. I see no fracture.
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Osteoarthritis without fracture evident.
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Generate impression based on findings.
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Frontal sinus: There is trace mucosal thickening in the right frontoethmoidal recess inferiorly. The frontal sinus and left frontoethmoidal recess are clear.Anterior ethmoids: There is trace mucosal thickening in a few anterior ethmoid air cells.Maxillary sinuses: There is mild mucosal thickening in the left greater than right maxillary sinus. The ostiomeatal units are clear. Small bilateral Haller cells are incidentally noted.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is minimal leftward nasal septal deviation. There is paradoxical configuration of the middle turbinates, with a right-sided concha bullosa. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Minimal torus palitini is incidentally noted. There is mild to moderate right and minimal left mastoid air cell fluid opacification. The fossa of Rosenmüller are aerated bilaterally.
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Very minimal scattered sinus inflammatory changes as detailed above. Nonspecific mastoid air cell fluid opacification bilaterally, for which clinical correlation is recommended.
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Generate impression based on findings.
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Reason: Neutropenic stem cell transplant patient with new onset of SOB History: SOB LUNGS AND PLEURA: Bibasilar linear opacities consistent with atelectasis correlating with recent chest radiograph. Small bilateral pleural effusions. Stable right apical scarring. No significant air trapping on expiratory phase images.MEDIASTINUM AND HILA: Diffuse esophageal wall thickening incompletely evaluated but appears new since prior studies. High attenuation material within the distal esophageal lumen is of uncertain etiology and clinical significance. Interval decrease in size of previously noted enlarged mediastinal lymph nodes. Severe coronary arterial calcifications.CHEST WALL: Mixed sclerotic/lucent lesion in the T10 vertebral body with a moderate compression deformity and a small sclerotic focus in the posterior-inferior T6 vertebral body are new since 2013 but not significantly changed compared with more recent prior studies. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Interval resolution of many of the previously seen hepatic hypodensities since 2013, though the liver is only partially imaged. Also interval improvement in abdominal lymphadenopathy since 2013, appearing grossly unchanged compared with recent PET CT.
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1. Bibasilar atelectasis and small pleural effusions without specific evidence of pneumonia.2. Diffuse esophageal thickening is suspicious for esophagitis. High attenuation material in the esophageal lumen is of uncertain clinical significance.3. Mixed sclerotic/lucent lesion in the T10 vertebral body with a moderate compression deformity and a small sclerotic focus in the posterior-inferior T6 vertebral body are new since 2013 but not significantly changed compared with more recent prior studies. Differential considerations for these lesions include either involvement by lymphoma or other metastatic disease.
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Generate impression based on findings.
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9-week-old female with bradycardia and desats after re-taping tubeVIEW: Chest AP (one view) 01/27/15, 1610 hour ET tube has been advanced with tip just above the carina. Left chest tube is in place. NG tube courses below the field-of-view.Interval aeration of the right lower lung. Persistent right upper lobe and left lower lobe atelectasis with bilateral patchy opacities. Interval decrease in right pleural effusion.
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1.Interval decrease in right pleural effusion with improved aeration of the right lower lung. 2.Persistent right upper lobe and left lower lobe atelectasis with bilateral patchy opacities.
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Generate impression based on findings.
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Inguinal pain status post hernia repair in 2011 PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Soft tissue attenuation of the right inguinal canal consistent with right inguinal hernia repair. No evidence of hernia recurrence.OTHER: Calcifications of the infrarenal abdominal aorta and branches.
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Postsurgical changes without evidence of inguinal hernia recurrence.
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Generate impression based on findings.
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Female 30 years old Reason: pulmonary abnormalities History: h/o pulm nodules, cough now with blood tinged sputum LUNGS AND PLEURA: Right upper lobe airspace opacity likely secondary to infectious etiology. Moderate right pleural effusion with overlying compressive atelectasis. Scarring of the left upper lobe along the major fissure and left cardiac border likely post infectious in etiology.MEDIASTINUM AND HILA: Hypodense region within the right atrium likely representing near occlusive intra-atrial thrombus. Significant narrowing of the SVC. Normal heart size with mild coronary calcifications. Enlarged paratracheal lymph node, unchanged. IVC catheter with tip in the right atrium, which is been pulled back compared to previous chest radiograph.CHEST WALL: Postsurgical hardware from median sternotomy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Enhancing anterior liver parenchyma likely secondary to collateralization through the liver capsule. Bilateral atrophic kidneys.
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1. Right upper lobe airspace opacity likely secondary to right upper lobe pneumonia.2. Large thrombus within the right atrium. Cardiac echo is recommended for better characterization.3. Moderate right pleural effusion.
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Generate impression based on findings.
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Fever and 5-week-old.VIEWS: Chest AP/lateral (two views) 1/27/2015 Peribronchial thickening is present and the lungs are hyperexpanded. Streaky bibasilar opacities suggests subsegmental atelectasis. The aortic arch, cardiac apex and stomach left-sided. The cardiothymic silhouette is normal. No pneumothorax or pleural effusion is seen.
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Bronchiolitis/reactive airways disease pattern.
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Generate impression based on findings.
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Left knee pain. Osteoarthritis? Four views of the left knee are provided. There is near bone-on-bone apposition of the medial compartment and tricompartmental osteophytes indicating severe osteoarthritis. There is also a mild varus deformity of the knee.Severe osteoarthritis also affects the right knee as seen on the frontal view.
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Osteoarthritis.
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Generate impression based on findings.
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Positive ANA. Ankle swelling and pain. Evaluate for inflammatory arthritis. Three views of the left ankle are provided. Mild osteoarthritis affects the midfoot articulations and tibiotalar joint. This appears similar to that seen on the lateral view of the foot from 2009. I see no specific radiographic features of inflammatory arthritis. There are small plantar and posterior calcaneal spurs. There also appears to be mild thickening of the distal Achilles' tendon which may reflect mild tendinopathy.Three views of the right ankle are provided. Moderate osteoarthritis affects the tibiotalar joint and mild osteoarthritis affects the midfoot articulations; this appears similar to that seen on the foot radiographs from 2009. There are small plantar and posterior calcaneal spurs.
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Osteoarthritis as described above without specific radiographic features of inflammatory arthritis.
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Generate impression based on findings.
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60 year-old female with endometrial cancer. Assess for metastatic disease.RADIOPHARMACEUTICAL: 14.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 119 mg/dL. Today's CT portion of the neck demonstrates no gross abnormality.Today's PET examination demonstrates symmetrical parotid gland uptake which may represent inflammatory changes. There is symmetric linear hypermetabolic activity in the proximal arms, likely muscular in origin. Bilateral linear foci of activity adjacent to the lateral femora may represent tendinopathy. Curvilinear area of hypermetabolic activity at the lateral edge of the right hip prosthesis likely represents postsurgical/arthritic inflammatory changes. Diffuse GI tract radiotracer uptake is also observed. Focus of moderately hypermetabolic activity is seen posterior to the bladder, just left of midline (SUV max 4.0). This demonstrates higher FDG avidity than adjacent bowel. This finding is suspicious for tumor activity in the vaginal cuff or possibly bowel, which cannot be differentiated in part due to streak artifact on CT from right hip prosthesis.Linear marked hypermetabolic activity at the greater curvature of the stomach is nonspecific.
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Moderately hypermetabolic focus posterior to the bladder is suspicious for tumor activity in the vaginal cuff or possibly bowel.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately.
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Generate impression based on findings.
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Back and bilateral leg pain. Evaluate stability of spine. Evaluate sagittal balance/abnormality. Two views of the lumbar spine are provided. The bones appear demineralized suggesting osteopenia/osteoporosis. There is moderate to severe multilevel degenerative disk disease, predominantly affecting the lower lumbar levels. There is also multilevel facet joint osteoarthritis. There is a grade 1 anterolisthesis of L4 that appears stable between the flexion and extension views, and a grade 1 to 2 anterolisthesis of L5 that appears stable between the flexion and extension views. Vertebral body heights are preserved. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries.Two views of the spine are provided. The bones appear demineralized suggesting osteopenia/osteoporosis. Again seen are the aforementioned degenerative arthritic changes of the lumbar spine. There is also moderate multilevel degenerative disk disease affecting the thoracic spine with anterior wedging of several midthoracic vertebrae likely representing chronic compression fractures, although I cannot exclude the possibility of acute compression fractures on the basis of this single study. Severe degenerative disk disease affects the lower cervical spine, with grade 1 retrolisthesis of C4 and C5. There is a minimal leftward curvature of the thoracolumbar spine associated with a positive coronal balance approximately 2.5 cm. There is a positive sagittal balance of approximately 4.5 cm. Surgical clips are noted in the abdomen.
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Degenerative disk disease, thoracic vertebral body wedging, positive sagittal balance, and other findings as above.
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Generate impression based on findings.
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12-year-old male swallowed 1.5 cm screw 5 hours agoVIEW: Chest AP, Abdomen AP (two view) 01/27/15, 1641 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities.Stool is noted throughout the colon. Nonobstructive gas pattern. A 1.5-cm screw is seen in the midabdomen likely in the ileum. No pneumoperitoneum.
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Metallic screw is seen in the midabdomen.
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Generate impression based on findings.
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Left shoulder pain I see no fracture or malalignment. I see no specific findings to account for the patient's shoulder pain.
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No specific findings to account for the patient's shoulder pain.
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Generate impression based on findings.
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CLINICAL DATA: Age: 59 years. Sex : Male. Indication: Reason: No contrast. This study is for liver volumetrics for OR tomorrow. LUNG BASES: Interval increased bilateral moderate, right greater than left, pleural effusions with associated atelectasis; favor postop etiologyLIVER, BILIARY TRACT: Post operative findings of isolated right hepatic lobe, with mixed perihepatic gas and fluid and associated percutaneous drains. The left hepatic lobe peripheral segment 3 lesion has been resected, and there is additional gas/fluid collection in the operative bed that is most likely postoperative in nature related to the wedge resection.Right hepatic lobe volume is 1363 cm³, previously 1045 cm³.Left hepatic lobe volume is 491 cm³, previously 536 cm³.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: Anterior abdominal wall surgical clips from recent procedure.OTHER:No significant abnormality noted.PELVIS:PROSTATE: 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. Postoperative findings from recent right hepatic lobe isolation and left segment 3 wedge resection, as above.2. Right hepatic lobe volume is 1363 cm³3. Left hepatic lobe volume is 491 cm³
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Generate impression based on findings.
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Female 71 years old; Reason: eval for progression History: metastatic RCC Multiple new abnormal lytic and blastic osseous foci are identified involving the right parietal bone, bilateral humeri, left posterior ninth rib, as well as posterior and lateral aspect of multiple right-sided ribs, bilateral iliac bones, two on the right and one on the left, and the right femur which contains two foci, one proximally near the femoral head and the other more distally. Patient is status post right nephrectomy. Patient is status post internal fixation of the left femur. There is symmetric activity of the bilateral clavicles, with the previously noted left mid clavicular focus of increased activity no longer seen.
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Multifocal osseous metastatic disease as described above.
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Generate impression based on findings.
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Female, 67 years old, with word finding difficulties. Assess for stroke. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The ventricular system is normal in size and morphology. The visualized paranasal sinuses and mastoid air cells are clear. The bones of the calvarium and skull base are intact.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Left shoulder pain The bones appear demineralized. In particular, there is endosteal scalloping of the proximal humeral diaphysis that may reflect osteoporosis, but I cannot exclude the possibility of a marrow-infiltrating process. I see no fracture or malalignment.
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Demineralized bones may simply reflect osteoporosis, although I cannot exclude the possibility of a marrow replacing process such as metastatic disease or multiple myeloma if the patient has a known primary malignancy.
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Generate impression based on findings.
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37 year old with biopsy proven IDC in the left breast, presents for ultrasound guided clip placement for the proven carcinoma, ultrasound guided biopsy with clip placement of a possible satellite lesion in the left breast and an enlarged left axillary lymph node. 1. Index lesion was re-identified at 1 o'clock position, 10 cm from nipple in the left breast.2. Left ultrasound re-identified the possible satellite lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 20 x 21 mm at the 1 o’clock position with increased vascularity, 12 cm from the nipple. The lesion was readily visible.3. Left axillary ultrasound re-identified the enlarged lymph node with effaced hilum for biopsy. It was in the inferior part of the axilla. Bipolar maximum dimension was 50 mm, and moderate non-hilar cortical blood flow was seen on color flow imaging. The target node was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast and axilla was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. 1. Clip placement for the proven carcinomaLocal anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, a Hydromark clip was placed into the lesion. 2. Biopsy with clip placement of a possible satelliteUsing the same skin entry, local anesthesia was obtained using 1% lidocaine with 1:100,000 epinephrine at depth. Using aseptic technique, continuous ultrasound guidance and a inferomedial to superolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using aseptic technique, continuous ultrasound guidance, a Bard wing clip was placed into the lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. 3. Biopsy with clip placement of an enlarged left axillary lymph nodeLocal anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and inferior to superior approach, a 14-gauge core needle (Inrad) was directed into the target node and three specimens were obtained, using the open-trough technique. Targeting was judged very good. One specimen sank to the bottom of the prefilled container of 10% formalin. Two specimens partially sank. Specimen quality was judged very good. Whitish tissue was noted in all specimens. Using aseptic technique, continuous ultrasound guidance, a Hydromark clip was placed into the lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Specimens were sent to Pathology with an accompanying history sheet. Post-procedure digital left CC, MLO and ML views revealed the percutaneously placed clip to be in the expected location in the superior aspect of the proven carcinoma, in the anterior aspect of the satellite lesion and in the superior aspect of the lymph node. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy sites and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.
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Successful ultrasound-guided clip placement of the proven carcinoma, core biopsy with clip placement of the possible satellite lesion in left breast, and core biopsy with clip placement of the enlarged lymph node in the left axilla. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Pain in left hip and leg. Concern for impending fracture from osseous metastases of left femur. Again seen is widespread mixed sclerosis and lucency within the proximal femur and visualized bones of the pelvis indicating diffuse prostate cancer metastases. I see no fracture on the current study. I see no focal cortical thinning to indicate a specific site of impending pathologic fracture. Mild osteoarthritis affects the left hip.
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Diffuse metastatic disease appearing similar to that seen on the prior study.
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Generate impression based on findings.
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89 year-old female with new onset gait disorder. Normal symmetric activity is seen in the basal ganglia.
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Normal examination. No evidence of nigrostriatal dopaminergic dysfunction. Given the history, these findings are suggestive of essential tremor.
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Generate impression based on findings.
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Knee pain Four views of the left knee are provided. Small osteophytes indicate mild osteoarthritis.Mild osteoarthritis affects the right knee as seen on the frontal views.
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Mild osteoarthritis.
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Generate impression based on findings.
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Male 14 years old; Reason: 14 year old male with fibrolamellar hepatocellular carcinoma, requesting Y90 radioembolization History: RUQ painTechnique: 1.7 mci was injected through the left hepatic artery by the interventional radiology team. Anterior and posterior planar imaging of the chest and abdomen, as well as SPECT imaging of the abdomen was obtained. There is relatively increased activity in the left lobe of the liver which correlates with injection of radiotracer through the left hepatic artery. There is diffusely increased activity in the lungs bilaterally. The liver lung shunt fraction is 4.6%.There is no abnormal activity outside the liver identified within the abdominal cavity.
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Expected radiotracer distribution in the liver with a liver lung shunt fraction of 4.6%. No abnormal activity is seen outside the liver within the abdominal cavity.
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Generate impression based on findings.
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Low back pain The bones appear demineralized, suggesting osteoporosis. There is a compression fracture of L1 with approximately 50% loss of height anteriorly. This was not evident on the chest radiographs from October. There is also loss of height of the T11 and T12 vertebral bodies which appears new when compared with the prior chest radiographs. Moderate degenerative disk disease affects L4/5. Rounded densities within the pelvis may either represent uterine fibroids or perhaps retained barium.
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Demineralized bones with compression fractures of L1, and to a lesser degree T11 and T12, that are new compared with prior chest radiographs.
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Generate impression based on findings.
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Reason: Patient with history of VC cancer, Cough and chest tightness since 12/18/2014. Not improved despite antibiotics History: Cough and chest tightness since 12/18/2014. Not improved despite antibiotics. R/O lung lesions LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Moderate coronary artery calcifications, the heart and pericardium otherwise normal.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Mild splenic artery calcifications, otherwise unremarkable.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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14-month-old female with lymphadenopathy and concern for mediastinal mass. CHEST:LUNGS AND PLEURA: Right upper and middle lobe atelectasis is evident as well as trace lingular atelectasis. No pneumothorax or pleural effusion is evident.MEDIASTINUM AND HILA: Prominent subcarinal lymph node measures up to 9 mm in short axis (image 16, series 5). The heart size is normal as is the caliber of the great vessels. No pericardial effusion is seen.CHEST WALL: Bulky bilateral axillary and subpectoral lymphadenopathy is seen. For reference purposes a left axillary lymph node measures 1.4 cm in short axis (image 10, series 5).ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: There is a large umbilical hernia, without evidence of obstruction. No pneumoperitoneum or pneumatosis intestinalis is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is nondistended.LYMPH NODES: Bulky bilateral inguinal lymphadenopathy is present, for reference purposes a right inguinal lymph node measures 0.9 cm in short axis (image 82, series 5).BOWEL, MESENTERY: There is a large umbilical hernia, without evidence of obstruction. No pneumoperitoneum or pneumatosis intestinalis is seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Axillary, mediastinal and inguinal lymphadenopathy as detailed above.2.Right upper and middle lobe atelectasis.3.No evidence of mediastinal mass as clinically questioned.
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Generate impression based on findings.
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Headache. Evaluate for aneurysm. NONCONTRAST CT HEADNo evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. No intra- or extra-axial fluid collection. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Prominent parotid glands are noted without adjacent inflammatory changes.CTA HEAD AND NECKNormal variant origin of the left common carotid artery off the brachiocephalic trunk. A retropharyngeal course of the carotid arteries is noted which cause mild mass effect on the adjacent pharyngeal soft tissues. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. No significant atherosclerotic disease.There is normal contrast opacification through anterior circulation through the bilateral internal carotid, anterior and middle cerebral arteries. There is a hypoplastic right A1 segment. The posterior circulation, including the vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries opacify normally.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.Degenerative changes are noted of the cervical spine. A small right pleural based opacity in the lung apex may represent scarring.
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1.No evidence of acute intracranial hemorrhage or mass.2.No significant steno-occlusive disease, aneurysm or dissection of the arteries of the brain and neck.
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Generate impression based on findings.
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Respiratory distress of the newborn.VIEW: Chest AP (one view) 1/27/15 at 1740 hrs ET tube terminates below thoracic inlet. NG tube tip is at the stomach. Cardiac silhouette size is normal. Persistent diffuse, granular lung haziness with development of right middle lobe opacity, likely atelectasis or pneumonia.
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Interval ET and NG tube placement and development of right middle lobe opacity on a background of diffuse, granular lung haziness consistent with surfactant deficiency.
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Generate impression based on findings.
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Male 8 months old Reason: assess for atelectasis, lung expansion History: 8 month old s/p ex lap and silo placementVIEW: Chest and abdomen AP (two views) 1/27/15 at 2055 hrs Tracheostomy tube terminates below thoracic inlet. NG tube tip is at the antral pyloric region. Left lower extremity central line terminates in the right atrium A urinary bladder catheter is noted. An abdominal silo has been placed. Cardiac silhouette size is top normal. Bilateral diffuse BPD with no focal opacities, effusions or pneumothorax.Disorganized, slightly distended nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. Most of the abdominal bowel loops are located inside the silo bag.
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Portable postsurgical changes as described.
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Generate impression based on findings.
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Male, 54 years old.RFO multiple surgical teams, BMI over 40 Enteric tube side port is above the diaphragm. Gastric band components are seen. Short segment of catheter tubing connecting the band and reservoir is not well seen, likely due to body habitus, however visualized portions of tubing appear intact. Pelvic drain seen. No unexpected radiopaque foreign body. Multiple loops of distended small and large bowel, compatible with ileus. Periphery of the abdomen and pelvis is outside the field of view due to patient's body habitus.
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No unexpected radiopaque foreign body. Mild diffuse ileus. Flank regions excluded from field of view due to patient's habitus.Findings discussed by telephone with Dr. Kim, resident, and Dr. Zagaja, the attending surgeon, on 1/27/2015 5:15 PM.
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Generate impression based on findings.
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14-year-old female with questionable mediastinal mass.VIEW: Chest AP (one view) 1/27/2015, 19:27 Persistent right middle lobe atelectasis, slightly improved from the prior examination. Persistent right upper lobe and left lower lobe atelectasis. The cardiothymic silhouette is normal.
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Persistent multifocal atelectasis.
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Generate impression based on findings.
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Female 14 years old Reason: assess ET tube History: s/p ET tubeVIEW: Chest AP (one view) 1/28/15 at 305 hours. NG tube and nerve stimulator again noted. ET tube tip is above the carina. Cardiac silhouette size is normal. Persistent right lung base opacity with interval improvement in right upper lobe atelectasis.
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Interval improvement in right upper lobe atelectasis after ET tube repositioning.
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Generate impression based on findings.
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88 years, Female. Reason: 88yo F with c diff and abdominal pain/distention. No evidence of free air. Air containing small and large bowel may reflect ileus. Rectal tube is faintly seen. Pleural effusions partially seen. Degenerative disk disease of the spine. Bones appear demineralized.
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No evidence of free air. Findings suggestive of ileus.
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Generate impression based on findings.
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Left forearm pain.VIEWS: Left elbow and forearm AP and lateral 1/27/15 (4 view/s) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling.
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Normal examination.
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Generate impression based on findings.
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Lung cancer and brain metastasis, altered mental status, rule out bleed/herniation. Compared to 1/25/2015, there is no significant change in multifocal areas of hypoattenuation compatible with vasogenic edema associated with multiple metastatic lesions, particularly involving the bilateral frontal and left parietal lobes. Subtle foci of hyperattenuation are seen involving the left frontal operculum compatible with known hemorrhagic lesion. There is mild sulcal effacement. No midline shift or uncal herniation. No hydrocephalus. There is mild mucosal thickening involving the right maxillary sinus. Calvarium is intact.
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1. No evidence of acute intracranial hemorrhage. No significant change in multifocal areas of hypoattenuation compatible with vasogenic edema associated with multiple metastatic lesions. Subtle areas of hyperdensity are again seen associated with the left frontal opercular lesion compatible with blood products within the lesion and present on prior MRI. 2. No new mass effect. No midline shift or uncal herniation.
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Generate impression based on findings.
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Please note lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: New small right pleural effusion with associated atelectasis. Heart size within normal limits. Moderate coronary artery calcifications. Bilateral calcified hilar lymph nodes.LIVER, BILIARY TRACT: Innumerable hypoattenuating hepatic metastases, incompletely evaluated without intravenous contrast. Calcified granulomata.SPLEEN: Multiple calcified splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged paraesophageal lymph node (3/27) measures 13 x 10 mm, previously 13 x 9 mm.BOWEL, MESENTERY: Moderate amount of abdominal and pelvic ascites. Several loops of small bowel demonstrate wall thickening, which may be related to the patient's ascites. No small bowel obstruction.Transverse colon intraluminal mass (3/83) measures 29 x 29 mm, previously 29 x 27 mm. An adjacent mesenteric lymph node (3/80) measures 17 x 16 mm, previously 16 x 15 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left pelvic reference nodule (3/120) measures 16 x 15 mm, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left anterior abdominal subcutaneous port, with catheter tip in the pelvis.
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1.No small bowel obstruction or free air.2.Innumerable hepatic metastases, incompletely evaluated on this noncontrast exam.3.Transverse colon mass, and other reference lesions as above.4.Moderate ascites, and new small right pleural effusion.
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Generate impression based on findings.
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Pain status post fall. Rule out fracture. I see no fracture or malalignment. I see no specific findings to account for the patient's pain.
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No fracture or other specific findings to account for the patient's pain are evident.
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Generate impression based on findings.
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66 years, Male. Reason: 66 male with bladder cancer, s/p endoscopy. Now with abdominal pain, evaluate for free air/perforation, please perform upright view History: Abdominal pain No evidence of free air. Nonobstructive bowel gas pattern. Bilateral nephroureteral tubes are partially visualized. IVC filter overlies L2 vertebral body. Left iliac stent noted. Pelvis is excluded from the field-of-view. Patient is status post sternotomy.
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No evidence of free air. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Reason: eval for endovascular leak. h/o hemi arch repair, aortic valve replacement, ascending aneurysm repair 9/2014 History: chest pressure left sided radiates to back. VASCULATURE: Redemonstration of a type A aortic dissection flap, with the true lumen giving rise to the great vessels. Variant anatomy of the aortic arch with the brachiocephalic trunk and left common carotid arteries sharing a common trunk. The true lumen also gives rise to the right renal arteries and the common iliac arteries. The false lumen gives rise to the celiac axis, left renal artery, and inferior mesenteric artery. The dissection flap extends into the superior mesenteric artery, with the majority of the blood flow arising from the false lumen. The ascending aorta measures 5.2 cm (series 13 image 43), the aortic measures 4.2 cm (image 33), and the descending aorta measures 4.0 cm at the hiatus (image 63), unchanged in size since the recent prior study. Mural thrombus of the ascending aorta and arch is not significantly changed. Delayed images demonstrate no evidence of leak around the graft prosthesis. CHEST:LUNGS AND PLEURA: Basilar subsegmental atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Enlarged main pulmonary artery measuring 3.6 cm unchanged. Other vascular findings as described above. Normal heart size without pericardial effusion.CHEST WALL: Median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic lymph nodes unchanged and nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate. 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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1. Type A aortic dissection and aortic valve/arch repair without acute interval change since the prior study. Narrowing of the origin of the right main coronary artery is of uncertain current clinical significance, and correlation with clinical and cardiac catheterization history is recommended. 2. Other findings as described above without acute interval change.
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Generate impression based on findings.
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14-month-old female with failure to thrive, diffuse lymphadenopathy and question of mediastinal mass.VIEWS: Chest AP/lateral (two views) 1/27/2015, 17:05 Right middle and upper lobe opacities suggest atelectasis. Streaky left lower lobe opacities suggests subsegmental atelectasis. No pneumothorax or pleural effusion is seen. The aortic arch, cardiac apex and stomach are left-sided.
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Multifocal atelectasis as detailed above.
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Generate impression based on findings.
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BRAIN: No restricted diffusion to indicate an acute infarct. No susceptibility weighted abnormalities to indicate hemorrhage. No focal mass effect, midline shift or herniation. Scattered periventricular and subcortical T2/FLAIR hyperintensities are nonspecific but compatible with chronic small vessel ischemic changes. The cerebellar tonsils are in normal position. A partially empty sella is noted. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses are clear. A small amount of fluid is noted in the left mastoid air cells.C-SPINE: Exam is limited by motion.Alignment is anatomic. Generalized disc dessication and endplate degenerative changes are noted, most severe in the C5 and C6 vertebral bodies. There is a background of mild heterogeneous marrow, which is nonspecific. There is increased T2 signal in the spinal cord from C4 to C6 with volume loss likely reflecting myelomalacia secondary to the degenerative changes. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: Normal atlantodental interval.C2/3: No significant spinal canal stenosis or neuroforaminal narrowing.C3/4: Small disk osteophyte complex with a small central disk protrusion as well as mild facet and uncovertebral hypertrophy, which causes mild central spinal canal stenosis and mild bilateral neuroforaminal narrowing.C4/5: Posterior disk osteophyte complex, moderate left greater than right facet and uncovertebral hypertrophy, and ligamentum flavum thickening which causes moderate spinal canal stenosis and moderate to severe bilateral neuroforaminal narrowing.C5/6: Posterior disc osteophyte complex with a significant left paracentral prominence, moderate facet and uncovertebral hypertrophy and ligamentum flavum hypertrophy which causes moderate to severe spinal canal stenosis and moderate-severe right and severe left neuroforaminal stenosis.C6/7: Disk osteophyte complex, moderate facet and uncovertebral hypertrophy, and ligamentum flavum thickening which causes moderate spinal canal stenosis and moderate to severe right and severe left neuroforaminal narrowing.C7/T1: No significant spinal canal stenosis or neuroforaminal narrowing.
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1.No acute brain abnormalities. Scattered chronic small vessel ischemic changes.2.Limited cervical spine evaluation secondary to motion. Degenerative changes of the cervical spine, especially at C4-5 and C5-6, where there is moderate-severe spinal canal stenosis at C5-C6. Moderate-severe to severe foraminal narrowing at these levels.3.Increased T2 signal abnormality from C4-C6 likely represents myelomalacia from chronic degenerative changes.
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Generate impression based on findings.
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53 years, Male. Reason: to verify NGT tip location after adjustment History: NGT in place Motion artifacts limits evaluation.Large loculated right pleural effusion and left chest tubes are again seen. Please see recent chest CT report for additional findings.Enteric tube tip overlies the gastric fundus. No significant change from prior study. Residual contrast seen in colon.
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Enteric tube tip overlies the gastric fundus. No significant change from prior study.
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Generate impression based on findings.
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17 year-old female with effusion status post left chest tube placementVIEW: Chest AP (one view) 01/28/15, 0557 hour Left chest tube is in place.Cardiothymic silhouette is unchanged. Low lung volumes. Persistent left pleural effusion with adjacent atelectasis. New patchy opacity in the right lower lung.
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Persistent left pleural effusion with bibasilar pulmonary opacities.
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Generate impression based on findings.
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Reason: 55 male with mediastinal lymphoma. Needs port-a-cath placement, please assess current status of vasculature to determine potential need for stenting first History: SVC syndrome LUNGS AND PLEURA: Right upper lobe pulmonary nodules and patchy ground glass opacity, decreased compared to prior PET/CT. For reference, the largest measures 10 x 9 mm (series 4 image 29), previously 15 x 16 mm (series 4 image 107). Interval decrease in small right pleural effusion. Moderate left pleural effusion with overlying atelectasis/consolidation, similar to prior.MEDIASTINUM AND HILA: Right subclavian catheter with tip at the cavoatrial junction. Small associated fibrin sheath (series 3 image 52).Large conglomerate lymphadenopathy involving the mediastinum and right pericardial region, portions of which are necrotic. For reference, prevascular portion measures approximately 54 x 68 mm (series 3 image 58). Lymphadenopathy encases and narrows the SVC.Mild coronary artery calcification. Heart size is normal with no pericardial effusion.CHEST WALL: Multiple small bilateral lower cervical, axillary and left supraclavicular lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left adrenal thickening. Small subcentimeter hypoattenuating foci in both kidneys are too small to characterize and incompletely imaged.
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1.Large conglomerate mediastinal and right pericardial lymphadenopathy compatible with patient's history of lymphoma. Lymphadenopathy encases and attenuates the SVC.2.Interval decrease in right upper lobe nodularity in ground glass opacity, more likely infectious/inflammatory in etiology.3.Decreasing right small pleural effusion. No significant wall change in left moderate pleural effusion.
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Generate impression based on findings.
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71 year-old female with bone spur on the fifth phalanx These non weight bearing views demonstrate no significant osseous abnormality. No fracture is evident.
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No specific findings to account for the patient's symptoms.
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Generate impression based on findings.
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4-year-old male with Darvet's syndrome.VIEW: Chest AP (one view) 1/28/2015, 03:21 The endotracheal tube tip terminates just above the carina. The right upper extremity PICC tip terminates at the cavoatrial junction. Gastrostomy tube in place.Resolved left upper lobe atelectasis, with persistent but improved left lower lobe atelectasis. Small bilateral pleural effusions are seen. No pneumothorax. The cardiothymic silhouette is normal.
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Improved atelectasis and persistent small bilateral pleural effusions.
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Generate impression based on findings.
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Male, 73 years old. RFO trigger: Organ transplant surgery. Attending: Dr. Becker No unexpected radiopaque foreign body seen. Diffuse mild bowel loop dilatation likely represents postoperative ileus. Multiple surgical clips and staples as well as a right nephroureteral stent are identified.
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1.No unexpected radiopaque foreign body. 2.Postoperative ileus pattern. Findings were discussed with the attending surgeon Dr. Becker via telephone on 1/27/2015 at 22:26 by the radiology resident on call.
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Generate impression based on findings.
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7-year-old female status-post bowel cleanoutVIEW: Abdomen AP (one view) 01/28/15, 0608 hour Cecostomy tube is present. Surgical sutures are noted within the left lower quadrant.Small amount of amorphous stool is seen within the rectum and left lower quadrant. Gas distended loops of colon nonobstructive bowel gas pattern. No pneumatosis.
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Small stool burden.
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Generate impression based on findings.
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History of status post fall/syncope. HEAD: There is subdural hematoma along the falx, measuring up to 9 mm, and extending around the left cerebral convexity, measuring up to 5 mm. There are foci of intraparenchymal and subarachnoid hemorrhage in the bilateral frontal lobes, left greater than right. A trace amount of blood is present in the right occipital horn. Isodense fluid along the left frontal lobe may represent subacute hemorrhage. There is effacement of the left lateral ventricle and mild rightward midline shift, measuring up to 1-cm, increased from 6 mm in the previous exam. No acute calvarial fractures are identified. A small subgaleal hematoma overlies the posterior parietal bone, measuring up to 9 mm. There is redemonstration postoperative findings related to right frontal pterional craniotomy and resection of right anterior temporal lobe mass, with resultant encephalomalacia. The previously described left frontal subcortical hyperdensity is not appreciated on this exam. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes, not significantly changed compared to prior exam. There are bilateral cataracts. Small polyps/mucosal retention cysts are present in the bilateral maxillary sinuses, there is an air-fluid level in the right sphenoid sinus. The mastoid air cells are clear. CERVICAL SPINE: There is a stable appearance of mild rightward curvature at the cervicothoracic junction. There is no evidence of acute malalignment of fracture, however, it should be noted that CT does not evaluate for ligamentous stability. There is moderate to severe degenerative changes of the cervical spine, including grade 1 anterolisthesis of C4 relative to C5. Multilevel disc-osteophyte complexes are again identified, most pronounced at the C5/C6 and C6/C7 levels, with partial ventral thecal sac effacement. Severe facet arthropathy is stable, greatest at left C4-C5, which appears fused. There is severe uncovertebral joint hypertrophy at the levels of C5/C6 and C6/C7, associated with severe neuroforaminal narrowing at right C6/7. There is redemonstration of the left apical pleural parenchymal scarring with associated calcifications. The thyroid gland remains diffusely heterogeneous. There is severe left and mild right atherosclerotic calcification of the carotid bifurcations, which is grossly unchanged.
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1. There is subdural hematoma along the falx, extending around the left cerebral convexity, measuring up to 9 mm, with resultant mild effacement of the left lateral ventricle and 1-cm rightward shift of the midline.2. Multiple foci of intraparenchymal and subarachnoid hemorrhage in the bilateral frontal lobes, left greater than right, with a small amount of intraventricular extension.3. Stable appearance of postoperative changes related to right frontal pterional craniotomy and resection of right anterior temporal lobe mass.4. Moderate to severe degenerative changes of the cervical spine and osteopenia, but no evidence of cervical spine fracture.
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Generate impression based on findings.
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4-year-old male with Darvet's syndromeVIEW: Chest AP (one view) 1/27/2015, 19:27 Interval placement of an endotracheal tube with the tip terminating just below thoracic inlet. The right upper extremity PICC tip terminates at the cavoatrial junction. Gastrostomy tube in place.Increased left upper lobe atelectasis, with persistent left lower lobe atelectasis. Small bilateral pleural effusions are seen. No pneumothorax. The cardiothymic silhouette is normal.
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Increased left-sided atelectasis. Endotracheal tube tip just below the thoracic inlet.
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Generate impression based on findings.
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58-year-old man with right wrist injury following punch. Evaluate for dislocation or fracture. There is mild deformity of the proximal diaphysis of the fourth metacarpal associated with an obliquely oriented poorly defined linear lucency. This is most compatible with a healing or healed fracture rather than an acute fracture. Mild deformity of the base of the fifth metacarpal as well as the hamate bone likewise suggests old healed fractures. I see no definite acute fracture. There is mild soft tissue swelling along the radial aspect of the wrist. A lucency within the radial margin of the lunate may represent a cyst or ganglion. Mild osteoarthritis affects the first and fifth carpometacarpal joints.
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Findings suggestive of old trauma to the fourth and fifth metacarpals and possibly the hamate bone. I see no definite acute fracture. If there is strong clinical concern for acute fracture, CT may be considered.
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Generate impression based on findings.
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Male 79 years old Reason: assess for PE History: RV dilation on CT, shock PULMONARY ARTERIES: Technically excellent quality infusion of the pulmonary vasculature. No evidence of acute pulmonary embolism. Pulmonary artery is enlarged measuring up to 33 mm suggestive of pulmonary hypertension.LUNGS AND PLEURA: Moderate centrilobular emphysema. Trace bilateral pleural effusions with overlying compressive atelectasis. No focal air space opacity. No suspicious masses or nodules.MEDIASTINUM AND HILA: Cardiomegaly without pericardial effusion. Right atrium and right ventricle are dilated with straight intraventricular septum.Mild dilatation of the descending portion of the aortic arch and the proximal descending portion of the intrathoracic aorta at the isthmus measuring up to 4.3 cm in the transverse dimension. No mediastinal hematoma.Atherosclerotic calcifications of the aorta and its branches with mild coronary artery calcifications. Multiple calcified hilar and mediastinal nodes consistent with prior infection. The esophagus is dilated and filled with air. NG tube with side hole in the distal esophagus and tip in the stomach. Endotracheal tube in place above the carina. Right central venous catheter with tip in the SVC.CHEST WALL: Mild degenerative thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Indeterminate left adrenal nodule which measures up to 2.4 cm and is mildly enlarged when compared to previous CT examination. The adrenal lesion does not meet CT criteria for adenoma and could be an atypical adenoma however malignancy cannot be excluded without dedicated imaging.Trace abdominal ascites.Dilatation and unsharp margins of the gallbladder neck compared to previous exam. No intrahepatic biliary dilatation.Numerous hepatic and renal hypodensities, incompletely characterized, but appear similar to prior study, and likely represent simple cysts. Nonobstructing left renal calculi. Hypoattenuating lesions in the pancreas too small to accurately characterize but may reflect a side branch IPMNs given the patient's age.
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1. No acute pulmonary embolism.2. New trace ascites, with gallbladder neck thickening and enlargement. Mild enlargement of the left adrenal nodule, which does meet CT create criteria for adenoma, and could represent an atypical adenoma or malignancy. Recommend dedicated abdominal CT imaging when clinically feasible. 3. Mild ectasia of the descending portion of the arch and aortic isthmus; the aorta is incompletely assessed due to inadequate systemic arterial contrast opacification but in the absence of trauma this may represent variant anatomy such as a ductus diverticulum with aortic spindle. 4. Emphysema without acute cardiopulmonary abnormality.5. Signs of pulmonary hypertension and right heart strain.Findings were discussed by telephone with Dr. Johnson, pager 3631 at 10:30 am on 1/28/2015.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive.
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Generate impression based on findings.
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4-year-old male with Darvet's syndromeVIEW: Chest AP (one view) 1/27/2015, 18:23 The right upper extremity PICC tip terminates at the cavoatrial junction. Gastrostomy tube in place.Persistent left lower lobe atelectasis. No pneumothorax. The cardiothymic silhouette is normal.
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Persistent left lower lobe atelectasis.
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Generate impression based on findings.
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19 year-old female with chest tubeVIEW: Chest AP (one view) 01/28/15, 0747 hour Right chest tube and bilateral surgical sutures and staples are again seen. The anterior fifth and sixth ribs have been resected. Tubular, subcentimeter, density likely representing a retained cuff from a prior central line overlies the left midlung.Cardiothymic silhouette is top normal. Right pneumothorax persists. Mild subsegmental bibasilar atelectasis.
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Persistent right pneumothorax.
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Generate impression based on findings.
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No evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. Scattered periventricular and subcortical white matter hypoattenuation is nonspecific but compatible with small vessel ischemic changes. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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1.No evidence of acute intracranial hemorrhage or mass.2.Scattered periventricular and subcortical white matter hypoattenuation is nonspecific but compatible with small vessel ischemic changes of indeterminate age.
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Generate impression based on findings.
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48 years, Male. Reason: GJ tube placement check. Gastrojejunostomy tube tip in the proximal jejunum at the ligament of Treitz. Nonobstructive bowel gas pattern. Scattered surgical clips and staples.
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GJ tube tip in proximal jejunum at ligament of Treitz.
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Generate impression based on findings.
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16 month old female with headaches, question of shunt malfunction.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 1/27/2015 Right parieto-occipital ventriculostomy catheter with tip extending past midline. The strata valve is set at a performance level of 2.0. The shunt catheter tubing traverses the right neck, right chest, and enters the abdomen in the epigastrium. The catheter is coiled in the abdomen with the tip in the mid left abdomen. No evidence of CSF pseudocyst formation.A gastrostomy tube is in place. The bowel gas pattern is nonobstructive and disorganized. The cardiothymic silhouette is normal, and no focal airspace opacity is seen.
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No evidence of extracranial shunt malfunction.
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Generate impression based on findings.
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Deep neck infection/abscess/fistula. There are postoperative findings related to deep neck incision and drainage and tonsillectomy with persistent foci of air and fluid centered in the left parapharyngeal space. There is now a fistulous track that extends from the overlying skin to the left lateral wall of the oropharynx, traversing the collections. Otherwise, there has been interval decrease in the degree of surrounding edema. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands appear unchanged. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is mild mucosal thickening in the maxillary sinuses. The imaged portions of the lungs are clear.
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Postoperative findings related to deep neck incision and drainage and tonsillectomy with interval development of an orocutaneous fistula that traverses the residual abscess centered in the left parapharyngeal space, but decrease in surrounding inflammatory changes.
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Generate impression based on findings.
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No evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. The ventricles and sulci are normal in size. Normal gray-white differentiation. There are no extraaxial fluid collections. The visualized portions of the paranasal sinuses and mastoid air cells are clear.
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No evidence of acute intracranial hemorrhage or mass.
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Generate impression based on findings.
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Known bilateral breast masses and cysts. Patient had left breast core biopsy at Rush Hospital. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple masses are waxing and waning in both breasts. No suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Ultrasound for both breasts is performed. Multiple simple and complicated cysts are present in both breasts. The largest cyst is seen at right 10 o'clock position measuring 19 x 12 mm and left 12 o'clock position measuring 22 x 9 mm. No solid lesion or suspicious findings in this study.
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No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations 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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11 year old female status post endotracheal tube placement with congenital CMV.VIEW: Chest AP (one view) 1/28/2015, 00:38 Interval placement of an endotracheal tube with the tip below the thoracic inlet and above the carina. Left upper extremity PICC tip is in left subclavian vein.Right lower lobe atelectasis persists. New left lower lobe opacity suggestive of atelectasis. The cardiothymic silhouette is unchanged. There is severe levoscoliosis of the thoracolumbar spine.
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Persistent right lower lobe atelectasis and new left lower lobe atelectasis.
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Generate impression based on findings.
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20 year-old male with pain, injury Oblique fractures of the bases of the third and fourth metacarpals without significant displacement. An additional intra-articular fracture extends through the radial styloid without significant displacement. The carpus and proximal forearm are intact.
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Metacarpal and radial fractures as described above.
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Generate impression based on findings.
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Male 24 years old Reason: follow up infected RP hematoma History: RP hematoma s/p IR drain ABDOMEN:LUNG BASES: Left sided pleural effusion with associated compressive atelectasis unchanged. Right basilar atelectasis also unchanged. Central venous catheter tips terminate in the inferior vena cava. IR notified; catheter should be retracted.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged nonspecific nodularity of the left adrenal gland.KIDNEYS, URETERS: The patient is status post left nephrectomy. There is a right nephroureterostomy catheter in unchanged position. Poorly defined areas of hypoattenuation in the renal parenchyma are unchanged. Nonobstructing renal stones again seen.RETROPERITONEUM, LYMPH NODES: Interval decrease in size left retroperitoneal fluid collection now measuring approximately 13.3 x 5.2 cm (image 65; series 3). Pigtail catheter terminates in the left renal fossa in the cephalad aspect of the fluid collection. Numerous prominent retroperitoneal lymph nodes again identified. IVC filter.BOWEL, MESENTERY: Gastrostomy tubes in place, position changed. Multiple mildly dilated loops of small bowel again seen, consistent with chronic ileus.BONES, SOFT TISSUES: Bilateral hip dysplasia and multilevel fusions of the thoracolumbar spine. Unchanged mild/moderate body wall edema.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: Bilateral hip dysplasia and multilevel fusions of the thoracolumbar spine. Unchanged mild/moderate body wall edema.
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1.Slight interval decrease in left retroperitoneal hematoma with interval insertion of a pigtail drainage catheter.2.Chronic ileus.3.Left pleural effusion and compressive atelectasis unchanged.4.Central venous catheter terminates in the IVC or a hepatic vein. IR was notified of this finding at the time of dictation and plan is for catheter retraction.
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Generate impression based on findings.
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64 years, Female. Reason: evaluate for obstruction, evaluate stool burden History: no defecation >1 week. Large stool burden. Nonobstructive bowel gas pattern. Left basilar subsegmental atelectasis. Spinal degenerative changes and right upper quadrant surgical clips.
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Large stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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Evaluation is slightly limited as the counting sequence was not performed.There is redemonstration of a thin T1 and T2/STIR hyperintense dorsal epidural collection. It again extends from T2 to T10 and measures 3-4 mm in greatest thickness. There is persistent thin irregular T2 hypointensity along the superficial aspect of this collection which may be related to hematocrit effect, versus more likely small layering subarachnoid blood products. There is again minimal mass effect on the dorsal thecal sac relatively greater in the upper thoracic spine. No high-grade spinal canal stenosis, cord compression, or cord signal abnormality is appreciated.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Overall marrow signal is low which is nonspecific and could be due to predominance of red marrow in a patient of this age, or a marrow replacing process. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There are bilateral small pleural effusions. The kidneys are atrophic bilaterally. There is fluid within the midesophagus. The isthmus of the thyroid gland is thickened, with a heterogeneous appearance of the thyroid tissue. There are focal T2 hyperintense lesions scattered in the thyroid gland. There may be a small hiatal hernia.
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1. Stable thin subacute dorsal epidural hematoma extending along the majority of the thoracic spine without significant mass effect on the thecal sac. No cord compression or cord signal abnormality.2. Small layering subarachnoid hemorrhage is suspected to be present in the upper thoracic spine, possibly related to redistribution from the intracranial subarachnoid blood products. 3. Similar appearing bilateral small pleural effusions.4. Heterogeneous thyroid gland with focal T2 hyperintense lesions as well as thickened isthmus. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.
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Generate impression based on findings.
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58-year-old man with right hand injury. Evaluate for fracture. Again seen is mild deformity of the fourth and fifth metacarpals likely representing old healed fractures. I see no definite acute fracture. Mild osteoarthritis affects the first and fifth metacarpophalangeal joints. Mild osteoarthritis also affects the distal interphalangeal joints.
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Findings suggestive of old trauma to the fourth and fifth metacarpals. I see no definite acute fracture.
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Generate impression based on findings.
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11-year-old female with hypoxia, assess lung fields.VIEW: Chest AP (one view) 1/27/2015, 21:15 Left upper extremity PICC tip is in left subclavian vein.Persistent right lower lobe atelectasis unchanged. No new focal air space opacities are seen. The cardiothymic silhouette is unchanged. There is persistent levoscoliosis of the thoracolumbar spine.
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Persistent right lower lobe atelectasis.
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Generate impression based on findings.
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56-year-old male with point tenderness of the upper lumbar spine Moderate to severe degenerative disk disease and moderate facet joint osteoarthritis affect L5/S1. No compression fracture is evident.
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Degenerative disk disease and facet joint osteoarthritis without compression fracture.
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Generate impression based on findings.
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Evaluate for bleed, intracranial mass, acute intracranial abnormalities. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with stable chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size for age with global parenchymal volume loss unchanged. There is no midline shift or herniation. There is unchanged mucosal thickening of the bilateral ethmoid and maxillary sinuses. The other imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is a right lens implant.
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No evidence of intracranial hemorrhage, mass, or cerebral edema. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern, MRI of the brain is recommended.
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Generate impression based on findings.
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Reason: Stem cell transplant patient with recent xray concerning for questionable opacity in retrocardiac area of LLL History: none LUNGS AND PLEURA: Small foci of scattered bronchovascular nodularity and bronchiectasis involving the right apex and bilateral lower lobes. Bibasilar dependent atelectasis. Small bilateral pleural effusions.MEDIASTINUM AND HILA: Right jugular catheter with tip in the right atrium. Mildly enlarged right paratracheal, precarinal, and subcarinal lymph nodes. Heart size is normal with trace pericardial effusion. No visible coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Accessory splenules. Spleen is incompletely imaged, although appears enlarged, measuring at least 12 mm in the craniocaudal dimension.
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1.Scattered foci of bronchiectasis, peribronchovascular nodularity and ground glass opacity suspicious for atypical infection, such as viral or mycobacterial infection.2.Mildly enlarged mediastinal lymph nodes, likely reactive in etiology.3.Splenomegaly.
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Generate impression based on findings.
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17-year-old male with left thumb injury.VIEWS: Left hand AP lateral and oblique (3 views) 1/27/2015 No acute fracture or malalignment. No significant soft tissue swelling evident.
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Normal examination.
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Generate impression based on findings.
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14 year old female with pain and inability to flex knee.VIEWS: Right knee AP lateral and oblique (3 views) 1/28/2015 No acute fracture or malalignment. A small/moderate joint effusion is present.
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Small/moderate joint effusion without underlying fracture or malalignment seen.
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