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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Personal history of skin cancer. Three standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the left breast. Stable arterial calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Reason: Pleural mesothelioma please compare to prior exam per RECIST criteria. History: Pleural mesothelioma. LUNGS AND PLEURA: Pleural nodularity and right small pleural effusion compatible with history of mesothelioma have not significantly changed. Reference measurements on the right as follows:1.Level of the aortic arch (series 5 image 30): 6 o'clock position measures 6 mm, unchanged. 9 o'clock position 0 mm, unchanged.2.Level of the right pulmonary artery (series 5 image 42): 5 o'clock position 3 mm, unchanged when measured in the same manner. 11 o'clock position 1 mm, unchanged.3.Level of the SVC/RA junction (series 5 image 50): 11 o'clock position measures 10 mm, unchanged. 6 o'clock position 2 mm, previously 3 mm when re-measured.Previously identified nonreference lesion along the right hemidiaphragm has decreased in size compared to prior (18-mm compared to 35-mm, image 65). Involvement of the right minor fissure is similar to prior (series 5 image 43).Subsolid and ground glass nodules bilaterally have not significantly changed. Reference right upper lobe nodule measures 14 mm. (Series 5 image 38), previously 13 mmMEDIASTINUM AND HILA: Left chest port with catheter tip at the cavoatrial junction. Mediastinal thickening and nodularity on the right, has slightly increased compared to prior. Interval increase in right hilar lymphadenopathy. Reference right paratracheal lymph node measures 22 mm in the short axis (series 80247 image 32), previously 17 mm when remeasured. Mild coronary artery calcifications, similar to prior. Heart size is normal with trace pericardial effusion, unchanged.Hypoattenuating thyroid nodules in the right lobe, unchanged.CHEST WALL: Right chest port. New right internal mammary lymph node (series 80247).UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Interval increase in mediastinal and right hilar lymphadenopathy. 2.New right internal mammary chain lymphadenopathy.3.No significant change in right pleural reference lesions or intrapulmonary nodules. 4.Right diaphragm nonreference lesion has significantly decreased in size.
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Generate impression based on findings.
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Severe osteoarthritis. Worsening knee pain. Two views of the left knee are provided. The bones appear demineralized, suggesting osteopenia/osteoporosis. Severe osteoarthritis affects the knee, with near bone on bone apposition of the medial tibiofemoral compartment. There are also tricompartmental osteophytes and a mild varus deformity of the knee. There is a small joint effusion. Arterial calcifications are noted in the posterior soft tissues.Severe osteoarthritis also affects the right knee as seen on the frontal view.
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Severe osteoarthritis.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography.History of benign left breast biopsy. History of breast cancer in maternal and paternal cousins. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Benign intramammary lymph nodes are present in the left upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. Screening mammography is most sensitive when evaluating for interval changes. If patient submits outside mammogram, comparison will be made. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Pain. Bunion formation. The bones appear slightly demineralized, suggesting osteopenia. There is a severe hallux valgus deformity associated with moderate to severe osteoarthritis at the first metatarsophalangeal joint and first tarsometatarsal joint. There is also a pes planovalgus deformity with additional osteoarthritis affecting the midfoot articulations. Mild deformity of the fourth metatarsal diaphysis likely represents an old healed fracture.
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Hallux valgus deformity, pes planovalgus deformity and osteoarthritis as described above.
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Generate impression based on findings.
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Mesothelioma ABDOMEN:LUNG BASES: Right basilar pleural abnormalities again seen. Please refer to separate chest CT report.LIVER, BILIARY TRACT: Stable perihepatic soft tissue thickening. SPLEEN: No significant abnormality notedPANCREAS: 0.6 cm cystic focus within the pancreatic neck seen on image 55 again noted and unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval decrease in size of right peri-aortic lymph node best seen on image 41 now measuring 1.2 x 0.7 cm; this is in comparison to 2 x 1.5 cm on 12/17/2014.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus atrophic or absent.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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Interval decrease in size of reference right periaortic lymph node.
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Generate impression based on findings.
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Subglottic stenosis due to post-traumatic intubation. There is focal narrowing of the subglottic airway by soft tissue. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a small amount of undescended infrahyoid thyroid tissue. The major cervical vessels are patent. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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Findings compatible with subglottic stenosis related to intubation.
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Generate impression based on findings.
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Persistent headache and neck pain, dizziness. History of gunshot wound with residual shrapnel to T4/T5. CervicalThe cervical vertebral bodies are appropriate height. Alignment is maintained. No fractures are identified in the cervical spine. No destructive osseous lesions are identified in the cervical spine. Nonspecific lytic lesion involving the right upper aspect of the C4 vertebral body as well as the posterior aspect of the T1 vertebral body. There is also a sclerotic focus involving the T2 vertebral body. Small osseous protuberance along the left inferior facet of C6 may represent a tiny osteochondroma.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Thoracic There is irregularity involving the posterior inferior aspect of the T4 vertebral body likely related to remote fracture. There is also sclerosis and osteophyte projecting from the posterior superior aspect of the T5 vertebral body. These findings are most compatible with sequela of remote trauma.Metallic density is noted involving the anterior spinal canal at the T4-T5 level compatible with shrapnel. Similar densities also noted involving the right posterior thoracic wall, right pedicle/transverse process junction at the T3 vertebral level, pleural surface as well as punctate focus in the lung parenchyma.Deformity seen involving the right posterior third and fourth ribs as well as right transverse process of T4, findings most compatible with healed fractures. There is mild right T4-T5 neural foramina stenosis related to facet osteophyte. Remainder of the thoracic spine demonstrates normal vertebral body heights and alignment and without spinal canal or neural foramina stenosis. Moderate degree of pulmonary emphysema noted.
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1. Chronic fracture deformity involving the posterior inferior corner of the T4 vertebral body on the left. Sclerosis and osteophyte formation at the T4-T5 level also compatible with sequela of prior trauma. Deformity of right T4 transverse process and the right fourth and fifth ribs also compatible with prior trauma.2. Dorsally projecting osteophyte at T4-T5 narrows the spinal canal. There is also an adjacent metallic fragment in the ventral spinal canal at the T4-T5 compatible with shrapnel. 3. Subcentimeter areas of lucency and sclerosis such as at C4, T1, and T2 may be benign, but remain nonspecific by imaging. Follow-up can be considered as clinically indicated.
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Generate impression based on findings.
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CT HEAD: There is expected contrast opacification of the CSF spaces of the brain including intraventricularly, right greater than left, secondary to patient postioning in the right lateral and Trendelenburg position prior to the exam. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. CT TEMPORAL BONES: The external auditory canal is patent bilaterally. The right middle ear is near completely opacified, including the epitympanum, mesotympanum and hypotympanum. The left middle ear is also partially opacified including the epitympanum, around the ossicles and posterior to the tympanic membrane which is thickened. A tubular lucency courses through the left tympanic membrane indicating presence of a tympanostomy tube (series 6, image 62). Bony defects are noted involving the tegment tympani and tegmen mastoideum bilaterally. High density is noted within the right aditus ad antrum adjacent to the tegmen mastoideum which measures up to 200 Hounsfield units (series 80378, image 58), most compatible with leakage of contrast into the middle ear cavity from the CSF spaces. Review of the outside hospital brain and IAC MRI indicates a small cephalocele in this region (series 10, image 32/56). No definite contrast is visualized in the left middle ear although this is could be secondary to patient positioning. A slow leak cannot be entirely excluded in the left middle ear. There is also osseous dehiscence noted at the level of the anterior genu of the facial nerves bilaterally. The bilateral mastoid air cells are completely opacified. Extensive opacification within the middle ear cavities limits evaluation of the ossicles. However, there are no obvious erosions.The inner ear structures are unremarkable. The jugular bulb and carotid canal are intact.
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1.CT cisternogram with expected contrast opacification of the CSF spaces of the brain including intraventricularly following intrathecal administration of 10 cc of Omnipaque 300 contrast.2.Opacification of the middle ear cavities and bilateral mastoid air cells, right greater than left.3.Bony defects involving the tegment tympani and tegmen mastoideum bilaterally. There are areas of high density within the RIGHT middle ear cavity and right aditus ad antrum suggestive of leakage of contrast. There is particular defect in the right tegmen mastoideum (best seen on right coronal oblique image 58/125) with suspected continuity of hyperdensity between the subarachnoid space and aditus ad antrum. Review of the outside hospital brain and IAC MRI suggests a small cephalocele in this region (outside MRI coronal CISS reformat series 10, image 32/56). 4.No definite contrast is visualized in the left middle ear although this is could be secondary to patient positioning. A slow leak cannot be entirely excluded if there is suspicion for CSF otorrhea on the LEFT. 5.Left tympanostomy tube courses within a thickened left tympanic membrane.
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Generate impression based on findings.
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8 year-old female with cystic fibrosis and intermittent cough.VIEWS: Chest PA/lateral (two views) 1/28/2015 Persistent mild peribronchial thickening is seen. No significant bronchiectasis is evident. The cardiothymic silhouette is normal. No focal lung opacities are seen. Blunting of the right costophrenic may reflect a small pleural effusion or mild pleural thickening.
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Persistent mild peribronchial thickening without focal opacity. Small right pleural effusion or mild pleural thickening.
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Generate impression based on findings.
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46 years old Female. Reason: presurgical evaluation for epilepsy surgery. History: right temporal epilepsy. The noncontrast brain CT portion of the study is not remarkable. The FDG PET imaging demonstrates mild decrease of metabolic activity in the left the right medial temporal lobes, more decrease in the right hippocampus and amygdala. There is decreased activity in the right temporal pole. There is also decreased metabolic activity in the right supramarginal gyrus.The FDG uptake in the remaining portion of the brain is physiological.
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Decreased metabolic activity in the bilateral medial temporal lobes, right greater than left. Decreased metabolic activity in the right temporal pole and right supramarginal gyrus.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of left breast aspiration in 2000. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round markers were placed on the skin lesions overlying the right breast. Benign calcifications are unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Bilateral hip pain, worse on left. Rule-out any pathology. Two views of the left hip are provided. Mild osteoarthritis affects the hip joint. Mild chronic appearing enthesopathic changes are noted along the greater trochanter.Two views of the right hip are provided. Mild osteoarthritis affects the hip. Mild chronic appearing enthesopathic changes are seen along the greater trochanter.AP view of the pelvis shows mild osteoarthritis of both hip joints, both sacroiliac joints, and pubic symphysis. Degenerative arthritic changes also affect the visualized lower lumbar spine.
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Osteoarthritis as described above.
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Generate impression based on findings.
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Altered mental status. Evaluate for intracranial hemorrhage. There is loss of gray-white matter differentiation with sulcal effacement in the right frontal lobe and right insula, representing recent ischemia possibly from an embolic source. Given the bilaterality of the areas of occipital lobe hypoattenuation, posterior reversible encephalopathy syndrome should be considered. There is no evidence of intracranial hemorrhage. There is also a small area of encephalomalacia in the left inferior frontal gyrus, likely related to prior ischemia. There are chronic lacunar infarcts in the right basal ganglia and right corona radiata. The lacunar infarct in the right thalamus is age-indeterminate. There is global parenchymal volume loss. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, which is non-specific, but most consistent with mild to moderate age-indeterminate small vessel ischemic changes. There is no midline shift or herniation. There is minimal mucosal thickening of the bilateral maxillary sinuses. The other imaged paranasal sinuses are clear. There is complete opacification of the bilateral mastoid air cells and middle ears, which is likely related to intubation.
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1. Recent infarct in the right frontal lobe and right insula. Focal areas of hypoattenuation of the bilateral occipital lobes, may be attributable to PRES if clinically appropriate, versus additional embolic infarcts. No intracranial hemorrhage. Per Dr. Sharma's EPIC note, clinical team is aware of ischemic stroke.2. Background of mild to moderate age-indeterminate small vessel ischemic changes.3. Complete opacification of the bilateral mastoid air cells and middle ears, which is likely related to intubation.
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Generate impression based on findings.
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Postop spinal stenosis, lumbar region, with neurogenic claudication. There is severe multilevel degenerative disk disease, most pronounced at L3/4, L4/5, and L5/S1. There is a slight rightward curvature of the lumbar spine. The bones appear demineralized, suggesting osteopenia. I see no findings to suggest an acute compression fracture. There is atherosclerotic calcification of the abdominal aorta and its branches.
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Severe degenerative disk disease and other findings as above.
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Generate impression based on findings.
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Male 59 years old; Reason: 59yo male with Diabetes and peripheral neuropathy and abdominal pain. Evaluate for gastroparesis Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 70.7 % of peak activity (normal >70 %)1 hour: 43.0 % of peak activity (normal 30-90 %) 2 hours: 4.6 % of peak activity (normal <60 %)
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Gastric emptying within normal limits.
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Generate impression based on findings.
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Six month old female with tachycardia and tachypnea.VIEWS: Chest AP/lateral (two views) 1/28/2015 Peribronchial thickening and streaky left basilar subsegmental atelectasis is seen. The cardiothymic silhouette is normal. No pleural effusion or pneumothorax is evident.
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Bronchiolitis/reactive airways disease pattern, without superimposed pneumonia.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal second cousin. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Reason: Assess for recurrent head and neck cancer History: Previous tonsillar cancer CHEST:LUNGS AND PLEURA: Stable left intrapulmonary lymph node, without evidence of metastases. New patchy ground glass opacities are suggestive of aspiration.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.No coronary calcifications are visible, and the heart and pericardium appear normal.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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No evidence of metastases, or other significant abnormality.
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Generate impression based on findings.
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Lung cancer follow-up. Fatigue. CHEST:LUNGS AND PLEURA: Innumerable pulmonary micronodules. Given the presence of motion artifact it is difficult to localize the lesions several are endobronchial . Post-therapeutic changes in the right lung. No pleural fluid. MEDIASTINUM AND HILA: No significant change in soft tissue about the right superior hilum (3/31). Mild cardiomegaly. No pericardial fluid. Coronary artery calcifications.CHEST WALL: Solid nodule in the left breast mid depth measuring 16 x 22 mm, previously characterized by mammography as a hamartoma. Punctate calcifications in the right breast too small to characterize by CT.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter cyst near the hepatic dome. Nonspecific subcentimeter hypoattenuating lesion in the periphery of the right hepatic lobe (3/85) too small to accurately characterize and can be followed on subsequent exams.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal artery aneurysms, the largest measuring 10 x 10-mm (anterior lesion 3/96) and the smaller measuring less than 5-mm (3/94), not significantly changed. Extrarenal pelves bilaterallyPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the aorta and its branches. Peripherally calcified 11-mm aneurysm, which appears to arise from the left gastric artery, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Innumerable pulmonary micronodules, most compatible with metastases given known brain lesions and absent clinical signs of atypical infection. 2. Several arterial aneurysms in the upper abdomen, two involving the left kidney and one involving the left gastric artery. The larger lesions appear to be peripherally calcified. Query history of vasculitis. Consider
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Generate impression based on findings.
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38 year old female with history of right breast cancer. CHEST:LUNGS AND PLEURA: Minimal dependent atelectasis, and a single right apical micronodule (3/34) that abuts the pleura and may represent scar. No consolidation or significant pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Several mildly enlarged right axillary lymph nodes are seen, with a reference lymph node (5/42) measuring 12 x 10 mm. Punctate hyperattenuating foci in the right breast likely from prior clips.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate non obstructing right renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Approximately 36 x 24 mm hypoattenuating focus in the left adnexa, with a second 29 x 21 mm hypoattenuating focus more posteriorly (6/130), nonspecific but most likely physiologic adnexal cysts. Additional work up with pelvic ultrasound may be obtained if clinically warranted.BLADDER: The bladder is distended, within normal limits.LYMPH NODES: Mildly enlarged bilateral inguinal lymph nodes, nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Right breast biopsy clips, and a mildly enlarged right axillary lymph node as above.Adnexal cysts
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the left breast. Benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Reason: h/o HNC/CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Several punctate micronodules are present, and there is mild upper lobe centrilobular emphysema.There is no evidence of pulmonary or pleural metastases.Scattered basilar basilar opacities likely related to aspiration, unlikely to be tumor.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Moderate coronary calcifications are present, although the heart and pericardium are otherwise unremarkable.CHEST WALL: Left breast lesion, by report diagnosed as invasive ductal carcinoma in late 2011, may be slightly larger if changed, and is partially calcified.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: Large right renal peripelvic cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive distal aortic calcifications are present.
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1. No evidence of metastases.2. Known left breast lesion, diagnosed in late 2011 as invasive ductal breast cancer, questionably larger.
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Generate impression based on findings.
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76-year-old female status post left mastectomy for breast cancer in 2013 presents for routine follow-up. History of right breast benign biopsy. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A marker clip is present in the right lower inner quadrant posterior depth. Arterial calcifications are noted in right breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations 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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73-year-old female with leukemiaTECHNIQUE One Panorex view of the mandible Multiple missing teeth are noted. There is no gross bone destruction. The maxillary sinuses are clear.
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Poor dentition without evidence of osteomyelitis.
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Generate impression based on findings.
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Male 66 years old; malignant neoplasm of esophagusRADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 120 mg/dL. Today's CT portion grossly demonstrates left paramediastinal pleural thickening with adjacent streaky opacities. There is a left lower neck and left upper chest wall soft tissue density as well as multiple small left axillary lymph nodes. There is a small right paratracheal lymph node. There are surgical clips in the scrotal region. There are multiple sclerotic foci noted in the upper thoracic spine.Today's PET examination demonstrates focus of increased uptake in the esophagus at the subcarinal level with an SUV max of 8.4.There is mild activity in the right small paratracheal lymph node which is nonspecific with an SUV max of 2.4.Minimal activity in the left apical pleural thickening consistent with posttherapy changes.Mild bilateral symmetric multifocal activity correlates with the bilateral hila on comparison CT likely inflammatory in nature.
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1. Increased activity in the mid esophagus consistent with patient's known esophageal cancer. 2. Mild activity in the small right paratracheal lymph node is nonspecific, cannot rule out metastatic disease.3. Mild bilateral hilar activity is likely inflammatory in nature.
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Generate impression based on findings.
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64-year-old female with pain There is no significant varus or valgus alignment of the knee relative to the neutral mechanical axis. Severe joint space narrowing, lateral, greater than medial, and small osteophytes affect the right knee.
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Osteoarthritis, as described above.
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Generate impression based on findings.
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Right shoulder pain. Assess for osteoarthritis versus fracture. I see no fracture or malalignment. I see no osteoarthritis. Spinal fixation hardware is incompletely imaged on this study.
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No fracture, osteoarthritis, or other specific finding to account for the patient's right shoulder pain.
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Generate impression based on findings.
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Male 43 years old Reason: eval for recurrence History: RCC s/p resection LUNGS AND PLEURA: No suspicious masses or nodules. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post left nephrectomy. No evidence of local recurrence.
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No evidence of metastasis.
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Generate impression based on findings.
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Proximal humerus fracture. Left arm pain. Again seen is a comminuted fracture of the proximal humerus involving the surgical neck and greater tuberosity, with slight posterior angulation of the diaphyseal fracture fragment. Increasing callus indicates some interval healing. Mild osteoarthritis affects the acromioclavicular joint.
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Healing proximal humerus fracture.
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Generate impression based on findings.
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90 year-old male with history of prostate cancer, left lateral femur pain Mild osteoarthritis affects the knee. The proximal femur is intact. There is no evidence of osseous metastasis. Small ossicles are noted posteriorly about the knee joint, likely in a Baker's cyst.
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Knee osteoarthritis without evidence of metastatic disease.
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Generate impression based on findings.
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68 years old Male. Reason: S/p Total Gastrectomy 12/27/10 for a stage 1b (T2NO MX0 adenocarcinoma). No adjuvant therapy. Recent EGD for dysphagia. Stricture in jejunum, biopsy positive recurrent adenocarcinoma with signet ring features. Need PET Scan for staging. History: Weight Loss, dysphagia. RADIOPHARMACEUTICAL: 13.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates a small lung nodule in the right middle lobe. A small hiatal hernia. The prostate is enlarged. Surgical sutures are seen in the upper abdomen. There is a calcified nodule in the right infrahilar region. Please refer to the diagnostic chest CT report for the details of CT findings.Today's PET examination demonstrates a focus of mildly increased activity in the right lung hilum with maximal SUV of 2.2. There is no definite CT correlation for this the finding. A focus of increased activity with SUVmax of 2.9 is seen in the left upper abdomen either in the mesentery or in the splenic flexure of the colon. There is a focus of increased activity in the upper abdomen with SUVmax of 2.9 near the midline adjacent to the gastric surgical site. This focus increased activity may be in the left lobe of liver or gastrohepatic ligament.Diffuse FDG uptake is seen in the esophagus and a hiatal hernia, which can be due to esophagitis.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the spleen, kidneys, intestines, testicles and bladder.
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1.Focus of increased activity in the upper abdomen either in the left lobe of liver or gastrohepatic ligament, which can be due to tumor or inflammatory change.2.Focal area of increased activity in the left upper abdomen located in the mesentery or hepatic flexure of the colon, which can be due to tumor or inflammatory change. Further evaluation can be obtained with the contrast CT or abdominal MRI, if clinically indicated.
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Generate impression based on findings.
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69-year-old male, evaluate left hip joint osteoarthritis There is prominence of the left femoral head-neck junction and marked joint space narrowing with subchondral sclerosis. No fracture is evident. A right total hip arthroplasty is noted on the frontal view.
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Marked left hip osteoarthritis.
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Generate impression based on findings.
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Left breast mass for which ultrasound guided biopsy is requested. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 21 mm at the 7 o’clock position with increased vascularity, 5 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. No specimens floated. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.
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Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Other benign morphology masses are not biopsied pending the results of this biopsy. Pathology is pending at this time.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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Palpable left breast mass. An outside ultrasound was performed for only the site of palpable concern, but a mammogram is requested now. Three standard views of both breasts and bilateral spot views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. There are multiple scattered benign morphology masses in the left breast, the largest located under the palpable marker near the 7:00 position. This is either a single bilobed mass or two adjacent masses of similar morphology. An asymmetry in the right breast disperses with spot compression. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND
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Multiple left breast masses. The largest of these is palpable and will be biopsied under ultrasound guidance. The findings morphologically benign and are compatible with cysts and fibroadenomas. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Clinical trial requirement. There is age-related global parenchymal volume loss. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate age-indeterminate small vessel ischemic changes. There is no midline shift or herniation. There are calcifications of the bilateral cavernous carotid arteries. There is patchy opacification of a few left ethmoid air cells. The other imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.
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Global parenchymal volume loss. Moderate age-indeterminate small vessel ischemic changes.
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Generate impression based on findings.
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Reason: renal cell carcinoma History: renal cell carcinoma ABDOMEN:LUNG BASES: Calcified pulmonary nodules and mediastinal lymph nodes consistent with prior granulomatous disease.LIVER, BILIARY TRACT: Hepatic granulomataSPLEEN: Splenic granulomataPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postoperative changes of partial right nephrectomy and multiple bilateral renal lesions.Multiple left renal cysts of varying attenuation without new enhancing lesion. The largest hypoattenuating cyst in the left mid polar region is increased in size measuring 3.9 x 3.1 cm (series 7 image 38) previously 3.8 x 2.2 cm. Its attenuation is decreased since the prior study which may reflect resolution of hemorrhage. Multiple right renal lesions of high intrinsic attenuation, some of which are increased in size since 2012, but do not appear significantly changed since the prior study, and do not demonstrate significant enhancement. RETROPERITONEUM, LYMPH NODES: Interval decrease in size of previously referenced mesenteric lymph node now measuring 7 mm (series 7 image 81). No new lymphadenopathy. BOWEL, MESENTERY: Colonic diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis. Residual high attenuation contrast impregnated stool in the rectum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Multiple bilateral renal cysts of varying complexity, with some interval change in size and intrinsic attenuation of some of the lesions, but no new enhancement or other change that would specifically raise concern for malignancy.
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Generate impression based on findings.
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Reason: h/o laryngeal ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified, unchanged. No new or suspicious pulmonary nodules or masses. No pleural effusions. Minimal aspirate at the lung bases.MEDIASTINUM AND HILA: Tracheostomy tube in place. Normal heart size with no pericardial effusion. Minimal coronary artery and aortic annular calcifications.Previous reference prevascular lymph node measures 4 mm, unchanged (series 4 image 38). No significant mediastinal hilar lymphadenopathy. Calcified mediastinal and left hilar lymph nodes compatible with prior granulomatous disease.Reference paraesophageal lymph node measures 11 mm (series 3 image 83), unchanged.CHEST WALL: Interval placement of tracheostomy tube. Absence of the right internal jugular vein is again noted and may represent thrombosis. The right brachiocephalic vein again appears atretic. Postsurgical changes in the neck. Please refer to dedicated CT neck performed the same day for details. Findings compatible with diffuse idiopathic skeletal hyperostosis again noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple scattered subcentimeter hypoattenuating lesions in the liver are too small to characterize, although unchanged and likely represent cysts. Cholelithiasis without CT evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, not significantly changed.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative changes of the spine. OTHER: No significant abnormality noted.
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1. No suspicious pulmonary nodules.2. Interval tracheostomy tube placement.
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Generate impression based on findings.
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Reason: Right sacroiliac lesion to be biopsed. increased uptake in the PET History: Right sacroiliac region pain, increased uptake in the PET. History of right sacroiliac metastastic squamous cell carcinoma, treated with radiotherapy in 2012. Normal PET post treatment. Question whether recurrence versus XRT changes.OPERATORS: Greg ChristoforidisEBL < 5ml Serial CT images obtained during the biopsy procedure demonstrate needle placement within the right sacral ala. Following needle removal images obtained that demonstrate no complications .
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Right sacral ala biopsy under CT guidance. A total of 8 biopsy specimens were delivered to pathology for analysis.
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Generate impression based on findings.
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Female 77 years old Reason: elevated bilirubin, hepatic cysts, eval for biliary dilatation, biliary obstruction History: hyperbilirubinemia LIVER: The liver measures 17.2 cm in length and demonstrates mildly hyperechoic hepatic parenchyma suggestive of fatty infiltration. Multiple hypoechoic lesions in the liver suggestive of hepatic cysts. No suspicious lesion is seen. Portal vein demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: No gallbladder wall thickening or pericholecystic fluid. The common bile duct measured at up limits of normal for age at 0.7 cm. Indeterminant non-shadowing, subcentimeter echogenic focus within the gallbladder body. This may represent a small gallstone but it was not possible to assess for mobility of this focus due to patient immobility.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 11.4 cm. The left kidney measures 11.0 cm. Multiple renal cysts identified. Mildly echogenic renal parenchyma suggestive of medical renal disease. OTHER: The spleen measures 4.8 cm. Bilateral pleural effusions.
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1. No evidence of intra-or extrahepatic biliary duct dilatation.2. Fatty infiltration of the liver. Multiple hepatic cysts identified. No suspicious lesion is seen.3. Echogenic renal cortex bilaterally suggestive of medical renal disease.4. Bilateral pleural effusions.
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Generate impression based on findings.
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Pleural mesothelioma ABDOMEN:LUNG BASES: Right pulmonary and pleural abnormalities again noted. Please refer to separate chest CT report.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Stable negative examination. No evidence for intra-abdominal neoplastic, inflammatory, or acute finding.
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Generate impression based on findings.
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Male 47 years old Reason: 46 yo with GB polyps please asses for growth History: none LIVER: The liver measures 14.2 cm in length and is mildly echogenic. No focal hepatic lesion. The portal vein demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Multiple non-mobile, echogenic foci are noted adherent to the gallbladder wall which are suggestive of polyps. The largest measures 0.5 cm in maximum dimension, and these are unchanged from prior study. No cholelithiasis, gallbladder wall thickening or pericholecystic fluid. No biliary dilatation.PANCREAS: Unremarkable where visualized.KIDNEYS: The right kidney measures 10.5 cm. There is a 0.6-cm echogenic focus in the lower pole cortex which is nonspecific. The left kidney measures 12.5 cm. Shadowing echogenic focus in the lower pole is suggestive of a renal calculus. There's no hydronephrosis.OTHER: No significant abnormalities noted.
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1. Echogenic hepatic parenchyma suggestive of fatty infiltration.2. Stable gallbladder polyps.3. Echogenic focus in the lower right kidney which is nonspecific. Angiomyolipoma is a differential consideration. Consider renal protocol CT for further evaluation.4. Nonobstructing left renal calculus.
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Generate impression based on findings.
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Female 63 years old; Reason: pelvic mass on abdominal ultrasound History: as above ABDOMEN:LUNG BASES: Calcified right hilar lymph nodes. Mild left pleural thickening.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: Mild calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large cystic mass and midline appears to originate from the right adnexa. It measures at least 24 x 17 cm (image 91/series 3). There is enhancing nodularity along the posterior inferior aspect of the mass.Mildly thickened endometrium.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites.
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1.Findings of a large right cystic ovarian mass with imaging features most compatible with a serous cystadenoma. However, given the nodularity along the cyst wall a malignant cystic neoplasm is also in the differential.
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Generate impression based on findings.
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Reason: lung cancer compare to last CT \T\ measure 1) RLL mass, 2) RLL nodule, 3) inferior RLL nodule \T\ 4) LUL nodule History: post 2 cycles of chemo CHEST:LUNGS AND PLEURA: Previous reference right lower lobe mass abutting the mediastinum measures 5.2 x 5.1 x 7.6 cm (series 4 image 64) previously measuring 5.0 x 5.0 x 7.2 cm. Adjacent subpleural thickening has not significantly changed.Reference superiormost right lower lobe nodule measures 12 mm, unchanged (series 4 image 44).Reference inferior most right lower lobe nodule measures 25 mm, unchanged (series 4 image 64).Reference superior segment right lower lobe sub-solid nodule measures 3 mm, unchanged (series 4 image 40).Right middle lobe solid nodule is not significantly changed (series 4 image 56).Reference left upper lobe nodule measures 12 mm (series 4 image 33), previously 11 mm.Upper lobe predominant centrilobular emphysema, not significantly changed.MEDIASTINUM AND HILA: Redemonstration of invasion of the mediastinum, including the right atrial wall, by the right lower lobe mass. Occlusion of the right inferior pulmonary vein again noted.Reference right paratracheal lymph node measures 14 mm in the short axis (series 3 image 22), previously 13 mm. Nonreference 14mm subcarinal lymph node and an 11mm right posterior paraesophageal lymph node have slightly increased in size, previously 11 and 8 mm respectively (series 3 image 48, 74, ).Right jugular catheter with tip at the cavoatrial junction.Heart size is normal with no pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Small sclerotic foci in the T7 and T10 vertebral bodies, unchanged. L1 compression deformity, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.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: Atherosclerotic calcification of the abdominal aorta and its branches. Small retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Skeletal lesions, unchanged.OTHER: No significant abnormality noted.
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1.Right lower lobe mass with invasion of the mediastinum continues to increase in size in the craniocaudal dimension.2.Pulmonary metastases similar in size compared to prior.3.Reference mediastinal lymph node has not significantly changed. Non-reference mediastinal lymph nodes have slightly increased in size.4.Stable skeletal lesions.
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Generate impression based on findings.
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Male 56 years old Reason: new elevated transaminitis, s/p cholecystectomy, eval biliary tree and liver - RUQ History: metastatic melanoma, transaminitis LIVER: The liver measures 18.0 cm in length. There is 3.8 x 3.6 x 2.4 cm solid mass in the gallbladder fossa corresponding to abnormality identified on recent PET study consistent with provided history of melanoma metastasis. The main portal vein is patent and demonstrates normal directional flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: There is minimal intra-and extrahepatic biliary duct dilatation. The common duct measures 0.6 centimeters in maximum axial dimension.PANCREAS: Unremarkable where visualized.SPLEEN: Splenomegaly measuring 15.1 cm.RIGHT KIDNEY: The right kidney measured 11.2 cm. The left kidney measures 10.7 cm. There is no hydronephrosis.
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1. Solid mass in the gallbladder fossa corresponding to patient's known melanoma metastasis.2. Minimal intra-and extrahepatic biliary duct dilatation.
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Generate impression based on findings.
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2-year-old male for pneumonia/acute chestVIEWS: Chest AP/lateral (two views) 01/28/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate bronchial wall thickening is suggestive of bronchiolitis/reactive airway disease.
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Bronchiolitis/reactive airway disease.
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Generate impression based on findings.
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Lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical changes of a right thoracotomy and diaphragmatic patch. Right pleural and fissural nodularity has slightly increased compared to prior. Reference measurements as follows: 1.At the level of the great vessels origins (image 31): Three o'clock position measures 26 mm, previously 21 mm. Six o'clock position measures 27-mm, previously 21 mm.2.At the level of the aortic arch (image 33): Three o'clock position measures 25 mm, previously 20 mm. Six o'clock position measures 22 mm, unchanged.3.At the level of the left ventricle (image 71): Five o'clock position lesion is confluent with adjacent anterior disease. When measured in a similar fashion, 55 mm, previously 47 mm.Scattered pulmonary micronodules are unchanged. No conclusive contralateral pleural or parenchymal disease.MEDIASTINUM AND HILA: Reference right high paratracheal lymph node measures 15 mm unchanged (image 34). Additional mildly enlarged bilateral mediastinal lymph nodes and right hilar lymph nodes are about the same.Mild pericardial thickening. Tumor abutting the right heart extends into the pericardium and great mediastinum with mass effect upon the azygos arch and extension in the subcarinal space surrounding the uncus. Tumor abuts the distal thoracic esophagus with loss of adjacent fat plane.Heart size is normal. No visible coronary calcifications.CHEST WALL: Tumor extends into the paravertebrally at anterior and to the right the lower thoracic spine several levels but without conclusive evidence of osseous erosion or extension into the spinal canal. Degenerative changes of the spine. Post surgical changes of a right thoracotomy. Extension through the right chest wall has slightly increased compared to prior in the lateral costophrenic sulcus. Right intercostal and internal mammary lymphadenopathy about the same. Anterior intercostal chest wall extension also slightly increased.UPPER ABDOMEN: Will be reported separately.
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Increasing right pleural reference measurements and chest wall tumor. Findings on the current study confirm pericardial/ mediastinal involvement.. :
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Generate impression based on findings.
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The spine is in normal alignment. There is straightening of the normal cervical lordosis. There is mild disk narrowing and diffuse disk dessication at L5-S1. There is also disk desiccation at T8-T9 and throughout the cervical spine. There is central moderate vertebral body height loss of L1 with abnormal T1 hypointense and scattered STIR hyperintense signal in the marrow, suggestive of a component of recent compression deformity. L1 is only partially visualized on the prior CT chest, but appear to be within normal limits. There is mild to moderate concavity of the superior endplate of L4 and to a lesser degree L3 and L5 without significant marrow signal abnormality. There is suggestion of perhaps mild concavity of superior endplate of L4 on previous radiograph.The vertebral body and disk heights are otherwise relatively well-maintained. The spinal cord is of normal caliber and grossly of normal signal. The conus terminates at the approximate L1 level.A trace disk bulge is suggested at T8-T9. There are mild spondylotic changes at C5-C6 and C6-C7 with perhaps mild central spinal canal stenosis. There is no high-grade central spinal stenosis or foraminal narrowing. On the sagittal STIR images, the cauda equina roots appear somewhat disordered and thickened although there is no significant central spinal canal stenosis. There is mild developmental narrowing of the distal lumbar spinal canal.There is partially visualized bilateral maxillary sinus mucosal retention cysts or polyps.
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1. No evidence of acute cord compression or significant central spinal calcinosis. Questioned thickened and irregular appearance of the cauda equina nerve roots on sagittal STIR images, for which MRI lumbar spine with and without contrast is recommended in order to obtain at the time of this dictation, for further evaluation.2. Moderate compression deformity with findings suggestive of recent component of fracture at L1. Mild-moderate compression deformity of L4, and to lesser degrees at L3 and L5, with new as well as progressed findings since previous radiograph of lumbar spine.3. Mild lower cervical, lower thoracic spondylotic changes.
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Generate impression based on findings.
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29-year-old female with history of trauma. There is mild reticulation about the anterolateral soft tissues, but we see no acute fracture.
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Mild soft tissue swelling without acute fracture.
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Generate impression based on findings.
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54-year-old male with history of knee pain. There is severe osteoarthritis affecting the patellofemoral joint with relatively mild osteoarthritis at the tibiofemoral articulation. We see no chondrocalcinosis. There is a moderate-sized joint effusion. Ossicles in the soft tissues surrounding the knee suggest loose bodies in the joint or in a Baker's cyst. Osteoarthritis affects the right knee as seen on the frontal view.
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Osteoarthritis and joint effusion as above.
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Generate impression based on findings.
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Malignant neoplasm of the kidney. Clinical trial. Baseline therapy. Metastatic RCC. CHEST:LUNGS AND PLEURA: Left lingular atelectasis. No definite pulmonary metastases.MEDIASTINUM AND HILA: No significant abnormality noted. Subcentimeter mediastinal lymph nodes.CHEST WALL: There is a 5.4 x 7.6 cm enhancing mass (image 15; series 4) invading and destroying portions of the T2 and T3 vertebral bodies and adjacent left third rib with extension into the spinal canal. Postsurgical changes are also noted posteriorly, presumed secondary to prior intervention in this region. Correlation with spine MR is advised as clinically indicated.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 3.7 x 3.7 cm exophytic left renal mass (image 123; series 4) compatible with renal cell carcinoma. No hydronephrosis of either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L5-S1 disk space loss and degenerative change.OTHER: Median acute ligament compression on the celiac axis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right inguinal hernia repair
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Left complex renal mass compatible with renal cell carcinoma. Destructive metastasis involving the upper left thoracic spine with extension into the spinal canal; correlation with spine MRI is advised. Findings were discussed with the clinical service (pager number 7068) at the time of dictation.
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Generate impression based on findings.
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51-year-old female with history of medial ankle pain. There is mild soft tissue swelling about the ankle. There is a mild pes planus deformity. Mild osteoarthritis affects the ankle joint.
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Mild soft tissue swelling, pes planus deformity, and osteoarthritis as above.
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Generate impression based on findings.
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Bilateral shoulder pain for one year.VIEWS: Left shoulder internal rotation, external rotation, wide view and axillary view (4 views) right shoulder internal rotation, external rotation, wide view and axillary view (4 views) 1/28/2015 LEFT SHOULDER: Well-circumscribed cortically based lucency in the superolateral aspect of the left humeral head likely represents a cyst, although is incompletely characterized. No acute fracture or malalignment evident.RIGHT SHOULDER: Well-circumscribed lucency in the greater trochanter measuring 1.1 x1.2 cm. No acute fracture or malalignment evident.
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Cystic changes in the bilateral proximal humeri are incompletely characterized and further evaluation with MRI can be considered as clinically indicated.
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Generate impression based on findings.
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76 year old female with history of newly diagnosed breast cancer and liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Hepatic dome/segment 7 hypoattenuating lesion with brisk, peripheral nodular arterial enhancement (10/24) measuring approximately 1.7 x 1.5 cm, which follows the blood pool on delayed sequences.An additional focus of arterial enhancement is noted in segment 3 (10/37) and measures approximately 1.2 x 1 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several small retroperitoneal lymph nodes are seen, none of which are pathologically enlarged. A reference gastrohepatic lymph node (10/36) measures 10 x 8 mm.BOWEL, MESENTERY: An area of fat density within the jejunum (10/59) measures approximately 20 x 31 mm, most consistent with a lipoma.BONES, SOFT TISSUES: Anterior abdominal wall midline ventral hernia mesh repair is noted. Sclerotic L4 vertebral body lesion, nonspecific.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hypoattenuating focus within the uterus, likely uterine fibroid.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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At least two arterial enhancing hepatic lesions, which follow the blood pool on delayed images, most consistent with hemangiomas but may represent focal nodular hyperplasia or adenoma. These lesions may be further evaluated with MRI liver protocol for additional specificity.
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Generate impression based on findings.
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T3N0 laryngeal squamous cell carcinoma treated via chemoradiation completed 8/23/13. There are post-treatment findings with persistent extensive diffuse laryngeal mucosal edema. The thyroid, arytenoid, and cricoid cartilages appear to be intact. There are no enlarged neck lymph nodes by CT criteria. The thyroid and salivary glands are unchanged. There is a tracheostomy tube in position and the airway inferior to the tube is patent. The right internal jugular vein remains thrombosed. The carotid arteries are patent. There is an unchanged 6 mm wide well-circumscribed lucent focus within the dens. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits and intracranial structures are unchanged. There is unchanged multilevel degenerative spondylosis and postsurgical findings in the cervical spine. There are multiple unchanged punctate polypoid skin lesions in the face. There are bilateral lens implants. There is mediastinal lipomatosis. The imaged portions of the lungs are clear.
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Post-treatment findings in the neck with persistent extensive laryngeal mucosal edema and tracheostomy tube in position, but no measurable residual laryngeal tumor or significant lymphadenopathy in the neck.
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Generate impression based on findings.
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16-month-old male with cystic fibrosis.VIEWS: Chest AP/lateral (two views) 1/28/2015 Mild peribronchial thickening is again evident. No focal lung opacity or bronchiectasis is seen.Cardiothymic silhouette is within normal limits. No pleural effusion or pneumothorax.
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Persistent mild peribronchial thickening, without significant bronchiectasis or focal air space opacity evident.
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Generate impression based on findings.
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Male 63 years old; Reason: pt with a history of prostate cancer, please assess for disease progression Interval resolution of activity in the T8 vertebral body. A focus in the right hemipelvis correlates with the sclerotic lesion seen in the right sacrum on same day CT as well as prior CT 8/29/2014, however this was not seen on prior bone scan.
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Interval resolution of activity in the T8 vertebral body. Focus of activity in the right sacrum not seen on prior bone scan however is identified on current and prior CT dated 8/29/2014 consistent with metastatic disease.
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Generate impression based on findings.
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Right knee pain. Please evaluate. Four views of the right knee are provided. The bones appear slightly demineralized. Mild osteoarthritis affects the right knee, particularly the patellofemoral compartment. There is a moderate-sized joint effusion.Mild osteoarthritis also affects the left knee as seen on the frontal view.
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Mild osteoarthritis.
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Generate impression based on findings.
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There is mild disk narrowing at L5-S1 with diffuse disk desiccation. There is moderate vertebral body height loss of L1 as well as moderate concavity of the superior endplate of L4. Less prominent superior endplate concavity is noted at L3 and L5, consistent with chronic compression deformities. There is mild enhancement of the L1 vertebra diffusely, suggesting possible recent fracture component. Although the sacrum and visualized right iliac bone appear to enhance on the fat saturated postcontrast images, this is favored to be artifactual given lack of any STIR abnormality. There is a focal area of abnormal signal in the right sacrum at the S2 level which demonstrates marginal T2 hypointensity and minimal enhancement which is nonspecific. There is also a focus of T1/T2 hypointensity likely representing sclerosis in the right iliac wing. There is mild developmental narrowing of the mid to distal lumbar spinal canal due to shortened pedicles and slight prominence of dorsal epidural fat.The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is no pathological intrathecal enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level.At T12-L1, there is bilateral facet arthropathy without stenosis.At L1-L2, there is no significant disk pathology or stenosis.At L2-L3, there is bilateral facet arthropathy and ligamentum flavum thickening as well as slight prominence of dorsal epidural fat. There is no significant stenosis.At L3-L4, there is bilateral facet arthropathy and ligamentum flavum thickening. Due to prominence of dorsal dural fat and developmental narrowing, there is mild central spinal stenosis.At L4-L5, there is prominent bilateral facet arthropathy and ligamentum flavum thickening. Due to the underlying developmental narrowing, there is moderate central spinal stenosis with bulging of the cauda equina nerve roots.At L5-S1, there is mild bilateral facet arthropathy and ligamentum flavum thickening along with a mild disk bulge. There is moderate central spinal canal stenosis at this level.There are incidental T2 hyperintense rounded structures associated with the left kidney, one of which may be partially exophytic and only partially visualized. These are nonspecific but may represent small cysts. There is disk desiccation at T8-T9 with a very trace disk bulge.
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1. Thickening and redundancy of the cauda equina nerve roots secondary to a combination of underlying developmental narrowing of the mid to distal lumbar spinal canal and superimposed mild spondylotic changes, resulting in moderate central spinal canal stenosis at L4-L5 and L5-S1. This accounts for appearance on previous screening cord compression protocol exam. No evidence of abnormal intrathecal enhancement.2. Scattered lumbar compression deformities as detailed previously, with probable recent component involving L1 and associated marrow changes and enhancement. This deformity was not present on the CT chest of 10/22/2014. Additional new compression fractures are present since lumbar radiograph of June 2014. No significant retropulsion of fracture fragments.3. Small focal minimally enhancing T2 hyperintense lesion within on the right at the S2 level, just lateral to the foramen, which may represent a myelomatous deposit.
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Generate impression based on findings.
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Large B cell NHL status post chemotherapy in presumed ongoing remission. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There is a left occipital subgaleal lipoma that measures up to 10 mm in width. The imaged portions of the lungs are clear.
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No evidence of significant lymphadenopathy in the neck to suggest recurrent lymphoma.
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Generate impression based on findings.
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Reason: Patient with previous radiation/chemotherapy, has h/o NSCLC History: f/u ct CHEST:LUNGS AND PLEURA: Paramediastinal fibrotic changes compatible was postradiation changes. Previously seen loculated intrafissural fluid collection has resolved or nearly resolved. There are few small subcentimeter fluid collections in the right lower lobe posterior to the fissure, which may represent loculated collections related to treatment, although intraparenchymal lesions cannot be excluded. Peripheral right lower lobe cavitary mass with peribronchial and pleural extension is difficult to accurately measure, measuring approximately 6 x 3.4 cm (series 6 image 58), previously 6 x 4 cm. Small right pleural effusion. Mild upper lobe predominant centrilobular emphysema. Left lower lobe scarring/atelectasis.MEDIASTINUM AND HILA: No significant mediastinum hilar lymphadenopathy. Previous reference subcarinal lymph node measures 8 mm in the short axis (series 4 image 49), unchanged.Heart size is normal with no pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Degenerative changes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic subcapsular cysts, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole hypoattenuating lesion with nodular peripheral enhancement measures 29 mm (series 4 image 122). Previously at this site airways a nonspecific 4 mm hypoattenuating lesion (series 4 image 121). Scattered non-obstructing renal calculi and vascular calcifications are noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified and noncalcified plaque involving the abdominal aorta and its branches with narrowing of the infrarenal abdominal aorta to 8 mm in diameter. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Although mass and posttreatment changes are difficult to differentiate, right lower lobe cavitary mass and adjacent posttreatment changes have overall decreased in size compared to prior.2.Resolution or near resolution of previously seen right intrafissural fluid collection. A few small fluid density foci in in the right lower lobe may represent residual loculated fluid collections, although parenchymal lesions cannot be entirely excluded. 3.Significant interval increase in size of right kidney inferior pole hypoattenuating lesion with slightly nodular peripheral enhancement. In the appropriate clinical setting, this may represent focal pyelonephritis. If the absence of such clinical setting, then lesion would be suspicious for a cystic metastasis and further characterization with renal protocol CT would be suggested. 4.Findings emailed to Dr. Salgia at the time of dictation (PNR). Livia Szeto (1393) text paged and a voice message was left regarding a finding.
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Generate impression based on findings.
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Pt is an 83 y/o male with met prostate cancer, evaluate for progression Interval solution of activity in the right humeral head. Uptake in the right acromioclavicular joint is consistent with degenerative changes. Increased activity in the left supraorbital region as well as midline upper face is unchanged and likely related to sinus disease when correlated with prior MRI pituitary study 1/30/2014. No new abnormal osseous foci are identified to indicate metastatic disease.
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Interval resolution of activity in the right humeral head. No new abnormal osseous foci are identified to indicate metastatic disease.
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Generate impression based on findings.
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70-year-old male with history of possible retained bullet fragment. Left tibia/fibula: Multiple metallic fragments are clustered along the posteromedial aspect of the tibial metadiaphysis compatible with a fragmented bullet. Focal sclerosis of the underlying tibia may reflect a healed fracture. There is mild diffuse soft tissue swelling. Moderate osteoarthritis affects the knee.Left femur: Again seen are the aforementioned bullet fragments within the proximal tibia. There are no bullet fragments noted within the thigh. Moderate osteoarthritis affects the hip and knee.Right tibia/fibula: We see no bullet fragments. Mild to moderate osteoarthritis affects the knee. There is diffuse soft tissue swelling.Right femur: We see no bullet fragments. Mild osteoarthritis affects the hip and knee.
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Bullet fragments adjacent to the proximal left tibia as described above. Findings relayed to the MRI technologist at 1500 on 1/28/15.
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Generate impression based on findings.
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Again seen are postoperative changes of posterior spinal fusion from T7 to T12, T8-T10 laminectomy, and partial corpectomies at T9 and posterior superior aspect of T10. Right costo-transversectomy also seen at T9 and T10 levels. Irregularity involving the left T9 and T10 transverse process disease is also seen, presumably also postsurgical. Interbody fusion at T8-T9. Paraspinous rods and pedicle screws at T7, T8, T11, and T12 appear similar position. No evidence of hardware fracture. Compared to 9/4/2014, interval development of lucency is seen involving the bilateral pedicle screws at T12 there is mild lucency surrounding the T11 screws, particularly on the right. There is loss of intravertebral disk space with vacuum disk phenomenon at T11-T12 and T12-L1 which was present on prior. Mild focal kyphosis is suspected at the T12 level and can be correlated with standing radiographs. There is mild anterior wedging involving the T12 vertebral body, stable to minimally worse compared to 9/4/2014. There appears to be a defect involving the device interconnecting the paraspinous rods at the T11-12 level similar to prior.There is soft tissue density in the surgical bed in the epidural space poorly evaluated on CT but presumably represents postoperative changes/granulation tissue. Small residual calcification/bone fragment is noted in the anterior epidural space at T9 with adjacent soft tissue resulting in mild effacement of the ventral thecal sac. Moderate narrowing of the right T11-T12 neural foramen.No discrete fluid collection is seen. IVC filter partially visualized.
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1. Periscrew lucencies suggestive of loosening involving the bilateral pedicle screws at T12 and and right pedicle screw at T11. 2. Mild anterior wedging involving the the T12 vertebral body stable to mildly worse compared to 9/4/2014. Apparent mild focal kyphosis at the T11-T12 level appears worse and can be correlated with standing radiographs.
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Generate impression based on findings.
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Female 42 years old Reason: RUQ pain, eval biliary tree and gallbladder History: abdominal pain LIVER: The liver measures 19.8 cm in length and demonstrates mildly hyperechoic parenchyma which is suggestive of fatty infiltration. There is no focal liver lesion.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: Unremarkable appearance of the pancreatic head and proximal body. The distal body and tail are poorly visualized.KIDNEYS: The right kidney measures 12.0 cm. The left kidney measures 12.1 cm. There is no hydronephrosis or shadowing stones.OTHER: The spleen measures 9.8 cm.
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1. Mildly hyperechoic hepatic parenchyma suggestive of fatty infiltration. 2. No evidence of cholelithiasis or acute cholecystitis.
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Generate impression based on findings.
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Lung mass, pleural effusion, dyspnea, longtime smoker evaluate for lung cancer. CHEST:LUNGS AND PLEURA: Moderate left pleural fluid collection. Assessment for pleural nodules limited given of intravenous contrast. Centrilobular and paraseptal emphysema with scattered cysts.Spiculated mass within the apical posterior left upper lobe measures 4.2 x 3.5 cm in transaxial dimensions at the level of the aortic arch (4/33) and is inseparable from the adjacent fissure. Bulky lymphadenopathy surrounds the left upper lobe bronchus and its proximal branches and a second mass extends along the anterior segmental bronchus, 3.4 x 2-cm (4/41).Diffuse septal and fissural thickening in the left upper lobe. Spiculated subpleural nodule left upper lobe (4/44). 8 mm subpleural nodule in the left lower lobe may represent an intrapulmonary lymph node and a similar subcentimeter lesion is seen on the right (4/49); these may be monitored on subsequent exams. No suspicious contralateral nodules or masses.MEDIASTINUM AND HILA: Moderate left hilar lymphadenopathy. Mild lymphadenopathy in the subaortic region. Mildly prominent right cardiophrenic lymph node.Moderate cardiomegaly. Small pericardial fluid collection. Mild coronary artery calcifications.CHEST WALL: Mild low left cervical lymphadenopathy. Loss of fat planes in the right axilla, replaced by soft tissue; although no discrete lymph nodes are appreciated, lymphadenopathy in this region cannot be ruled out with without intravenous contrast. This is suspicious for perivascular inflammation due to venous thrombosis of the subclavian vein.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Sludge in the gallbladder.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: Atherosclerotic calcifications of the abdominal aorta and its branches. Mild fusiform dilatation of the distal abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Left upper lobe masses and nodules with ipsilateral mediastinal, hilar and low cervical lymphadenopathy; highly suspicious for primary pulmonary neoplasm. Moderate left pleural effusion and a small pericardial effusion are present; metastases to these areas cannot be excluded. Diffuse septal thickening throughout the left upper lobe may be secondary to venous obstruction however is suspicious for a localized lymphangitic spread of disease. Right subclavian perivascular soft tissue/inflammatory changes suspicious for venous thrombosis or less likely tumor/lymphadenopathy, incompletely characterized without intravenous contrast.
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Generate impression based on findings.
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Female 38 years old; Reason: chest pain, similar to previous PE in 2007; recent surgery and current immobility; Xarelto held for surgery; has Lupus nephritis with renal insufficiency so cannot get CT PE protocol The comparison chest radiograph performed on 10/30/2014 demonstrates stable blunting of the left costophrenic angle.The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. There is blunting of the left costophrenic angle which is a stable finding when compared to prior chest x-ray.The perfusion images show a physiologic distribution of pulmonary perfusion. There is blunting of the left costophrenic angle which is a stable finding when compared to prior x-ray
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Very low probability for pulmonary embolism.
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Generate impression based on findings.
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78 year old female with history of left mastectomy for breast cancer in March 2014, after remote history of left lumpectomy for breast cancer in 1995. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations 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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There is carious disease of ADA 31 and a root canal of ADA 30 with carious disease of the posterior portion. There is enhancing soft tissue thickening measuring 14 x 6 mm at the medial aspect of the left maxillary alveolar process at ADA 16. ADA 16 is smaller in size than the contralateral tooth in the same position. There is no definite dental abscess.There is cervical lymphadenopathy, likely reactive. For example, there is a 12 mm left level 1b lymph node and 8 mm level 1a lymph nodes. There is mild mucosal thickening of the right maxillary sinus and moderate mucosal thickening of the left maxillary sinus. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. The imaged intracranial structures are unremarkable.
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1. Enhancing soft tissue thickening measuring up to 14 mm along the medial aspect of the left maxillary alveolar process at ADA 16. Recommend correlation with direct inspection. No discrete fluid collection.2. Right-sided dental caries.
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Generate impression based on findings.
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There is premature fusion of the left coronal suture with asymmetric flattening of the left frontal calvarium. The metopic suture is partially fused. The sagittal suture, right coronal, and bilateral lambdoid sutures are patent. The anterior and posterior fontanelles are closed. The ventricles and sulci are within normal limits. There is no gross intracranial abnormality. The visualized portions of the paranasal sinuses are grossly clear. There is nonspecific opacification of the bilateral mastoids.
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1. Unilateral left coronal craniosynostosis with anterior plagiocephaly.2. Closure of the anterior and posterior fontanelles.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of abnormal attenuation or pathological enhancement. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No CT evidence of intracranial metastases. If there is continued clinical concern and no contraindication to MR, MRI may be considered.
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Generate impression based on findings.
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History of rheumatoid arthritis, limited range of motion of neck, paresthesias of left fourth and fifth fingers. Rule out instability. Evaluation of the cervical spine is limited due to inability to optimally position the patient. Evaluation of the lower cervical spine is further limited on the lateral views by overlying anatomy. There is a cervicothoracic scoliosis. Severe degenerative disk disease affects C5/6 and C6/7. Moderate to severe degenerative disk disease affects C3/4 and C4/5. The anterior atlantodental interval measures approximately 3-4 mm, which may reflect slight subluxation, but I see no frank instability between the flexion, neutral, and extension views. Approximately 4 mm of anterolisthesis of C2 is elicited on flexion. There is approximately 4 mm of anterolisthesis of C3 that increases to approximately 6 mm on flexion. Approximately 5 mm of anterolisthesis of C4 is elicited on flexion. There is moderate to severe multilevel facet joint osteoarthritis. There is also multilevel narrowing of the neuroforamina, although this would be better evaluated with cross-sectional imaging. There is atherosclerotic calcification of the aortic arch.
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Severe degenerative disk disease and facet joint osteoarthritis, with anterolistheses elicited on flexion as described above, suggesting instability.
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Generate impression based on findings.
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Family history of breast cancer in her mother and grandmother. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted 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 recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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12-year-old male with abdominal pain, assess stool burden VIEW: Abdomen AP (one view) 01/28/15 Moderate amount of stool throughout the abdomen. No pneumatosis. Nonobstructive bowel gas pattern.
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Moderate stool burden.
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Generate impression based on findings.
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59-year-old female with left breast asymmetry presents for short-term follow-up of left breast and annual mammogram for right breast. 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 elements, unchanged in pattern and distribution. A circumscribed oval, focal asymmetry in the upper inner left breast appear unchanged. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound was performed for upper inner quadrant of left breast. Detected was clustered simple cysts measuring 6 x 4 mm, corresponding to the focal asymmetry.
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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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70 years, Male. Reason: evaluate for ileus History: no bm in days Pelvis is excluded from field of view. Nonobstructive bowel gas pattern. Partially visualized patchy airspace opacity and tenting of left diaphragm.
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Pelvis is excluded from field of view. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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66 years, Male. Reason: Serial evaluation of stool burden in the setting of constipation/abdominal pain History: Abdominal pain Average stool burden. Distended bowel loops without significant change from prior study. Streaky bilateral lung base opacities compatible with atelectasis.
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Average stool burden. Distended bowel loops without significant change from prior study.
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Generate impression based on findings.
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23 old female with history of JIA Left hand: There multiple erosions at the bases of the metacarpals as well as marked intercarpal joint space narrowing and small carpal erosions. The distal osseous structures appear within normal limits.Right hand: There may be mild periarticular osteopenia involving the bases of metacarpals and carpal bones, without discrete erosionRight foot: The osseous structures appear normal for the patient's age. Alignment is within normal limits.Left foot: The osseous structures appear normal for the patient's age. Alignment is within normal limits.Right knee: Alignment is anatomic. Small joint effusion. No erosions or significant degenerative changes.Left knee: Moderate joint effusion. No erosions or significant degenerative changes.
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1. Erosions and narrowing of the intercarpal joints involving the left hand, consistent with the history of JIA.2. Knee joint effusions.
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Generate impression based on findings.
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The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. There is mild to moderate disk narrowing at L2-L3, with mild disk desiccation at this level as well as at L3-L4. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level. There is mild developmental narrowing of the mid lumbar spinal canal due to shortened pedicles and slight prominence of dorsal epidural fat.At L1-L2, there is mild bilateral facet arthropathy and ligamentum flavum thickening.At L2-L3, there is a trace disk bulge with bilateral facet arthropathy and ligamentum flavum thickening there is slight flattening of the ventral thecal sac without stenosis. This does abut the descending left L3 nerve root minimally. At L3-L4, there is a shallow left foraminal disk protrusion mild bilateral facet arthropathy. There is minimal encroachment upon the inferior aspect of the foramen. At L4-L5 and L5-S1, there is no significant disk pathology or stenosis. There is mild bilateral facet arthropathy.
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Minimal scattered spondylotic changes with mild developmental narrowing of the mid lumbar spinal canal. Findings most prominent at L2-L3 where there is a trace disk bulge which does abut the descending left L3 nerve root. Additional minimal encroachment upon the inferior aspect of the left L3-L4 foramen by a shallow left foraminal disk protrusion.
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Generate impression based on findings.
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59-year-old presents for annual mammogram. No new breast complaints. History of breast carcinoma in daughter diagnosed at the age of 33 and two maternal aunts. 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 elements, unchanged in pattern and distribution. Focal asymmetry in the right upper outer quadrant is unchanged. There is a cluster of stable benign calcifications in the right breast at 12 o'clock position. A few stable masses are seen in the right breast. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted 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 recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.
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Generate impression based on findings.
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80 year-old female with pain and osteoarthritis Pelvis: The pelvis appears within normal limits for the patient's age.Left knee: There is a large joint effusion. Tibiofemoral joint compartment narrowing and small osteophytes are consistent with moderate osteoarthritis.Right hand: Marked osteoarthritis affects the basilar joint and interphalangeal joint of the thumb.Left hand: Severe osteoarthritis affects the basilar joint and interphalangeal joint of the thumb.Lumbar spine: Moderate degenerative disk disease affects L5/S1 and L4/L5. There is grade 1 anterolisthesis of L4 on L5. The sacrum is obscured by bowel gas.
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Degenerative arthritic changes as described above. Large knee joint effusion.
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Generate impression based on findings.
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56 years, Female. Reason: evaluate stool burden History: abdominal pain, n/v, diarrhea, chronic narcotic use Nonobstructive bowel gas pattern. Less than average stool burden. Right periphery is excluded from the field-of-view. Multiple surgical clips overly the pelvis and abdomen. Central venous catheter tip overlies right atrium. Mild degenerative joint disease of the spine.
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Nonobstructive bowel gas pattern. Less than average stool burden.
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Generate impression based on findings.
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History of superficially invasive keratinizing squamous cell carcinoma of the larynx, status post radiation therapy. Surveillance examination. There is unchanged mucosal thickening of the pharynx and larynx, but there is no evidence of distinct enhancing mass. There are secretions within the hypopharynx. There is no evidence of cervical lymphadenopathy on the basis size criteria. A punctate subcentimeter hypoattenuating focus in the right thyroid lobe is unchanged. The imaged paranasal sinuses and mastoid air cells are clear. There is degenerative spondylosis of the cervical spine, which is unchanged. There are numerous dental caries with associated periodontal lucencies. There is extensive emphysema, as well as scarring of the imaged lung apices appears unchanged.
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1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. 2. The presence of secretions within the hypopharynx may indicate a risk for aspiration. 3. Extensive dental disease.
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Generate impression based on findings.
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7-year-old female status post falls now sleepy, AMSVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 01/28/15 A left posterior transparietal approach ventriculostomy tube with tip at midline. The extracranial shunt tubing courses down the soft tissues of the left neck, anterior chest wall, and enters the abdomen with tip terminating in the left lower quadrant. There is no evidence of discontinuity or kinking of the shunt tubing.Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusions or pneumothorax. Nonobstructive gas pattern.
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No evidence of shunt discontinuity and kinking.
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Generate impression based on findings.
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Reason: eval for tumor History: one month of abd pain with weight loss and palpable huge liver ABDOMEN:LUNG BASES: Small right pleural effusion with question of pleural nodularity, suspicious for neoplastic involvement. LIVER, BILIARY TRACT: Innumerable peripherally enhancing hepatic lesions and hepatomegaly consistent with metastatic disease of unknown primary origin, not favored to be a primary hepatic malignancy. No biliary ductal dilation. The hepatic and portal veins are attenuated but appear patent.Cholelithiasis with collapsed gallbladder and no specific secondary signs of inflammation. SPLEEN: Numerous hypoattenuating splenic lesions consistent with metastases.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia. No evidence of acute obstruction. No discrete peritoneal carcinomatosis. BONES, SOFT TISSUES: Numerous sclerotic lesions throughout the visualized skeleton consistent with metastases. OTHER: PELVIS:UTERUS, ADNEXA: Engorged pelvic veins. No convincing masses. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Numerous sclerotic lesions throughout the visualized skeleton consistent with metastases. OTHER: Small amount of pelvic free fluid.
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1. Widespread metastatic disease in the liver, spleen, and throughout the visualized skeleton, consistent with metastatic disease of unknown primary origin. 2. Small right pleural effusion with question of nodularity, also suspicious for neoplastic involvement.
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Generate impression based on findings.
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83-year-old female with breast cancer. Restaging.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates new moderate left-sided pleural effusion, stable 6-mm right lower lobe nodule, new linear lingular density likely representing subsegmental atelectasis or scarring. Stable thickening of the left pectoral muscle. Left subpectoral lymph nodes appear smaller than that previously seen. Stable left shoulder joint effusion. Multiple hypoattenuating liver lesions; most are well defined and approach water density, compatible with cysts; though again there is a solitary, large, ill-defined segment 4 lesion measuring soft tissue density, compatible with hepatic metastasis. Stable exophytic right renal cyst. Left iliac bone lesion demonstrates increased size and sclerosis. Left T8 sclerotic transverse process lesion redemonstrated.Today's PET examination demonstrates mild hypermetabolic activity associated with the left pectoral muscle, left subpectoral lymph nodes, and left chest wall, significantly decreased from the previous exam. FDG avid liver lesion is increased in size though similar in intensity (SUV max 5.6, previously 5.7). Left iliac bone lesion is also increased in size though similar in intensity (SUV max 3.4, previously 3.8). T1 and T2 vertebral body hypermetabolic foci as well as T6 and T8 transverse process hypermetabolic foci demonstrate decreased activity from that seen on the previous exam.No new FDG avid lesions are identified to suggest new sites of hypermetabolic tumor.
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Mixed response to therapy, with decreased hypermetabolic activity associated with left pectoral muscle, left chest wall, left subpectoral lymph nodes, and most osseous lesions though also increased activity associated with the solitary liver and left iliac lesions.
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Generate impression based on findings.
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Left shin pain. Evaluate for stress fracture. There is slight focal thickening of the cortex along the anterior aspect of the distal tibial diaphysis, as well as along the medial aspect of the proximal tibial diaphysis. These findings are nonspecific and do not necessarily represent stress fractures, but if there is strong clinical for stress fracture, repeat radiographs may be obtained in 10 to 14 days.
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Foci of mild cortical thickening as described above are of uncertain clinical significance. If there is strong clinical concern for stress fracture, repeat radiographs may be obtained in 10 to 14 days. Alternatively, MRI may be considered.
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Generate impression based on findings.
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68-year-old female status post right TKA Hardware components of a total knee arthroplasty device are situated in near-anatomic alignment without evidence of complication. Foci of gas, drain and staples in the soft tissues reflect recent surgery.
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Status post right TKA revision, as above.
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Generate impression based on findings.
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56 year old woman with angina referred to evaluate for coronary artery disease.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the proximal and mid LAD. The distal LAD is poorly seen due to image quality.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the proximal LCx. The mid and distal LCx are poorly visualized due to image quality.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the proximal and mid right coronary artery. The distal RCA is not well seen due to image quality.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be mildly dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. There is mild aortic calcification. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.
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1.There are no significant coronary artery stenoses noted; however, the distal vessels are not well seen due to limited image quality.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.
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Generate impression based on findings.
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74 year-old female, evaluate bunion formation There is severe hallux valgus deformity and mild osteoarthritis affecting the first MTP joint. The remainder of the foot appears unremarkable.
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Severe hallux valgus deformity.
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Generate impression based on findings.
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One year status post chelectomy first metatarsal head with residual pain and swelling. Evaluate first metatarsophalangeal joint for degenerative joint disease. Severe osteoarthritis affects the first metatarsophalangeal joint. Mild osteoarthritis affects the interphalangeal joints of the toes. There is a small plantar calcaneal spur. There is a mild pes planovalgus deformity.
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Severe osteoarthritis of the first metatarsophalangeal joint and other findings as above.
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Generate impression based on findings.
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30-year-old male with history of ankle injury. There is a 4-mm ovoid density just distal to the tip of the fibula which may represent an avulsion fracture, but given its morphology, we suspect that it is chronic in etiology. There is a small tibiotalar joint effusion. Mild soft tissue swelling about the ankle.
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Soft tissue swelling and tibiotalar joint effusion. Small ossicle distal to the tip of the fibula is thought to be chronic in etiology.Findings relayed to the ordering physician (pager 6137) on 1/28/15 at 1530.
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Generate impression based on findings.
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79-year-old male with history of metastatic lung cancer, initial staging exam. Multiple punctate enhancing foci are evident in the left frontal lobe (series 6, image 23; series 80424, image 39), left inferior parietal lobe (series 6, image 18), and left cerebellar hemisphere (series 6, image 11). The relatively largest left frontal lesion measures up to 8 mm. There is no evidence of mass-effect or significant midline shift. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. No extra-axial collections are identified. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes. The frontal sinuses appear hypoplastic. The paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is evidence of prior right cataract surgery.
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1. Multiple punctate enhancing foci within the left frontal lobe, left inferior parietal lobe, and the left cerebellar hemisphere are concerning for metastases. The relatively largest left frontal lesion measures up to 8 mm. No evidence of mass-effect or significant midline shift is present. Consider MRI brain for further evaluation.2. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging.
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Generate impression based on findings.
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54 years, Female. Reason: 54F s/p completion proctectomy, now with N/V History: Nausea, emesis There is dilatation of small bowel loops measuring up to 4.0 cm, caliber gradient noted with relatively collapsed distal loops seen in lower abdomen, suspicious for small bowel obstruction but postoperative ileus another differential consideration. Skin staples overlie the abdomen and pelvis.
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Dilated small bowel, may be seen in setting of a small bowel obstruction, postoperative ileus another differential consideration, correlation with patient's clinical history/physical exam and continued followup recommended.Findings discussed with Dr. James Warnecke on 1/28/2015 3:04PM.
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Generate impression based on findings.
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63-year-old male with history of renal cell carcinoma, baseline exam for research study. There are no areas of abnormal attenuation or pathological enhancement. No intracranial hemorrhage is identified. No intracranial mass, evidence of mass-effect or significant midline shift is present. The gray-white differentiation is maintained. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. No extra-axial collections are identified. 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. The paranasal sinuses clear. The mastoid air cells are mildly under-pneumatized. The skull and scalp soft tissues are unremarkable.
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1. No CT evidence of intracranial metastatic disease. If clinically indicated MRI brain can be considered for more sensitive evaluation. 2. No evidence of intracranial hemorrhage or mass effect.
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Generate impression based on findings.
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25-year-old male with history of non-Hodgkin's lymphoma. Increasing lymph nodes, status post ASCT and radiation.RADIOPHARMACEUTICAL: 15.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates increased right maxillary sinus opacification, increased size of left submandibular as well as left cervical level 2 and 3 lymph nodes. Increased number of bilateral axillary lymph nodes and bilateral inguinal lymph nodes is also noted. Diffuse hypoattenuation of the liver is again compatible with fatty infiltration.Today's PET examination demonstrates moderately FDG avid left submandibular lymph node (SUV max 8.9). Mild hypermetabolic activity associated with left cervical level 2 and 3 lymph nodes. Moderately increased radiotracer activity is also noted in bilateral axillary and subpectoral lymph nodes (right axillary lymph node SUV max 6.3). Right paratracheal, bilateral hilar and anterior pericardial lymph nodes also demonstrate hypermetabolic activity. FDG avid retroperitoneal lymph nodes, external iliac chain, and bilateral inguinal lymph nodes are also noted. These findings are new from the previous exam and are compatible with new lymphomatous involvement of numerous lymph nodes in the neck, chest, retroperitoneum, and pelvis. Additional left paraspinal focus of increased metabolic activity is seen at the level of L3-4, compatible with additional site of tumor.
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New FDG activity associated with numerous lymph nodes in the left neck, chest, retroperitoneum, and pelvis as well as left paraspinal focus, compatible with recurrent lymphoma.
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Generate impression based on findings.
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Malignant neoplasm of the prostate. Pain and elevated alkaline phosphatase. Please evaluate. The following observations are made given limitations of an unenhanced study.ABDOMEN:LUNG BASES: Calcified granulomata are stable.LIVER, BILIARY TRACT: Benign calcifications are again noted. No mass lesions are evident.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: There is a right adrenal nodule which is unchanged and presumably benign.KIDNEYS, URETERS: Cystic lesions in both kidneys are again noted without substantial interval change.RETROPERITONEUM, LYMPH NODES: Marked interval enlargement of retroperitoneal adenopathy. Enlarged reference peripancreatic node (image 55; series 3) measures 3.4 x 1.7 cm, larger. Retrocaval lymph node 3.5 x 2.4 cm (image 90; series 3), larger. Adenopathy extends through the iliac bifurcation, progressive in size.BOWEL, MESENTERY: No substantial interval change.BONES, SOFT TISSUES: Diffuse sclerotic bony metastases. Correlate with bone scan.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate remains markedly enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Interval progression of adenopathy. The reference left external iliac lymph node is larger measuring 6.0 x 4.2 cm (image 122; series 3), larger compared to previous.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse bony metastasesOTHER: No significant abnormality noted
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Progressive adenopathy in the abdomen and pelvis. Diffuse bony metastases.
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Generate impression based on findings.
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45-year-old female with history of pain and fever. Additional history obtained via EPIC review: Vaginal hysterectomy on 1/5/15 and known postoperative abscess formation. Please note lack of IV and oral contrast limits evaluation of solid organ pathology, and also of the GI tract.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clips.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 small bowel traction or free air. The appendix is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Evaluation of pelvis is limited due to lack of oral contrast, however there appears to be free fluid in the pelvis, although it is impossible to determine the amount of loculation.
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Free fluid in the pelvis; without contrast it is impossible to determine the extent to which this is loculated. This is consistent with the patient's known history of pelvic abscess.
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Generate impression based on findings.
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Reason: 61 yo m w cough, lung masses seen on abd ct, further eval History: cough LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular emphysema. Partially necrotic right lower lobe mass with chest wall invasion that measured approximately 5.5 x 4.2 cm on recent CT abdomen and pelvis with contrast is again identified and better assessed on the prior exam. Associated surrounding atelectasis/consolidation is difficult to differentiate from the mass on this noncontrast examination. Right hilar partially necrotic mass measures approximately 4.2 x 4.1 cm (series 3 image 70). MEDIASTINUM AND HILA: Enlarged right hilar lymph node measures 14 mm in the short axis (series 3 image 54). Mildly enlarged superior mediastinal, bilateral upper and lower paratracheal and precarinal lymph nodes. For reference prevascular lymph node measures 10 mm in the short axis (series 3 image 22). Heart size is normal with no pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Residual contrast within the left upper kidney. Known left upper pole mass with perinephric stranding incompletely imaged.
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1.Large right lower lobe partially necrotic mass with chest wall invasion and large right hilar partially necrotic mass most compatible with primary lung malignancy with metastases. These masses are better assessed on recent CT abdomen and pelvis with contrast, which extended to the level of the hilum.2.Mediastinal lymphadenopathy.3.Incompletely visualized left renal lesion may represent a metastasis or a second primary malignancy.
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Generate impression based on findings.
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Male 29 years old; Reason: eval for mass History: L testicular pain RIGHT TESTIS: Status post right orchidectomy.LEFT TESTIS: The left testis measures 5.2 x 2.4 x 3.5 cm and appears unremarkable demonstrating normal color Doppler flow.RIGHT EPIDIDYMIS: Surgically resected.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Subcentimeter lymph node in the left groin measuring 0.7 cm in maximum dimension demonstrates benign morphology.
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Status post right orchidectomy. Unremarkable appearance of the left testis.
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