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Generate impression based on findings.
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66-year-old male with history of shoulder pain. Mild osteoarthritis affects the acromioclavicular joint. The shoulder otherwise appears normal for age.
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Mild osteoarthritis of the acromioclavicular joint.
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Generate impression based on findings.
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Reason: mets lung cancer, diffuse bone mets on PET scan and bone scan. Pls evaluate dz status. History: lung cancer ABDOMEN:LUNG BASES: Innumerable bilateral pulmonary nodules. Right lower lobe consolidation and interstitial/ground glass opacities. Please see separately dictated chest CT for description.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: Retrocrural lymphadenopathy. No discrete lymphadenopathy in the abdomen or pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mesh in the anterior abdominal wall consistent with prior hernia repair.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate brachytherapy seeds.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multilevel thoracolumbar degenerative changes. Lucent lesion in the posterior aspect of T10 and other osseous metastases better characterized on recent PET CT. OTHER: No significant abnormality noted
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1. Osseous metastases better characterized on recent PET CT. Otherwise, no evidence of metastatic disease in the abdomen or pelvis.2. See separately dictated chest CT for description of known lung cancer.
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Generate impression based on findings.
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68-year-old male with history of left shoulder pain. Hardware components of a reverse total shoulder arthroplasty device are present. The humeral component is malpositioned with anterior subluxation and rotation resulting in the medial margin of the hardware abutting the center of the glenosphere. Immature heterotopic ossification is seen at the anterior aspect of the shoulder. There are tiny lucent foci along the superior aspect of the joint which have the appearance of gas and may represent infection in the absence of recent intervention. There is also an incompletely imaged cardiac conduction device.
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Malposition of right total shoulder arthroplasty and foci of gas suggesting infection in the absence of recent intervention.Findings directly relayed to Dr. Shi at 1630 on 1/28/14.
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Generate impression based on findings.
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CT CARDIAC CORONARY ARTERY CTA (CORCTA), 1/28/2015 11:00 AM Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection, aneurysm, or coarctation is noted. The thoracic aorta has moderate tortuosity. There is mild to moderate atherosclerosis of the descending thoracic aorta. There is mild calcification of the aortic arch. There is moderate, non-obstructive atherosclerosis the proximal left subclavian artery. Aortic Valve: There mild calcification of the aortic valve which extends onto the anterior mitral valve leaflet.Mitral Valve: There is thickening of the mitral valve leaflets with mild calcification of the anterior leaflet and bileaflet prolapse.Left Ventricle: Qualitatively, the left ventricle is normal in size. The morphology of the interventricular septum is within normal limits. Right Ventricle: Qualitiatively the right ventricle appears to be mildly dilated.Left Atrium: The left atrium is moderately 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 atrium is mildly dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.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 is no significant stenosis of the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is a long partially calcified, non-obstructive plaque in the proximal LAD causing a <25% stenosis. The mid LAD and most of the distal LAD are free of atherosclerosis. The mid LAD is involved in a myocardial bridge. Some of the distal LAD is not well visualized due to the inability to provide nitrates.LCx: The left circumflex coronary artery courses normally in the the left AV groove and is the dominant artery. It gives rise to the obtuse marginal branches and left posterolateral and posterior descending arteries. There is a non-obstructive, non-calcified plaque with low attenuation in the proximal portion of the vessel resulting in <25% stenosis. The remainder of the vessel and its branches are free of significant atherosclerosis. RCA: The right coronary artery is small and non-dominant. It arises normally from the right sinus of Valsalva. No significant atherosclerosis is noted. Coronary Bypass Grafts:None present.
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1. Non-obstructive coronary artery disease is noted in the proximal LAD and LCx. There is additionally myocardial bridging of the mid LAD. 2. Thoracic aortic anatomy as described above. 3. Mild calcification of the aortic valve and anterior mitral leaflet. 4. Mitral valve thickening with bileaflet prolapse is noted. 5. Biatrial dilation. 6. Mild right ventricular dilation.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. The abdominal/ pelvis CTA will be reported separately.
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Generate impression based on findings.
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63 year old male s/p EGD with dilation of cervical esophageal stricture. Evaluation for esophageal perforation. Single contrast evaluation of the esophagus and gastric cardia/fundus did not reveal any gross morphologic abnormalities. Contrast passed through the esophagus and into the stomach in the expected manner without evidence of perforation/leak. Fluoroscopic evaluation of esophageal peristalsis demonstrated some breakup of the primary peristaltic wave with strong secondary peristalsis.TOTAL FLUOROSCOPY TIME: 1:38 mm:ss
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1.No evidence of esophageal perforation as clinically questioned. 2.Mild esophageal dysmotility as described above.
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Generate impression based on findings.
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73 year old male with history of anemia and obscure GI bleeding. Evaluate for small bowel mass lesion. Scout radiograph showed a nonobstructive bowel gas pattern and left nephrostomy tube. Transit time to the colon was 30 minutes. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, without ulcers, sinus tracts, fistulae, or adhesions. No mass lesions or strictures were identified. No separation of bowel loops was present to suggest fibrofatty proliferation. Spherical filling defect in a single left pelvic bowel loop was not seen on subsequent spot image and presumed to be an air bubble. The terminal ileum and ileocecal valve were normal in appearance. The ascending colon was unremarkable.TOTAL FLUOROSCOPY TIME: 5:53 mm:ss
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Unremarkable examination of the small bowel and proximal colon, without focal mass lesion or other specific finding identified to account for the patient's symptoms.
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Generate impression based on findings.
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The ventricles and sulci are prominent consistent with global volume loss expected for the patient's stated age. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is a tiny mucosal retention cyst in the right maxillary sinus and trace mucosal thickening in the left. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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No acute intracranial abnormality.
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Generate impression based on findings.
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Follow-up of T2 N2c M0 left tonsil squamous cell carcinoma. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. There is mucosal thickening within the maxillary sinuses. The imaged intracranial structures and orbits are unremarkable. There are partially-imaged ground glass opacities in the right lung apex.
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1. No evidence of locoregional tumor recurrence or significant lymphadenopathy.2. Partially-imaged ground glass opacities in the right lung apex. Please refer to the separate chest CT report for additional details.
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Generate impression based on findings.
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Male 62 years old Reason: PE? History: SOB, Ca PULMONARY ARTERIES: Acute right middle lobe subsegmental pulmonary embolism without associated infarction. The pulmonary artery size is normal without right heart strain.LUNGS AND PLEURA: Bilateral dependent atelectasis. No focal air space opacity. No pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No hilar or mediastinal lymphadenopathy. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple surgical clips are noted in the tail of the pancreas, and the right and left lobe of the liver. New 3 cm subcapsular hypoattenuating lesion at the dome of the liver suspicious for fluid collection. Status post splenectomy.
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Acute right middle lobe subsegmental pulmonary embolism. New subdiaphragmatic hypoattenuating lesion may represent a subcapsular hepatic fluid collection although this is not completely characterized; post-therapeutic change, hematoma/seroma or tumor are in the differential.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Single.Most Proximal: Subsegmental.RV Strain: Negative.
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Generate impression based on findings.
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57-year-old male with history of left shoulder pain. There is a mild deformity of the distal clavicle and acromion that is thought to represent prior surgery. Small glenohumeral and acromioclavicular osteophytes indicate mild osteoarthritis. The acromiohumeral interval appears slightly narrowed measuring approximately 8 mm. The glenohumeral alignment is otherwise normal. A small ossicle along the lateral aspect of the acromion appears chronic in etiology.
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Postoperative changes and mild osteoarthritis without acute fracture.
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Generate impression based on findings.
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Malignant neoplasm of thymus, chemotherapy follow-up. Additional history of thyroid cancer. CHEST:LUNGS AND PLEURA: Mild emphysema. No pleural pneumothorax. Unchanged right paramediastinal radiation fibrosis. Right lower lobe pneumatoceles and calcific plaques are evident there is a new one. Linear scarring in the superior segment of the left lower lobe.The reference right upper lobe semi-solid nodule not significantly changed measuring approximately 1.5 x 2.2 cm, unchanged when the prior examination is remeasured, borders are better seen on the current study (4/35). The solid nodular components each measuring 10 x 5 mm, previously 8 x 5 mm (3/35).MEDIASTINUM AND HILA: Reference precarinal/lower right paratracheal lymph node (3/36) remains 2.2 x 0.8 cm. Calcified and noncalcified lymph nodes elsewhere unchanged.Mild cardiomegaly with a small loculated pericardial fluid collection at the base of the heart unchanged. Focal hypoattenuation at the left ventricular apex is consistent with an old infarct. Severe coronary artery calcifications. Unchanged fluid in the thymic bed, but no measurable soft tissue.CHEST WALL: Bone island in the left posterior ninth rib and right clavicle. Additional suspected bone island in T7 also unchanged. Sternotomy fixation wires.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small suspected punctate simple cyst in the dome of the liver and adjacent to the falciform ligament. Gallbladder unremarkableSPLEEN: 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 aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Osteopenia with stable sclerotic foci in the spine present dating back to at least 2008.OTHER: No significant abnormality noted.
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1. No significant change in right upper lobe nodule compared to the most recent previous exam, measurements provided. Lymphadenopathy also similar in appearance.2. Unchanged pericardial fluid collection with signs of an old LV apex infarct.3. No signs of recurrence in the thymic bed.
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Generate impression based on findings.
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Abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal scarring.RETROPERITONEUM, LYMPH NODES: Mildly enlarged and calcified gastrohepatic ligament lymph nodes. A representative gastrohepatic ligament lymph node seen on image 32 series 3 measures 1.4 x 1.1 cm. Enlarged perigastric lymph node best seen on image 46 of series 3 measuring 1.6 x 1.1 cm.BOWEL, MESENTERY: Asymmetrical posterior gastric wall thickening best seen on image 46 of series 3 with questionable central ulceration.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: 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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Asymmetrical posterior gastric wall thickening with questionable central ulceration. While this frequently is a nonspecific finding, the presence of regional adenopathy raises the possibility of a gastric malignancy. Endoscopy is suggested. No evidence for bowel obstruction.
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Generate impression based on findings.
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Reason: is there evidence of appendicitis History: rlq pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mildly prominent right lower quadrant mesenteric lymph nodes are likely reactive.BOWEL, MESENTERY: Dilated thick walled appendix measuring up to 1.1 cm is consistent with acute appendicitis. There is mild surrounding inflammatory stranding but no evidence of abscess or free intraperitoneal air.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: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Acute uncomplicated appendicitis.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are areas of cortical and subcortical T2/FLAIR hyperintensity in the left superior frontal gyrus, as seen on 501/4-7, with additional more laterally located cortical hyperintensity on 501/8. There may be mild thickening of the gyri with blurring of the gray-white junction. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Specifically, no hypothalamic mass is seen.MRA HEAD
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1. Areas of nonenhancing abnormal T2/FLAIR hyperintensity in the left superior frontal gyrus cortex and adjacent white matter, as well as an additional cortical focus more posteriorly and laterally. Findings are concerning for possible focal cortical dysplasia, and correlation with EEG findings is recommended. Low-grade neoplasm is felt to be less likely.2. Unremarkable MRA of the head and neck. Please note that MRA images were inadvertently obtained centered on the circle of Willis rather than with coverage of the entire head.
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Generate impression based on findings.
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Metastatic breast cancer. Clinical trial. CHEST:LUNGS AND PLEURA: There is a cavity measuring 3.5 cm in diameter posteriorly in the right upper lobe (image 27; series 5) which was the site of a prior lung mass which has presumably been resected. Nodularity is noted along the cavity which should be followed to exclude residual or recurrent tumor.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left chest port. Right breast implant. There is a 3.3 x 2.3 cm subcutaneous nodule noted superficial to the implant (image 46; series 3); correlate with physical exam and mammogram. This is new since the prior examination. Right axillary node dissection.ABDOMEN:LIVER, BILIARY TRACT: Numerous new large hepatic metastases. For reference purposes, the largest metastasis in the right lobe measures 10.2 x 10.0 cm (image 77; series 3). SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Status-post resection of right upper lobe lung mass. New liver metastases. New subcutaneous mass superficial to the right breast implant.
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Generate impression based on findings.
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49-year-old with history of dense breasts and scattered calcifications. No current complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple bilateral benign calcifications do not appear significantly changed. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually, given multiple prior call-backs. 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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79-year-old male with malignant neoplasm of bronchus and lung. Pathology report from outside biopsy 1/16/2015 states non-small cell carcinoma. LUNGS AND PLEURA: Right perihilar poorly defined mass with distal right lower lobe consolidation/atelectasis. Innumerable bilateral pulmonary nodules compatible with metastases. For reference, right upper lobe posterior nodule measures 7 mm (series 6 image 26). Narrowing of the right middle lobe bronchus. No pleural effusions.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy including superior mediastinal, AP window, bilateral high and lower paratracheal, precarinal lymph nodes. For reference, right lower paratracheal lymph node measures 17 mm in the short axis (series 4 image 36). Enlarged right hilar lymphadenopathy. Right jugular catheter with tip at the cavoatrial junction. Heart size is normal with no pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Enlarged paraesophageal and left cardiophrenic lymph nodes. Scattered sclerotic and lytic lesions in the thoracic spine and ribs. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Poorly defined right perihilar lung mass with distal atelectasis likely represent primary lung malignancy. 2.Innumerable pulmonary metastases. 3.Mediastinal lymphadenopathy. 4.Osseous metastases.
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Generate impression based on findings.
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55-year-old female with acute left flank pain, evaluate for renal stone. Also history of right breast cancer. ABDOMEN:LUNG BASES: Right breast mass and skin thickening consistent with known malignancy.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: Retrocrural lymphadenopathy. BOWEL, MESENTERY: Fat containing abdominal wall hernia appearing similar to the prior study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Lobulated fluid attenuation cystic structure in the right adnexa and small round fat attenuation focus in the left adnexa are not acutely changed since the recent prior study, and incompletely evaluated on CT.BLADDER: No significant abnormality notedLYMPH NODES: As aboveBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.No evidence of renal/collecting system stone or other acute abnormalities to explain the patient's symptoms.2.Right breast mass with skin thickening and retrocrural lymphadenopathy consistent with the patient's known metastatic malignancy.3. Right adnexal cystic structure incompletely evaluated on CT. Pelvic ultrasound may be helpful for further evaluation as clinically warranted.
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Generate impression based on findings.
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42-year-old male with history of metastatic renal cell carcinoma. Baseline exam status post radiation therapy to the back and neck. CHEST:LUNGS AND PLEURA: Subtle pleural nodularity, particularly at the right base (4 slice 62), and additional scattered nonspecific pulmonary micronodules.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. Left upper paramediastinal soft tissue density (3/14) measures 33 x 14 mm, and is likely an enlarged lymph node.CHEST WALL: L4 vertebral body loss of height centrally, in the setting of a sclerotic rimmed lucent lesion (coronal image number 37) raising the likelihood of a pathologic fracture in this location.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged para-aortic retroperitoneal lymph node (3/119) measures approximately 14 x 13 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L4 vertebral body pathologic fracture.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L4 vertebral body pathologic fracture.OTHER: No significant abnormality noted
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1.Scattered pulmonary micronodules and right lower lung pleural nodularity, which are suspicious for metastatic disease.2.Left upper mediastinum paravertebral soft tissue density, may represent a metastatic lesion/enlarged lymph node.3.L4 vertebral body pathologic fracture as above.4.Retroperitoneal metastatic lymphadenopathy, with measurements above.
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Generate impression based on findings.
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Frontal sinus: The frontal sinuses are underpneumatized; the frontoethmoidal recesses are clear.Anterior ethmoids: There is mild mucosal thickening of the anterior ethmoid air cells.Maxillary sinuses: There is minimal mucosal thickening of the maxillary sinuses with small polyp/mucosal retention cyst in the left maxillary sinus. The ostiomeatal units are clear.Posterior ethmoids: Mild mucosal thickening of the posterior ethmoid air cells.Sphenoid sinus: The sphenoid sinus are clear. There is mild opacification of the bilateral sphenoethmoidal recesses.There is minimal leftward nasal septal deviation. There is hypertrophy of the inferior turbinates.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.
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Minimal mucosal thickening in the paranasal sinuses.
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Generate impression based on findings.
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CLL/SLL, multiply relapsed. There is continued interval decrease in size of the cervical lymph nodes, with residual mildly prominent lower neck and upper mediastinal lymph nodes. For example, a left level 4 lymph node measures up to 17 mm, previously 21 mm. There is an unchanged nodular right thyroid lobe. The salivary glands are unremarkable. The osseous structures are unchanged. The partially imaged intracranial structures are grossly unremarkable. There is a right subclavian venous catheter. The airways are patent. There are unchanged calcified granulomas in the partially-imaged right lung.
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Continued interval decrease in size of the cervical lymph nodes, with residual mildly prominent lower neck and upper mediastinal lymph nodes.
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Generate impression based on findings.
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60 year-old male with right-sided radiculopathy pain for 3 weeks Severe degenerative disk disease affects L4/5 and L5/S1. Moderate degenerative disk disease affects L3/4. Mild degenerative disk disease affects L1/2. Although oblique views are not provided, there appears to be mild facet joint osteoarthritis affecting the lower lumbar spine with associated neuroforaminal narrowing. There is a slight rightward curvature of the thoracolumbar spine.
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Degenerative disk disease and other findings as described above.
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Generate impression based on findings.
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Male 33 years old Reason: elevated liver enzymes please assess contour of liver and rule out steatosis History: elevated liver enzymes LIVER: The liver measures 17.1 cm in length. The hepatic parenchyma is mildly hyperechoic suggestive of fatty infiltration. No focal liver lesion is identified. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or distention. There is no biliary dilatation.PANCREAS: The pancreas is largely obscured by bowel gas.KIDNEYS: The right kidney measures 12.2 cm. The left kidney measures 13.8 cm. There is no hydronephrosis.OTHER: The spleen measures 11.1 cm.
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Echogenic hepatic parenchyma suggestive of fatty infiltration.
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Generate impression based on findings.
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Infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defects within the uterine cavity. Bilateral tubal patency confirmed with free peritoneal spillage of contrast seen. TOTAL FLUOROSCOPY TIME: 1:03 minutes
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Patent bilateral fallopian tubes.
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Generate impression based on findings.
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Reason: surveillance imaging after radiation for left lingular lung cancer History: lung cancer CHEST:LUNGS AND PLEURA: Previous identified left lingular nodule has significantly decreased and is obscured by posttherapy changes and not accurately measurable. Residual posttherapy scarring/atelectasis. Surgical clips and calcifications in the left upper lobe again noted. Left lower lobe pulmonary micronodules, unchanged. Right upper lobe ground glass nodule has not significantly changed, measuring 5 mm (series 4 image 32), previously 4 mm. No new pulmonary nodules or masses.Moderate to marked upper lobe predominant centrilobular and paraseptal emphysema. No pleural effusions.MEDIASTINUM AND HILA: Right thyroid lobe dense calcification. Small nonenlarged mediastinal lymph nodes. No significant mediastinal or hilar lymphadenopathy. Heart size is normal with no pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Stable multilevel compression deformities and vertebroplasties.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Postsurgical changes of a cholecystectomy. Interval resolution of pneumobilia.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal artery stents. Left atrophic kidney.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: Degenerative changes.OTHER: No significant abnormality noted.
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1.Significant interval decrease in left lingular nodule obscured by residual scarring/atelectasis and no longer accurately measurable. No new nodules. 2.Right upper lobe ground glass nodule has not significantly changed.3.Additional findings as above.
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Generate impression based on findings.
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44-year-old female status post fall The bones are demineralized, suggesting osteopenia/osteoporosis. There is lateral subluxation of the first metatarsal relative to the first cuneiform. An orthopedic screw affixes the first metatarsal to the first cuneiform. A second orthopedic screw affixes the first cuneiform to the base of the second metatarsal. There is lateral subluxation of the third, fourth, and fifth metatarsals relative to their normal articulations with the third cuneiform and cuboid bones. Abduction of the metatarsals relative to the midfoot is noted. There is soft tissue swelling, particularly along the dorsum of the foot.
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Findings compatible with Lisfranc dislocation and orthopedic fixation of the first and second metatarsals as described above.
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Generate impression based on findings.
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Reason: evaluate for metastatic disease History: liver mets, hypoxemia, no cough LUNGS AND PLEURA: Multiple small bilateral solid pulmonary nodules, ranging up to 6 mm in diameter, highly suspicious for metastases.Small lung volumes with right pleural effusion and underlying atelectasis in the right lower and middle lobes. Moderate subsegmental atelectasis in the left lower lobe.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Severe degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Extensive abnormalities are present which will be described in detail on the CT scan of the abdomen, reported separately.
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1.Multiple small pulmonary nodules, suspicious for metastases.2. Small right pleural effusion and underlying atelectasis.
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Generate impression based on findings.
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42-year-old male with history of renal cell carcinoma the right kidney, status post nephrectomy. Known metastases. Status-post radiation to back and neck. Increased radiotracer activity in the L4 vertebral body is compatible with bone metastasis. Additional foci at the skull base may represent additional bone metastases, especially in the right occipital bone; however, this is equivocal and correlation with head CT may be considered if clinically indicated. Additional mild focus of increased radiotracer uptake is seen in the right proximal femur and may represent additional metastasis.
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1.L4 vertebral body metastasis. 2.Questionable metastases in the skull base; head CT may be considered if clinically indicated for further evaluation. 3.Possible right proximal femur metastasis.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are digital mammographic images (11/20/14) and images from stereotactic core needle biopsy of left breast with specimen radiograph and post procedural left digital mammographic images (12/16/14) performed at River Forest Breast Care Center. For comparison, digital mammographic images (3/27/12, 9/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (11/20/14):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There are scattered benign stable calcifications in both breasts. A marker clip is identified at central posterior aspect in the left breast.There is a cluster of developing calcifications in the left breast at posterior upper outer quadrant. Those calcifications are somewhat coarse, and similar to the stable calcifications located anteriorly.No dominant mass or areas of architectural distortion are noted in either breast. IMAGES FROM STEREOTACTIC CORE NEEDLE BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POST PROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (12/16/14):Stereotactic biopsy was performed for the developing calcifications at upper outer quadrant in the left breast. Specimen radiograph demonstrates multiple target calcifications within the samples.Post procedural left mammographic images show a marker clip located at the superior and posterior to the biopsy cavity. There are a few residual calcifications at the biopsy site.Per outside radiology report, the pathology results were benign, including radial scar which is a high risk lesion.
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Status post stereotactic biopsy of the left breast. The pathology results included radial scar. Surgical consultation is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.
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Generate impression based on findings.
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Contrast was visualized within the thecal sac extending cranially within the cervical region. Contrast in the subarachnoid spaces in the brain verified with CT.
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Successful fluoroscopic guided lumbar puncture with intrathecal instillation of contrast for subsequent CT cisternogram.
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Generate impression based on findings.
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Metastatic lung carcinoma ABDOMEN:LUNG BASES: Please refer to separate chest CT report for description of extensive intrathoracic abnormalities.LIVER, BILIARY TRACT: Interval increase in size and number of numerous bilobar hepatic metastatic lesions. Reference segment 6 mass best seen on image 60 of series 7 now measures 4.6 x 5.6 cm; this is in comparison to a corrected measurement of 4.1 x 3 cm on 11/25/2014.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Increase in size of peri-celiac metastatic adenopathy/encasement. The peri-celiac focus best seen on image 57 measures 1.3 x 1.9 cm; this is in comparison to 1.9 x 1.5 cm on 11/25/2014.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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Interval increase in size and number of numerous bilobar hepatic metastatic lesions. Interval increase in size of peri-celiac metastatic adenopathy/encasement.
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Generate impression based on findings.
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Female 49 years old Reason: concern for cirrhosis History: ALF LIVER: The liver measures 18.4 cm in length and demonstrates echogenic parenchyma suggestive of diffuse fatty infiltration. No biliary dilatation. The main portal vein is patent and demonstrates normal directional flow. Smooth contour to the liver capsule.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intra-or extrahepatic biliary duct dilatation.PANCREAS: Not visualized.KIDNEYS: The right kidney measures 11.3 cm. The left kidney measures 11.6 cm. There is no hydronephrosis.OTHER: The spleen measures 12.6 cm.
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Diffuse fatty infiltration of the liver without capsular nodularity to suggest cirrhosis.
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Generate impression based on findings.
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66 year old female with anterior knee pain after fall, rule out fracture Moderate osteoarthritis affects the knee. A small to moderate joint effusion is noted. No fracture or malalignment.
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Osteoarthritis and joint effusion without fracture evident.
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Generate impression based on findings.
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Reason: follow up blastomycosis History: cough LUNGS AND PLEURA: Interval resolution of focal consolidation in the superior segment of the right lower lobe with residual architectural distortion and perihilar scarring.Small scarlike nodular opacity in the left upper lobe (series 5/106) unchanged since 4/17/2014.No pleural effusion.MEDIASTINUM AND HILA: Interval decrease in mediastinal lymphadenopathy, with some residual in the subcarinal area.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Interval resolution of right lower lobe consolidation with mild focal residual scarring, and decrease in mediastinal lymphadenopathy, consistent with treated blastomycosis.
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Generate impression based on findings.
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Headache, posterior fossa malformation, and occipital encephalocele status post repair. There is an unchanged left transparietal ventricular catheter that terminated in the left lateral ventricle. There is no significant interval change in size of the ventricular system, which is dilated throughout. There is a cavum septum pellucidum. There are findings suggestive of tectocerebellar dysraphism with an enlarged posterior fossa filled largely with cerebrospinal fluid spaces that communicate with the fourth ventricles and what appears to be an accessory cerebellar hemisphere. There are postoperative findings related to occipital cephalocele repair with a persistent defect in the midline of the occipital bone that measures up to 3 cm in width. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. There appears to be a congenitally narrow upper cervical spine. The imaged paranasal sinuses and mastoid air cells are clear.
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1. No significant interval change in the shunted ventricular system, which is dilated.2. Findings suggestive of tectocerebellar dysraphism with what appears to be an accessory cerebellar hemisphere and midline occipital bone defect, status post associated cephalocele repair. A brain MRI with diffusion tensor imaging may be helpful for further characterization of this malformation.3. Apparent congenitally narrow upper cervical spine.
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Generate impression based on findings.
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Female 53 years old Reason: hx cholelithiasis, eval CBD for stones History: abd pain, N/V LIVER: The liver measures 13.3 cm in length. No focal liver lesion. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 0.7 cm. There is no intrahepatic biliary duct dilatation.PANCREAS: Unremarkable appearance of the pancreatic head and proximal body. The distal body and tail are not visualized.KIDNEYS: The left kidney measures 9.7 cm. The right kidney measures 11.8 cm. There is no hydronephrosis.OTHER: The spleen measures 7.6 cm.
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Status post cholecystectomy with expected mild dilatation of the common bile duct. While there is no evidence of choledocholithiasis, consideration should be given to M.R.C.P. if there is high clinical suspicion for same.
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Generate impression based on findings.
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63-year-old male with history of metastatic renal cell cancer. Focus of decreased radiotracer activity in the upper thoracic spine, predominantly on the left, with peripheral increased activity is compatible with soft tissue mass with bony destruction seen on CT. Increased activity in the left aspect of the L4 vertebral body likely represents degenerative changes, as seen on CT. No additional definite osseous metastases are identified.
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Upper thoracic vertebral metastasis as seen on CT. No additional definite osseous metastases are identified.
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Generate impression based on findings.
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78 years, Female. Reason: abdominal pain, alteration in mental status, evaluate for perforation, obstruction History: alteration in mental status, abdominal pain Cardiomediastinal silhouette is unremarkable. Atherosclerotic calcification of the aorta is noted. No significant pleural or pulmonary abnormality.Surgical sutures seen overlying the pelvis. Nonobstructive bowel gas pattern. Average stool burden. No evidence of free air. Degenerative spinal disease most pronounced at L4/5 level.
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Nonobstructive bowel gas pattern. No evidence of free air.
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Generate impression based on findings.
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59-year-old male with esophageal cancer.RADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates mild circumferential distal esophageal thickening, compatible with stated history of primary esophageal cancer. Colonic diverticulosis is also noted.Today's PET examination demonstrates mild increased FDG activity of the distal esophagus (SUV max 3.7), which likely represents known primary esophageal cancer.Moderately hypermetabolic focus in the descending colon is seen (SUV max 8.6). This may represent additional benign or malignant primary colonic neoplasm, less likely metastasis.No additional sites of abnormal FDG uptake are seen to suggest hypermetabolic metastases.
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1.Mild hypermetabolic activity of the distal esophagus likely represents known primary esophageal cancer.2.Hypermetabolic focus of the descending colon may represent additional benign or malignant clonic neoplasm, less likely metastasis. Confirmation up-to-date colonoscopy is recommended, otherwise colonoscopy may be considered for further evaluation.3.No other FDG avid sites of tumor.
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Generate impression based on findings.
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44-year-old male with chronic loss of balance, loss of vertical gaze concerning for supranuclear palsy. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is redemonstration of encephalomalacia within the left middle cerebral artery territory, as well as ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. There is mild reduction of the anteroposterior midline midbrain diameter at the level of the superior colliculi, measuring 11 mm, which may be seen in the setting of progressive supranuclear palsy. There is also mild global parenchymal atrophy and mild cerebellar atrophy. The mastoid air cells are clear. There are bilateral small maxillary sinus retention cysts. The skull and extracranial soft tissues are unremarkable.
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1. Mild parenchymal atrophy and cerebellar atrophy, which is more pronounced than expected for patient's age.2. There is mild disproportional volume loss involving the midbrain, which may be seen with progressive supranuclear palsy in the appropriate clinical setting. 3. Chronic left middle cerebral artery territory infarct. No evidence of acute intracranial hemorrhage.If clinically indicated, consider MR for further evaluation.
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Generate impression based on findings.
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Female 35 years old; History: Relapsed Hodgkin Lymphoma S/P 3 cycles of ICE chemotherapy in need of final PET to document CR prior to proceeding with SCT. Please compare to prior.RADIOPHARMACEUTICAL: 14.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates a large soft tissue lesion located within the prevascular and paratracheal space. Right neck small lymph node is not clearly seen.Today's PET examination demonstrates focus of FDG activity in the right neck which correlates with the small lower neck lymph node on CT with an SUV max of 3.4, previously 1.9. Previously noted two additional foci in the right neck have resolved.Interval decrease in FDG activity of the multiple hypermetabolic areas within the prevascular/paratracheal mass noted on CT, for example a right paratracheal focus within the mass has an SUV max of 1.5, previously 2.0.No new suspicious FDG avid lesions are identified.
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Interval metabolic response of the tumor activity in the right neck and mediastinum.
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Generate impression based on findings.
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71 years, Male. Reason: Examine for obstruction History: NG tube output Enteric tube tip overlies the gastric body. Nonspecific paucity of bowel gas, which may reflect fluid filled small bowel. No definitive evidence of obstruction otherwise. Pelvis is excluded from the field of view.Patient is status post sternotomy. Cardiac support device partially visualized. Degenerative disease of the spine noted. Please see same day chest radiography for additional findings.
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Enteric tube tip in region of gastric body. Nonspecific paucity of bowel gas, which may reflect fluid filled small bowel. No definitive evidence of bowel obstruction.
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Generate impression based on findings.
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Reason: 42F with Hx ARDS \T\ Hx PNA and influenza History: hypoxia s/p trach requiring pressure support ventilation LUNGS AND PLEURA: Tracheostomy tube in place. Low lung volumes. Diffuse dense ground glass opacities. In the lung bases mild traction bronchiectasis. No pneumothorax. No pleural effusions. Findings compatible with ARDS.MEDIASTINUM AND HILA: Right subclavian catheter with tip in the cavoatrial junction. Right jugular catheter with tip deep in the right atrium. Mildly enlarged mediastinal lymph nodes, likely reactive. Heart size is normal with no pericardial effusion. Main pulmonary artery is mildly enlarged, measuring 3.3 cm, raising the question of pulmonary arterial hypertension. No visible coronary calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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1.Low lung volumes with diffuse ground glass opacity and very mild basilar traction bronchiectasis compatible with ARDS. 2.Likely reactive mediastinal lymphadenopathy. 3.Mildly enlarged main pulmonary artery, raising the question of pulmonary arterial hypertension.
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Generate impression based on findings.
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Left shoulder pain Again seen is a minimally displaced fracture of the greater tuberosity of the proximal humerus. This appears similar to that seen on the prior study accounting for slight positional and technical differences. Mild osteoarthritic changes affect the acromioclavicular joint. Glenohumeral joint alignment is within normal limits.
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Minimally displaced fracture of the greater tuberosity appearing similar to that seen on the prior study.
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Generate impression based on findings.
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7-year-old female with NJ tubeVIEW: Abdomen AP (one view) 01/28/15 NG tube tip is in the stomach. Gastrostomy tube is present. NJ tube tip is in the distal gastric body. Left femoral line is in place.Solitary loop of gas distended bowel in the right lower quadrant with otherwise relative paucity of bowel gas. No pneumoperitoneum. No pneumatosis intestinalis or portal venous gas. Again seen is lateral uncovering of both femoral heads, right greater than left. Body wall edema is present.Retrocardiac atelectasis.
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NJ tube tip is in the distal gastric body.
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Generate impression based on findings.
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62 years, Female. Reason: Pt. is a 62 with history of small bowel dilatation and multiple partial SBO, requires evaluation to assess for malrotation. History: nausea and vomiting Surgical clips overly the right upper quadrant and pelvis. Anastomotic suture material also seen. Again seen are dilated loops of small bowel in the upper abdomen with some gas in the colon, which may reflect partial small bowel obstruction. There is small amount of stool in the descending colon. Abdominal radiograph is insensitive for malrotation, consider dedicated contrast enhanced CT.
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Again seen are dilated loops of small bowel in the upper abdomen with some gas in the colon, which may reflect partial small bowel obstruction. Abdominal radiography is insensitive for malrotation, consider dedicated contrast enhanced CT.
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Generate impression based on findings.
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Right shoulder pain status post surgery of right shoulder Components of a "reverse" total shoulder arthroplasty device are situated in near anatomic alignment without radiographic evidence of hardware complication. The bones appear demineralized, suggesting osteopenia/osteoporosis. Moderate osteoarthritis affects the acromioclavicular joint.
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Reverse total shoulder arthroplasty in near anatomic alignment.
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Generate impression based on findings.
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50 year-old male with history of shoulder pain. Hardware components of a total shoulder arthroplasty are situated in anatomic alignment. Thin lucency at the interface of the glenoid component and the underlying bone appears similar to the prior studies and is of doubtful clinical significance. We see no acute fracture. Mild osteoarthritis affects the acromioclavicular joint.
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Total shoulder arthroplasty and mild AC joint osteoarthritis without acute fracture.
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Generate impression based on findings.
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Left arm weakness. Needs pre-operative clearance. NONCONTRAST CT HEADNo evidence of acute intracranial hemorrhage. No mass effect, midline shift or herniation. Scattered periventricular and subcortical white matter hypoattenuation is nonspecific but compatible with small vessel ischemic changes. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKExam is limited by suboptimal contrast opacification of the arteries of the brain and neck.There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left common carotid artery is tortuous with a retropharyngeal course of the left internal carotid artery which causes mild mass effect on the adjacent airway. There is mild atherosclerotic calcific involvement of the carotid bifurcations. The bilateral vertebral artery origins are grossly normal.Within the anterior circulation, there is prominent calcified atherosclerosis in the bilateral cavernous/supraclinoid carotid arteries. The ICAs, MCAs and ACAs are otherwise patent.In the posterior circulation, the post-PICA portion of the left vertebral artery is developmentally diminutive with atherosclerotic calcifications involving the V4 segment. The PICA, AICA and SCA are patent. The right posterior communicating artery is not visualized and there is normal variant fetal origin of the left PCA. No evidence of aneurysm, occlusive thrombus, dissection, or vascular malformation is noted.Degenerative changes are again noted about the cervical spine which is described in detail on the same day cervical spine MRI.The right thyroid gland is heterogenous and somewhat enlarged compared to the left measuring up to 3.9 cm in greatest axial dimension. The isthmus also appears thickened. The left thyroid gland appears normal.Periapical and periradicular lucencies are noted about the #1 and #14 maxillary molars are noted as well as a suspected dental carie of the #2 molar. Please correlate with dental exam.
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1.No evidence of acute intracranial hemorrhage or mass.2.Scattered periventricular and subcortical white matter hypoattenuation is nonspecific but compatible with small chronic vessel ischemic changes. 3.CTA of the brain and neck is limited secondary to the suboptimal phase of contrast. 4.Mild atherosclerosis as described above without significant steno-occlusive disease or gross aneurysm of the arteries of the brain and neck.5.Heterogenous and somewhat enlarged right thyroid gland. This can be correlated with clinical thyroid function tests and/or with thyroid ultrasound can be obtained if clinically warranted.
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Generate impression based on findings.
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85-year-old male with history of known AAA, now with lower abdominal pain radiating into groin. CHEST:LUNGS AND PLEURA: Right upper lung nodule in the major fissure (8/35) measures 9 x 7 mm, nonspecific and may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. Calcified mediastinal and hilar lymph nodes, without significant mediastinal or hilar lymphadenopathy. Marked coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule (3/148) measures approximately 1 cm, unchanged.KIDNEYS, URETERS: The left kidney is atrophic and does not demonstrates the expected enhancement on arterial images, and there is occlusion of the left renal artery. Small right renal cyst, but otherwise the right kidney is within normal limits. No significant right renal artery stenosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air, and no bowel wall thickening.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 notedVASCULATURE: Again seen is extensive atherosclerotic disease of the aorta and its branches, including marked mural thrombus and an infrarenal saccular aneurysm (9/190) measuring 1.4 cm, unchanged. There has been interval occlusion of the left renal artery, and the left kidney does not enhance.The left common iliac artery remains occluded, with distal reconstitution of the left internal and external iliac arteries through the lumbar, superior rectal, deep circumflex iliac and inferior epigastric artery collaterals.Significant right common iliac atherosclerotic narrowing.
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1.Severe atherosclerosis of the distal abdominal aorta, with persistent left common iliac artery occlusion and unchanged 1.4-cm saccular aneurysm of the infrarenal abdominal aorta.2.Interval occlusion of the left renal artery, with an atrophic left kidney that does not enhance.3.Right upper lung pulmonary nodule, may represent an intrapulmonary lymph node although this is nonspecific and may be followed on subsequent imaging if clinically desired.
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Generate impression based on findings.
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Reason: 69 yo F with COPD, pulmonary nodule, eval nodule History: pulmonary nodule LUNGS AND PLEURA: Evaluation of fine parenchymal detail is limited in the lung bases due to motion. Severe upper lobe predominant centrilobular emphysema. Previously identified more nodular density in the medial left upper lobe measures 3 mm (series 4 image 19), previously 6 mm, likely benign. Scattered bilateral calcified and noncalcified pulmonary micronodules. No new or suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size is normal with no pericardial effusion. Severe coronary artery and aortic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta.
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1.Interval decrease in size of likely benign left apical nodular density, compatible with post inflammatory/infectious etiology. No additional follow-up for this findings is recommended.2.Severe emphysema.
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Generate impression based on findings.
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Reason: mets lung cancer, ALK+, s/p multiple chemo therapies. Pls c/w previous study and evaluate tx response. History: lung cancer. LUNGS AND PLEURA: Marked interval increase in size and number of multiple small solid pulmonary nodules some of which are clustered and confluent.Previously described right lower lobe reference nodules and a right hilar mass are now obscured by atelectasis and effusion and are not measurable on the current scan.A new reference nodule (36/42) measures 8 mm, increased from 4 mm on the previous scan.Interval increase in right middle lobe and right lower lobe atelectasis apparently secondary to proximal bronchial obstruction by tumor.New moderate right pleural effusion. In the lungs.MEDIASTINUM AND HILA: Tumor extends into the right perihilar and subcarinal regions with no discrete lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: Partial collapse of the T6 vertebra with previous kyphoplasty, unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Findings will be described in the separate report of the abdominal portion of the scan.
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Progression of disease in the lungs.
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Generate impression based on findings.
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63-year-old male with history of wrist fracture. Redemonstrated is a nondisplaced transverse fracture of the distal radial metaphysis in near anatomic alignment appearing similar to the prior studies.
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Distal radius fracture in near anatomic alignment.
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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. There are no areas of abnormal attenuation or pathological enhancement. Stable postsurgical changes related to left frontotemporal craniotomy and supraclinoid aneurysm clipping. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Examination of supraclinoid left internal carotid artery is limited secondary to beam hardening artifact. However, there is no evidence of gross residual aneurysm in this location. A 2-mm extracranial aneurysm arises from the pre-cavernous segment of the left internal carotid artery, and is not significantly changed when compared to previous studies. Normal contrast opacification through the anterior circulation, posterior circulation, and distal intracranial vasculature.
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1. Stable postsurgical changes related to prior left frontotemporal craniotomy and left supraclinoid internal carotid artery aneurysm clipping. Streak artifact limits evaluation, however, no evidence of residual or recurrent aneurysm.2. Stable appearance of 2-mm pre-cavernous, extracranial left internal carotid aneurysm, which was described on previous angiogram dated 4/24/10.
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Generate impression based on findings.
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Fourth finger PIP and DIP pain.VIEWS: Left hand PA lateral and oblique (3 views) 1/28/2015 Irregularity of the metaphysis of the fourth proximal phalanx most likely reflects a Salter-Harris type II fracture.
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Probable Salter Harris type II fracture of the proximal fourth phalanx.
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Generate impression based on findings.
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Is there any evidence bleed or fracture. Recent fall with hit to head without loss of consciousness. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The paranasal sinuses, middle ear cavities, and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is incomplete fusion of the posterior C1 arch, which is an anatomic variant.
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1. No evidence of acute intracranial hemorrhage.2. No evidence of displaced skull fracture.3. The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.
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Generate impression based on findings.
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87 years, Female. Reason: Confirm placement of Dobbhoff tube. Dobbhoff tube tip in gastric body. Nonobstructive bowel gas pattern. Average stool burden. Spinal degenerative changes. Left retrocardiac opacification and mediastinal clips; please see same day chest radiography for further details.
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Dobbhoff tip in gastric body.
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Generate impression based on findings.
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Bladder carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of liver without mass or ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign-appearing renal cysts. Subcentimeter nonobstructing left renal stone. No worrisome renal mass. Unremarkable upper collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: 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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No evidence for regional adenopathy or metastatic focus. Nonobstructing subcentimeter left renal stone. Fatty infiltration of the liver without mass.
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Generate impression based on findings.
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Reason: 71yo F with exophytic R renal mass on ultrasound, recommended dedicated CT renal protocol. History: abd discomfort, renal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Nonspecific hypoattenuating splenic foci.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic left lower pole mass measures 4.6 x 3.5 cm (series 7 image 69), highly suspicious for malignancy and correlating with findings from recent ultrasound. Additional numerous left renal cysts of varying intrinsic attenuation without significant enhancement. Delayed phase images demonstrate no significant contrast excretion into the collecting system consistent with end stage renal disease. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Mildly enlarged left retroperitoneal lymph nodes. Reference node measures 10 mm in short axis (series 7 image 59).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Abnormal attenuation in the right body wall subcutaneous soft tissues involving the right abdominal musculature partially imaged. No discrete fluid collections identified.OTHER: Mild abdominal/pelvic ascites.PELVIS:UTERUS, ADNEXA: Calcified small uterine fibroids.BLADDER: Partially collapsed. LYMPH NODES: As above.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multilevel degenerative changes most severely affecting L2-3 and L3-4 in a pattern suggesting renal osteodystrophy.OTHER: No significant abnormality noted
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1. Left lower pole renal mass highly suspicious for renal cell carcinoma, with mild nonspecific regional lymphadenopathy. 2. Abnormal attenuation in the right body wall subcutaneous soft tissues partially imaged, likely edema which is positional in etiology. Mild ascites.3. Status post right nephrectomy. 4. Multilevel degenerative changes most severely affecting L2-3 and L3-4 in a pattern suggesting renal osteodystrophy.
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Generate impression based on findings.
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18 years, Female. Reason: dht placement Pelvis is excluded from the field-of-view. Enteric tube containing guide wire with tip overlying the gastric antrum. Moderate stool burden in the visualized portions of the colon without definite evidence of obstruction.
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Enteric tube tip overlies the gastric antrum. Moderate stool burden in the visualized portions of the colon without definite evidence of obstruction.
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Generate impression based on findings.
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This grade 1 degenerative anterolisthesis of L4 on L5. There is disc height loss at L4-L5 and L5-S1 as well as vacuum disc phenomenon at L4-L5. There are multilevel endplate degenerative changes as well as minimal unchanged anterior wedging of the L1 vertebral body. There is atherosclerotic calcification of the abdominal aorta and its major branches. There multiple punctate foci of high attenuation within the soft tissues surrounding the right hip seen on scout view and possibly compatible with shotgun pellets.L1-L2: There is no significant disc disease, spinal canal, or neural foramen stenosis.L2-L3: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening. There is moderate bilateral neural foramen stenosis, left greater than right, and mild spinal canal stenosis.L3-L4: There is a moderate disc bulge as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in moderate to severe spinal canal stenosis as well as severe left and mild to moderate right neural foramen stenosis.L4-L5: There is a mild disc bulge as well as disc uncovering along with severe facet arthropathy and moderate ligamentum flavum thickening. These findings result in moderate to severe spinal canal stenosis as well as severe bilateral neural foramen stenosis. L5-S1: There is a mild disc bulge as well as disc uncovering with small posterior osteophytes that result in severe bilateral neural foramen stenosis. There is no significant central canal stenosis.
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Moderate to severe lumbar spine degenerative changes as detailed above that are most severe at the L3-L4 and L4-L5 levels where there is moderate to severe spinal canal stenosis.
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Generate impression based on findings.
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75 year old female s/p Dobbhoff placement. Dobbhoff tip is in the gastric body but appears kinked near distal tip. Nonobstructive bowel gas pattern. Please see same day chest radiography report for further details.
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Dobbhoff tip in gastric body, appears kinked near tip, consider repositioning.
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Generate impression based on findings.
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57-year-old female with history of lung cancer. Evaluate for inflammatory arthritis. Left knee: There are no specific radiographic features of inflammatory arthritis in the knee joint. Mild enthesopathic changes are noted at the quadriceps tendon insertion. Scattered arterial calcifications are present. There is single layer chronic-appearing periosteal reaction along the distal femur and proximal tibia which is nonspecific. We see no joint effusion.Right knee: There are no specific radiographic features of inflammatory arthritis in the knee joint. Mild enthesopathic changes are noted at the quadriceps tendon insertion. Scattered arterial calcifications are present. There is single layer chronic-appearing periosteal reaction along the distal femur and proximal tibia which is nonspecific. We see no joint effusion.
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There are no specific radiographic features of inflammatory arthritis in the knee joint. There is mild chronic appearing periosteal reaction along the distal femur and proximal tibia which is nonspecific although may represent hypertrophic osteoarthropathy given this patient's history of lung carcinoma.
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Generate impression based on findings.
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Male 13 years old; Reason: patient with pulmonary hypertension in setting of congenital heart disease s/p Fontan, working toward heart transplant History: hepatic cirrhosis with ascites requiring frequent paracentesis The comparison chest radiograph performed on 9/18/2014 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a nonsegmental defect in the left lower lung; otherwise there is normal distribution of activity on single-breath and wash-in images throughout the remaining bilateral lungs. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a nonsegmental defect in the left lower lung; otherwise the remaining bilateral lungs show a physiologic distribution of pulmonary perfusion.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 40% (upper lung 10%; middle lung 17%; lower lung 14%)Right lung: 60% (upper lung 11%; middle lung 26%; lower lung 23%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 37% (upper lung 11%; middle lung 19%; lower lung 7%)Right lung: 63% (upper lung 10%; middle lung 36%; lower lung 18%)
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1. Low probability scan for pulmonary embolism. 2. Matched ventilation perfusion defect in the left lower lung as quantified above.
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Generate impression based on findings.
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Non-dedicated CT with concern for PE. PULMONARY ARTERIES: Main pulmonary artery is enlarged, measuring 3.4-cm in transverse dimension, consistent with pulmonary hypertension. Multiple filling defects involving all lobes from the proximal lobar to subsegmental branches of lungs bilaterally, most pronounced in the right descending pulmonary artery which is enlarged and has filling defects to the subsegmental level. Given lack of adequate opacification on the prior examination is unclear whether any of the lesions in the smaller branches are acute. LUNGS AND PLEURA: Dependent atelectasis at the lung bases. No areas of infarct or pulmonary hemorrhage are appreciated.MEDIASTINUM AND HILA: The trachea and esophagus are deviated by 2.5-cm to the right of midline by a large heterogeneous thyroid gland mass containing areas of hypoattenuation and calcification which extends substernally to the level of the aortic arch, measuring 5.2 x 6.4 cm in greatest transaxial dimensions (7/47). At the level of the thoracic inlet, the trachea is severely narrowed in the AP dimension measuring 5-mm (7/26). The great vessels are splayed by the thyroid mass.Moderate cardiomegaly. Straightening of the intraventricular septum is consistent with right heart strain. CHEST WALL: Degenerative change of the left glenohumeral joint with sclerosis and destruction of the joint space.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Nonspecific hypoattenuating lesions in the kidneys too small to characterize.
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Multiple acute to subacute pulmonary emboli in with high clot burden, signs of pulmonary hypertension and right heart strain. Large heterogeneous thyroid mass with substernal extension causing tracheoesophageal deviation and narrowing; mass is indeterminate by CT and may be further evaluated by nuclear scintigraphy to exclude neoplastic process if required. PULMONARY EMBOLISM: PE: Positive..Chronicity: Acute..Multiplicity: Multiple..Most Proximal: Lobar..RV Strain: Positive..
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Generate impression based on findings.
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Male 49 years old; Reason: Rule out stone History: Hematuria with flank pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral punctate renal calculus. There is mild to moderate hydronephrosis and dilated right ureter. There is a 6-mm stone in the mid right ureter causing hydronephrosis. No evidence of hydronephrosis or hydroureter on the left side.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. Bilateral nephrolithiasis. Right mid ureteral stone causing right-sided hydronephrosis and hydroureter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Male 38 years old Reason: acute abd pain with rigid abd r/o appy c/f perf vs diverticulitis/colitis vs obstruction History: acute abd pain with rigid abd ABDOMEN:LUNG BASES: Bibasal atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are bilaterally atrophic and hypoenhancing consistent with end-stage renal disease.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are nonspecific but may be reactive.BOWEL, MESENTERY: Moderately dilated small and large bowel loops with severe submucosal edema and mural thickening. There is no clear transition point. There is no pneumatosis or pneumoperitoneum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse anasarca. Pelvic ascites.OTHER: Bilateral fluid containing inguinal hernias.
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Nonspecific bowel wall thickening with ascites and anasarca. There is a broad differential for this appearance. Given the a history of hypertension and ACE inhibitor therapy, this may represent acute angioedema. Bowel ischemia could have a similar appearance although no ancillary findings are identified to suggest this.Findings discussed with the radiology resident on call with Dr. Uppal at 11 PM 01/28/15.
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Generate impression based on findings.
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Female 22 years old Reason: ovarian cyst? ovarian pathology? appendicitis? History: rlq pain and tenderness ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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:UTERUS, ADNEXA: There is a 6 x 4 cm enhancing cystic mass in the right adnexa. Small amount of fluid is present around this mass. Left hydrosalpinx.BLADDER: No significant abnormality notedLYMPH NODES: Borderline enlarged pelvic lymph nodes. Index node measures 1 x 0.9 cm on image number 88, series number 3.BOWEL, MESENTERY: Trace amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Right ovarian cystic mass in the left hydrosalpinx. Differential diagnosis includes tubo-ovarian abscess, ovarian cystic neoplasm. Given the history of acute ipsilateral pain, ovarian torsion cannot be excluded based on CT.Dr. Mo was notified and acknowledged about the above findings at the time of dictation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Female 30 years old Reason: eval for stone History: L flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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:UTERUS, ADNEXA: 5 x 4 cm left adnexal cystic lesion likely arising from the left ovary. Follow-up transvaginal ultrasound in 3 months is recommended for further evaluation.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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No specific CT findings to explain patient's acute abdominal pain. Specifically appendix is unremarkable.5 x 4 cm left adnexal cystic lesion likely arising from the left ovary. Follow-up transvaginal ultrasound in 3 months is recommended for further evaluation.Dr. Mo was notified and acknowledged about the above findings at the time of the dictation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Male 15 years old; Reason: b/l lower extremities History: klebsiella bacteremia, concern for osteo, paraplegic h/o GSW The angiographic phase images are unremarkable with no significant hyperemia to the pelvis and left proximal thigh. Blood pool images demonstrate markedly decreased activity in the region of the left femoral head.On delayed osseous phase images there is again seen essentially absent activity in the left femoral head which is very suspicious for infarction.Given clinical suspicion for osteomyelitis, cold/chronic osteomyelitis would be very unlikely given the absence of osseous findings on comparison CT.
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1. No evidence for osteomyelitis.2. Decreased activity in the left femoral head on blood pool and delayed osseous phase images is very suspicious for osteonecrosis.Findings were discussed with Dr. Jonathan Twu by telephone on 1/29/2015 at 11:00 AM.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. 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, bilateral 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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vertigo No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel ischemic disease.The ventricular catheter enters via a right high convexity paramedian on, traverses the right frontal lobe and with the tip within the left frontal horn of lateral ventricle similar to prior exam.However, the ventricular system size appears to be a bit smaller than prior exam. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The paranasal sinuses and mastoid air cells are clear.
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1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel disease.3. Slightly smaller ventricular system size than prior exam. Otherwise no remarkable finding.
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Generate impression based on findings.
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Female 48 years old Reason: IV contrast only; evaluate biliary leak History: Abdominal pain ABDOMEN:LUNG BASES: Small left pleural effusion.LIVER, BILIARY TRACT: There are two plastic stents in the common bile duct extending into the right and left hepatic ducts. There is a percutaneous catheter around liver. Small amount of air is present around the liver without any fluid. No obvious intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 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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Multiple biliary stents and a percutaneous perihepatic stent. No evidence of biliary dilatation or abscess.
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Generate impression based on findings.
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Male 16 days old Reason: Rule out bowel obstruction/NEC History: Full abdomenVIEW: Abdomen AP (one view) 1/28/15 at 1819 hrs. NG tube proximal side port is at GE junction. Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.
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Disorganized, slightly distended and nonspecific abdominal gas pattern.
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Generate impression based on findings.
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altered mental status No evidence of acute ischemic or hemorrhagic lesion.Mild diffusion brain atrophy with minimal non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The paranasal sinuses and mastoid air cells are clear. Left nasal bone fracture without surrounding soft tissue swelling indicating possible chronic fracture deformity. Clinical correlation is recommended.
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No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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There is no evidence of acute intracranial hemorrhage. The skull appears intact. The ventricles and sulci and prominent, particularly in the medial temporal lobes. There is extensive patchy periventricular and subcortical hypoattenuation. There is no midline shift or mass effect. There is no extraaxial fluid collection. The imaged portions of the paranasal sinuses and mastoids air cells, and middle ears are grossly clear.
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1.No acute intracranial hemorrhage or skull fracture.2.Extensive small vessel ischemic disease.3.Cerebral volume loss that is most pronounced in the medial temporal lobes, which is suggestive of Alzheimer's disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered, benign appearing calcifications are seen within the both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Pain over right lateral malleolus.VIEWS: Ankle right AP lateral and oblique (3 views) right foot AP lateral and oblique (3 views) 1/28/2015 ANKLE: There is a small joint effusion, but no underlying fracture or malalignment is seen.FOOT: No acute fracture or malalignment.
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Small joint effusion but no underlying fracture or malalignment.
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Generate impression based on findings.
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Male 60 years old Reason: Rule out solid tumor, malignancy History: Encephalitis, positive paraneoplastic panel CHEST:LUNGS AND PLEURA: Right lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Mediastinal and hilar adenopathy. Etiology is unknown. An index prevascular node measures 1.9 x 1.1 cm on image number 37, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Bladder wall is slightly thickened. Small amount of fat stranding is present around the gallbladder. These findings may be compatible with acute cholecystitis in the right clinical setting. Clinical correlation and further evaluation with right upper quadrant ultrasound is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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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Nonspecific borderline enlarged mediastinal or hilar lymph nodes. Etiology is unknown. Mild wall thickening of the gallbladder associated with mild. Cholecystic inflammation. This finding may be compatible with acute cholecystitis in the right clinical setting. Correlation with clinical history and presentation and if necessary, further evaluation with right upper quadrant ultrasound is recommended.Dr. Bernard was notified and acknowledged about the above findings at the time of dictation.
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Generate impression based on findings.
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headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. There is a small retention cyst on the left side frontal sinus.
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No evidence of acute ischemic or hemorrhagic lesion.Retention cyst on the left frontal sinus.
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Generate impression based on findings.
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There are postsurgical findings related to Chiari decompression. The ventricles and sulci appear unchanged. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. The paranasal sinuses and mastoid air cells, and middle ears are clear.
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Postsurgical findings related to Chiari decompression without evidence of acute intracranial hemorrhage or ventriculomegaly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Re-demonstration of right trigone area likely embolized intra axial mass, known as AVM with surrounding edema and mass effects. The degree of midline shift toward left side appears to be a bit lessen than prior scan.The size of the lesion does not appear to be changed since prior exam.No evidence of acute hemorrhagic or ischemic lesion on this scan.The osseous structures are unremarkable. The mastoid air cells are clear. Retention cyst on the left maxillary sinus.
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No significant interval change of right parietal AVM with surrounding edema and mass effect since prior exam. The degree of midline shift appears to be a bit lessen, however.Rec: Brain MRI for the evaluation of the nature of the lesion as well as surrounding brain parenchyme is recommended. Catheter angiography can be also considered.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard and pushback 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. There are bilateral retropectoral silicone implants, normal in contour and position. 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, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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48 years, Female. Reason: repeat abd film w/ gtube position to R side History: verify metallic fragment is external to pt's body Nonobstructive bowel gas pattern. Residual contrast material in the colon. Interval removal of the enteric tube. G-tube balloon projected over gastric body. G-tube tubing seen overlying mid abdomen.
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Nonobstructive bowel gas pattern. Interval removal of the enteric tube. G-tube balloon projected over gastric body. G-tube tubing seen overlying mid abdomen.
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Generate impression based on findings.
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4-month-old male with nonaccidental traumaVIEWS: Chest AP (one view), cervical spine AP and lateral (two views), pelvis AP/frog leg (two view), 01/29/15 , time The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal. No focal lung opacity, pleural effusion or pneumothorax is seen. Vertebral body heights and disk spaces are normal. No fracture is seen. Pseudo-thickening of the prevertebral soft tissues secondary to image acquisition in the expiratory phase.The femoral heads are directed into the acetabula. No pelvic fracture is seen. Overlying bowel gas limits evaluation of the sacrum.
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Normal chest, cervical spine and pelvis.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram.
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Generate impression based on findings.
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Male 38 days old Reason: ?Fixed dilated loop VIEW: Abdomen AP (one view) 1/29/2015, 07:03 Nasogastric tube tip terminates in the body of the stomach.Persistent gaseous distention of multiple loops of bowel, perhaps slightly improved compared to the prior examination. No portal venous gas, pneumatosis intestinalis or pneumoperitoneum is evident. Streaky bibasilar opacities consistent with atelectasis.
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Nonspecific gaseous distention of multiple loops of bowel, perhaps slightly improved.
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Generate impression based on findings.
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Male 24 years old Reason: Dedicated renal protocol, complex R renal cyst needs further evaluation History: see above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. Cholelithiasis.SPLEEN: .Splenic capsular calcifications and nonspecific hypodense lesion in the spleen measuring 2.5-cm in diameter image number 42, series number 10. These have not significantly changed from previous study.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing renal cysts. Some of these lesions are too small to accurate characterize. The right sided renal cyst seen on MRI dated 3/30/2010 has resolved. Multiple bilateral renal cysts have developed since 2010. A follow-up contrast enhanced renal MRI may be helpful for further evaluation of these lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Hepatomegaly. Cholelithiasis. Bilateral renal cysts. Some of these cysts are too small to accurate characterize. A follow-up MRI in one year may be helpful for further evaluation.Splenic capsular calcifications and nonspecific hypodense lesion in the spleen measuring 2.5-cm in diameter image number 42, series number 10. These have not significantly changed from previous study.
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Generate impression based on findings.
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16-year-old male with respiratory failure, evaluate ET tube positionVIEW: Chest AP (one view) 01/29/15, 0138 hour ET tube tip is below thoracic inlet and above the carina. NG tube side-port is above the GE junction with tip in the proximal gastric body. Cardiothymic silhouette is normal. No pleural effusion. Very small left pneumothorax. No focal pulmonary opacities.
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1.NG tube side-port is above the GE junction, recommend advancement.2.Very small left pneumothorax.
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Generate impression based on findings.
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Right side foot drop. No evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the bilateral cerebellar hemispheric SCA territories.There is also arachnoid cyst on the posterior aspect of vermis.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. Mucosal thickening on the left maxillary sinus.
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No evidence of acute ischemic or hemorrhagic lesion.
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Generate impression based on findings.
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Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A circumscribed benign mass is seen in the upper outer left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.
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Generate impression based on findings.
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Male 38 days old Reason: ex preterm male w/ feeding intolerance, abd distension, rule out nec, free air History: abd distensionVIEW: Abdomen AP (one view) 1/29/2015, 00:37 Nasogastric tube tip terminates in the body of the stomach, with the side port below the GE junction.Gaseous distention of multiple loops of bowel is again present, not significantly changed. No pneumatosis intestinalis, portal venous gas pneumoperitoneum is seen. Streaky bibasilar opacities likely reflect atelectasis.
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Persistent gaseous distention of multiple loops of bowel without evidence of pneumoperitoneum.
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Generate impression based on findings.
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Female 62 years old Reason: Malignancy vs pna History: Cough, pain, LUNGS AND PLEURA: Two areas of nonspecific irregular subpleural consolidation in the anterior lingula and posterior left lower lobe with cavitation. These consolidations contain central hypoattenuation with air and peripheral rim enhancement with surrounding coarse reticular and ground glass opacities. Mild centrilobular emphysema. No pleural effusion.MEDIASTINUM AND HILA: Regional left hilar lymphadenopathy, not present on previous study. Normal heart size without pericardial effusion. Atherosclerotic calcifications of the aorta and its branches with mild coronary artery calcifications.CHEST WALL: Endplate deformities in the thoracic spine which are most likely degenerative in nature and may be minimally progressed since prior exam. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Subpleural consolidation with internal necrosis in the lingula and left lower lobe with draining regional lymphadenopathy which likely represent pneumonia with abscess formation. Less likely consideration is a necrotic metastasis in a patient with a history of squamous cell laryngeal cancer.
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Generate impression based on findings.
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Female, 26 years old.RFO Mildly prominent loops of bowel compatible with generalized ileus. Epidural catheter seen along the midline. Slight bending of the epidural catheter at its projection over the stomach. Skin staples seen partially at the lower most filled view. Subcutaneous gas seen over the right abdomen, likely postsurgical. No unexpected radiopaque foreign body.
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No unexpected radiopaque foreign body.Findings discussed by telephone with Dr. Ismail, the attending surgeon, on 1/29/2015 00:16.
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Generate impression based on findings.
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Female 28 years old; Reason: 28 year female, returning from hernia repair, due to periumbilical pain History: umbilical pain The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal or ureteric calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric contrast within the gastric fundus appears to extend beyond the expected mucosal border (series 3, image 31, series 80264, image 49). There is no extraluminal oral contrast. This appearance can be seen in the setting of a gastric ulcer.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. The neck measures approximately 8 mm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Enteric contrast within the gastric fundus appears to extend beyond the expected mucosal border. This appearance can be seen in setting of a gastric ulcer.
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Generate impression based on findings.
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Male 38 days old Reason: ex preterm male w/ abdominal distension, on continuos feeds, rule out NEC History: abdominal distensionVIEW: Abdomen AP (one view) 1/28/2015, 22:51 NG tube tip terminates in the body of the stomach with the side port below the GE junction.There is nonspecific gaseous distention of multiple loops of bowel in a disorganized pattern. No pneumoperitoneum, portal venous gas or pneumatosis intestinalis is evident. Streaky bibasilar opacities suggest atelectasis.
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Nonspecific gaseous distention multiple loops of bowel, disorganized bowel gas pattern.
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Generate impression based on findings.
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18 years, Female. Reason: stool burden History: constipation / abd pain Nonobstructive bowel gas pattern. Above average stool burden. No free air.
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Nonobstructive bowel gas pattern. Above average stool burden.
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Generate impression based on findings.
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17 year-old female with chest tubeVIEW: Chest AP (one view) 01/29/15, 0451 hour Left chest tube is in place. Cardiothymic silhouette is normal. Interval decrease in left-sided pleural effusion with persistent retrocardiac consolidation. Discoid atelectasis in the right lower lung on background haziness. Persistent small left apical pneumothorax.
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Improving pleural effusions with persistent left basilar consolidation.
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Generate impression based on findings.
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Two month old female with chylothorax.VIEW: Chest and abdomen AP (two view) 1/29/2015, 0417 Endotracheal tube tip terminates below the thoracic inlet and above the carina. The left chest tube position is unchanged. NG tube tip is in the body of the stomach.Multifocal streaky opacities, overall slightly improved from the prior examination, particularly in the upper lobes. Background coarse pulmonary opacities unchanged. Persistent small right pleural effusion. No definite pneumothorax identified. The cardiothymic silhouette is normal.The bowel gas pattern is nonobstructive. No pneumoperitoneum, portal venous gas and pneumatosis intestinalis is seen. Persistent body wall edema is evident.
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Improved multifocal atelectasis, with persistent small right pleural effusion and no pneumothorax identified.
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Generate impression based on findings.
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20 year-old female with history of right lower quadrant pain, evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No small bowel obstruction or free air. The appendix is within normal limits. Mildly thickened duodenum, nonspecific.OTHER: Free fluid extends from the pelvis on the right into Morison's pouch.PELVIS:UTERUS, ADNEXA: An approximately 5.2 x 3 cm cystic area is noted within the left adnexa (3/104), including subtle internal septations. This may represent a hemorrhagic cyst and pelvic ultrasound could provide additional diagnostic specificity. An additional hypoattenuating structure in the area of the right adnexa has a more tubular appearance, and could be an elongated ovary versus mild hydrosalpinx.BLADDER: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedOTHER: Moderate free fluid in the pelvis.
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1.No evidence of acute appendicitis.2.Pelvic findings likely associated with ruptured hemorrhagic cyst. Additional evaluation with pelvic ultrasound may add diagnostic specificity, and would help exclude torsion (however, patient's pain reportedly on contralateral side). An additional hypoattenuating structure in the area of the right adnexa has a more tubular appearance, and could be an elongated ovary versus mild hydrosalpinx.
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