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Generate impression based on findings. | Respiratory distress. Concern for aspiration. 12 month-old male.EXAMINATION: Chest AP (one view) 1/4/15 1133 Tracheostomy tube in place. G-tube partially visualized.Normal cardiothymic silhouette.Large lung volumes with diffuse coarse opacities. Persistent right upper lobe atelectasis. Otherwise, no new focal pulmonary opacities. | Unchanged diffuse coarse pulmonary opacities and right upper lobe atelectasis. |
Generate impression based on findings. | Female 72 years old; Reason: evaluating for etiology of LLQ pain History: llq pain, intermittent x 2 yrs, now becoming more frequent rating 9/10 at worst ABDOMEN:LUNG BASES: Tree in bud opacities at the right lung base with ground glass nodularity suggestive of pneumonitis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is atrophic/removed.BLADDER: Please see the "OTHER" heading below.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focus of fat attenuation adjacent to the left facet joint at L3-L4 could represent a focus of fat necrosis, but is nonspecific.OTHER: Pelvic floor laxity, with a cystocele and rectocele, the urinary bladder, measuring at least 3 cm below the inferior pubic ramus. | 1.No acute CT findings to suggest source of left lower quadrant pain within limitations of a noncontrast CT scan.2.Pelvic floor laxity with a cystocele and rectocele, further described above, may account for symptoms, but correlate with history.3.Tree in bud opacities at the right lung base, suggestive of pneumonitis. |
Generate impression based on findings. | ContractureEXAMINATION: Pelvis AP (one view) 1/5/15 1308 The femoral heads are well directed into normal appearing acetabula. Femoral head contours are smooth and round. No fracture or malalignment is present. | Normal examination. |
Generate impression based on findings. | Female 42 years old; Reason: Hx fibroids, evaluate for neoplasm RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged heterogeneous uterus, measuring approximately 14.5 cm in AP dimension by 9.6 cm in transverse dimension by 15 cm in craniocaudal dimension. Endometrial complex not well assessed on CT but possibly seen displaced to right, axial image 33. In the left uterine body is a dominant uterine mass, structure is apparently relatively hypoenhancing and intramural in location, measures approximately 10.3 x 7.6 cm x 13.2 cm in craniocaudal dimension, image 28 series 3. No definite associated calcification, no internal gaseous foci. Structure is suspicious for a dominant fibroid, may be degenerating due to internal hyperdense appearance. However, underlying neoplastic transformation not entirely excluded. Small follicles suggested in both ovaries. Mildly complex focus in bilateral adnexal areas measuring 3.3 x 1.4 cm on the left, image 18 series 3/image 30 series 3, may be intraovarian physiologic cysts/follicles (versus separate subserosal fibroid, particularly on the left). Small air seen in the cervix. Trace pelvic free fluid.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter iliac lymph nodes.BONES, SOFT TISSUES: Degenerative disease at level of symphysis pubis. | 1. Enlarged fibroid uterus suggested with dominant structure in central/left uterine body, may be a dominant intramural degenerating fibroid with possible internal hemorrhage but malignant degeneration into a uterine leiomyosarcoma not entirely excluded. Noncontrast imaging unavailable for comparison, thus unable to evaluate for enhancing internal components. Endometrial complex not well assessed. Comparison to prior imaging recommended to assess for interval enlargement of aforementioned dominant uterine mass. |
Generate impression based on findings. | 27-year-old male presents with testicular pain since Saturday. RIGHT TESTIS: The right testicle is normal in morphology, echogenicity and size, measuring 2.8 x 3.0 x 5.0 cm. Spectral Doppler demonstrates normal arterial and venous blood flow.LEFT TESTIS: The left testicle is normal in morphology, echogenicity and size, measuring 2.4 x 2.7 x 4.6 cm. Spectral Doppler demonstrates normal arterial and venous blood flow.RIGHT EPIDIDYMIS: The right epididymis is normal morphology and size.LEFT EPIDIDYMIS: The left epididymis is normal morphology and sizeOTHER: No significant abnormalities noted. | Normal testicular ultrasound. |
Generate impression based on findings. | 61-year-old female status post radial fracture 10 days ago The bones are slightly demineralized. There is a step off along the cortex of Lister's tubercle dorsally and along the radial styloid indicating a minimally displaced fracture which probably extends to the articular surface. Chondrocalcinosis is noted affecting the wrist. | Minimally displaced distal radius fracture as described above. |
Generate impression based on findings. | 12-year-old male status post curettage of left proximal fibula aneurysmal bone cyst, evaluate for recurrence There is mild deformity of the proximal fibula diaphysis compatible with the history of curettage of solid variant aneurysmal bone cyst. The surgical margins are less distinct, indicating interval healing. There is no specific radiographic evidence of recurrence. A lucent lesion along the cortex of the distal femur likely represents a nonossifying fibroma. The right knee is unremarkable on the frontal view. | Postoperative changes of proximal fibular solid variant ABC curettage, without evidence of recurrence. |
Generate impression based on findings. | 18 year-old male status post intramedullary rod placement of left tibia fracture, evaluate for healing An intramedullary rod affixes a transverse fracture of the distal tibia in near-anatomic alignment without evidence of hardware complication. The fracture line remains visible, but bridging callus formation indicate some interval healing. A transverse fracture is present through the distal fibular diaphysis with bridging callus formation indicating some interval healing. | Healing distal tibia and fibula fractures as described above. |
Generate impression based on findings. | 20 year-old female with left fifth metatarsal base fracture, evaluate for healing Again seen is a transverse fracture through the base of the fifth metatarsal. On the oblique view the inferolateral aspect of the fracture line remains visible, but the superomedial aspect of the fracture line is less distinct, indicating some interval healing. | Fifth metatarsal fracture at described above with findings suggestive of some interval healing. |
Generate impression based on findings. | 74-year-old female with history of tender mass in right shin We see no mass. Mild osteoarthritis affects the knee, but the tibia and fibula appear otherwise normal. Mild soft tissue swelling affects the lower leg. | Soft tissue swelling and osteoarthritis with no radiographic evidence of mass. If further evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Female 58 years old Reason: evaluate AAA repair and R iliac artery repair History: AAA ANGIOGRAM: Again seen is an aortobiiliac endograft and embolization coil within the region of the right internal iliac artery.The aortic aneurysm is unchanged, with a maximal diameter of 3.1 cm (image 46, series 80933), previously 3.1 cm. Additionally, the right common iliac artery aneurysm appears sightly smaller, now measuring 2.1 cm in maximal diameter (image 43, series 80933), previously 2.6 cm.There is no definite evidence of endograft leak; however, contrast opacification on the delayed phase is somewhat suboptimal, slightly limiting evaluation. The left internal iliac aneurysm again measures 1.3 cm in diameter (image 97, series 11). ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Heterogeneous but predominantly hypoattenuating lesion in the caudate lobe is incompletely characterized, but not significantly changed since the 2007 exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is ptotic, unchanged. There is unchanged scarring in the inferior pole of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fluid density collection previously seen anterior to the right femoral artery has resolved.PELVIS:UTERUS, ADNEXA: Bilateral adnexal cystic lesions. Significant amount of gas and fluid within the endocervical canal.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: Fluid density collection previously seen anterior to the right femoral artery has resolved. | 1.Aortobiiliac stent graft without evidence of endoleak.2.Stable aneurysmal dilatation of the aorta and left internal iliac artery. 3.Slight interval decrease in size of the right internal iliac artery aneurysm.4.Fluid and gas within the endocervical canal, correlation with menstrual history or sonogram may be considered as clinically indicated.5.Indeterminate caudate lobe lesion is unchanged since 2007. MRI of the liver may be pursued as clinically indicated as this lesion is incompletely characterized, although the interval stability suggests a benign etiology. |
Generate impression based on findings. | Male 57 years old; Reason: Distal gastric adenocarcinoma please assess prior to the start of neoadjuvant chemo History: As above CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. The hepatic and portal veins are patent. There is a lesion near segment 5 of the liver which indents the capsule measuring 1.9 x 1.0 cm (image 95/series 604) that is new from prior and is suspicious for metastatic disease.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: Soft tissue mass near the gastric antrum representing the primary neoplasm. There is mild thickening of the fat anterior to the gastric wall highly suspicious spread across the gastric wall.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 | 1.New perihepatic/hepatic lesion suspicious for metastatic disease. |
Generate impression based on findings. | Female 73 years old; Reason: pancreatic cancer, surveillance mid-cycle History: pancreatic cancer, mid-cycle surveillance CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heart size is enlarged. Trace pericardial effusion. Multiple small mediastinal lymph nodes, unchanged in size from prior.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. The left portal vein is thrombosed. There is atrophy of the left hepatic lobe.No new liver lesions have developed. Common bile duct stent is unchanged in position.SPLEEN: Spleen is normal in size. Thrombosis of the splenic vein.PANCREAS: Pancreatic head neoplasm measures 3.1 x 2.3 cm (image 96/series 4) previously, 3.3 x 2.2 cm.The tumor abuts the celiac artery. There is occlusion of the gastroduodenal artery. The common hepatic artery is encased but remains patent. The tumor abuts the portal vein and the SMV with splenic veinocclusion, with multiple large perigastric collaterals.Multiple small mesenteric lymph nodes remain.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Decrease in the thrombus within the IVC.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. | 1.Stable exam without significant change in the primary pancreatic neoplasm.2.No definite new sites of disease.3.Decrease in the size of the IVC thrombus. |
Generate impression based on findings. | History of breast cancer and shortness of breath. There is hyperattenuation of the vascular structures due to residual contrast material from an earlier exam. There is no evidence of intracranial mass. The grey-white matter differentiation appears to be intact. There is patchy hyperattenuation in the bilateral basal ganglia, which likely represent mineralization. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of intracranial mass. |
Generate impression based on findings. | 46 years Female. Reason: s/p NGT placement; eval position History: s/p NGT placement Nasogastric tube coiled in the stomach with tip oriented superiorly at the region of the GE junction. Distal side-port is below the level of GE junction. Nonobstructive bowel gas pattern. Enteric contrast within the colon from recent prior study.Peritoneal dialysis hardware in expected location. | NG tube coiled in the stomach with tip oriented superiorly at the region of the GE junction. |
Generate impression based on findings. | 60 years Female. Reason: obstruction History: hx of abdominal hernia s/p appendectomy Exam is somewhat limited due to patient's body habitus. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 57 years Male. Reason: Abdominal distention, concern for ileus History: abdominal distention Nonobstructive bowel gas pattern. Mildly prominent loops of colon, with moderate stool burden. | No specific evidence of bowel obstruction. Mildly prominent loops of colon. |
Generate impression based on findings. | Male 58 years old Reason: 58 cirrhotic male with recurrent obscure occult GI bleeds. History of small bowel AVMs, triple phase CT enterography to evaluate History: Symptomatic anemia ABDOMEN:LUNG BASES: Trace bibasilar dependent atelectasis.LIVER, BILIARY TRACT: Cirrhotic morphology the liver. Patent hepatic vasculature. Recanalization of the umbilical vein compatible with portal hypertension. Nonspecific pericholecystic fluid.SPLEEN: Splenomegaly measuring up to 17 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys are atrophic with numerous bilateral cysts.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches. BOWEL, MESENTERY: There are two foci of hyperattenuation seen on the arterial phase only within the mid to distal ileum (image 117, series 6). The gas fluid interface at these areas of hyperattenuation suggests possible artifact, although these could conceivably represent the patient's reported AVMs. Extensive esophageal varices. There is colonic diverticulosis without evidence of diverticulitis.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There are two foci of hyperattenuation seen on the arterial phase only within the mid to distal ileum (image 117, series 6). The gas fluid interface at these areas of hyperattenuation suggests possible artifact, although these could conceivably represent the patient's reported AVMs. Extensive esophageal varices. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is trace free fluid within the pelvis | 1.Two foci of hyperattenuation seen only on the arterial phase in the mid to distal ileum, may be artifactual in etiology, although possible may reflect patient's reported AVMs.2.Cirrhotic morphology the liver with sequelae of portal hypertension including splenomegaly, esophageal varices and recanalization of the umbilical veins.3.Trace pelvic ascites.4.Nonspecific pericholecystic fluid nonspecific, clinical correlation is recommended to exclude cholecystitis, perhaps chronic. |
Generate impression based on findings. | 42 years old, Female, Reason: R ureteral stent obstruction; pyelo History: R flank pain ABDOMEN:LUNG BASES: Mild dependent bibasilar atelectasis.LIVER, BILIARY TRACT: Patient status post cholecystectomy. Hepatic steatosis is present.SPLEEN: Splenic calcified granulomata present.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Minimally delayed nephrogram on the right, which may be seen in the setting of a ureteral stent, appearing similar to prior exam. Ureteral stent is in unchanged position with pigtail in the bladder and within the right renal pelvis. There is perinephric fat stranding around the right ureter, which is slightly increased at the level of the UPJ. Due to this stranding at the UPJ, pyelonephritis cannot be entirely ruled out, although there is no striated nephrogram or significant perinephric fat stranding otherwise. No obstructing stone or mass identified. The left kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction, pneumatosis, or free air. Diastases of the abdominal rectus muscles. There is mild mesenteric haziness present suggesting mesenteric adenitis, appearing similar to prior exam. No significant lymphadenopathy.PELVIS:UTERUS, ADNEXA: Cystic structures in right adnexa likely physiologic. Stable cystic focus in the region of the cervix likely representing a nabothian cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Stable hydronephrosis with unchanged position of the ureteral stent. Mildly increased periureteral fat stranding at level of UPJ without evidence of significant perinephric stranding or striated nephrogram. Findings nonspecific and equivocal for pyelonephritis, correlation with patient's clinical history/physical exam and urinalysis recommended.2.Mesenteric haziness suggesting mesenteric adenitis.3.Hepatic steatosis. |
Generate impression based on findings. | 54 years Male. Reason: replaced Dobbhoff History: replaced dubhoff, confirm placement Interval adjustment of the Dobbhoff tube, tip now overlying the distal gastric body.Nonobstructive bowel gas pattern. Unchanged appearance of the partially visualized lung bases. | Dobbhoff tube tip overlying the distal gastric body. |
Generate impression based on findings. | 29-year-old male with abdominal distention. History of ESRD and constipation. Nonobstructive bowel gas pattern. Centralization of the bowel which suggest ascites. Surgical clips are noted in the medial left upper abdomen and left pelvis. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: S/P LVAD. eval for stroke History: AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is hypodensity present along the right centrum semiovale and adjacent right frontal lobe subcortical white matter.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Right vertebralNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Exam is stable since yesterday's exam. 3.There is redemonstration of a focus of encephalomalacia centered in the right centrum semiovale. Presumably this is related to a prior vascular insult. |
Generate impression based on findings. | 66 or old male ALS pt going for diaphragmatic pacer. Nonobstructive bowel gas pattern. Average amount of stool. Degenerative changes are noted in the lumbosacral spine. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 5 years old Reason: evaluation of left femoral catheter History: catheter not drawing, evaluation of line for kinksVIEWS: Left femur AP 1/5/15 (one views) Left lower extremity Port-A-Cath catheter show no kinking or discontinuities. Tip of the catheter is not visualized. No fracture or malalignment. No soft tissue swelling. | No kinking or discontinuities in the visualized portion of the femoral venous access. |
Generate impression based on findings. | Female, 37 years old. Reason: h/o cdiff eval for free air History: c diff, colitis Enteric contrast within the colon from recent prior study. Nonobstructive bowel gas pattern. No gross free air seen on upright imaging. Severe rotatory scoliosis and hip dysplastic changes. Bilateral pleural effusions. | Nonobstructive bowel gas pattern. No gross free air. |
Generate impression based on findings. | Male 8 years old Reason: rule out fracture History: pain and decreased ambulationVIEWS: Right ankle AP, lateral and oblique 1/5/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 8 years old Reason: rule out SCFE, fracture History: pain and difficulty ambulatingVIEWS: Pelvis AP and frog leg 1/5/15 (two views) Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. No evidence of SCFE or AVN. | Normal examination. |
Generate impression based on findings. | 96-year-old female with Dobbhoff tube placement. Also with right upper lobe pneumonia, flu and malnutrition. Note that the pelvis was not included in the exam. The feeding tube terminates over the body of the stomach. Nonobstructive bowel gas pattern. Right pulmonary opacity and probable moderate to large pleural effusion again noted. | Dobbhoff tube tip within the body of the stomach. |
Generate impression based on findings. | Male, 72 years old. Reason: s/p DHT adjustment History: as above Dobbhoff tube again seen curled within the intrathoracic portion of the stomach, with the tip oriented superiorly.Nonobstructive bowel gas pattern. Surgical clips in right upper quadrant. | Dobbhoff tube again seen curled within the intrathoracic portion of the stomach, with the tip oriented superiorly. Additional adjustment recommended. |
Generate impression based on findings. | Female 73 years old Reason: Patient with concern for small cell lung cancer, neck mass, L axillary lymphadenopathy abdominal and retroperitoneal lymphadenopathy, on OSH scans, now with abdominal pain; please evaluate for lung mass, other abdominal mass to explain pt's pain ABDOMEN:LUNG BASES: Please see chest CT report from the same day for full evaluation of the thorax. Extensive necrotic appearing left axillary lymphadenopathy incompletely imaged.LIVER, BILIARY TRACT: The left hepatic lobe abuts and is slightly superiorly displaced by the extensive retroperitoneal lymphadenopathy. There is marked attenuation of the proximal portal vein at the level of the confluence, without complete occlusion. SPLEEN: The splenic vein is thrombosed and there are extensive perigastric varices.PANCREAS: The pancreatic parenchyma is nearly completely encased by the retroperitoneal lymphadenopathy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The bilateral renal veins and arteries are encased and attenuated by the retroperitoneal adenopathy, but without complete occlusion. Thrombus is evident within the left gonadal vein and a collateral vein draining into the left renal vein. There is no evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: There is a 14.8 x 17.2 cm (image 50, series 3) heterogeneous retroperitoneal mass extending from the gastroesophageal junction to the external iliac veins, suggestive of a conglomerate necrotic retroperitoneal lymph nodes, which displaces the aorta anteriorly, encases the celiac axis, SMA, renal arteries and veins as well as the portal vein and SMV. The inferior vena cava is also compressed by the mass, and evaluation for thrombus is suboptimal. For reference purposes a somewhat more isolated mesenteric lymph node measures approximately 2.7 x 2.6 cm (image 79, series 3).BOWEL, MESENTERY: There is nonspecific thickening of the rectal wall. There is no evidence of bowel obstruction. The stomach is displaced anteriorly by the retroperitoneal mass. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are moderate/severe degenerative changes of the lower lumbar spine. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Marked partially necrotic pelvic lymphadenopathy extending to the level of the external iliac veins bilaterally. For reference purposes a right external iliac chain node measures 2.0 x 2.2 cm (image 108, series 3).BOWEL, MESENTERY: There is nonspecific thickening of the rectal wall. There is no evidence of bowel obstruction. The stomach is displaced anteriorly by the retroperitoneal mass. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are moderate/severe degenerative changes of the lower lumbar spine. There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: Nonspecific presacral soft tissue thickening. | 1.Large retroperitoneal mass as detailed above which appears to be a conglomerate of necrotic retroperitoneal lymph nodes. The necrotic appearance is more suggestive of metastases rather than lymphoma, although lymphoma is not excluded, necrotic adenopathy may be seen in the setting of treated lymphoma, correlation with patient's clinical history recommended.2.Circumferential rectal wall thickening is nonspecific, but correlation with colonoscopy is recommended to exclude a primary rectal neoplasm.3.Encasement and attenuation of the proximal portal vein at the level of the confluence, without complete occlusion, secondary to encasement by the retroperitoneal mass. Occluded splenic vein.4.Compression of the IVC by the retroperitoneal mass; however, evaluation for possible IVC thrombus is suboptimal on this examination. |
Generate impression based on findings. | Male 14 years old Reason: L1 fracture History: blunt trauma with focal painVIEWS: Lumbar spine AP lateral and both obliques. Sacrum lateral view 1/5/15 (5 views) There is a wedge compression fracture of L1, a small triangular impacted fragment of the superior plate is noted as well. Remaining vascular body heights and disk spaces are maintained. | Wedge compression fracture of L1 as described. |
Generate impression based on findings. | Reason: Patient with metastatic pancreatic cancer s/p fall now with worsening memory problems and R sided weakness, please evaluate for bleed History: As above There multiple hyperdense foci scattered in both hemispheres of the brain as well as in the posterior fossa. When the left cerebellar hemisphere measures approximately 37 by 47 mm axial dimensions. One in the right temporal lobe measures 35 x 33 mm axial dimensions one in the left basal ganglion measures 12 mm diameter. One in the right frontal lobe measures 23 mm diameter. One in the medial aspect of the left frontal lobe measures 13 mm. One in the left paracentral lobule measures 26 x 34 mm. Some of these are associated with vasogenic edema. There is associated mass effect.There is a 13 x 14 mm axial dimension round somewhat hyperdense lesion in adjacent and contiguous with basilar artery .The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There are multiple lesions scattered in both hemispheres of the brain is also posterior fossa. These are suspicious for hemorrhagic metastases. MRI of the brain would be helpful to further evaluate.2.A mass in the suprasellar cistern may represent a large aneurysm. MRA may be helpful to differentiate.3.Findings were discussed with the clinical service (pager 4174). |
Generate impression based on findings. | 67-year-old male status-post nasogastric tube placement. Nonobstructive bowel gas pattern with contrast retained in the colon. The nasogastric tube loops in the fundus of the stomach with the tip in the fundus. Right-sided Port-A-Cath terminates at the Superior cavo-atrial junction. Right basilar atelectasis. | Nasogastric tube tip in the fundus of the stomach with the sidehole beyond the gastroesophageal junction. |
Generate impression based on findings. | 67 years old, Female, Reason: acute on chronic diarrhea at osh, then ngt placed at osh due to worsening n/v, now w no bm or gas, free pelvic fluid on osh ct History: hyperbilirubinemia, conjugated, evaluate for sbo, toxic megacolon, liver and gallbladder pathology Lack of IV contrast limits evaluation of abdominal parenchyma. Within these limitations the following observations are made:ABDOMEN:LUNG BASES: Moderate right and trace left pleural effusion, increased from prior exam. There is associated bibasilar atelectasis, right worse than left.Incompletely imaged cardiac leads.LIVER, BILIARY TRACT: Micronodular contour of the liver with perihepatic fluid and mild widening of the fissures, may be seen in the setting of cirrhosis although is nonspecific with ascites present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Persistent nephrograms suggesting underlying nephropathy possibly contrast induced.RETROPERITONEUM, LYMPH NODES: Dense atherosclerotic calcification of the abdominal aorta splenic artery and some of its branches. Bilaterally iliac stents present.BOWEL, MESENTERY: Small amount of pneumoperitoneum which is increased since prior exam. Thickening of the bowel in the left upper abdomen with adjacent mesenteric induration and fat stranding suggestive of possible perforation in this area as the source of pneumoperitoneum. Left colonic diverticulosis. No evidence of pneumatosis. No definite evidence of obstruction. Stable to mild increase in ascites. OTHER: There is a moderate amount of ascites as well as anasarca.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: There is air within the urinary bladder, which is likely iatrogenic.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Small amount of pneumoperitoneum which is increased since prior exam. Thickening of the bowel in the left upper abdomen with adjacent mesenteric induration and fat stranding suggestive of possible perforation in this area as the source of pneumoperitoneum. 2.Moderate amount of ascites.3.Persistent nephrogram suggests underlying nephropathy.Findings were discussed between the on-call resident and Dr. Modes at 0845 on 1/6/15. |
Generate impression based on findings. | Follow-up from surgery Again seen are two screws affixing the first tarsometatarsal joint in near-anatomic alignment. Portions of the articulation are indistinct suggesting fusion. A round defect in the navicular tuberosity likely represents a site of tendon transfer. Two screws affix a calcaneal osteotomy in near anatomic alignment. The osteotomy margin appears slightly less distinct on the current study than on the prior study, suggesting some interval healing. | Postoperative changes of calcaneal osteotomy fixation and other findings as above. |
Generate impression based on findings. | Female 8 years old Reason: trauma, pain with wrist flexion History: trauma, pain with wrist flexionVIEWS: Right wrist, elbow and forearm AP and lateral 1/6/15 (6 views) There is no evidence of fracture, malalignment or soft tissue swelling. Previously described bone fragment or foreign body is the pisiform bone. | Normal examination. |
Generate impression based on findings. | 6-year-old female with pain and tenderness, rule out fracture Markers were placed over the left lower chest wall. No underlying rib fracture is visualized. Surgical clips are noted in the right upper quadrant. | No fracture or other specific findings to account for the patient's symptoms. |
Generate impression based on findings. | concern for undifferentiated malignancy of lung, staging work up. Prominent left supra-ophthalmic vein with enhancement comparing to that of the right side. Differential diagnosis include dural arteriovenous fistula or normal variation.No evidence of hemorrhagic or ischemic lesion on this scan. No evidence of abnormal enhancement.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 osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. Enlarged left supra-ophthalmic vein as described above, differential diagnosis include dural arteriovenous fistula involving cavernous sinus or normal variation. Clinical correlation is recommended and diagnostic angiography can be considered for further evaluation.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. No evidence of abnormal enhancement. |
Generate impression based on findings. | 31-year-old female with tailbone pain after fall, evaluate for fracture The SI joints appear within normal limits. No sacral or coccygeal fracture is visualized. Vacuum phenomena is noted at L5/S1. | No fracture visualized. |
Generate impression based on findings. | Bony nodule on the forehead There is a small nodular lesion in the right forehead scalp soft tissues measuring 1 cm in diameter and 2 mm in thickness with central attenuation compatible with fat (axial image 10/32). Lesion was present on prior CT from 11/11/2010. Underlying calvarium is intact.No intracranial mass or evidence of mass-effect. No intracranial hemorrhage. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | Small lesion in the right forehead scalp, presumably corresponding to the palpable abnormality, is compatible with a small lipoma. This lesion was present on prior CT from 1/11/2010. |
Generate impression based on findings. | Female 8 years old Reason: eval for pelvic fracture History: MVC with roll-overVIEWS: Pelvis AP and chest AP 1/6/15 (two views) Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax. | Normal examination. |
Generate impression based on findings. | Lower lumbar pain Vertebral body heights and intervertebral disk spaces appear normal. Alignment is within normal limits. Tiny osteophytes project from the anterior aspects of the lumbar vertebrae. | Tiny vertebral body osteophytes, but no otherwise no specific findings to account for the patient's pain. |
Generate impression based on findings. | Male 41 days old Reason: r/o pna History: feverVIEW: Chest AP (one view) 1/6/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Right upper lobe ill-defined opacity, likely pneumonia or atelectasis.. No effusions or pneumothorax. | Right upper lobe ill-defined opacity as described. |
Generate impression based on findings. | Headache. Question of mass. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is scattered partial opacification of the ethmoid sinuses. The mastoid air cells and middle ear cavities are clear. The skull and scalp soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Pain. Fracture? There is perhaps mild narrowing of the L5/S1 intervertebral disk, but I see no fracture or malalignment. Note is made of small hypoplastic ribs at what I presume to be T12. | No fracture evident. There is perhaps mild narrowing of the L5/S1 intervertebral disk space. |
Generate impression based on findings. | Male; 47 years old. Reason: r/o fx History: sig swelling around knee, NWB Four views of the right knee demonstrate an acute vertical fracture of the medial aspect of the right patella in near-anatomic alignment. Large knee joint effusion. Mild medial compartment osteoarthritis. | Acute patellar fracture. |
Generate impression based on findings. | Reason: evidence of PE History: increased O2 needs, A-a gradient in Cancer patient with persistent fevers PULMONARY ARTERIES: Technically adequate study, without evidence of pulmonary embolism. Prominence of the main pulmonary artery suggest pulmonary arterial hypertension.LUNGS AND PLEURA: Multifocal ground glass opacities, predominantly in the left lung base. Small left and trace right pleural effusion with basilar consolidation/atelectasis.Biapical scarring is unchanged. Previously described bilateral micronodules are obscured by overlying groundglass.MEDIASTINUM AND HILA: Heart size is upper normal without significant pericardial effusion.Scattered, nonenlarged mediastinal and hilar lymph nodes, likely reactive.Moderate coronary artery calcifications.Apparent interval improvement mural thickening of the distal esophagus. Compatible measurements are difficult to obtain while the esophagus is nondistended.Small hiatal hernia.Reference paraesophageal lymph node is unchanged measuring 8 mm (series 8, image 173).Common origin of the brachiocephalic and left common carotid artery is noted, a normal variant.CHEST WALL: Degenerative disease of the spine. No significant axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Interval improvement of previously described soft tissue density superior to the celiac artery, and posterior to the pancreas, now measuring 12 x 17 mm (series 8, image 256), previously 23 x 21 mm, likely representing improvement of confluent lymphadenopathy.Degenerative disease of the spine. | 1. No evidence of pulmonary embolism.2. Multifocal ground glass opacities, small bilateral pleural effusions with associated consolidation/atelectasis, is compatible with edema, although superimposed infection, including atypical etiology, cannot be excluded. 3. Apparent interval improvement of distal esophageal mural thickening and upper abdominal lymphadenopathy. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 8-year-old female with persistent fevers x 5 days, pyuria, abdominal pain/back pain. ABDOMEN:LUNG BASES: No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Liver enhances homogeneously without focal lesion.SPLEEN: No focal splenic lesion.PANCREAS: No focal pancreatic lesion or peripancreatic stranding.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically without evidence of inflammatory changes, abscess, or renal mass.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: No suspicious focal osseous lesion.OTHER: No significant abnormality noted | No CT evidence of pyelonephritis. |
Generate impression based on findings. | Reason: trauma with LOC History: frontal laceration CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.CT maxillofacial bones:There are no fractures identified involving the maxillofacial bones. There is some soft tissue swelling present along the soft tissues anterior to the frontal sinuses .The walls of the right maxillary sinus are thickened. Is a small opacity at the posterior aspect of the right maxillary sinus.The skull base foramina are intact.The orbits are intact with no abnormal mass lesions in either orbit. The visualized eyeballs are intact lacrimal glands are unremarkable. Extraocular muscles are intact. The suprasellar cistern is unremarkable.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses are clear. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.No evidence for maxillofacial bone fractures are3.findings suggest chronic sinusitis involving the right maxillary sinus there is paranasal sinus no outlet obstruction is appreciated.4.There is soft tissue swelling present adjacent to the frontal bone. |
Generate impression based on findings. | 64 year old female with history of shortness of breath. Evaluate for PE. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Severe centrilobular emphysema, unchanged. Scarring at the bases, with focal lingula and subsegmental right middle/lower lobe atelectasis. Minimal lower lobe bronchial wall thickening and unchanged subtle bronchiectasis. Left upper lobe nodule (8/58) is slightly smaller and scarlike appearance. Scattered pulmonary micronodules, similar to prior. A left upper lobe approximately 5 mm nodule (10/66) is relatively flat, and unchanged, likely represents an intrapulmonary lymph node. No pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications. Heterogeneous thyroid with coarse calcifications, unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia and hepatic cysts are similar to prior. Right upper quadrant with surgical clips, and a mild biliary dilatation which is often seen after cholecystectomy. Right renal hypoattenuating foci, likely cysts. | No pulmonary embolus, but multiple areas of bibasilar atelectasis and bronchiectasis which suggests recurrent episodes of aspiration and/or infection.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 14-year-old male with history of L1 compression fracture. Reason: L5 compression fracture, evaluate for retropulsion into spinal canal History: L5 compression fracture, evaluate for retropulsion into spinal canal There is an anterior wedge deformity of L1 with a small bony fracture fragment situated at the anterior-superior aspect of the L1 vertebral body. This fracture extends transversely and involves the middle and posterior columns including bilateral pedicles, laminae, facets, right transverse process and spinous process. There is approximately 7 mm of distraction between the fracture fragments measured at the spinous process. There is slightly more distraction on the right when compared to the left. There is minimal bony canal encroachment. There is an additional small displaced fracture through the posterior inferior aspect of the T12 spinous process. The remaining thoracic and lumbar spine are unremarkable. Intervertebral disc spaces are maintained. Alignment is anatomic. Limited visualization of the abdomen is unremarkable. | 1.Flexion-distraction fracture of L1 as above (Three column injury suggests this is unstable).2.Tiny displaced fracture of the T12 spinous process.3.No evidence of L5 compression fracture. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. Postoperative changes of right frontal craniotomy for hematoma evacuation are redemonstrated. Hypoattenuation in right frontal lobe from the evolving hematoma and progression of encephalomalacia are again seen. There is no evidence of new hemorrhage. Mild mass effect on the right frontal horn and minimal midline shift have resolved. Foci of hypoattenuation in the left cerebellar hemisphere remain compatible with chronic lacunar infarcts. Mucosal thickening within the right maxillary sinus has resolved. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.No evidence of acute intracranial hemorrhage.2.Expected changes from evolution of right frontal intracranial hemorrhage and craniotomy.3.Chronic lacunar infarcts in left cerebellum, unchanged. |
Generate impression based on findings. | Male; 66 years old. Reason: Fx? History: ankle pain s/p fall Three views of the right ankle demonstrate soft tissue swelling about the ankle with possible tibiotalar joint effusion. Osteoarthritis affects the tibiotalar joint of the ankle. Arterial calcifications are seen in the soft tissues. No acute fracture or malalignment is evident. | Soft tissue swelling with possible ankle joint effusion, but we see no acute fracture. |
Generate impression based on findings. | Altered mental status. Question of ICH. There is no evidence of acute intracranial hemorrhage. There is extensive periventricular and subcortical white matter hypoattenuation along with foci of hypoattenuation in the pons which is nonspecific but may represent small vessel ischemic disease. The ventricles and cortical sulci are prominent in size compatible with age related volume loss. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are dural calcifications. | 1. No evidence of acute intracranial hemorrhage.2. Extensive age-indeterminate small vessel ischemic disease. CT is insensitive for the detection of non-hemorrhagic, acute ischemic infarcts. If clinical concern for ischemia persists, MRI may be obtained for further evaluation. |
Generate impression based on findings. | Male 18 days old Reason: evaluate for interval change History: history of Hirschsprung's, s/p resectionVIEW: Abdomen and chest AP (two views) 1/6/15 at 607 hours. Central line tip is at the right atrium. NG tube tip is at the antral pyloric region. Abdominal surgical sutures noted. Interval E. T. tube and urinary bladder catheter removal. Cardiac silhouette size is top normal. No focal opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval removal of ET tube and urinary bladder catheter and repositioning of NG tube. |
Generate impression based on findings. | 50 year-old female status post fall onto right elbow with residual pain Alignment is anatomic. No fracture or joint effusion. | No fracture or malalignment. |
Generate impression based on findings. | Female 57 years old Reason: Abdominal pain post G-tube insertion. Please assess for tube placement, hematoma, or abscess that could explain symptoms History: abdominal pain ABDOMEN:LUNG BASES: New small bilateral pleural effusions, right greater than left with associated compressive atelectasis. Unchanged micronodules along the right major fissure likely reflects an intrapulmonary lymph node.LIVER, BILIARY TRACT: Mild prominence of the common duct again seen, perhaps slightly improved from the prior examination.SPLEEN: No significant abnormality notedPANCREAS: Mild nonspecific prominence of the pancreatic duct again seen, again measuring up to approximately 3 mm, without significant interval change. Hypoattenuating rounded foci in the uncinate process and pancreatic head are incompletely characterized, but possibly represent small sidebranch IPMNs, which are unchanged.ADRENAL GLANDS: Nonspecific thickening of the left adrenal gland is unchanged.KIDNEYS, URETERS: Punctate hyperdensity in the right renal parenchyma is too small to characterize.RETROPERITONEUM, LYMPH NODES: There are moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There has been interval placement of the gastrostomy tube, which is in appropriate position. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are extensive left adnexal varices, some of which contain thrombus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There has been interval placement of the gastrostomy tube, which is in appropriate position. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval placement of a gastrostomy tube, without evidence complication.2. New small bilateral pleural effusions with associated compressive atelectasis.3. Slightly improved common duct dilatation and stable pancreatic duct dilatation.4. Unchanged hypoattenuating lesions in the uncinate process and pancreatic head, which may represent small side branch IPMNs, although are incompletely characterized.5. Extensive left adnexal varices, some of which contain thrombus. |
Generate impression based on findings. | 87 years old, Female, Reason: evaluate for primary tumor History: enhancing brain lesion suspicious of metastasis CHEST:LUNGS AND PLEURA: Scarring in the right lower lobe versus postsurgical changes. No suspicious pulmonary nodule or mass.MEDIASTINUM AND HILA: Marked circumferential thickening of the distal esophagus (series 3, image 54), with dilatation more proximally suggesting an element of obstruction. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Incompletely imaged dystrophic calcification of the right breast, which can be correlated with dedicated breast imaging.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense foci, which are too small to characterize at this time.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 gastrohepatic or retroperitoneal lymphadenopathy. Atherosclerotic calcification of the aorta and iliac vessels.BOWEL, MESENTERY: 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: Degenerative joint disease affects the spine with mild grade 1 anterolisthesis of L3 on L4. | 1. Marked circumferential thickening of the distal esophagus with dilatation more proximally suggesting an obstructive element, suspicious for esophageal cancer and correlation with patient's clinical history and direct visualization/endoscopy recommended.2. Multiple hepatic hypodensities which are too small to characterize although should be followed as metastasis cannot be entirely excluded. |
Generate impression based on findings. | There are subtle asymmetric soft tissue phlegmonous changes in the preseptal space near the left medial canthus, which extends close to the globe. There is no discrete fluid collection or adjacent osseous erosion. There is mild asymmetric prominence of the left nasolacrimal duct, which is opacified. The intraconal fat is preserved. The extraocular muscles and optic nerves are normal in size and density. No abnormal enhancement or mass is seen in the orbits. No bone destruction of the orbital walls is seen. There is a small osteoma in the right frontal sinus. There is minimal mucosal thickening of the left maxillary sinus. There is mild frothy secretions in the right sphenoid sinus. The other paranasal sinuses are clear. | Subtle phlegmonous changes near the left medial canthus confined to preseptal structures, reflecting known dacryocystitis. No discrete fluid collection or radiopaque foreign body is appreciated. |
Generate impression based on findings. | 66-year-old female status post reverse total shoulder arthroplasty Hardware components of a reverse total shoulder arthroplasty are situated near anatomic alignment without evidence of complication. Drains and gas in the soft tissues reflect recent surgery. | Status post reverse total shoulder arthroplasty in near-anatomic alignment. |
Generate impression based on findings. | Female 4 years old Reason: 4 yo F HIE, CP/DD, mult aspiration events, on BIPAP with copious secretions. Evaluate for opacities. History: hypoxiaVIEW: Chest AP (one view) 1/6/15 at 256 hours. Central line deep is at the RA/SVC junction. Upper abdominal surgical clips unchanged. Cardiac silhouette size is normal. Bibasilar opacities again noted. Possible small underlying pleural effusions cannot be excluded. | Bibasilar opacities with possible small underlying per effusions. |
Generate impression based on findings. | 37-year-old female, liver transplant workup Several dental fillings are noted. No evidence of bone erosion or fracture. | Several dental fillings, without evidence of osteolysis. |
Generate impression based on findings. | Female 33 years old; Reason: metastatic breast cancer - evaluate response to treatment with comparison to 12/8 exam per recist 1.1. Target lesion is anterior lesion in right hepatic lobe History: known mets to liver, lung, bone CHEST:LUNGS AND PLEURA: Multiple pulmonary micronodules again seen, stable to slightly more pronounced than on prior study. For example, unchanged right upper lobe 3 mm lung nodule, image 21 series 4. An additional focus in right upper lobe measures 5 mm, image 26 series 4, previously measured 3 mm. No pleural effusion.MEDIASTINUM AND HILA: Stable aneurysmal dilatation of ascending aorta, measuring 3.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypovascular hepatic lesions seen, compatible with metastatic disease. A reference lesion located in hepatic segment IVa/8 demonstrates interval increase in size, measuring 4.5 x 2.9 cm on image 76 series 3, previously measured 3.2 x 2.4 cm. Stable to mild interval increase in size of reference hepatic segment IVb lesion, measuring 1 x 0.7 cm, image 91 series 3, previously measured 0.9 x 0.7 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Unchanged indeterminate left adrenal nodularity.KIDNEYS, URETERS: Relative atrophy of medial portions of both kidneys, may reflect post radiation sequela.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: Underdistended bladder.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures subjectively similar to prior study. Again seen multiple sclerotic lesions, including in left humeral head. Please note that medicine bone scan more accurate indicator of metastatic osseous disease activity and extent. Multilevel loss of height of vertebral bodies, most marked at T12, L2, L3 and L4 vertebral bodies. | 1. Stable to mild interval increase in size of hepatic metastases, see reference lesions.2. Multiple pulmonary micronodules again seen, stable to slightly more pronounced than on prior study. 3. Diffuse osseous metastatic disease subjectively similar to earlier exam. However, please note nuclear medicine bone scintigraphy more accurate indicator of metastatic osseous disease extent and activity. |
Generate impression based on findings. | 56-year-old male, evaluate for osteomyelitis A screw affixes the first interphalangeal joint without evidence of complication. Mild osteoarthritis affects the first MTP joint. There is no erosion or other specific evidence of osteomyelitis. | No specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | Female 12 years old Reason: evaluate interval changes in lung fields History: intubated pulmonary hemorrhageVIEW: Chest AP (one view) 1/6/15 at 541 hours. Cardiac silhouette size is enlarged but stable. Persistent diffuse pulmonary opacities concerning for either pulmonary hemorrhage, ARDS or drug reaction. No effusions or pneumothorax. | No change in diffuse pulmonary opacities. |
Generate impression based on findings. | Male; 67 years old. Reason: pain to dorsal wrist History: no trauma Three views of the left wrist demonstrate chondrocalcinosis of the wrist including the TFCC. Widening of the scapholunate interval, suggestive of ligamentous laxity or disruption. Volar rotary subluxation of the scaphoid and degenerative arthritic changes of the radioscaphoid articulation are also seen. Soft tissue swelling is seen along the dorsum of the wrist. No acute fracture is evident.Three views of the left hand demonstrate the aforementioned wrist findings. Mild osteoarthritis of the DIP joint of the middle finger, which may be due to old trauma. No acute fracture is evident. | Soft tissue swelling along the dorsum of the wrist and arthritic changes as described above, including chondrocalcinosis which raises the question of pseudogout. No acute fracture is evident. |
Generate impression based on findings. | There is mild mucosal thickening involving the frontal sinuses, left relatively worse than right, extending to the frontal recesses. There is moderate patchy opacification involving the bilateral anterior ethmoid air cells and to a lesser degree the posterior ethmoid air cells. Mild mucosal thickening is also seen in the right sphenoid sinus. Mild mucosal thickening is also seen in the bilateral maxillary sinuses, right relatively worse in left. Frothy secretions also seen in the right maxillary and left frontal sinuses.No findings to suggest an aggressive sinonasal infection. Nasal septum is leftward deviation. The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.Evidence of bilateral intraocular lens replacement. Limited evaluation of intracranial structures is unremarkable. | Mild pansinus disease as described above. There are frothy secretions in the left frontal and right maxillary sinuses which can be seen with acute sinusitis. Findings are progressed since MR 10/4/2014. |
Generate impression based on findings. | Ms. Hanyzewski is a 51 year old female presenting with a recent history of left breast mastectomy in January 2014 for IDC . She has no current breast related complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 64-year-old male presents for restaging of colon cancer. CHEST:LUNGS AND PLEURA: Scattered right lower lobe pulmonary micronodules are again noted. At least two of them are increased in size. For future reference the largest measures 5 mm (series 5/77). No new suspicious pulmonary nodule or mass is identified. Scattered, small foci of tree in bud opacity are new to slightly progressed in the left upper lobe, likely represent mild non-specific pneumonitis.No pleural effusions.MEDIASTINUM AND HILA: Noted again is prevascular lymphadenopathy. The reference node measures 2.5 cm in short axis (series 3/43) compared to 1.8 cm previously. Calcified subcarinal lymph node is again noted. No significant hilar lymphadenopathy.There is new let paravertebral lymphadenopathy along the lower thoracic spine (series 3, images 76 through 88). Progression of retrocrural lymphadenopathy as well. Note again is a right-sided chest port with the catheter tip at the mid-SVC.Normal cardiac size with mild pericardial effusion/thickening. Mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense liver lesions are significantly increased in size. There is at least one new small hypodense liver lesion compatible with a new metastatic site of disease.The previously referenced right liver lesion measures 4.2 x 2.4 cm (series 3/113); it has associated calcifications and capsular and retraction likely reflecting that it is a treated metastasis accounting for its stable size. Although the reference lesion is relatively stable in size, numerous other lesions are significantly increased in size. For example a caudate lobe lesion measured 1.7 x 1.2 cm previously (series 3/101) and currently measures 4.3 x 3.4 cm (series 3/103).SPLEEN: No significant abnormality noted.PANCREAS: Noted again are findings of pancreas divisum.ADRENAL GLANDS: The right adrenal nodule measures 2.8 x 1.9 cm (series 3/120), compared to 2.9 x 1.7 cm previously. The left adrenal gland mildly nodular thickening is not significantly changed.KIDNEYS, URETERS: There has been interval progression of right-sided hydronephrosis and hydroureter to the level of the ureterovesical junction.RETROPERITONEUM, LYMPH NODES: Interval increased size of the moderate retroperitoneal lymphadenopathy. Mild atherosclerotic calcification of the abdominal aorta and iliac vessels without aneurysmal dilatation.BOWEL, MESENTERY: The small and large bowel are normal in caliber and wall thickness without adjacent inflammatory changes evident. The stomach is partially distended with fluid.BONES, SOFT TISSUES: Moderate degenerative disk disease of the lumbar spine, worst at the L5-S1 level.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: There is marked globular enlargement of the prostate gland.BLADDER: The urinary bladder is severely distended with simple fluid attenuation contents.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval progression of disease including increased size of the pulmonary micronodules, liver metastases, prevascular mediastinal and retroperitoneal lymphadenopathy. New paravertebral lymphadenopathy and liver lesion.2. Increased right hydroureteronephrosis to the level of the ureterovesical junction.3. Enlarged prostate, and distended urinary bladder, suggesting outlet obstruction. |
Generate impression based on findings. | Female 7 years old Reason: intubated, eval pulmonary consolidation VIEW: Chest AP (one view) 1/6/15 at 558 hours. Tracheostomy tube again noted. Cardiac silhouette size is normal. Worsening in right upper and middle lobe opacities with no change in left lower lobe pneumonia or atelectasis. No effusions or pneumothorax. | Worsening in multifocal opacities as described. |
Generate impression based on findings. | Reason: evalaute abnormal chest XRAY History: sob, cough LUNGS AND PLEURA: Motion limits evaluation.Perihilar and basilar predominant nodular and patchy groundglass opacities are compatible with edema.Atypical infection including PCP cannot be excluded .Small right pleural effusion.MEDIASTINUM AND HILA: Right central venous catheter with its tip in the SVC.Marked cardiac enlargement without evidence of a pericardial effusion.Decreased attenuation of the blood pole compatible with anemia.Prominent mediastinal lymphadenopathy . Right paratracheal lymph node (image 32 series 3) measuring 13 mm in short axis.Hilar lymphadenopathy cannot be evaluated without intravenous contrast.CHEST WALL: Bilateral prominent axillary lymph nodesUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Diffuse groundglass opacities are compatible with edema. However atypical infection including PCP cannot be excluded.2.Severe cardiac enlargement with right pleural effusion and evidence of anemia.3.Mediastinal and axillary lymphadenopathy |
Generate impression based on findings. | Altered mental status. Question of ICH. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. Mild periventricular white matter hypoattenuation is non-specific but likely represents small vessel ischemic disease. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening of the paranasal sinuses with sclerosis of the thickened lateral wall of the left maxillary sinus, which may reflect chronic sinusitis. The skull and scalp soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage.2. Mild age-indeterminate small vessel ischemic disease. 3. Sclerotic left maxillary sinus walls suggests evidence of chronic sinusitis. |
Generate impression based on findings. | Male 7 months old Reason: is threr improvement in aeration? History: atelectasis on previous film.VIEW: Chest and abdomen AP (two views) 1/6/15 at 622 hours. Chest tube tip is below the thoracic inlet. NG tube terminates in the lower thoracic esophagus.Cardiac silhouette size is top normal or mildly enlarged. Multifocal streaky opacities of the left upper lobe and both lung bases with no effusions or pneumothorax.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. Large bilateral inguinal hernias. | Misplaced NG tube.Multifocal streaky air space opacities, likely subsegmental atelectases.Disorganized, slightly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | Reason: trauma with LOC History: frontal laceration CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.CT maxillofacial bones:There are no fractures identified involving the maxillofacial bones. There is some soft tissue swelling present along the soft tissues anterior to the frontal sinuses .The walls of the right maxillary sinus are thickened. Is a small opacity at the posterior aspect of the right maxillary sinus.The skull base foramina are intact.The orbits are intact with no abnormal mass lesions in either orbit. The visualized eyeballs are intact lacrimal glands are unremarkable. Extraocular muscles are intact. The suprasellar cistern is unremarkable.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses are clear. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.No evidence for maxillofacial bone fractures are3.findings suggest chronic sinusitis involving the right maxillary sinus there is paranasal sinus no outlet obstruction is appreciated.4.There is soft tissue swelling present adjacent to the frontal bone. |
Generate impression based on findings. | Female 52 years old Reason: intraabdominal abscess History: abdominal pain Within the limits of a non IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN: LUNG BASES: Right lower lobe pulmonary micronodules. Small pericardial effusion.LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: Atrophic transplanted pancreas identified in the right lower quadrant, incompletely evaluated without contrast.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The patient is status post left nephrectomy. The native right kidney is atrophic, containing unchanged punctate calcifications. Presumed transplant kidney is noted in the lower mid abdomen, which appears atrophic, unchanged the prior examination. Additional soft tissue focus is seen in the left lower quadrant along the left psoas muscle, which may represent residual soft tissue from an additional renal transplant. Finally, there is a unchanged oblong partially calcified soft tissue mass in the left hemipelvis, which may be postoperative etiology.RETROPERITONEUM, LYMPH NODES: There are atherosclerotic calcifications of the abdominal aorta and its branches. There is an IVC filter in place, position unchanged. There is an unchanged partially calcified soft tissue mass in the posterior left retroperitoneum, which is presumably postoperative in etiology.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. There is a small hiatal hernia.BONES, SOFT TISSUES: There is partial loss of height of multiple thoracic vertebral bodies, likely related to renal osteodystrophy. Postsurgical changes are evident in the ventral abdomen.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: There is no urine within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. There is a small hiatal hernia.BONES, SOFT TISSUES: There is partial loss of height of multiple thoracic vertebral bodies, likely related to renal osteodystrophy. Postsurgical changes are evident in the ventral abdomen. | 1.No specific findings seen to account for the patient's abdominal pain.2.Atrophic midline and left lower quadrant transplant kidneys, appearing unchanged.3.Sites of soft tissue in the left hemipelvis/posterior left retroperitoneum presumably postoperative in etiology, and also unchanged.4.Atrophic transplanted pancreas in the right iliac fossa, unchanged.5.Osseous sequelae of renal osteodystrophy with associated loss of height of multiple thoracic vertebral bodies. |
Generate impression based on findings. | Female; 56 years old. Reason: injury History: pain Three views of the left ankle demonstrate soft tissue swelling about the ankle. The bones are demineralized, suggestive of osteopenia/osteoporosis. There is a small, well-corticated ossification at the anterior and dorsal margin of the talus, most likely due to old trauma. The subtalar joint is poorly visualized, which is most likely artifactually due to positioning, but as a result, subtalar coalition cannot be excluded.Three views of the left foot demonstrate demineralized bones, again suggestive of osteopenia/osteoporosis. There is soft tissue swelling along the dorsum of the foot. A 2-3 mm, rounded density seen only on the lateral view dorsal to one of the toes is most likely due to old trauma with its appearance being atypical for acute fracture. Normal variant os peroneum noted. | Soft tissue swelling and findings suggestive of old trauma as above. We see no definite acute fracture. |
Generate impression based on findings. | Male 30 days old Reason: abdominal process History: feeding intoleranceVIEW: Abdomen and chest AP (two views) 1/6/15 at 613 hours NG tube terminates in the stomach. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, slightly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | Female 7 years old Reason: PICC placement History: PICC placementVIEW: Chest AP (one view) 1/5/15 at 1730 hrs Skeletal deformities, gastrostomy and tracheostomy tubes unchanged. NG tube terminates in the lower thoracic esophagus. Left upper extremity PICC tip is in the right atrium.Cardiac silhouette is no sizable due to patient's anatomical characteristics. Persistent chronic left retrocardiac opacity. | Interval central line and NG tube placement as described. |
Generate impression based on findings. | Male 9 months old Reason: intubated, head trauma VIEW: Chest AP (one view) 1/6/15 at 306 hours. Left subclavian central line tip is at the confluence of both innominate veins. NG tube tip is in the antropyloric region. ET tube terminates at the carina. Cardiac silhouette size is normal. Improvement in left lower lobe atelectasis. | ET tube tip is at the carina.Improvement in left upper lobe atelectasis. |
Generate impression based on findings. | Female 10 years old Reason: intubated History: Status epilepticus.VIEW: Chest AP (one view) 1/6/15 at 313 hours. Central line tip is in the SVC. ET tube tip is below the thoracic inlet. Feeding tube terminates at the antropyloric region.Cardiac silhouette size is normal. Interval improvement in bibasilar atelectasis. | Interval improvement in bibasilar airspace opacities. |
Generate impression based on findings. | No evidence of acute intra-cranial hemorrhage. A small region of hypoattenuation is now seen along the left middle frontal gyrus compatible with the known ischemic lesion seen on recent MRI. There is no evidence of hemorrhagic conversion. Hypoattenuation within the left basal ganglia compatible with chronic lacunar infarct as well as patchy periventricular hypodensity of age indeterminate small vessel ischemic disease are unchanged. The ventricles and sulci are within normal limits for age. There is no midline shift or mass effect. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.No acute intracranial hemorrhage.2.Hypoattenuation in the left middle frontal gyrus compatible with the known ischemic lesion seen on recent MRI. No evidence of hemorrhagic conversion.3.No significant change in findings of microvascular ischemic disease. |
Generate impression based on findings. | The inner ears appear within normal limits without masses within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. Bilateral 7th and 8th cranial nerves are symmetric in size. No findings to suggest enlarged endolymphatic sac. Mastoid air cells are clear. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. 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. | High-resolution noncontrast MRI of the internal auditory canals demonstrates no masses at the cerebellopontine angles or internal auditory canals. Postgadolinium study may be helpful if there is persistent clinical suspicion of a structural abnormality. |
Generate impression based on findings. | Cough and fever.VIEWS: Chest AP and lateral 1/5/15 at 2003 hrs. (2 view/s) Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening and right lower lobe, ill-defined opacity likely atelectasis or pneumonia. . No effusions or pneumothorax. | Peribronchial thickening and right lower lobe , ill-defined opacity, likely atelectasis or pneumonia. |
Generate impression based on findings. | Female 34 years old Reason: evaluate for stone or other RUQ/R flank etiology for pain History: R flank/abdominal pain, N/V, hx lumbar pain, cholecystectomy ABDOMEN: Within the limits of a non IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: LUNG BASES: 6-mm left lower lobe pulmonary nodule unchanged.LIVER, BILIARY TRACT: Status post cholecystectomy. There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mesenteric fat stranding about the distal descending colon, in the area of previously seen mesenteric fat stranding, which extends mildly more superiorly in location from the prior examination. There are multiple adjacent diverticula as well as diverticula seen more proximally and distally. These findings are consistent with acute diverticulitis. There is no evidence of drainable fluid collection, micro or macro perforation, or pneumoperitoneum.Contrast within the distal esophagus may reflect gastroesophageal reflux. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBONES, SOFT TISSUES: Orthopedic rod and screw fixation hardware evident in the lower thoracic spine. | Findings consistent with uncomplicated diverticulitis affecting the descending colon, in the same region as seen previously affected by diverticulitis. |
Generate impression based on findings. | Seven month old patient with osteopenia and rising alkaline phosphatase. Rule out long bone fractures. Known rickets.VIEWS: Right humerus AP, left humerus AP, right forearm AP, left forearm AP, right femur AP, left femur AP, right tibia/fibula AP, left tibia/fibula AP (8 views), 1/5/2014, 1533 hrs. Continued healing of a right humerus mid diaphyseal fracture as well as fractures of the right distal radius and ulna. Healing fracture of the left humerus. Bowing deformity of the left ulna is noted. Corner fracture of the left proximal left tibia is present. Diffuse periosteal reaction of the long bones may be physiologic. Fraying and cupping of the metaphyses of the distal left ulna/radius, distal right femur, left femur, and left tibia/fibula. | Metaphyseal corner fracture of the left proximal tibia. Healing fractures of the right humerus, radius, and ulna, as well as left humerus. Stigmata of rickets. |
Generate impression based on findings. | 73-year-old female with history of possible small cell lung cancer, left neck mass and left axillary lymphadenopathy. Additionally, retroperitoneal and abdominal lymphadenopathy were noted on outside hospital scans. Currently with abdominal pain. LUNGS AND PLEURA: No significant pleural effusion or consolidation. Minimal dependent atelectasis. No suspicious masses.MEDIASTINUM AND HILA: Cardiac size normal limits, no pericardial effusion. Moderate coronary artery calcifications. Right chest single lumen Port-A-Cath tip is in the SVC.CHEST WALL: Extensive bulky lymphadenopathy, with areas of central necrosis, spanning from the left neck base (beyond the superior margin this exam), left axilla/chest wall, to the retroperitoneum/abdomen. A few mediastinal and hilar calcified lymph nodes. No significant mediastinal lymphadenopathy. A reference left axillary lymph node (8024/31) measures approximately 25 mm in the short axis. The left axillary vasculature is displaced by these lymph node conglomerations, but not significantly narrowed.Minimal degenerative changes affect the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Extensive upper abdominal retroperitoneal lymphadenopathy, with areas of central necrosis. This will be further described on the abdomen portion of today's exam. Left renal cyst partially visualized. | Left neck base, left axillary and abdominal/retroperitoneal lymphadenopathy, most consistent with malignancy such as lymphoma. |
Generate impression based on findings. | 67-year-old male with newly diagnosed gastric cancer. Evaluate extent of disease. CHEST:LUNGS AND PLEURA: No significant pulmonary parenchymal or pleural abnormality. Minimal basilar atelectasis.MEDIASTINUM AND HILA: There is an 1.1 x 0.9 cm para-esophageal lymph node. No additional suspicious mediastinal or hilar lymphadenopathy. Normal cardiac size without pericardial effusion. No significant coronary calcifications.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: The liver is decreased in attenuation, suggesting diffuse fatty infiltration. Segment 4A subcentimeter hypodense lesion is too small to characterize, but favor benign etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are bilateral simple fluid attenuating renal lesions, compatible with benign cysts. Additional subcentimeter lesions are too small to characterize, but favor benign etiology. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy. Minimal atherosclerotic calcification of the abdominal aorta. There is a 1.9 x 1.8 cm left internal iliac artery aneurysm.BOWEL, MESENTERY: There is focal soft tissue attenuating thickening with an ulcerative appearance of the gastric antrum, which may represent the patient's known primary malignancy. There are small adjacent perigastric lymph nodes, measuring approximately 5 mm, which are suspicious for local metastatic lymphadenopathy given their close proximity to the presumed primary malignancy. The bowel is normal caliber.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 | 1. Focal thickening and ulcerative appearance of the gastric antrum presumably represents the patient's known primary malignancy. Very small adjacent perigastric lymph nodes are suspicious for local metastatic lymphadenopathy.2. Left paraesophageal 1.1 cm lymph node may represent more distant metastatic lymphadenopathy. PET/CT may be helpful in further characterizing this finding.3. Diffuse fatty infiltration of the liver. |
Generate impression based on findings. | There is mild ex vacuo dilatation of the left frontal horn along the medial aspect, due to an area of focal encephalomalacia is hyperintense marginal gliosis in the centrum semiovale extending to the ventricular margin. The ventricles and sulci are otherwise within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. 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, the cerebellar tonsils are in normal position, without crowding of the foramen magnum. CSF flow imaging demonstrates normal biphasic flow both ventrally and dorsally along the foramen magnum, along the brainstem and cerebellar tonsils. There is trace mucosal thickening within the sphenoid sinus. | 1. No MR evidence of Chiari malformation. Normal CSF flow.2. Incidental note made of encephalomalacia in the left centrum semiovale extending to the left lateral ventricular margin, with mild ex vacuo dilatation. |
Generate impression based on findings. | 57 years old, Female, Reason: infected pleural fluid, questionable free air History: sob, abdominal pain Lack of IV contrast limits evaluation of abdominal parenchyma. Within these limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Right greater than left effusions which appear increased with associated atelectasis.MEDIASTINUM AND HILA: Mild aneurysmal dilatation of the ascending aorta measuring 3.4 cm. Severe coronary artery calcifications.CHEST WALL: Lipomatous changes in the breasts bilaterally.ABDOMEN:LIVER, BILIARY TRACT: Calcified lesion in the dome of the left liver possibly represents a large granuloma. Numerous hepatic hypoattenuating lesions are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities not well delineated on this noncontrast study. Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches. Right femoral line is again present.BOWEL, MESENTERY: Questionable wall thickening of the anorectal region. Mild thickening versus underdistention of the ascending and transverse colon which is nonspecific especially in the setting of ascites. Previously noted mucosal enhancement is not seen on this noncontrast study. Previously noted foci of air not well visualized on this study.Again seen is a 2.7 x 2.3 fat containing structure which may be extraluminal and could represent a dermoid, unchanged. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Previously noted foci of gas in the soft tissues of the anterior right thigh are no longer present. There are osseous changes consistent with renal osteodystrophy. Degenerative changes of the spine are present. Question of soft tissue ulceration in the perineum with some pooling of enteric contrast, please correlate with physical exam to exclude decubitus ulceration.OTHER: Moderate anasarca and ascites. | 1. Mildly increased pleural effusions and associated atelectasis.2. Questionable bowel wall thickening in the anorectal region as well as mild wall thickening versus underdistention in the ascending and transverse colon which is nonspecific in the setting of ascites.3. Moderate ascites and anasarca.4. Severe atherosclerotic calcifications of the abdominal aorta and its branches.5. Evidence of renal osteodystrophy.6. Question of soft tissue ulceration in the perineum with some pooling of enteric contrast, please correlate with physical exam to exclude decubitus ulceration. |
Generate impression based on findings. | concern for undifferentiated malignancy of lung, staging work up. Prominent left supra-ophthalmic vein with enhancement comparing to that of the right side. Differential diagnosis include dural arteriovenous fistula or normal variation.No evidence of hemorrhagic or ischemic lesion on this scan. No evidence of abnormal enhancement.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 osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. Enlarged left supra-ophthalmic vein as described above, differential diagnosis include dural arteriovenous fistula involving cavernous sinus or normal variation. Clinical correlation is recommended and diagnostic angiography can be considered for further evaluation.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. No evidence of abnormal enhancement. 4. Normal brain MRA |
Generate impression based on findings. | 78-year-old male with history of cough and shortness of breath. Evaluate for interstitial lung disease. Fibrosis noted on outside exam. LUNGS AND PLEURA: Subpleural reticulation with mild bronchiectasis and minimal architectural distortion, particularly in the subpleural lower lungs. No definite honeycombing, no significant air trapping and no significant groundglass opacities. Small right pleural effusion. MEDIASTINUM AND HILA: No significant pericardial effusion. Heart size within normal limits. Moderate coronary artery calcifications. Scattered small lymph nodes are seen throughout the mediastinum and hila.CHEST WALL: Extensive degenerative changes affect the spine, including bridging anterior osteophytes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right upper quadrant cholecystectomy clips. | Predominantly lower lung, subpleural mild fibrosis in a pattern of possible UIP/IPF, less likely hypersensitivity pneumonitis. |
Generate impression based on findings. | 86 years old, Female, Reason: abdominal pain Lack of IV contrast limits evaluation of abdominal parenchyma. ABDOMEN:LUNG BASES: Increasing bilateral pleural effusions and associated atelectasis. Cardiomegaly is present with a small pericardial effusion.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: Atherosclerotic calcifications of the abdominal aorta and iliac vessels.BOWEL, MESENTERY: Evidence of pancolitis with bowel wall thickening essentially the entire colon, may reflect pseudomembranous colitis. Circumferential bowel wall thickening particularly pronounced at the level of the rectum. No definite evidence of pneumatosis or free air.BONES, SOFT TISSUES: Degenerative changes of the spine present, most severe at the level of L4-L5 where there is grade 1 anterolisthesis.OTHER: Diffuse anasarca and small amount of ascites.PELVIS: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 noted | 1.Pancolitis, appearance may be seen in setting of pseudomembranous colitis and correlation with patient's clinical history recommended.2.Increasing bilateral pleural effusions and associated atelectasis.3.Anasarca and small amount of ascites. |
Generate impression based on findings. | Reason: Evaluate for progression of metastatic disease; compare to previous scan History: None CHEST:LUNGS AND PLEURA: No significant change of bilateral perihilar scarring, architectural distortion, and bronchiectasis.Redemonstration of postsurgical changes in the left lower lobe.No new nodule/mass.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. Reference prevascular lymph node is stable, measuring 16 mm (series 3, image 30).No new significant lymphadenopathy.Moderate coronary artery calcifications.CHEST WALL: No significant axillary lymphadenopathy.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered calcifications unchanged.SPLEEN: Unchanged scattered calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications 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: Marked degenerative disease of the lumbar spine. Thickening of the ligamentum flavum at the L4/L5 level is producing central spinal stenosis.OTHER: No significant abnormality noted. | Stable perihilar scarring and architectural distortion, as well as postsurgical changes in the left lower lobe. No new nodule/mass. No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 6-week-old female with pleural effusion status post chest tube and octreotide. Evaluate pleural effusions.VIEW: Chest AP (one view) 1/6/2015, 0900 hrs. ET tube tip between the thoracic inlet and carina. Enteric tube tip beyond the field of view. Left upper extremity PICC tip at the confluence of the brachiocephalic veins. Left chest tube unchanged in position.Multifocal pulmonary opacities appear similar to the previous exam, likely atelectasis. Moderate left and probable right pleural effusions are present, increased on left. Normal cardiac silhouette size. | Increased left pleural effusion. Persistent multifocal pulmonary opacities. |
Generate impression based on findings. | Ms. Choco is a 59 year old female who presents for routine imaging. No new breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There are scattered calcifications seen in both breasts, all of which have a benign appearance. In particular, a grouping of calcifications in the left lower inner breast is unchanged from multiple prior exams. Stable benign asymmetries are present in both breasts. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable benign calcifications in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 81 years old Reason: evaluate for perirectal abscess History: large sacral decubitus ulcer, infection UTERUS, ADNEXA: The patient status post hysterectomy.BLADDER: There is a Foley catheter in place.LYMPH NODES: There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There is fat stranding affecting the presacral fat as well as the medial left gluteal cleft, with an associated gaseous tract extending from the skin surface to the coccyx as well as gaseous foci in the right gluteal area medially as well. There are erosive changes of the coccyx, concerning for osteomyelitis. No drainable fluid collection is evident. Subcutaneous emphysema of the anterior abdominal wall likely secondary to subcutaneous injections. | Sacral decubitus ulceration with associated cellulitis and a gaseous tract extending from the left gluteal cleft to the coccyx, with erosive changes of the coccyx concerning for osteomyelitis, medial right gluteal gaseous foci also seen. No drainable fluid collection is evident. |
Generate impression based on findings. | Female, 69 years old, history of adenoid cystic carcinoma of the right submandibular gland, status post CRT. Evidence of right neck dissection is redemonstrated with absence of the submandibular gland, volume loss and scarring along the fascial planes. Ill-defined soft tissue thickening persists within the right submandibular resection bed appearing smaller to the prior examination. No new lesions are detected.The remaining visualized salivary glands are unremarkable. The right lobe of the thyroid is absent. The left lobe contains a heterogeneous nodule which has not significantly changed. No pathologic adenopathy is detected in the neck by size criteria. The cervical arterial vessels enhance normally. The right IJ vein is of small caliber above the level of the thyroid bed.Pulmonary nodules are demonstrated which seem slightly larger, but this has been better evaluated on dedicated chest imaging.No concerning or destructive osseous lesions are seen. Small scattered sclerotic foci in the vertebral bodies are unchanged and nonspecific. | No evidence of locally recurrent tumor or nodal metastasis. |
Generate impression based on findings. | 61-year-old with history of calcified intraductal mass noted on prior mammogram and ultrasound. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a mixed echogenicity mass measuring 11 x 3 mm in the retroareolar region with increased vascularity, The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, four 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. Specimen radiograph did not demonstrate calcifications within the specimens. Two specimens sank to the bottom of the prefilled container of 10% formalin while one partially sank, and one floated. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral posteroinferior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe and van Beek. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 60 years old Reason: bowel obstruction History: hx of ventral incision site hernia after prior appendectomy. Now presenting with pain over hernia site, 3 days of black tarry stool, black emesis episodes. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse hepatic hypoattenuation consistent with hepatic steatosis.SPLEEN: Punctate intraparenchymal calcifications suggest prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 6-mm hyperattenuating focus in the inferior pole of the right kidney may represent a nonobstructing renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There are postsurgical changes related to a ventral hernia repair. There is a rounded fluid collection with a thickened wall in the subcutaneous fat anterior to the ventral hernia repair, which demonstrates fat stranding around its periphery and is worrisome for an abscess, although this may also represent a postoperative seroma. | 1.Fluid collection with thickened wall and adjacent fat stranding anterior to the ventral hernia repair concerning for an abscess, although this could also represent a postoperative seroma. Correlation with patient's clinical history and physical exam recommended.2.Hepatic steatosis. |
Generate impression based on findings. | 72-year-old male with testicular swelling and pain since last night. The examination was suboptimal and limited due to the patient's discomfort during the examination.RIGHT TESTIS: The right testicle is normal in morphology, echogenicity and size, measuring 3.5 x 2.3 x 4.3 cm. Spectral Doppler evaluation demonstrates normal arterial blood flow.LEFT TESTIS: The left testicle measures 3.2 x 3.0 x 5.1 cm without a discrete lesion. On side-by-side comparison color Doppler demonstrates left testicular and epididymal hyperemia. The left testicle is mildly hypoechoic relative to the right. Spectral Doppler demonstrates arterial blood flow to the left testicle.RIGHT EPIDIDYMIS: The right epididymis is normal in morphology and size.LEFT EPIDIDYMIS: The left epididymal head and tail appear slightly enlarged and hyperemic relative to the right as noted above.OTHER: No significant abnormalities noted. | Limited examination as described above with findings favoring left epididymoorchitis. No evidence of testicular torsion. |
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