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Generate impression based on findings. | History of liver transplant and immunosuppression with new fevers, evaluate for source of infection. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions with associated compressive atelectasis/consolidation.MEDIASTINUM AND HILA: Endotracheal tube with tip terminating just above the carina.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post orthotopic liver transplant. There is a 2.7 x 3.9 cm (image 74, series 4) heterogenous hypoattenuation in the posterior aspect of the right hepatic lobe, favor benign post-operative lesion. There are additional foci of hypoattenuation in the anterior right hepatic lobe and subcapsular left hepatic lobe which may also be post procedural in etiology. Posterior perihepatic fluid is present with suggestion of small hematocrit effect and is likely postsurgical. A drain is present in this collection. Again noted is attenuation and nonocclusive thrombus of the native portal vein with opacification of the transplant liver portal venous branches. SPLEEN: Splenomegaly and splenic varices again noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A nonobstructive right renal stone is present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large lesser sac post-operative hematoma (image 14, series 4) measuring 18.7 x 9.7 cm. There is additional small volume ascites. An enteric feeding tube in place with the tip terminating in the antrum of the stomach.BONES, SOFT TISSUES: Marked body wall edema. Postsurgical defect of the anterior right abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Gas within the bladder may be postprocedural.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a large lesser sac post-operative hematoma (image 14, series 4) measuring 18.7 x 9.7 cm. There is additional small volume ascites.BONES, SOFT TISSUES: Marked body wall edema. Postsurgical defect of the anterior right abdominal wall.OTHER: No significant abnormality noted | 1.Postsurgical changes of liver transplant.2.Large lesser sac postsurgical hematoma.3.Posthepatic loculated fluid collection, favor postoperative etiology.4.Attenuation and nonocclusive thrombus of the native portal vein with contrast opacification of the transplant portal vein branches. |
Generate impression based on findings. | 26-year-old male, dropped weight on great toe There is a bicondylar fracture of the head of the proximal phalanx of the great toe with intra-articular extension. The fracture fragments are in near anatomic alignment. Orthopedic screws are present in the talus and distal tibia. There may be partial subtalar joint fusion, but this is equivocal. | Nondisplaced, intra-articular fracture the head of the proximal phalanx of the great toe. |
Generate impression based on findings. | Male 3 months old; Reason: PCVC placement VIEW: Chest AP and abdomen AP (two views) 1/1/14 1228 Enteric tube tip is at the GE junction. The right lower extremity PICC tip is at the L3 level. The ET tube has been removed.The mediastinum remains right shifted. Otherwise, the cardiothymic silhouette is normal.Coarse bilateral lung opacities with innumerable round lucencies persist. No focal lung opacities are present.Multiple healing rib fractures are again noted.The bowel gas pattern is disorganized and nonobstructive. No pneumatosis, portal venous gas, or pneumoperitoneum is present. A faint serpiginous opacity projecting over the right hemiabdomen is likely external. The inguinal hernia is partially imaged. | RLE PICC tip at the L3 level. Unchanged PIE. |
Generate impression based on findings. | 38-year-old female with pain, evaluate for fracture Mild to moderate osteoarthritis affects the hip. We see no evidence of fracture. | Osteoarthritis without fracture evident. |
Generate impression based on findings. | 92 year-old female with abnormality of her pain post fall Ankle: Soft tissue swelling about the ankle without fracture evident. Knee: There is a comminuted fracture of the patella with fracture fragments in near anatomic alignment. A small joint effusion is noted. Mild to moderate osteoarthritis affects the knee. | Comminuted, nondisplaced patella fracture. |
Generate impression based on findings. | Female 37 years old; Reason: Evaluate for progression of ileus, r/o free air History: severe C. diff, abdominal distension Gastrostomy tube projects over the stomach. Additional findings including lines/catheters essentially stable from prior study. Bowel gas pattern and distribution of enteric contrast without significant change. Stable osseous structures. No large amount of free air. | No large amount of free air. Note that supine radiographs are insensitive for detection of small amounts of free air.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 28 short female with pain and tenderness to palpation over foot and ankle Ankle: A small density dorsal to the head of the talus could represent a small avulsion fracture, although we are uncertain whether this is acute or chronic. No additional fractures are evident. There may be a small joint effusion.Foot: We again see a small density dorsal to the head of the talus which could represent a small avulsion fracture of uncertain chronicity. A bipartite medial sesamoid is present, representing normal variant anatomy. | Small density dorsal to the head of the talus, which may represent an avulsion fracture of uncertain chronicity. |
Generate impression based on findings. | Fall on face. Suspected nasal fracture. There is a right nasal bone fracture with posterior angulation of the fracture fragment and overlying soft tissue swelling. No other fractures are identified. The lamina papyracea are intact. The orbits are unremarkable. There is mild mucosal thickening of the maxillary sinuses. The mastoid air cells are clear. There are numerous dental caries and periapical lucencies, most predominantly affecting the bilateral molars. There are multiple subcentimeter cervical lymph nodes. There are multilevel degenerative changes of the cervical spine. A hypoattenuating right thyroid nodule is partially imaged and is better seen on the prior CT cervical spine. | 1. Right nasal bone fracture with overlying soft tissues edema. 2. Multifocal periodontal disease with numerous dental caries and periapical lucencies. 3. Minimal mucosal thickening of the maxillary sinuses. 4. Hypoattenuating right thyroid nodule; ultrasound may be considered for further evaluation. |
Generate impression based on findings. | 78-year-old female with shortness of breath. PULMONARY ARTERIES: Note is made of multiple filling defects in segmental branches of the right lower lobe, consistent with pulmonary emboli. The main pulmonary artery, measures 3.2 cm in diameter, suggestive of pulmonary artery hypertension. There is reflux of contrast into the hepatic veins which is nonspecific but can be seen in increased right heart pressures.LUNGS AND PLEURA: Scattered bilateral peripheral ground glass opacities may represent infection or scarring. There are large bilateral pleural effusions, right greater than left, with underlying atelectasis/consolidation. No evidence of pneumothorax. Scattered pulmonary nodules, some of which are calcified, suggestive of prior granulomatous disease. Right apical scarring/atelectasis.MEDIASTINUM AND HILA: Vascular calcifications of the aorta and its branches. No pericardial effusion. Moderate coronary artery calcifications.CHEST WALL: Hemangioma of the T9 vertebral body. Multilevel degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. High attenuation material in the stomach likely represents oral contrast/ingested material. | 1. Multiple filling defects in the segmental branches of the right lower lobe consistent with pulmonary emboli. Dilation of the main pulmonary artery is suggestive of pulmonary artery hypertension. 2. Large bilateral pleural effusions with underlying atelectasis/consolidation. PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Segmental.RV Strain: Negative. |
Generate impression based on findings. | Female 6 years old; Reason: r/o fx History: knee painVIEWS: Left knee AP/oblique/lateral (3 views) 1/1/15 No fracture or malalignment is present. A small knee joint effusion is noted. | Small joint effusion, without fracture. |
Generate impression based on findings. | Female 6 years old Reason: post reduction History: wrist pain and splintVIEWS: Right wrist AP and lateral 1/1/15 (two views) Last material obscures fine bone details. Distal radius Salter-Harris two fracture is in anatomic alignment. | Distal radius Salter-Harris two fracture in anatomic alignment after casting. |
Generate impression based on findings. | Female 6 years old Reason: r/o fracture History: distal forearm pain and swellingVIEWS: Right elbow and wrist AP, lateral and oblique. Right forearm AP and lateral 1/1/15 (8 views) There is a minimally displaced Salter-Harris two fracture of the distal radius. Normal right elbow. | Minimally displaced distal Salter-Harris two fracture of the radius. |
Generate impression based on findings. | Hypoxia, chest pain. PULMONARY ARTERIES: No evidence of pulmonary embolism. No pulmonary artery enlargement.LUNGS AND PLEURA: Diffuse bilateral predominantly perihilar and apical groundglass opacities with central distribution. Small left and trace right pleural effusion with underlying left lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Normal sized heart with a moderate to large pericardial effusion. An enlarged right hilar lymph node measures 1.7 x 1.2 mm (series 12, image 98). The previously described prevascular mediastinal tissue/thymic rebound is not clearly delineated due to pericardial effusion.CHEST WALL: Right central venous catheter tip at the superior cavoatrial junction. Left central venous catheter tip in the SVC.UPPER ABDOMEN: No significant abnormality noted. Please see separate abdomen CT report for further evaluation. | 1. No evidence of pulmonary embolism.2. Diffuse bilateral ground glass opacities. The differential for this appearance includes atypical infection, early acute edema, or GVHD. 3. Moderate to large pericardial effusion. |
Generate impression based on findings. | History of extensive rectovaginal fistula repair now with persistent leukocytosis, evaluate for sources of infection or leak ABDOMEN:LUNG BASES: Bilateral pleural effusions. Please see chest CT from same day for full description.LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval placement of percutaneous right nephrostomy tube. Bilateral nephroureteral stents remain in place. There is new minimal left hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Pelvic hematoma anterior to the bladder again present (series 13, image 115) measuring 11 x 10 cm, similar to prior. Postsurgical findings related to subtotal colectomy and right lower quadrant end ileostomy without evidence of bowel obstruction.BONES, SOFT TISSUES: Moderate body wall edema. Post-surgical changes to anterior abdominal wall. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: Foley catheter present in decompressed bladder. Postoperative reimplantation right ureter. Previously described urethral defect cannot be evaluated due to lack of contrast instillation within the bladder and urethra.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Pelvic hematoma anterior to the bladder again present (series 13, image 115) measuring 11 x 10 cm, similar to prior. Postsurgical findings related to subtotal colectomy and right lower quadrant end ileostomy without evidence of bowel obstruction.BONES, SOFT TISSUES: Moderate body wall edema. Post-surgical changes to anterior abdominal wall. OTHER: No significant abnormality noted | 1.Pelvic hematoma, similar to prior. No evidence of abscess.2.Interval placement of right percutaneous nephrostomy tube. New minimal left hydronephrosis.3.Please see chest CT from same day for chest findings. |
Generate impression based on findings. | 35-year-old female status post fall Knee: An ossicle within the intracondylar notch appears to represent a well corticated loose body and is unlikely to represent an acute fracture. An additional well corticated ossicle is present along the lateral joint. Moderate osteoarthritis affects the knee. No joint effusion.Hip: Moderate osteoarthritis affects the hip. No fracture is evident.Shoulder: No fracture is evident. Mild osteoarthritis affects the glenohumeral joint. | Degenerative arthritic changes and findings suggestive of old trauma without acute fracture evident. |
Generate impression based on findings. | 46 years old, Female, Reason: h/o reccurent C.Diff diarrhea with fecal transplant in 12/'14 now presenting with constipation; r/o obtsruction History: constipation Lack of IV contrast limits the evaluation of abdominal parenchyma. Within these limitations following observations are made:ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is severely atrophic. There is severe cortical thinning, hydronephrosis, and hydroureter on the left side, chronic in etiology and not significant change from prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild right-sided colonic wall thickening with adjacent stranding, and fascial thickening, which may represent colitis. However the bowel is under distended, which limits evaluation of the bowel wall. No evidence of obstruction, or pneumatosis. Small amount of free air is favored to be iatrogenic secondary to peritoneal dialysis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peritoneal dialysis catheter in place with a moderate volume of ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See abdomen section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of pelvic ascites, slightly decreased from prior exam. | 1.Mild thickening of the proximal colon may represent colitis.2.Moderate amount of ascites. |
Generate impression based on findings. | There is no midline shift or mass effect. There is no evidence of acute intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with age-indeterminate small vessel ischemic changes. The ventricles and sulci are prominent, consistent with cerebral volume loss. There is a partially empty sella. There are vascular calcifications in the anterior and posterior circulations. The imaged portions of the paranasal sinuses and mastoids and middle ears are grossly clear. There is debris within the right external auditory canal, which likely represents cerumen. There are degenerative changes involving the left temporomandibular joint. | 1. No evidence of acute intracranial hemorrhage. 2. Mild age-related parenchymal volume loss and age-indeterminate small vessel ischemic changes. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended, assuming there are no contraindications for this modality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 10 years old Reason: post intubation History: status epilepticusVIEW: Chest AP (one view) 1/1/15 ET tube tip is below the thoracic inlet. NG tube terminates at the antropyloric region. Right IJ central line tip is at the RA/SVC junction. 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. | No focal opacities. |
Generate impression based on findings. | Male 9 years old Reason: rule out fracture History: injury and lacerationVIEWS: Left hand AP and left fourth digit lateral and oblique 1/1/15 (3 views) Partial amputation of the soft tissues and distal phalanx of the fourth finger with comminuted fracture. | Comminuted fracture and partial amputation of the distal phalanx of the left forth finger. |
Generate impression based on findings. | Concern for brain metastases. Right sided tremors/visual disturbance. There is a new mass in the left frontal lobe that measures up to 18 mm with surrounding mild vasogenic edema, adjacent to an areas of encehaplomaalcia. There is also a new mass within the right cerebellar hemisphere that measures up to 20 mm with surrounding mild vasogenic edema. 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. | New mass lesions within the left frontal lobe and right cerebellar hemisphere are compatible with metastases.Discussed with Dr. Nabhan at 8:30 AM on 1/2/15. |
Generate impression based on findings. | 22-year-old female with bite to index finger DIP There is irregularity of the soft tissue along the tip of the index finger with loss of the nail compatible with stated history of bite injury. No fracture is evident Note is made of negative ulnar variance. | Soft tissue and nail injury without fracture or dislocation. |
Generate impression based on findings. | 79-year-old with new calcifications noted on screening mammogram. No current breast complaints. Mediolateral and spot magnification CC and mediolateral 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. Redemonstration of two groups of calcifications within the upper outer breast, 9 o'clock radian. These calcifications were new on the most recent screening mammogram and ones located more posteriorly have an irregular morphology. No suspicious mass lesion or architectural distortion is noted. | New grouped irregular calcifications in the right upper outer breast as described. Further evaluation with stereotactic biopsy is recommended for the calcifications located posteriorly.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Abdominal pain after bariatric surgery ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Multiple nonobstructing subcentimeter right renal stones.RETROPERITONEUM, LYMPH NODES: Vena caval filterBOWEL, MESENTERY: Status post gastric bypass surgery. Unremarkable bowel without evidence for acute inflammation or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post gastric bypass without evidence for acute bowel inflammation or obstruction. Nonobstructing right nephrolithiasis.Fatty infiltration of the liver. |
Generate impression based on findings. | Female 12 years old Reason: rule out fracture History: bony TTP, lateral malleolusVIEWS: Left ankle AP, lateral and oblique 1/2/15 (3 views) Soft tissue swelling with no malalignment or monitoring diffusion or fracture. | Soft tissue swelling, no fracture. |
Generate impression based on findings. | Possible stroke. Question of CVA and fracture. Head: There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the maxillary sinuses. The mastoid air cells are clear. There is posterior angulation of the right nasal bone with overlying soft tissue edema. Aerated secretions are noted throughout the right nasal cavity.Cervical spine:There is no evidence of fracture. There is mild straightening of the normal cervical lordosis. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. There is mild multi-level cervical spondylosis with anterior disc-osteophyte complexes. There is no prevertebral soft tissue swelling. The airway is patent. There is a 1 cm hypoattenuating right thyroid nodule. | 1. No acute intracranial hemorrhage.2. Mild degenerative changes of the cervical spine without fracture. 3. Right nasal bone fracture with overlying soft tissue edema.4. Hypoattenuating right thyroid nodule; ultrasound may be considered for further evaluation. |
Generate impression based on findings. | 46-year-old female with swelling and pain of left first through third digits There is soft tissue swelling along the dorsum of the hand extending along the thumb, index, and middle fingers. No subcutaneous gas or radiographic evidence of osteomyelitis or gout is evident. Mild osteoarthritis affects the basilar joint. | Soft tissue swelling without radiographic evidence of osteomyelitis, subcutaneous gas or gout. |
Generate impression based on findings. | Male 0 days old Reason: post-intubation tube placement History: intubated for respiratory distress, 36 weekerVIEW: Chest and abdomen AP (two views) 1/2/15 at 636 hours Umbilical line terminates at the IVC. ET tube tip is at the thoracic inlet. NG tube terminates at the stomach. R. Cardiac silhouette size is normal. Bilateral diffuse lung haziness right greater than left with no effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval ET tube placement and repositioning of umbilical line as described.Persistent diffuse lung haziness consistent with TTN or RDS.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | History left lower quadrant pain and fever, evaluate for diverticulitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral mild/moderate hydronephrosis with abrupt transition at the ureteropelvic junctions. Nonobstructive left renal stones. RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes of uncertain etiology and significance.BOWEL, MESENTERY: New small foci of intraperitoneal free air. There is fat stranding about the proximal sigmoid colon which has slightly improved. Again present are two air and fluid containing pericolonic collections, the most superior measuring approximately 2.6 x 2.6 cm (image 106, series 3), and the more inferior of which measuring 2.5 x 3.2 cm (image 113, series 3). These findings are again consistent with intramural abscesses. There is diverticulosis of the remaining colon. The appendix is visualized and unremarkable. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: Mildly prominent retroperitoneal lymph nodes of uncertain etiology and significance.BOWEL, MESENTERY: New small foci of intraperitoneal free air. There is fat stranding about the proximal sigmoid colon which has slightly improved. Again present are two air and fluid containing pericolonic collections, the most superior measuring approximately 2.6 x 2.6 cm (image 106, series 3), and the more inferior of which measuring 2.5 x 3.2 cm (image 113, series 3). These findings are again consistent with intramural abscesses. There is diverticulosis of the remaining colon. The appendix is visualized and unremarkable. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Redemonstration of diverticulitis of the sigmoid colon with intramural abscesses. Overall surrounding inflammation has slightly improved, but new small amount of free air suggests abscess perforation.2.Left nonobstructive nephrolithiasis. Bilateral mild/moderate hydronephrosis with abrupt transition at the UPJ.Findings discussed by on-call resident Dr. Padella via telephone at 20:57 1/1/2015. |
Generate impression based on findings. | Reason: 42F with ESRD on peritoneal dialysis, POD2 s/p bilateral nephrectomies for suspicious renal lesions, now with dyspnea and tachycardia History: dyspnea and tachycardia, please assess for PE PULMONARY ARTERIES: Technically adequate study. No evidence of pulmonary embolism.The main pulmonary artery is of normal caliber.LUNGS AND PLEURA: Small bilateral pleural effusions with associated compressive atelectasis.Previously described left lower lobe nodule is obscured secondary to effusion and atelectasis.MEDIASTINUM AND HILA: Heart size is upper limits of normal, without significant pericardial effusion. No evidence of significant right heart strain.Mild coronary artery calcifications.No significant hilar/mediastinal lymphadenopathy.CHEST WALL: Mild degenerative disease spine. Prominent, but not enlarged bilateral axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Persistent mild dilatation of the gallbladder, without evidence of acute cholecystitis.There has been interval increase in the volume of intra-abdominal ascites, which may be related to peritoneal dialysis/post operative.Stable appearance of innumerable splenic granulomas.Status post bilateral nephrectomy. Multiple foci of air in the peritoneum and retroperitoneum may be postsurgical in nature.Layering and loculated hyperdense fluid collections in the retroperitoneum with internal areas of stranding suggests retroperitoneal hematoma in the surgical bed. | 1. Technically adequate study without evidence of pulmonary embolism.2. Bilateral pleural effusions with associated compressive atelectasis.3. Status post bilateral nephrectomy; layered hyperdense fluid collections within the retroperitoneum suggests hematomas within the surgical beds.4. Multiple foci of air in the peritoneum, retroperitoneum, and anterior abdominal wall is likely postsurgical.5. Interval increase in the volume of ascites.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 0 days old Reason: r/o pneumonia History: increased wobVIEW: Chest and abdomen AP (two views) 1/2/15 at 234 hours. UVC tip is at the confluence of the right IJ and the right subclavian vein. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Diffuse lung haziness. No focal lung opacities. No effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced UVC.Bilateral diffuse lung haziness consistent with TTN versus RDS.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | There is artifact from dental amalgam. Within this limitation, there is periapical lucency at ADA 29 with adjacent cortical dehiscence. There is overlying soft tissue swelling and fat stranding without discrete fluid collections. There is no significant lymphadenopathy in the upper neck. The salivary glands are unremarkable. The paranasal sinuses and mastoid air cells and middle ears are grossly clear. The orbits are unremarkable. The partially imaged brain is unremarkable. | Periodontal disease at ADA 29 with cortical dehiscence and overlying cellulitis, but no discrete abscess, although the assessment is limited by dental amalgam artifact. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 0 days old Reason: position of UVC? History: Pulled back UVCVIEW: Chest and abdomen AP (two views) 1/2/15 at 647 hours UVC terminates at the the umbilical vein. Likely instrumental portal venous gas is again noted.Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | UVC with positioning as described. Persistent, likely instrumental portal venous gas. |
Generate impression based on findings. | 69 year old female with metastatic colon cancer and profound new bilateral lower extremity edema. Evaluate the patency of the inferior vena cava. LIVER: The liver is markedly heterogeneous in echotexture with numerous predominantly hyperechoic mass lesions, consistent with the patient's known metastatic disease as seen on the recent comparison CT.INFERIOR VENA CAVA: Grayscale, color Doppler, and spectral Doppler was performed of the visualized inferior vena cava. The visualized portions of the infrahepatic and intrahepatic portions of the inferior vena cava appear patent.OTHER: A right pleural effusion is noted. | 1. The visualized portions of the inferior vena cava appear patent. If there is concern for lower extremity DVT, dedicated sonography recommended.2. Right pleural effusion. 3. Known diffuse metastatic disease of the liver. |
Generate impression based on findings. | History appendiceal carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post resection of appendiceal mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post resection of appendiceal mass. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Male 0 days old Reason: evaluate lung fields, line placement History: increased work of breathing, uvc placementVIEW: Abdomen and chest AP (one view) 1/2/15 UVC terminates at the right portal vein., Likely instrumental portal venous gas is noted.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 abdominal gas pattern. No evidence of obstruction or free air. Pneumatosis intestinalis. No ascites. | Misplaced UVC with portal venous gas likely related to the procedure of UVC placement. |
Generate impression based on findings. | Altered mental status with cirrhosis. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. There is an unchanged focus of ossification near the midline of the tentorial cerebelli. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull appears unremarkable. There is an unchanged nonspecific subcentimeter skin excrescence along the right parietal scalp. There are bilateral lens implants. | No evidence of acute intracranial hemorrhage. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct or encephalopathy. |
Generate impression based on findings. | Male 2 years old Reason: infiltrate? History: trach dependent with fever, coughVIEW: Chest AP (one view) 1/2/15 at 450 hours. Tracheostomy tube terminates below the thoracic inlet. PDA clip again noted. Omphalocele/gastroschises again noted. Cardiac silhouette size is normal. Interval development of left upper and lower lobe opacities, likely atelectasis or pneumonia. | Multifocal opacities development as described. |
Generate impression based on findings. | 60 year old male with metastatic thyroid cancer. Please evaluate for bone metastases prior to treatment. There is increased radiotracer uptake consistent with a left frontal skull lesion. There is also subtle increased radiotracer uptake in the left scapula, left ischium and left iliac consistent with multiple osseous metastatic lesions better seen on F-18 NaF PET Bone scan from the same day.Degenerative changes of the bilateral acromioclavicular joints and bilateral knees are noted. Left scrotal hydrocele is present. | Multiple osseous metastatic lesions better characterized on concurrent F-18 NaF PET Bone scan. |
Generate impression based on findings. | 84 years old, Female, Reason: Diverticulitis? History: LLQ abdominal pain ABDOMEN:LUNG BASES: Small calcified nodule no superior aspect of the left lower lobe likely sequela of prior granulomatous disease. Left calcified hilar lymph nodes also likely sequela of prior granulomatous disease. Severe coronary artery calcifications are present. Multiple cardiac leads visualized.LIVER, BILIARY TRACT: Intrahepatic biliary ductal dilatation, which appears to extend to the pancreatic head, without associated pancreatic ductal dilatation. No obstructing mass or stone is identified. Evidence of prior cholecystectomy. This is favored to represent chronic biliary disease however if further imaging is clinically warranted recommend MRCP to further evaluate.Multiple hypoattenuating lesions in the hepatic parenchyma, some of which are too small to characterize however the largest of which measures fluid density and likely represents a cyst.SPLEEN: Scattered splenic granulomata, likely sequela of prior granulomatous disease.PANCREAS: No pancreatic ductal dilatation. Mild pancreatic atrophy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Significant calcification of the abdominal aorta and its branches. There is calcification at the ostia of the celiac, SMA, and renal arteries. The SMA, IMA, celiac axis and renal arteries appear patent.BOWEL, MESENTERY: No evidence of obstruction. No inflammatory changes to suggest diverticulitis. No bowel wall edema, pneumatosis, or free air. There are two narrow necked fat-containing ventral hernia. The more superior fat-containing ventral hernia has a small adjacent inflammatory changes. The inferior narrow neck fat-containing ventral hernia appears periumbilical, is smaller, and does not have any adjacent fluid collection or fatty haziness.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes of the lumbar spine with narrowing of the space and vacuum phenomenon.OTHER: No significant abnormality noted | 1.Intra-hepatic and extrahepatic hepatic biliary ductal dilatation without associated pancreatic ductal dilatation and no obstructing stone or mass identified. This is favored to represent chronic biliary disease however if further imaging is clinically warranted MRCP may be helpful for further evaluation.2.Two fat-containing ventral hernias.3.Evidence of prior granulomatous disease. |
Generate impression based on findings. | History of colon cancer now with abdominal distention, evaluate for obstruction. ABDOMEN:LUNG BASES: Enlarged cardiophrenic lymph node.LIVER, BILIARY TRACT: Diffuse bilobar, confluent hepatic metastases are present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is marked gastric distention as well as marked dilation of the entire small bowel which measures up to 5.5 cm in diameter. There is also moderate distention of the right colon. The transverse colon is filled with air and stool. The descending colon has a more normal caliber, but there is a masslike transition point (image 173, series 4) at the origin of the sigmoid colon. These findings are consistent with distal obstruction due to colonic mass. Moderate ascites.BONES, SOFT TISSUES: Mild body wall edema.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is marked gastric distention as well as marked dilation of the entire small bowel which measures up to 5.5 cm in diameter. There is also moderate distention of the right colon. The transverse colon is filled with air and stool. The descending colon has a more normal caliber, but there is a masslike transition point (image 173, series 4) at the origin of the sigmoid colon. These findings are consistent with distal obstruction due to colonic mass. Moderate ascites.BONES, SOFT TISSUES: Mild body wall edema.OTHER: No significant abnormality noted | Distal partial bowel obstruction secondary to colon cancer. Diffuse metastatic disease. |
Generate impression based on findings. | known left PCA territorial ischemic infarction, further investigation for underlying vascular lesion. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 50% of luminal narrowings on the right MCA M1 segment and left MCA M1 segments with additional less than 50% luminal narrowings on bilateral MCA branches and luminal irregularities.Bilateral PCAs' P2 segments also showed luminal irregularities.Thus, combining anterior and posterior circulations' findings indicate intracranial atherosclerotic changes.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origins is normal but the right vertebral artery origin appears to have less than 50% luminal narrowing. However, the degree of stenosis cannot be precisely measured on MRA. If necessary, CTA can be considered for further evaluation. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. Multifocal luminal narrowings and irregularities on both anterior and posterior circulations indicating intracranial atherosclerosis. 2. Mild luminal narrowing on the right vertebral artery origin, otherwise not significant on extracranial cervico-carotid arterial system. |
Generate impression based on findings. | There is straightening of the normal cervical lordosis which may be secondary to patient positioning or muscle spasm. No acute fracture or subluxation. The prevertebral soft tissues are within normal limits. The airway is patent. There are scattered mildly enlarged cervical lymph nodes. | 1.No acute fracture or subluxation.2.Scattered mildly enlarged cervical lymph nodes are nonspecific. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of thyroid cancer and esophageal cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on a scar overlying the right axilla. A right axillary mass is stable, previously demonstrated to represent a superficial skin lesion by ultrasound. Arterial calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable right axillary mass. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 77-year-old history of IDC/DCIS in the left breast status post lumpectomy in 2003 and radiation. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear scar markers overlie the right central upper and left lower inner breast. Stable postsurgical architectural distortion and dystrophic calcifications are present in the left lower inner quadrant. Scattered benign calcifications are present bilaterally.No new masses or suspicious microcalcifications are present in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 18 years old; Reason: 18 y/o F with acute onset L flank pain, h/o lymphoma, day +28 s/p BMT, eval for stone vs PE History: acute onset L flank pain, hypoxia, SOB Please note that evaluation for solid organ pathology is limited by lack of IV contrast.ABDOMEN: LUNG BASES: Bilateral ground glass opacities. Small bilateral pleural effusions, left greater than right with underlying subsegmental atelectasis. Moderate to large pericardial effusion. Please see separate chest CT report from the same day for further evaluation.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 radiopaque renal or ureteral stones are evident. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy by CT size criteria.BOWEL, MESENTERY: No significant abnormality noted. No evidence of obstruction. No associated fluid collections.BONES, SOFT TISSUES: Mild subcutaneous edema in the lower back, likely due to recumbent position.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No evidence of obstruction. No associated fluid collections.BONES, SOFT TISSUES: Mild subcutaneous edema in the lower back, likely due to recumbent position. | 1. No intra-abdominal pathology.2. Bilateral pulmonary opacities, small pleural effusions, and moderate to large pericardial effusion. Please see separate chest CT report from the same day for further evaluation. |
Generate impression based on findings. | 58-year-old male with history of left tonsil mass and muffled voice. Evaluate for peritonsillar abscess. There is a hypoattenuating collection demonstrating peripheral enhancement in the left tonsillar pillar measuring approximately 2.2 x 2.1 x 3.2 cm. This lesion causes narrowing on the adjacent oropharynx although it is patent. There is no evidence of osseous involvement. There is layering debris within the posterior oropharynx. The airway is patent. There is asymmetric effacement of the left piriform sinus, which may be a normal variant or secondary to the aforementioned tonsillar lesion. There is mild mucosal thickening of the lateral maxillary sinuses. There is air in the right jugular vein which is likely iatrogenic. The salivary glands are unremarkable. There is a 5-mm hypoattenuating right thyroid nodule. There are scattered mildly enlarged cervical lymph nodes likely reactive in etiology, however not pathologically enlarged by CT size criteria. | 1.Findings compatible with left peritonsillar abscess as above.2.Nonspecific hypoattenuating nodule in the right thyroid gland. |
Generate impression based on findings. | 66-year-old female with respiratory distress. Rule out PE. PULMONARY ARTERIES: Technically adequate study. Note is made of bilateral filling defects in lobar, segmental and subsegmental branches of the pulmonary arteries in the left upper and right middle lobes consistent with pulmonary emboli. The main pulmonary artery, measures 2.7 cm in diameter. There is no evidence of right heart strain.LUNGS AND PLEURA: There are large bilateral pleural effusions with underlying atelectasis/consolidation. There is a 5-mm groundglass nodule in the right upper lobe (27; series 9). There is an additional 5-mm groundglass nodule in the left upper lobe (21; series 9). There is a 10 mm ground glass nodule in the left upper lobe (51; series 9). Right basilar suture material. Right basal pleural calcifications. Mild apical predominate centrilobular emphysema. MEDIASTINUM AND HILA: Left subclavian catheter tip terminates in the SVC. Severe coronary artery calcification.CHEST WALL: Soft tissue reticulation, most pronounced along the right lateral hemithorax, suggestive of anasarca.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small amount of abdominal ascites. | 1. Multiple pulmonary emboli in the left upper and right middle lobes. 2. Large bilateral pleural effusions with underlying compressive atelectasis/consolidation. Ascites and anasarca. 3. Multiple ground glass nodules in the upper lobes are nonspecific. Follow up examination in 6-12 months to establish resolution is recommended to exclude the possibility of AAH or AIS. PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Negative. |
Generate impression based on findings. | Male 16 days old Reason: PCVC placement History: PCVC placementVIEW: Chest AP (one view) 1/1/15 at 1222 hrs Soft tissue edema and umbilical line unchanged. Misplaced NG tube again noted. ET tube is below thoracic inlet. Interval placement of left upper extremity PICC, tip is at the SVC.Cardiac silhouette size is normal. Persistent right upper lobe atelectasis on the coronal large lung volumes, diffuse lung haziness pattern of PIE. | Interval central line placement as described. |
Generate impression based on findings. | Trauma. Evaluate for intracranial bleed. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles and basal cisterns are normal in size and configuration for the patient's age. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are grossly clear. The skull and scalp soft tissues are unremarkable. There is a right lens implant. | No acute intracranial hemorrhage or other acute intracranial abnormality. |
Generate impression based on findings. | Female 20 years old Reason: 20yo F with history of HgbSS with left shoulder pain eval for AVN VIEWS: Left shoulder AP in internal and external rotation. 1/1/15 (two views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. No evidence of AVN. | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Mammography is most sensitive when evaluating for interval changes. If patient submits outside mammogram, comparison will be made. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Acute respiratory insufficiency.VIEW: Chest AP (one view) 1/1/15 at 1554 hrs. Central line tip is at the right atrium. ET tube tip is below the thoracic inlet. Abdominal clips unchanged. Cardiac silhouette size is normal. Bibasilar patchy opacities, either atelectasis or pneumonia with no effusions or pneumothorax. | Multifocal patchy air space opacities, as described. |
Generate impression based on findings. | Nausea, vomiting, and previous neurosurgery. Question of signs of bleeding. There is no evidence of acute intracranial hemorrhage. Redemonstration of a pituitary mass which is grossly similar in size to the prior MRI. There are postsurgical changes of a prior transphenoidal resection. The surrounding basal cisterns are patent. The ventricles are stable in size. No midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. No acute intracranial hemorrhage.2. Redemonstration of a pituitary mass which is grossly similar in size to the prior MRI; if further evaluation of the pituitary mass is warranted, MRI is a more sensitive means of characterizing changes in size and extent of the lesion. 3. Grossly stable size of the ventricles. |
Generate impression based on findings. | Reason: eval for PE History: tachycardia, hypoxia PULMONARY ARTERIES: Technically adequate study. Bilateral segmental pulmonary emboli (series 5, image 114 and 137). There is no specific evidence of right heart strain. The main pulmonary artery is of normal caliber. LUNGS AND PLEURA: Interval worsening of bilateral pleural effusions with associated compressive atelectasis/consolidation.Persistent ground-glass opacity in the anterior right upper lobe.New focus of dense ground-glass opacity in the right upper lobe (series 6, image 62). Multiple new areas of predominantly apical, subpleural ground glass and air space opacities may be secondary to infection/aspiration.New 5-mm nodular opacity in the left upper lobe also likely secondary to infection (series 6, image 49).No specific evidence to suggest pulmonary infarction/hemorrhage.Basilar bronchial wall thickening is not significantly changed.Stable, mild apical predominant centrilobular and paraseptal emphysema.Layering debris within the trachea.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. No significant hilar/mediastinal lymphadenopathy. Scattered cardiophrenic lymph nodes measuring up to 7 mm in short axis, not significantly changed.Moderate coronary artery calcifications.Right PICC line tip at the cavoatrial junction.Unchanged appearance of partially calcified left thyroid nodule.Scattered calcifications of the thoracic aorta. Eccentric mural foci of hypoattenuation suggestive of thrombus within the thoracic and abdominal aorta.CHEST WALL: Bilateral axillary lymphadenopathy, minimally improved when compared to previous exam.Stable degenerative disease of the spine.Evidence of subcutaneous edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Enteric tube terminates out of field-of-view.Minimal increase in the amount of peritoneal ascites.Unchanged splenomegaly with geographic hypoattenuation, likely related to known splenic infarction.Extensive perigastric and splenic collateral vessels and varices.Cirrhotic morphology of the liver. Previously described geographic areas of hypoattenuation within the liver are not completely characterized on this exam.Incompletely evaluated upper abdominal lymphadenopathy. | 1. Bilateral segmental pulmonary emboli, without specific evidence of right heart strain.2. Interval worsening of bilateral pleural effusions and basilar consolidation/atelectasis.3. Worsening multifocal ground glass and air space opacities suggestive of infection, possibly secondary to aspiration. 4. Evidence of portal hypertension; worsening ascites.5. Splenomegaly and evidence of previous splenic infarction.6. Multiple mural aortic thrombi.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Segmental.RV Strain: Negative. |
Generate impression based on findings. | 35-year-old with history of right benign biopsy presents for follow-up exam. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense, unchanged in pattern and distribution. Percutaneously placed clip is present at upper outer quadrant in the right breast. Stable masses are again seen in both breasts. There is a new circumscribed mass at lower outer quadrant in the left breast. No suspicious microcalsifications or architectural distortions are seen in either breast.Whole bilateral breast ultrasound was performed. Biopsy proven fibroadenoma is again seen at 10 o'clock position measuring 20 x 12 mm. There are 3 more circumscribed hypoechoic masses in the right breast, likely fibroadenomata. In the left breast, there are at least 5 circumscribed hypoechoic masses, consistent with fibroadenomata. One of the masses located at 5 o'clock position corresponds to the new mass seen on the mammogram. There are no suspicious masses in either breast on ultrasound study. | Multiple fibroadenomata in both breasts, without mammographic or sonographic evidence for malignancy. Diagnostic mammogram is recommended in one year for follow-up. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | There 2-3 punctate foci of T2 hyperintensity within right frontal subcortical white matter without associated mass effect, restricted effusion, or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | There 2-3 punctate foci of T2 hyperintensity within right frontal subcortical white matter without associated mass effect, restricted effusion, or susceptibility abnormality. These are nonspecific in appearance, and the differential diagnosis most likely includes residua from prior head trauma, sequelae of migraine headaches, or small vessel disease. Given lesional morphology and locations, demyelination is felt to be unlikely. |
Generate impression based on findings. | Intussusception status-post reductionVIEW: Abdomen AP (one view) 1/1/15 1342 Enteric tube tip in the gastric body.Small amount of residual barium with air in the colon. Disorganized nonobstructive bowel gas pattern. No pneumatosis, pneumoperitoneum, or portal venous gas. | Small amount of residual colonic barium. |
Generate impression based on findings. | 55-year-old female with history of seizure. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage. There is extensive confluent areas of hypoattenuation within the periventricular and subcortical white matter compatible with age indeterminate ischemic small vessel disease. There are chronic lacunar infarcts in bilateral basal ganglia. There is no midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium and scalp are unremarkable. | Extensive age indeterminate ischemic small vessel disease and chronic basal ganglia lacunar infarcts. No evidence of intracranial hemorrhage. |
Generate impression based on findings. | Gunshot woundVIEWS: Left forearm AP/lateral (two views), left humerus AP/lateral (two views), left elbow AP/lateral (two views). 1/1/15 Punctate bullet fragment with subcutaneous emphysema in the posterior distal upper arm. No underlying fracture or malalignment. No elbow joint effusion evident. | No fracture or malalignment. |
Generate impression based on findings. | Distal radius fracture.VIEWS: Left wrist AP, lateral and oblique 1/2/15 (3 views) Cast material obscures fine bone dose. Healing distal fractures of both forearm bones are in near anatomic alignment. | Healing fractures in near-anatomic alignment. |
Generate impression based on findings. | Shortness of breath and tachypneaVIEW: Chest AP (one view) 1/1/15 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal.No focal lung opacities or pleural effusions are present. No pneumothorax is evident.Radiopaque letters projecting across the upper thorax are likely from clothing. | Normal examination. |
Generate impression based on findings. | Female 8 years old; Reason: Wilm's tumor; off therapy LIVER: 13.2 cm in length. Normal hepatic echotexture, without focal lesions. Patent portal vein with hepatopetal flow.GALLBLADDER, BILIARY TRACT: Normal gallbladder. No biliary ductal dilation.PANCREAS: No significant abnormality noted in the visualized head and body.SPLEEN: No significant abnormality noted. 8.2 cm in length.KIDNEYS: Status post left nephrectomy. No soft tissue is present in the left renal fossa. The right kidney is 10.9 cm in length and normal in appearance. ABDOMINAL AORTA: Patent, without significant abnormality noted.INFERIOR VENA CAVA: Patent, without significant abnormality noted.OTHER: The bladder is mildly distended without abnormality. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 54 year old female diagnosed with breast cancer. Evaluate for metastatic disease. No abnormal osseous foci are identified to indicate metastatic disease. A punctate focus of increased radiotracer uptake is visualized at the right glenohumeral joint which likely represents degenerative change. These findings were compared to CT chest from the same day. Degenerative changes are also noted in the acromioclavicular joints bilaterally. | No evidence of bone metastases. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 80 year-old female with metastatic breast cancer. Please reevaluate and compare to prior scans. Multiple foci of increased radiotracer uptake are visualized throughout the axial and appendicular skeleton compatible with diffuse metastatic disease, which is overall slightly progressed compared to previous exam. Specifically, there is slight but significant progression in size and activity including the bilateral ribs, spine, left femur, and pelvis.There is interval development of two benign-appearing fractures in the eighth and ninth posterior right ribs, which correlate with CT findings.Again noted is a cold defect within the right femur consistent with an intra-medullary rod and surrounding increased uptake consistent with postsurgical changes. | 1.Widespread osseous metastatic disease which is slightly progressed. 2.Interval development of two new benign appearing fractures of the right posterior eighth and ninth ribs. |
Generate impression based on findings. | There is mild left proptosis and marked left preseptal soft tissue swelling. There is a comminuted fracture of the left orbital floor that traverses a portion of the infraorbital nerve canal with inferior displacement of the fracture fragments. There is swelling and contour deformity of the left medial and inferior rectus muscles with mild partial herniation of the left inferior rectus muscle and minimal herniation of orbital fat. There is minimal left orbital fat stranding. There is hemorrhage layering within the left maxillary sinus and partial opacification of the left ethmoid air cells. The right orbit appears unremarkable. The dentition and temporomandibular joints appear to be intact. The partially imaged brain is grossly unremarkable. | Comminuted left orbital floor blowout fracture with mild partial herniation of the left inferior rectus muscle and minimal herniation of orbital fat. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | New diagnosis of leukemia Evaluation of the mandible is limited due to inability to optimally position the patient. Specifically, the posterolateral aspect of the left mandibular ramus, left mandibular condyle, and left temporomandibular joint are not visualized on this study. Given this limitation, I see no focal lesions within the mandible. The patient is edentulous. | Limited study showing no focal mandibular lesions. |
Generate impression based on findings. | Status post fusion. Evaluate hardware. Evaluation of the cervicothoracic junction on the lateral views is limited due to overlying anatomy. There is an anterior plate with screws entering the C4 and C5 vertebrae. An intervertebral spacer device is noted between the C4 and C5 vertebral bodies. There are also posterior stabilization rods with screws entering the C3, C4, C5, C6, and T1 vertebrae. I see no hardware complications. Skin staples, a drain, and foci of gas density in the soft tissues reflect recent surgery. Severe degenerative disease affects C5/6 and C6/7. Calcifications lateral to the cervical spine likely reside in the carotid vasculature. | Postoperative changes of cervical fusion as described above. |
Generate impression based on findings. | Female 70 years old; Reason: dysphagia/ hx extensive surgery due to MVA History: dysphagia. Scout radiograph showed cardiomegaly and interstitial opacities which may indicate aspiration.Single contrast barium swallow demonstrated no abnormal contour, stricture or mass in the region of the esophagus. Esophageal motility evaluation revealed abnormal peristalsis with breakup of the primary wave, severe proximal escape and stasis which required water swallow to clear the contrast from the esophagus. No hiatal hernia was noted. Severe spontaneous gastroesophageal reflux was witnessed which also places the patient at risk for aspiration.TOTAL FLUOROSCOPY TIME: 3 minutes and 34 seconds | 1.Severe gastroesophageal reflux up to the thoracic inlet.2.Abnormal esophageal motility with breakup of the primary wave, severe proximal escape and stasis.3. interstitial basilar pulmonary opacities which may indicate aspiration. |
Generate impression based on findings. | Shoulder pain. Evaluate for fracture. The bones are demineralized. I see no fracture. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. There is an os acromiale, a normal variant. There is a dual lumen Port-A-Cath, the distal tip of which is not visualized on this study. | Mild osteoarthritis and other findings as above without fracture evident. |
Generate impression based on findings. | 50 year-old with dense breast tissue and history of cysts noted on prior exams. Annual screening mammogram. No current breast related complaints. MAMMOGRAM: Three standard views of both were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND: Whole breast ultrasound was performed bilaterally. There are multiple cysts in both breasts, but no solid lesions or other abnormal findings. | No mammographic or sonographic 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. | 55 year old female with right upper extremity lymphedema.RADIOPHARMACEUTICAL: The right upper extremity was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected subcutaneously. Following injection, intraoperative probe localization was performed. No images were acquired. | Successful right upper extremity injection for intraoperative identification of lymph nodes for future lymph node transfer. |
Generate impression based on findings. | Male 7 months old Reason: is the trach in correct placement History: new trach , resting at the stress of the newbornVIEW: Chest AP (one view) 1/2/15 at 841 hours NG tube tip is in the stomach. Tracheostomy tube terminates below the thoracic inlet. Cardiac silhouette size is top normal. Persistent large lung volumes and hyperinflation of the right lung, mediastinal shift as well as bibasilar streaky opacities like atelectasis. | No change in lung aeration after tracheostomy tube exchange. |
Generate impression based on findings. | Right thumb injuryVIEWS: Right thumb AP, lateral and oblique 1/2/15 (3 views) Healing Salter-Harris two fracture of the proximal follicles the right thumb is in near-anatomic alignment. | Healing fracture, in near anatomic alignment. |
Generate impression based on findings. | History of finger injury.VIEWS: Right fourth finger AP, lateral and oblique 1/2/15 (3 views) Soft tissue swelling about the PIP joint as well as medial periosteal reaction over the proximal flanks of the fourth digit is noted. Mid phalanx avulsion fracture is healed. | Periosteal reaction and soft tissue stranding as described around the PIP joint.Healed mid phalanx avulsion fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Circumscribed masses in both breasts are most likely intramammary lymph nodes. An ill-defined focal asymmetry is present in the right retroareolar region for which spot compression imaging and possible ultrasound are recommended.No suspicious microcalcifications or areas of architectural distortion are present. | Right focal asymmetry. Spot compression imaging and ultrasound are recommended. As well, patient should submit outside mammogram for comparison.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 41 year old presenting with history of a lump in the left breast upper outer quadrant with associated pain. History of breast cancer in the patient's maternal grandmother. MAMMOGRAM: Three standard views of both breasts along with CC and mediolateral spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A marker over the left upper outer breast in the 2 o'clock radian identifies the site of the patient's palpable abnormality. No underlying lesion is identified on mammography. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND: Targeted ultrasound was performed of the left breast in the region of the patient's palpable abnormality. Physical exam demonstrated a focal area of thickening in the left breast two o'clock position 4 cm from the nipple. Ultrasound of this region showed a focal fat lobule. No suspicious mass lesion is identified. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Male 65 years old; Reason: concern for fistula, bladder to rectum History: fecal material in urine. Scout radiograph demonstrated a nonobstructive bowel gas pattern. Retained contrast in the colon. Large amount of stool, gas and retained contrast projects over the lower pelvis. Upon placement of a Foley catheter, brown urine with fecal material emptied into the Foley tubing and bag. Contrast opacification of the bladder demonstrated a large amount of gas and debris within the bladder indicating probable large amount of fecal material. The posterior wall of the bladder was not visualized secondary to the filling defect. Although no definite fistulous connection was visualized between the bladder and the rectum, a fistula is highly suspected. Multiple outpouching diverticula are noted arising from the inferior bladder.TOTAL FLUOROSCOPY TIME: 3 Minutes and 29 seconds | 1.Brown colored urine with fecal material visualized emptying from the Foley catheter.2.Large filling defect containing gas and debris in the bladder which obscured visualization of the posterior bladder, highly suspicious for feculent material.3.Although no definite fistulous connection was visualized between the bladder and the rectum, a fistula is highly suspected. |
Generate impression based on findings. | 66-year-old male with history of bilateral hydronephrosis and renal failure secondary to urine retention status post TURP, assess for resolution. RIGHT KIDNEY: The right kidney measures 9.4 cm in length without hydronephrosis or shadowing calculus. There is a 1.8 x 2.0 x 1.7 cm simple appearing interpolar cyst with an adjacent several millimeter sized cyst. The renal cortex is mildly echogenic.LEFT KIDNEY: The left kidney measures 9.5 cm in length without hydronephrosis or shadowing calculus. The renal cortex is mildly echogenic. URINARY BLADDER: The bladder contains a small amount of anechoic urine. There is apparent diffuse wall thickening, which may be in part due to only partial distention. A right ureteral jet is identified. The left ureteral jet is not visualized.OTHER: There is lobular enlargement of a heterogeneous prostate. | No evidence of hydronephrosis. |
Generate impression based on findings. | Status post right hemicolectomy with severe neutropenia and fever ABDOMEN:LUNG BASES: New moderate bilateral pleural effusions with associated compressive atelectasis/consolidation. 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: No significant abnormality noted.BOWEL, MESENTERY: There is diffuse dilation of the small bowel measuring up to 6 cm in diameter with an apparent transition point just proximal to the ileocolonic anastomosis after which the large bowel is nearly completely decompressed. These findings are consistent with a distal partial small bowel obstruction. Small volume ascites.BONES, SOFT TISSUES: Marked body wall edema. Postsurgical changes to the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Nodule along the dome of the bladder is nonspecific and may represent a redundant fold.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diffuse dilation of the small bowel measuring up to 6 cm in diameter with an apparent transition point just proximal to the ileocolonic anastomosis after which the large bowel is nearly completely decompressed. These findings are consistent with a distal partial small bowel obstruction. Small volume ascites.BONES, SOFT TISSUES: Marked body wall edema. Lucent lesions with well-defined sclerotic borders within the bilateral femoral heads have a benign appearance.OTHER: No significant abnormality noted | Partial small bowel obstruction with transition point just proximal to the ileocolonic anastomosis. No abscesses. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Round markers were placed on skin lesions overlying both breasts. Arterial calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | There are postoperative findings related to bilateral uncinectomies, ethmoidectomies, and sphenoidotomies. There is new mucosal thickening of the bilateral frontal sinuses, mild on the right and moderate on the left. There is increased near complete opacification of the bilateral anterior ethmoid air cells and partial opacification of the posterior ethmoid cavities. There is increased near complete opacification of the right maxillary sinus and moderate opacification of the left maxillary sinus. There is new mild mucosal thickening of the right sphenoid sinus and minimal mucosal thickening of the left sphenoid sinus. There is mild diffuse thickening and sclerosis of the paranasal sinus walls. There is S-shaped nasal septal deviation. The ethmoid roofs are intact and nearly symmetric. The carotid grooves and optic canals appear to be covered by bone. The orbits and imaged intracranial structures are unremarkable. There is new fluid within the left mastoid air cells and middle ear. | 1. Interval postoperative findings related to endoscopic sinus surgery with overall increased sinonasal opacification, which likely represents acute upon chronic sinusitis and perhaps nasal polyposis.2. New fluid within the left mastoid air cells and middle ear may represent otomastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 13 year old with bilateral clear nipple discharge, presents for ultrasound evaluation. Ultrasound for nipple areola area in both breasts was performed. There are no dilated ducts, solid or cystic lesions in either breast. | No sonographic evidence for malignancy or any abnormal findings. Clinical follow-up is recommended. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal aunt. Two standard digital views and tomosynthesis of both breasts and a cleavage view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round markers were placed on skin lesions overlying the left breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 38-year-old male with hand pain, rule out fracture There is a laceration along the soft tissues of the proximal phalanx of the middle finger. No fracture or foreign body evident. | Laceration without fracture evident. |
Generate impression based on findings. | Female 65 years old; Reason: endometrial cancer with abdominal adenopathy and pulmonary nodules. Compare to outside CT in epic from 10/2014. Please measure using recist criteria History: post 2 cycles of therapy CHEST:LUNGS AND PLEURA: Nonspecific micronodules seen bilaterally. For instance, punctate 2-mm right upper lobe lung nodule, image 63 series 5, stable. Additional anteriorly located left upper lobe 2-mm lung nodule, image 42 series 5, unchanged in size, surrounding small ground glass attenuation improved. Small bibasilar atelectasis and areas of linear scarring, for example, in right upper lobe. No pleural effusion. MEDIASTINUM AND HILA: No enlarged mediastinal, hilar or axillary lymph nodes by size criteria. Reference precarinal lymph node measuring 1.2 x 0.7 cm, image 40 series 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic segment 2 focus, image 82 series 4, measuring simple fluid and most likely a cyst. Cholelithiasis. No secondary signs of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter hypoattenuating focus in left lower renal pole, coronal image 44, too small to characterize. Bilateral extrarenal pelvises suggested.RETROPERITONEUM, LYMPH NODES: Mildly atherosclerotic abdominal aorta. IVC filter present. Mild to moderate retroperitoneal lymphadenopathy. Reference left paraaortic lymph node measures 1.8 x 0.9 cm, image 123 series 4, previously measured 1.3 x 0.7 cm. Ill-defined retroperitoneal soft tissue attenuation also demonstrates mild interval increase in size, measuring approximately 1.7 x 1.2 cm, image 131 series 4, previously measured 1.5 x 1 cm. Subcentimeter upper abdominal/gastrohepatic lymph nodes.BOWEL, MESENTERY: Small hiatal hernia, moderate to large stool burden. Diastasis of rectus abdominis muscles. Small bowel containing ventral abdominal hernia, located eccentrically to the left, defect measures 4 cm in transverse dimension and bowel containing hernia sac measures approximately 6.5 x 2.8 cm on transaxial imaging. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic adenopathy present. Reference left external iliac lymph node, measuring 1.3 x 0.8 cm, image 162 series 4 (lymph node located alongside left ureter, no definite associated ureteral dilatation seen at this time), previously measured 1 x 0.7 cm. Subcentimeter additional pelvic sidewall and inguinal lymph nodes.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. Ventral abdominal subcutaneous emphysema and soft tissue nodularity, likely representing sequela of prior injections. | 1. Retroperitoneal and pelvic adenopathy as above.2. Bilateral pulmonary micronodules, nonspecific. |
Generate impression based on findings. | 77 years old, Male, Reason: staging History: pt with HCC CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, left greater than right with associated compressive atelectasis. Right hilar nodular scarring/atelectasis.MEDIASTINUM AND HILA: Minimally enlarged right paratracheal lymph node.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Extensive confluent bilobar large tumor consistent with bilobar hepatocellular carcinoma measuring 22 cm in greatest dimension (series 4, image 114). There is extensive tumor thrombus occupying the left portal venous system. Moderate amount of perihepatic ascites is present. There are regional metastatic lymph nodes.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Calcifications of the abdominal aorta. Enlarged lymph nodes in the porta hepatis.BOWEL, MESENTERY: Peritoneal nodularity representing metastasis (series 4, image 110).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: See abdomen section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of pelvic ascites. | 1.Confluent bilobar large hepatic tumor consistent with bilobar hepatocellular carcinoma with regional metastatic lymphadenopathy and peritoneal metastasis.2.Moderate amount of ascites present.3.Bilateral pleural effusions, left greater than right. |
Generate impression based on findings. | Male 38 years old; Reason: 38 male with hydrocephalus History: OGT placement Note that the pelvis was not included in the exam. Nonobstructive bowel gas pattern. Interval placement of a orogastric tube which loops in the fundus and terminates in the body of the stomach. IVC filter projects over the T12-L1 level. | Orogastric tube tip in the body of the stomach with the sidehole beyond the gastroesophageal junction. |
Generate impression based on findings. | Abdominal pain, evaluate for ischemic process. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. No free air, free fluid, or bowel obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right adnexal cyst, likely physiologic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No free air, free fluid, or bowel obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute findings to account for patient's pain. |
Generate impression based on findings. | Male 44 years old; Reason: evaluate for dilated loops of bowel, SBO v. ileus v. colitis History: abdominal pain, constipation Nonobstructive bowel gas pattern. Average amount of stool in the colon. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in daughter. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Round marker was placed on a skin lesion overlying the left breast. Arterial calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: evaluate for progression of esophageal cancer History: known esophageal cancer CHEST:LUNGS AND PLEURA: Unchanged left lower lobe scarring and mild bronchiectasis.No suspicious nodule/mass. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA:Heart size is normal without significant pericardial effusion. Moderate coronary artery calcifications.Reference high right paratracheal lymph node measures 8 mm, unchanged (series 3, image 16). Additional smaller regional lymph nodes are stable.Paraesophageal mass/lymph node at the level of the carina measures 13 mm, previously 13 mm (series 3, image 40). Distal esophageal wall thickening consistent with stated history of esophageal cancer and post-treatment change, similar to prior. CHEST WALL: Right chest port tip terminates at the distal SVC.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable appearance of biliary drain terminating in the gallbladder and second portion of the duodenum.SPLEEN: Persistent nonvisualization of the splenic vein, likely chronically occluded.ADRENAL GLANDS: Unchanged left adrenal nodule, measuring 13 x 10 mm (series 3, image 100).KIDNEYS, URETERS: Unchanged right renal cyst.PANCREAS: Stable appearance of pancreatic duct drain with pancreatic tail ductal dilatation. Dense calcifications in the head of the pancreas consistent with history of chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph nodes are essentially unchanged, measuring 19 x 18 millimeters (series 3, image 90). Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Percutaneous gastrostomy tube in expected location.BONES, SOFT TISSUES: Mild degenerative changes of the spine. Stable compression deformity of L2.Foci of gas and hypoattenuation in the anterior abdominal wall likely related to recent injection.OTHER: Multiple perigastric and perisplenic collateral vessels. | Stable appearance of esophageal mass and multiple reference lymph nodes, no new suspicious nodule/mass/lymphadenopathy. |
Generate impression based on findings. | History of MSSA bacteremia and fever, evaluate for abdominal source of infection ABDOMEN:LUNG BASES: Scattered ill-defined pulmonary nodular opacities the largest of which measures approximately 1 cm in the right lower lobe which are probably infectious/inflammatory in etiology but should be followed until resolution to exclude neoplastic process. Coronary artery calcifications.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Subcentimeter right anterior hepatic lobe lesion too small to characterize. Cholelithiasis.SPLEEN: Spleen top normal in size. A splenule is present.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal lower pole subcentimeter lesion too small to characterize. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: Trace ascites is present. No free air or bowel obstruction. BONES, SOFT TISSUES: Degenerative changes affect the visualized thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Trace ascites is present. No free air or bowel obstruction. BONES, SOFT TISSUES: Degenerative changes affect the visualized thoracolumbar spine.OTHER: No significant abnormality noted | 1.Cirrhotic liver morphology and mild ascites. 2.No abscess or abdominal source of infection identified. 3.Ill defined pulmonary nodules may be infectious/inflammatory but should be followed until resolution to exclude neoplastic process.4.Subcentimeter hepatic and renal lesions too small to characterize. |
Generate impression based on findings. | There is no evidence of acute intracranial hemorrhage or mass. There is unchanged mild patchy cerebral white matter hypoattenuation. There is an unchanged small area of hypoattenuation in the right cerebellar hemisphere. The ventricles are normal in size and configuration. There is no midline shift or herniation. There are calcifications in the carotid siphons and right vertebral artery. The mastoid air cells are clear. There is mild mucosal thickening in the left maxillary sinus. There is a new balloon catheter within the right nasal cavity. There is interval removal of the balloon catheter from the left nasal cavity. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants. | No evidence of acute intracranial hemorrhage. Mild patchy cerebral white matter hypoattenuation may represent small vessel ischemic disease and a small area of hypoattenuation in the right cerebellar hemisphere may represent an infarct of indeterminate age. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. If there is continued clinical concern and no contraindications to MR, MRI of the brain is recommended. |
Generate impression based on findings. | Reason: eval for aortic dissection History: s/p PEA arrest, widened mediastinum on CXR LUNGS AND PLEURA: Dense consolidation in both lower lungs and poorly defined nodular opacities in the left upper lobe, consistent with infection and likely aspiration.Small bilateral pleural effusions, greater on the right.MEDIASTINUM AND HILA: Mediastinal widening secondary to diffuse lymphadenopathy and excess fat deposition.Normal aortic caliber with no findings to suggest aortic dissection on this limited nonenhanced scan.Multiple enlarged nodes are present, especially in the upper mediastinum, measuring up to 15 mm in short axis diameter.Enlarged main pulmonary artery measuring 42 mm in diameter, suggestive of pulmonary hypertension.Venous catheter extending to the SVC and ET tube terminating within 2 cm of the carina.Mild coronary artery calcification.No pericardial effusion.CHEST WALL: Degenerative disease and diffuse skeletal sclerosis suggestive of metabolic bone disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis and possible chronic liver disease.Enlarged retroperitoneal lymph nodes measuring up to 13 mm in short axis diameter. | 1. No findings to suggest aortic dissection.2. Extensive bilateral pulmonary consolidation, suggestive of infection and aspiration.3. Pulmonary hypertension.4. Probable metabolic bone disease.5. Mediastinal and retroperitoneal lymphadenopathy of uncertain etiology. |
Generate impression based on findings. | 67-year-old male with history of subdural hematomas. There is redemonstration of a left hemispheric heterogeneous subdural collection measuring 18 mm in maximal coronal dimensions, previously 18 mm (image 42 of series 8021). There is associated mass effect, sulcal effacement, and rightward midline shift of approximately 8 mm, previously 8 mm. Additional smaller subdural hematomas are located in the right frontal and parietal regions measuring 6 mm, not significantly changed. There is no evidence of ischemia. Scattered parenchymal calcifications are present. The basal cisterns are intact. Mild mucosal thickening of the right maxillary sinus. The mastoid air cells are clear. | Persistent bilateral subdural hematomas with associated rightward midline shift without significant interval change. |
Generate impression based on findings. | Metastatic colorectal carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable bilateral thyroid nodulesCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval decrease in size of several of the previous noted bilobar hepatic metastatic lesions. This finding is also associated with interval increase in degree of dystrophic calcification within these metastatic nodules. The reference segment 6 lesion best seen on image 108 of series 4 now measures 5.5 x 4.9 cm; this is in comparison to 7.1 x 6.4 cm on 10/17/2014. The more inferiorly located segment 6 lesion best seen on image 133 of series 4 now measures 1.1 x 0.9 cm; this is in comparison to 1.5 x 1.5 cm on 10/17/2014.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small parastomal nonobstructing hernia again 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. | Interval decrease in size of several of the previously noted bilobar hepatic metastatic lesions. No new metastatic focus. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in half-sister. Two standard digital views and tomosynthesis of both breasts and an additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable arterial calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Cellulitis and abscess of buttock ABDOMEN:LUNG BASES: Normal in appearance.LIVER, BILIARY TRACT: Normal appearance without focal lesions or biliary ductal dilation.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Normal in appearance without focal lesions or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appearing bowel loops. No intra-abdominal fluid collections.BONES, SOFT TISSUES: Ulceration and soft tissue edema over the coccyx. The ulceration extends approximately 1 cm below the skin surface. The soft tissue edema extends down to the coccyx, without osseous erosion to suggest osteomyelitis. No distinct drainable soft tissue fluid collection is evident. The previously described soft tissue lucencies on the radiographs represent focal areas of nonedematous fat.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal appearing bowel loops.BONES, SOFT TISSUES: Ulceration and soft tissue edema over the coccyx. The ulceration extends approximately 1 cm below the skin surface. The soft tissue edema extends down to the coccyx, without osseous erosion to suggest osteomyelitis. No distinct drainable soft tissue fluid collection is evident. The previously described soft tissue lucencies on the radiographs represent focal areas of nonedematous fat. | Ulceration and soft tissue edema over the coccyx, without drainable fluid collection or evidence of osteomyelitis. |