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Generate impression based on medical findings. | Age: 68 yearsGender: MaleReason for Study: Reason: Line position History: As above Tubes and lines unchanged.Stable cardiac mediastinal silhouette.Pleural effusions left greater than right, pulmonary opacities, and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified. | Support devices unchanged. Stable cardiopulmonary appearance. |
Generate impression based on medical findings. | Again seen are postsurgical changes of bifrontal craniotomy for resection of right frontal meningioma. There is unchanged appearance of the encephalomalacia in the right superior frontal gyrus. There is minimal linear enhancement along the medial aspect of the resection cavity compatible with postsurgical change. No findings to suggest residual or recurrent tumor. Focal linear enhancement likely representing a tiny developmental venous anomaly within the right paramedian superior frontal lobe is again incidentally noted and unchanged. No evidence of acute infarct or hemorrhage. No intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Nonspecific foci of T2 hyperintensity are seen involving the globi pallidi which may be related to remote toxic or metabolic injury, but unchanged since earliest available study from 5/31/2011. Brain parenchyma is otherwise unremarkable. | Postsurgical changes of right frontal meningioma resection. No findings to suggest residual or recurrent tumor. |
Generate impression based on medical findings. | Male, 40 years old.Reason: evaluate for TB or nodules History: night sweats, increasing bump to left breast The cardiomediastinal silhouette is upper limits of normal. No focal pulmonary opacity, pleural effusion, or pneumothorax. No cavitary lesions, pleural thickening or calcified granulomas. | No acute cardiopulmonary disease. No evidence of tuberculosis. |
Generate impression based on medical findings. | Female, 29 years old.Reason: eval for pna, effusion History: SOB, CP Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. | No acute cardiopulmonary process on radiography. |
Generate impression based on medical findings. | 36-year-old female with fever tachycardia and hypotension CHEST:LUNGS AND PLEURA: Nonspecific, dependent atelectasis in the lung bases and lower lobes. Bilateral trace pleural effusions.MEDIASTINUM AND HILA: Nonspecific borderline enlarged hilar and mediastinal lymph nodes. An index pretracheal node measures 1.1 x 1.2 cm on image number 29, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Presumed hepatic hemangioma in the posterior segment of the right lobe of the liver is unchanged measuring 3.7 x 2.1 cm in image number 88, series number 3. Mild periportal edema, nonspecificSPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific enlarged portacaval lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of fluid in the pelvis. | Mild periportal edema. Hepatic hemangioma is unchanged.Bilateral small pleural effusions and pericardial effusion.Nonspecific borderline enlarged mediastinal and upper retroperitoneal lymph nodes. |
Generate impression based on medical findings. | Age: 58 yearsGender: FemaleReason for Study: Reason: Pre-op clearance History: same The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions. | No acute cardiopulmonary abnormalities are identified. |
Generate impression based on medical findings. | There are nonspecific foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are favored to represent chronic small vessel ischemic disease. A focus of peripherally increased T2-weighted signal in the left anterior parietal white matter is favored to represent a chronic lacunar infarct. Foci of increased T2 weighted signal in the globi pallidi may be related to prior toxic metabolic or ischemic injury. No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no abnormal enhancement within the brain. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. The visualized paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable. | 1. No evidence of intracranial metastases.2. Additional chronic findings, including mild chronic small vessel ischemic disease, lacunar infarct in the left anterior parietal white matter and areas of T2 hyperintensity in the globi pallidi, which may be related to remote toxic metabolic or ischemic injury. |
Generate impression based on medical findings. | The ventricles and sulci are normal in size. There are scattered foci of T2 hyperintensity within the white matter without associated mass effect. The cerebellar tonsils are in appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There has been previous sinus surgery and opacification is noted throughout all the paranasal sinuses, sparing the sphenoid sinuses. The mastoid air cells demonstrate fluid within a few bilateral dependent air cells. There is no abnormal enhancement within the brain. | 1.Chronic small vessel ischemic disease.2.No masses, mass affect, or midline shift. |
Generate impression based on medical findings. | Male, 50 years old.Assess position of endotracheal tube. ETT and enteric tube unchanged in position.No pneumothorax or signs of CHF. Retrocardiac scarring or atelectasis on the left unchanged. Dependent atelectasis in the right lung similar to most recent previous but improved compared to earlier radiographs.Lung volumes remain low. | No acute change in atelectasis. ETT tip 2 cm above the level of the carina. |
Generate impression based on medical findings. | Postoperative for hernia, cirrhosis with rising LFTs LIVER: Coarse echotexture of the liver consistent with cirrhotic morphology. Liver measures 15.2 cm. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency. Perihepatic fluid/ascites noted which now demonstrates multiple septations and possibly loculated in nature.GALLBLADDER, BILIARY TRACT: Distended gallbladder with sludge and gallstones. Mild gallbladder wall thickening is secondary to the ascites. No intrahepatic biliary ductal dilatation.PANCREAS: Limited evaluation due to overlying bowel gas.RIGHT KIDNEY: Kidneys are mildly echogenic. Right kidney is not well visualized due to overlying bowel gas. Left kidney measures 11.6 cm with a nonobstructing stone in the mid pole which is unchanged from prior study.OTHER: Spleen measures 13 cm, mildly enlarged in size. | Cirrhotic morphology of the liver with portal hypertension mild splenomegaly. Moderate amount of perihepatic ascites which now demonstrates multiple septations and possibly loculated.CholelithiasisMildly echogenic kidneys. Limited evaluation of the right kidney. Nonobstructing left renal calculus. |
Generate impression based on medical findings. | Female, 41 years old.Reason: intubated History: intubated Previously noted right basilar opacities have improved. Lungs are hypoinflated. Persistent left lower lobe opacity likely atelectasis or aspirate.Bilateral venous catheters, endotracheal tube and nasogastric tube are unchanged. | Previously noted right basilar opacities have improved. Lungs are hypoinflated. Persistent left lower lobe opacity likely atelectasis or aspirate. |
Generate impression based on medical findings. | Female, 57 years old.Cough. Unremarkable cardiomediastinal silhouette.Bilateral patchy opacities with bronchial wall thickening, suspicious for infection. | Bilateral opacities with bronchial wall thickening, suspicious for infection. Atypical and viral etiologies should be considered. Pulmonary edema also on the differential diagnosis. |
Generate impression based on medical findings. | Female, 56 years old.Reason: Preop MVR History: Preop MVR Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.Mild chronic interstitial opacities versus artifact, possibly hemosiderin deposition given the history of mitral disease. | No significant abnormality. |
Generate impression based on medical findings. | Age: 67 yearsGender: FemaleReason for Study: Reason: pneumonia History: cough, sob x 1 week, wheezing hx of asthma, sleep apnea The cardiomediastinal silhouette is unremarkable.Minimal left basilar scarring/discoid atelectasis.No focal airspace opacities.No pleural effusions. | No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection. |
Generate impression based on medical findings. | Female, 51 years old.Reason: chest pain, sob History: above No acute cardiopulmonary abnormality. | No acute cardiopulmonary abnormality. |
Generate impression based on medical findings. | Bladder cancer No cardiopulmonary abnormality. Mild pectus deformity, a normal variant | Normal |
Generate impression based on medical findings. | Female, 72 years old.Reason: evaluate lung fields History: shortness of breath with exertion Heart size upper normal.No specific evidence of infection or edema. | No acute abnormality. |
Generate impression based on medical findings. | Reason: eval acute pathology History: leukocytosis Unremarkable cardiac and mediastinal silhouette. Catheter tip in the SVC.Mild basilar scarring but no sign of pneumonia or other acute findings. | No acute abnormalities. |
Generate impression based on medical findings. | Reason: Evaluate for new leukocytosis History: leukocytosis Unremarkable cardiac and mediastinal silhouette. Diffuse interstitial opacity, greater in the upper lobes with a focal nodular component in the right upper lobe measuring approximately 4 cm in maximum diameter.The differential diagnosis includes postinfectious scarring, sarcoidosis and neoplasm.A text page was sent to Dr. Gera at the time of reporting. | Nodular right upper lobe opacity with a differential diagnosis that includes neoplasm. If previous radiographs or CT scans can be obtained from elsewhere for comparison that would be helpful. Unless it resolves promptly, a thoracic CT scan is recommended. |
Generate impression based on medical findings. | Reason: ARDS, intubated History: ARDS, intubated ET tube tip approximately 5 cm above the carina.NG tube tip in the stomach and catheter tip in the SVC.Temperature probe tip in the lower esophagus.Large layered out pleural effusions with underlying opacity compatible with atelectasis and consolidation, not significantly changed. | ET tube in acceptable position. |
Generate impression based on medical findings. | Reason: pain History: pain Five lumbar type vertebral bodies are presumed to be present. There is grade 1 anterolisthesis of L4 on L5. There is slight straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is multilevel loss of intervertebral disc space with endplate degeneration particularly at L2-3 and L5-S1. The conus medullaris on sagittal imaging is intact.There is a combination of disc disease and facet hypertrophy resulting in narrowing of the bilateral neuroforamina at T10-11 and T11-12.T12-L1: There is mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.L2-L3: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in moderate narrowing of the spinal canal, mild narrowing of the left neuroforamen and mild to moderate narrowing of the right neuroforamen. There is also mild bilateral lateral recess stenosis.L3-L4: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in moderate narrowing of the spinal canal and moderate narrowing of the both neuroforamina, right greater than left. There is also moderate bilateral lateral recess stenosis.L4-5: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in severe narrowing of the spinal canal, moderate narrowing of the right neuroforamen and moderate to severe narrowing of the left neuroforamen. There is also severe bilateral lateral recess stenosis.L5-S1: There is asymmetric left annular disc bulge with bilateral lateral osteophytes in addition to facet and ligamentum flavum hypertrophy resulting in mild narrowing of the spinal canal and moderate narrowing of both neuroforamina. Additionally, the bilateral S1 nerve root origins are flattened and compressed. | 1.Multilevel spondylotic changes affect the lumbar spine, most pronounced at L3-4, L4-5 and L5-S1 where there is central stenosis, lateral recess stenosis, and neural foraminal stenosis, as detailed above.2.There is a combination of disc disease and facet hypertrophy resulting in narrowing of the bilateral neuroforamina at T10-11 and T11-12. If the patient has symptoms localized to thoracic spine, a dedicated MRI of the thoracic spine may be of benefit. |
Generate impression based on medical findings. | Female, 27 years old.Reason: OHS History: As above ET tube approximately 2 cm above the carina.No change in appearance of marked cardiomegaly, widened mediastinum and pulmonary edema. | No interval change in the marked cardiomegaly and pulmonary edema |
Generate impression based on medical findings. | Age: 54 yearsGender: MaleReason for Study: Reason: check ETT placement History: intubated ET tube and right IJ venous catheter are unchanged.Decreased lung volumes with stable cardiac enlargement.Basilar opacities are compatible with atelectasis and pleural effusions.No new pulmonary opacities identified. | Support devices unchanged with ET tube tip 5 cm above the carina. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis. |
Generate impression based on medical findings. | Female, 74 years old.Reason: rule out PNA History: rule out pna Moderate cardiomegaly.No specific evidence of infection or edema. | Cardiomegaly, but no acute abnormality. |
Generate impression based on medical findings. | Female 16 years old Reason: MRCP to check bile ducts for abnormalities in view of persistently elevated GGT in patient 15 years post transplant. and no evidence of rejection or autoimmune hepatitis on most recent liver biopsy. History: Elevated GGT. ABDOMEN:LIVER, BILIARY TRACT: Changes related to orthotopic liver transplant. The signal and morphology of the liver is within normal limits. No intrahepatic biliary ductal dilatation is present. No gallbladder is seen. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable subcentimeter cysts are present in both kidneys. Mild prominence of the left renal collecting system. A single varix arises off the left renal vein and extends inferiorly out of the field of view.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of intrahepatic biliary ductal dilatation.2.Surgical changes related to orthotopic liver transplant. |
Generate impression based on medical findings. | Male 64 years old Reason: lvad work up History: lvad workup LIVER:Liver is normal in appearance without evidence of focal hepatic mass. Liver measures 14.3 cm. Main portal vein is patent with normal directional flow and a peak velocity of 33 cm/s.GALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary duct dilatation. Common bile duct measures approximately 4 mm. Small amount of sludge is present within the gallbladder. No evidence of acute inflammation of the gallbladder.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 9.4 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or solid mass. Right kidney measures 11.6 cm. Left kidney measures approximately 10 cm. Superior pole of the left kidney there is a large simple appearing anechoic renal cyst measuring 6.0 x 6.3 cm.ABDOMINAL AORTA: The abdominal aorta is normal with a normal waveform.INFERIOR VENA CAVA: IVC is patent and has a normal waveform.OTHER: Bladder is decompressed around a Foley. | No sonographic abnormality of the visualized abdominal viscera. |
Generate impression based on medical findings. | Female, 72 years old.Concern for aspiration. There are low lung volumes and motion artifact limiting assessment of the lungs. Left basilar discoid atelectasis. No new abnormal focal parenchymal opacities to suggest aspiration pneumonitis, as clinically questioned.Limited assessment for pleural effusions. No pneumothorax.] Enlargement of the cardiac silhouette. Status post median sternotomy and CABG. | Assessment is limited by motion artifact and hypoventilatory projection. Within these limitations, no findings to suggest aspiration pneumonitis or aspiration pneumonia. |
Generate impression based on medical findings. | Male, 79 years old.Shortness of breath. Evaluate volume status. Interval worsening of previously seen right pleural thickening and loculated effusion, now with aeration limited to the right upper lobe. No evidence of pulmonary edema. No left pleural effusion or pneumothorax.Cardiomediastinal silhouette is within normal limits. | Interval worsening of previously seen right pleural thickening and loculated effusion, now with aeration limited to the right upper lobe. No evidence of pulmonary edema. |
Generate impression based on medical findings. | Age: 24 yearsGender: MaleReason for Study: Reason: bilateral lung transplant s.p bilateral chest tube insertion History: hypoxia Status post bilateral lung transplant.New right-sided chest tube has been placed with its tip directed at the apex.New left-sided chest tube identified in the upper thorax with its tip directed medially.Right apical pneumothorax unchanged.Suspected small left apical pneumothorax.Diffuse interstitial and dense airspace opacities, particularly in the left midlung similar in appearance to prior exam.Bilateral pleural effusions redemonstrated.Tracheostomy tube, left central venous catheters, and NG tube unchanged. | Interval placement of new bilateral chest tubes with persistent right pneumothorax and suspected left apical pneumothorax. Extensive pulmonary opacities unchanged.. |
Generate impression based on medical findings. | Reason: pneumothorax History: work of breathing up Persistent small left pneumothorax with the apex of the lung about 2 cm from the chest wall.Left pleural drain in place and basilar opacities suggestive of aspiration pneumonia. | Persistent small left apical pneumothorax. |
Generate impression based on medical findings. | Shortness of breath Left PICC line remains unchanged with tip projected into the proximal SVC. Swan-Ganz removed. Underlying cardiopulmonary appearance similar with grossly clear lungs. Decreased lung volumes with suspected basilar scarring and/or atelectasis. Scattered calcified granuloma throughout in the spleen | Swan-Ganz removed |
Generate impression based on medical findings. | Female, 59 years old.Check for ET tube NG tube tip looped in the stomach. ET tube approximately 3 cm from the carina. Worsening trend of diffuse pulmonary opacities. Stable cardiomediastinal silhouette. | Worsening trend of diffuse pulmonary opacities consistent with multifocal pneumonia. |
Generate impression based on medical findings. | 65 year old male with a history of multiple arrhythmias including non-sustained ventricular tachycardia and frequent PVCs, supraventricular tachycardia, and paroxysmal atrial fibrillation who is referred for cardiac MRI for further evaluation.MEDICATIONS: Atenolol and Aspirin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifact is noted at stress and rest. Viability/ Myocardial ScarThere is evidence of mid-myocardial late gadolinium enhancement in the basal inferior and inferolateral, basal anteroseptum, and apical right ventricular insertion site. These patterns are not typical for prior myocardial infarction and suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 244 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 34 g/m2, and the LV mass is 66 g. There is global hypokinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 245 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. 3. The left ventricle is moderately dilated with low normal systolic function (LVEF 52%) and evidence of myocardial fibrosis, inflammation, or infiltration as described above. 4. The right ventricle is mildly dilated with normal systolic function (RVEF 56%).5. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Female, 60 years old.Reason: Need CXR to interpret V/Q scan No focal lung consolidation or evidence of overt left-sided heart failure. Probable nipple shadow overlies the left lower hemithorax. Unchanged cardiomegaly. Small right pleural effusion. No pneumothorax. | Small right pleural effusion.Probable nipple shadow overlies the left lower hemithorax. |
Generate impression based on medical findings. | Reassess lung fields assess for pulmonary edema or new infiltrate. Metastatic prostate CA, CHF, concern for pneumonitis which improved with steroids now with acutely worsened hypoxia. Motion artifact. Low lung volumes. Left subclavian ICD unchanged. Coarse interstitial opacities and volume loss in the bases with peripheral fibrotic appearing opacities in the lung periphery bilaterally. | Limited assessment of the interstitial abnormality due to motion artifact, but no conclusive acute change allowing for differences in inspiration compared to the prior study. |
Generate impression based on medical findings. | Reason: smoker with chronic cough History: chronic cough in a smoker Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease. | No significant abnormalities. |
Generate impression based on medical findings. | 61-year-old male patient with left foot wound and elevated CRP/ESR. Evaluate for osteomyelitis. The first toe is amputated through the metatarsophalangeal joint. The second and third toes are amputated through the proximal phalanges. There are foci of signal void in the soft tissues at the amputation sites, which may be postsurgical in etiology.There is thickening of the skin along the undersurface of the head of the second metatarsal with replacement of subcutaneous fat with intermediate signal intensity, likely representing a combination of granulation tissue and edema. There is also focal irregularity of the plantar skin surface more proximally with underlying signal abnormality. These skin abnormalities may represent sites of ulceration. There is a flattening of the second metatarsal head with abnormal low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging as well as mild enhancement following gadolinium administration. While we cannot exclude osteomyelitis (likely chronic given the radiographic appearance), this could represent sequelae of chronic mechanical trauma, similar to that seen in Freiberg's infraction as described in the prior radiograph report, as we see no sinus tract leading to the bone. There is also abnormal signal intensity in the second metatarsal diaphysis more proximally. While this is nonspecific, we suspect this is degenerative in etiology as there are osteoarthritic changes in the tarsometatarsal joints that have progressed compared to prior MRI. This finding raise the possibility of early neuropathic arthropathy. We see no evidence of osteomyelitis in the remaining metatarsals, phalanges, or sesamoid bones. There is atrophy of the musculature of the foot and edema type signal within the musculature on fluid sensitive sequences, which is not uncommon in diabetic patients. There are no fluid collections to suggest abscess. | Abnormal signal intensity and flattening of the second metatarsal head as described above. While we cannot exclude osteomyelitis (likely chronic given the radiographic appearance), these findings could represent sequelae of chronic mechanical trauma, similar to that seen in Freiberg's infraction, as we see no sinus tract leading to the bone. |
Generate impression based on medical findings. | Reason: Fever; PNA or other cause for fever? History: Fever Unremarkable cardiac and mediastinal silhouette. Coarse basilar interstitial opacities, unchanged since previous radiographs, suggestive of bronchiectasis and fibrosis, possibly related to recurrent aspiration. | Chronic basilar opacities which raise the question of recurrent aspiration, but no specific evidence of pneumonia. |
Generate impression based on medical findings. | Chest pain, sickle cell disease Extensive osseous stigmata related to known sickle cell disease. Cholecystectomy clips and an unchanged right subclavian single port.Cardiopulmonary appearance is significant for persistent decreased volumes with new mixed interstitial and minimally nodular airspace opacities greater both bases mixed with atelectasis/scarring. Concern for superimposed vascular congestion without evidence of superimposed focal airspace abnormalities to suggest pneumonia. No effusions | Osseous and vascular changes related to sickle cell disease without superimposed findings to suggest infection. |
Generate impression based on medical findings. | Female, 21 years old.Reason: sickle cell, SOB History: see above No specific findings of acute chest syndrome. No pleural effusion or pneumothorax. No focal pulmonary opacities. Cardiac mediastinal silhouette is within normal limits. Right chest port terminates in the SVC. | No acute cardiopulmonary abnormality or findings to suggest acute chest syndrome. |
Generate impression based on medical findings. | Nausea with vomiting, unspecified [R11.2], Reason for Study: ^Reason: NSCLC mets to brain with bulky dz and hz of radiation (last in 12/2015), now with intractable nausea/vomiting History: nausea/vomiting There are significant interval decrease in size as well as the extent of surrounding edema of all previously seen intra axial enhancing lesions since prior scan including the right corpus callosum splenium lesion and multiple left cerebellar hemispheric lesions.Those lesions demonstrate susceptibility artifacts indicating the nature of those lesions contain internal hemorrhages. No evidence of acute ischemic or hemorrhagic lesion. There is no evidence of new enhancing lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The left frontal sinus shows fluid collections.Bilateral mastoid air cells demonstrate fluid collections. | 1. Interval decrease in size and the extent of surrounding edema on previously seen intra axial metastatic lesions since prior scan indicating interval improvement.2. No new metastatic lesion is found.3. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on medical findings. | Chiari, status post decompression, syrinx, worsening head and neck pain. Brain: There are postoperative findings related to Chiari decompression surgery and fourth ventricular stenting. There is kinking of the cervicomedullary junction posteriorly towards the overlying dura, which appears similar as on the prior exam. There is flow of cerebrospinal fluid across the neo-foramen magnum anteriorly, but not posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There are 13 thoracic vertebrae. There is residual trace prominence of the thoracic spinal cord central canal. The conus medullaris is positioned at the lower L1 level. There are postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with residual punctate T1 hyperintensity at the L1-2 level and linear T1 hyperintensity extending from the L3-L4 level to the distal end of the thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild degenerative spondylosis involving the lower lumbar spine, but no significant spinal canal stenosis. | 1. Postoperative findings related to Chiari decompression with kinking of the cervicomedullary junction posteriorly towards the overlying dura, which may secondary to adhesion formation.2. Trace residual thoracic syrinx. 3. Postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with the conus medullaris positioned at the lower L1 level. 4. Nonspecific partially empty sella. |
Generate impression based on medical findings. | 62-year-old male with metastatic prostate cancer, restage disease. CHEST:LUNGS AND PLEURA: Mild bilateral lower lobe subpleural fibrosis is again seen and slightly improved. No suspicious nodules, masses, or pleural effusion are visualized. MEDIASTINUM AND HILA: Reference node in the aortopulmonary window measures 1.1 cm x 0.5 cm (image 32, series 3). The other prominent lymph nodes in the mediastinum are not significantly changed in size or appearance. Heart size is normal without pericardial effusion.CHEST WALL: Right chest with tip is in the SVC. Sclerotic metastatic disease of the axial skeleton and 6th thoracic rib is again seen and not significantly changed. Correlate progression of bone disease with the recently ordered bone scan. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis is again seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts are again seen without change.RETROPERITONEUM, LYMPH NODES: Hazy ill-defined soft tissue densities seen in the aortocaval space and adjacent to the common iliac vessels are again seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic sclerotic changes of the lumbar spine are noted. Compression of the L3 vertebra is unchanged.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post bilateral orchiectomyBLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter nodes and ill defined soft tissue haziness adjacent to the common iliac vessels is again seen and unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic sclerotic changes of the lumbar spine are noted. Compression of the L3 vertebra is unchanged.OTHER: No other significant abnormality noted. | No significant change in appearance of the metastatic bone changes and prominent lymph nodes as described above. Correlate bone findings with recently ordered bone scan. |
Generate impression based on medical findings. | Neurofibromatosis type I. Evaluate myelomeningocele status post repair, thoracic dural ectasia, yearly follow-up. Susceptibility artifact from spinal hardware limits evaluation for possible signal abnormalities in the spinal cord. There are postoperative findings related to attempted myelomeningocele obliteration and scoliosis fixation with stabilizing rods and laminar hooks with unchanged moderate levo thoracic scoliosis. There is a fluid collection enclosed by an expanded thecal sac that extends into the right thoracic cavity via expanded right T2-3 through T6-7 neural foramina. The fluid collection appears to be unchanged in size, measuring up to 13 x 5.3 x 8 cm (CC x AP x TR), previously 12.6 x 5.3 x 7.9 cm. The thoracic spinal cord is incompletely visualized; however, there is suggestion of the thoracic spinal cord extending extraspinally into the medial aspect of the fluid collection. There is stable associated mass effect on the right lung and the esophagus. There is unchanged scalloping of multiple thoracic vertebral bodies without loss of height. The portions of the spinal cord that are not obscured by artifact display normal signal characteristics. There is no evidence of mass lesions. The cerebellar tonsils appear to be mildly low-lying, which is unchanged. | Susceptibility artifact somewhat limits evaluation; however, there is no gross interval change in the right thoracic myelomeningocele. Other stigmata of neurofibromatosis 1 and associated postoperative findings are unchanged. |
Generate impression based on medical findings. | Female, 68 years old.Reason: mets small cell lung cancer,. s/p R thoracentesis on Monday, c/o increased SOB, pls evaluate effusion. History: increased SOB Enlarging right pleural effusion with right basilar consolidation.Unchanged small left pleural effusion.No significant pneumothorax.Right jugular catheter, tip in SVC. | No pneumothorax following right thoracentesis. |
Generate impression based on medical findings. | Male, 58 years old.Reason: eval for new infiltrate History: neutropenic fever Interval placement of right central venous catheter with tip in projection of superior vena cava. No pneumothorax.Heart size normal.Lungs clear. | Central venous catheter. No pneumothorax.No evidence of infection or edema. |
Generate impression based on medical findings. | 52-year-old male presents for evaluation of a Swan-Ganz and an intra-aortic balloon pump. Swan-Ganz catheter has its tip overlying the right main pulmonary artery. An intra-aortic balloon pump marker projects approximately 6.7 cm below the top of the aortic arch. An ICD overlies the left chest wall has its leads superimposing the right atrium, right ventricular apex, and coronary sinus.The cardiomediastinal silhouette is normal. Diffuse interstitial opacities are without substantial change. Left lower lobe patchy opacities suggestive of aspirated secretions and atelectasis. Right upper lobe opacity nonspecific and may correlate to a prior opacity seen on outside CT chest dated 03/17/16. Recommend follow up chest radiograph. No large pleural effusion. No pneumothorax. Diffuse bronchial wall thickening is chronic. | 1.Swan-Ganz and intra-aortic balloon pump as described above.2.Right upper lobe opacity indeterminate but may been present previously and could be enlarging. Recommend follow-up chest radiographs to assess for improvement/resolution and exclude possibility of neoplastic process.3.Probable acute on chronic bronchitis with aspirated or retained secretions bilaterally and patchy atelectasis in the left lung base.Paged Dr. Abdulrahman Dia at the time of dictation to discuss findings. |
Generate impression based on medical findings. | Female, 67 years old.Reason: evaluate for pneumonia History: cough, chest pressure, sob Increased opacification in the medial right lung base, difficult to distinctly delineated on lateral view. Postsurgical changes in the left hemithorax are unchanged. Unchanged heart size. No new pleural effusion or pneumothorax. No acute bony abnormality. Mild spinal curvature again noted. | Increased opacification medial right lung base, consistent with aspiration, pneumonia, or atelectasis. Chest radiograph follow-up in 8 weeks after treatment is suggested. |
Generate impression based on medical findings. | 40 year-old male with history of colon cancer, status post resection. Liver metastases, jaundice. CHEST:LUNGS AND PLEURA: Interval development of bilateral numerous parenchymal metastases. Previously mentioned right middle lobe nodule now measures 2.9 x 2.1-cm image number 51/106.MEDIASTINUM AND HILA: Subcarinal adenopathy measuring 1.6 by 1.3-cm image number 46/226.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in the liver. Large lesion in the right lobe measures 8.5 x 5.6 cm image number 90/226. Significant intrahepatic biliary dilatation. Common bile duct is completely decompressed. The level of obstruction is at the Klatskin point by an opacity hepatic lesion, and/or adenopathy.Main portal vein and left portal vein are patent. However right anterior and right posterior portal vein branches are diminutive and likely invaded by the ill-defined mass at the hepatic hilum.There are two percutaneous likely biliary drainage catheters in the right lobe. The intrahepatic biliary tree in the posterior segment of the right lobe is decompressed however biliary tree and anterior segment of the right lobe and left lobe are significantly dilated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Paraceliac, hepatic hilar, left para-aortic adenopathy. There efferents note in the left para-aortic region measures 11 x 11 mm image number 137.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative changes involving the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval progression of disease with increase in number and size of the lung metastases. New hepatic metastases and intrahepatic biliary dilatation as described above. Retroperitoneal adenopathy. |
Generate impression based on medical findings. | Reason: why does she have labored breathing? History: above Diffuse severe nonspecific bilateral air space opacity compatible with edema, infection or hemorrhage, with a moderately large left pleural effusion and possibly a smaller effusion on the right.Catheter tip in the SVC. | Markedly increased diffuse severe airspace opacity compatible with edema, infection, and/or hemorrhage. |
Generate impression based on medical findings. | Male, 72 years old.Reason: IABP placement check History: ADHF Interval placement of an intra-aortic balloon pump which terminates in the proximal descending thoracic aorta. A femoral Swan-Ganz catheter has also been placed with mild redundancy in the subvalvular RVOT and terminating in the proximal descending left pulmonary artery. This has been repositioned on subsequent radiograph. External defibrillator pads and right axillary stent remain in place.Stable cardiomegaly. Slight increased perihilar opacities favoring edema with small pleural effusions. No pneumothorax. | Successful placement intra-aortic balloon pump. Femoral Swan-Ganz catheter terminates in a left descending pulmonary artery, repositioned on subsequent radiographs. |
Generate impression based on medical findings. | 58-year-old male with metastatic esophageal cancer and persistent pleural effusions, question esophageal fistula. CHEST:LUNGS AND PLEURA: Interval decrease in size of a small non-loculated left effusion with persistent left basilar consolidation/atelectasis. Left chest tube tip terminates near the left apex within the effusion. Minimal amount of pleural air adjacent to chest tube. Highattenuating pleural fluid dependently on left, possible hemorrhage. Small right effusion persists with interval decrease in consolidation/atelectasis in the right base. Multiple scattered focal ground glass lesions in the periphery of the right lung, likely atelectasis/aspiration.MEDIASTINUM AND HILA: Interval placement of additional esophageal stents with fluid within the stents. Stents now extending from just below the thoracic inlet to the gastric body. No definite evidence of esophageal fistula. Tracheostomy tube tip with adjacent fluid within the trachea. Extensive coronary artery calcifications.CHEST WALL: Left chest port with tip in the SVC. ABDOMEN: Solid organ evaluation is limited by lack of intravenous contrast.LIVER, BILIARY TRACT: Gallbladder is prominent.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, similar to prior.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate/severe degeneration of the lumbar spine. L5/S1 laminectomy.OTHER: No significant abnormality noted. | 1) Left chest tube tip directed toward the left apex with a now small, non-loculated left pleural effusion with small amount of pleural hemorrhage. Left basilar atelectasis/consolidation persists.2) Persistent right small effusion with decreased basilar consolidation.3) Esophageal stents extend from just below the thoracic inlet to the gastric body. |
Generate impression based on medical findings. | Ms. Finlay is a 62 year old female with a personal history of right breast biopsy in 2007 for LCIS and left breast biopsy in 2007 for ALH. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Stable hepatic cysts. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Corresponding to the area of abnormal signal predominantly in the L4 vertebral body posteriorly extending into the left pedicle, there is prominent stippled enhancement. More ill-defined enhancement also involves the superior endplate of L5 on the left, also extending into the left pedicle. There is severe disk space narrowing at this level with enhancement within the posterior disk space on the left side, as well as along the left facet. No definite associated paravertebral or epidural soft tissue mass is identified. Concurrent left hip MRI images demonstrate mild ill-defined T2 hyperintensity and enhancement extending into the left paraspinal soft tissues. No other areas of abnormal enhancement are seen.Correlation with previous PET/CT demonstrates a prominent sclerotic area involving this portion of the L4 vertebral body with extra vertebral bone formation extending along the left anterolateral aspect. There is a small focal lucency along the very left lateral aspect of the posterior L4 vertebral body. Severe bilateral facet arthropathy is noted at L4-L5. There is also a prominent left lateral osteophyte at L5-S1. Review of the outside PET/CT images demonstrates and oval area of increased uptake along the left L5 level, although not beyond the confines of the vertebral body.There is redemonstration of a large nonenhancing partially visualized cyst off the lower pole the left kidney. There are additional partially exophytic lesions of both kidneys, some of which demonstrate intrinsic T1 hyperintensity suggestive of blood products, especially as there is some layering. | Corresponding enhancement involving the left posterior L4 vertebral body and to a lesser degree the left L5 superior endplate extending into the left pedicles, in areas of previously noted abnormal signal. Given severe degenerative changes and lack of epidural/paravertebral soft tissue, findings are more favored to represent severe degenerative changes with adjacent reactive changes rather than metastatic disease or infection. However, outside PET/CT demonstrates a small area of corresponding increased uptake along the left L5 vertebral body in addition to corresponding significant sclerosis and osteophyte formation. Biopsy is recommended for further evaluation, to exclude metastatic involvement. Bone scan could also be considered to evaluate for other osseous metastatic disease. |
Generate impression based on medical findings. | Male, 67 years old.Swan placement. Right jugular Swan-Ganz catheter and IABP marker unchanged in position.A radiopaque device which may reflect a catheter hub projects over the left lower thorax but is of unclear etiology.Moderate interstitial edema. No pneumothorax. | No significant change in cardiopulmonary appearance. Moderate CHF. |
Generate impression based on medical findings. | Female, 72 years old.Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices Moderate right and small left apical pneumothoraces are stable.Unchanged pneumomediastinum.Extensive soft tissue emphysema has significantly worsened.Stable lower lung zone opacities consisting of edema, right base consolidation and pleural effusions.Right jugular catheter, tip in SVC. | Stable pneumothoraces and pneumomediastinum, but increased soft tissue emphysema. Stable pulmonary opacities. |
Generate impression based on medical findings. | Female, 78 years old.Reason: CTICU History: Daily CXR Chest tubes postop with no pneumothorax.Unchanged left basilar consolidation with enlarging pleural effusions.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter, tip in right ventricular outflow tract. | Enlarging pleural effusions with persistent left lower lobe consolidation. Unchanged support devices except for a new Dobbhoff tube. |
Generate impression based on medical findings. | Female, 37 years old.Reason: 37yo F w/ R pleural effusion, evaluate for interval change History: as above Decreased right hemithorax volume with an enlarging right apical air-fluid level in the cavity, and fluid adjacent to the right lung base.Left lung unremarkable.A Dobbhoff tube extends below the lower margin of the image. | Enlarging right upper lobe air-fluid collection and further compression of the right lung. |
Generate impression based on medical findings. | Diagnosis: Other idiopathic scoliosis, site unspecifiedClinical question: evaluate for neurological injurySigns and Symptoms: signals lost during surgeryComments: Non infused MRI complete spine. Patient status post surgery for spinal fusion. Signals lost during surgery. All hardware removed. Patient to be in PICU | Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is dextroscoliosis present. There is no compromise of thoracic spinal canal or exiting nerve roots appreciated. The patient is status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a compensatory levocurvature to the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There is no compromise to the spinal cord appreciated. No spinal cord compression is identified.2.No abnormal lesion is identified in the spinal cord. Please note that no diffusion sequences were performed for the detection of acute spinal cord infarction.3.Findings were discussed with Dr Sullivan at around 7pm on 11/13/15.4.Status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are identified in the bilateral pedicles of T11, T12, L1 and L2. |
Generate impression based on medical findings. | Age: 67 yearsGender: MaleReason for Study: Reason: right kidney tumor. metastatic work up History: weight loss The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Moderate degenerative changes and mild kyphosis of the thoracic spine. | No acute cardiopulmonary abnormalities are identified. No evidence of metastatic disease. |
Generate impression based on medical findings. | Head and neck cancer as well as lung cancer and a new mass within the left cerebellar hemisphere on CT neck: evaluate for metastatic disease. There appear to be four supratentorial and infratentorial peripherally-enhancing masses with surrounding T2 hyperintensity. For example, a left cerebellar hemisphere lesion measures up to approximately 25 mm and a left parietal lobe lesion measures up to approximately 22 mm. There are otherwise a few unchanged scattered nonspecific foci of punctate T2 hyperintensity in the cerebral white matter without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is mild effacement of the fourth ventricle, but no dilatation of the third and lateral ventricles. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | A few supratentorial and infratentorial masses with associated edema are compatible with metastatic disease. |
Generate impression based on medical findings. | Male, 51 years old.Reason: Pulm edema History: HF Stable support devices.Severe cardiomegaly is unchanged. Increasing right basilar opacity and effusion.No pneumothorax. | Stable marked cardiomegaly however increasing right basilar opacity and effusion. Support devices unchanged. |
Generate impression based on medical findings. | Male, 79 years old.Presenting with shortness of breath and chest pain, please rule out pneumothorax. The right central venous catheter via internal jugular line has become retracted in the subcutaneous tissues. It is unclear whether the tip is intravascular. Unchanged cardiomegaly. There may be a small left pleural effusion. Left lower lobe opacity appears worsened in comparison to prior examination. Other support devices are unchanged. | 1. Right central venous catheter is coiled within the subcutaneous tissues. Recommend replacing the line. Even if the catheter flushes, would recommend not using for inotropic therapy.2. Worsening left lower lobe pulmonary opacity. |
Generate impression based on medical findings. | Female, 59 years old.Dyspnea off anticoagulation history of PE. Right costophrenic angle volume loss, scarring and pleural thickening unchanged. New lower lobe subpleural rounded consolidation visible on the lateral radiograph.Pulmonary vascular redistribution, but no specific signs of pulmonary edema. No pneumothorax. Normal heart size.Bird's-nest type IVC filter is partially visualized | New lower lobe focal opacity is visible only on the lateral radiograph nonspecific and could reflect rounded atelectasis, although infarct is within the differential diagnosis. |
Generate impression based on medical findings. | Reason: eval gallbladder for pathology abdomen for fluid collection History: abd pain, s/p gallbladder shunt, abd wound infection LIVER: Liver measures 14.3 cm with coarse echogenicity. Portal vein is patent with normal direction and velocity of 0.3 m/s. No suspicious hepatic mass is noted.BILIARY TRACT: Common bile duct measures 3 mm. Gallbladder wall measures 3 mm. Gallstone noted measuring 1.2 x 1.0 x 0.8 cm. No pericholecystic fluid collection. PANCREAS: Distal pancreas is obscured by overlying bowel gas. Visualized part is within normal limits.SPLEEN: Spleen measures 13.7 cm and is normal in echogenicity and configuration.KIDNEYS: Right kidney measures 8 cm with normal echogenicity and without hydronephrosis. Left kidney is not well seen. No renal calculi identified. OTHER: Survey of the right upper quadrant did not show discrete drainable fluid collection. | Gallstone noted without evidence of acute inflammation or biliary ductal dilatation. Coarse echogenic liver compatible with steatosis. |
Generate impression based on medical findings. | 38-year-old male with metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Multiple metastatic lung nodules are reidentified. Reference right upper lobe lesion measures 19 x 17 mm on image number 33, series number 3. Left upper lobe reference lesion measures 24 x 19 mm image number 22, series number 3. All the lung nodules have increased in size within the interval.MEDIASTINUM AND HILA: AP window adenopathy measuring 15 x 12 mm on image number 36, series number 3 has slightly increased in size. Previously closed measuring 13 by 8mm on image number 41, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Metastatic lesion in the segment 4 of the liver measures 4.1 by 3.7 cm, slightly larger compared to previous study. Additional lesion at the lateral length of the left lobe is also increased in size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate right-sided hydronephrosis and hydroureter are unchanged. This is secondary to a pelvic mass invading the distal right ureter. Minimally complex large left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patient is status post left colectomy with diverticula some of the left lower abdomen. Postsurgical changes are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The fine soft tissue invading the distal right ureter and causing moderate right-sided hydronephrosis. | Interval increase in the size of the hepatic and pulmonary metastases.Right-sided moderate to severe hydronephrosis called by invasion of the distal right ureter by a pelvic soft tissue mass is unchanged. |
Generate impression based on medical findings. | Age: 92 yearsGender: FemaleReason for Study: Reason: fever History: fever Decreased lung volumes with stable cardiac enlargement.Minimal basilar atelectasis.No focal airspace consolidation.No pleural effusions. | No acute cardiopulmonary abnormalities identified without interval change. No specific evidence |
Generate impression based on medical findings. | CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | No significant abnormality noted in the extra cardiovascular portions of the examination. |
Generate impression based on medical findings. | Reason: evaluate mets History: hx of osteosarcoma Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease. | No sign of metastases or other significant change. |
Generate impression based on medical findings. | Male, 51 years old.Reason: assess ETT placement and lines History: assess ETT and line placement Bilateral pleural effusions and basilar opacities are unchanged.ET tube tip approximately 6 cm above the carina. An NG tube terminates in the stomach. Multiple central lines are unchanged in position as is a right upper quadrant drainage catheter. | Unchanged support devices. ET tube tip approximately 6 cm above the carina. Stable pulmonary opacities and pleural effusions. |
Generate impression based on medical findings. | 56-year-old male with shock. ETT placement ET tube approximately 5 cm above the carina. Right IJ central venous catheter tip in the central SVC. An Impella device overlies the cardiac shadow. There is near complete opacification of the right lung which is likely due to layering pleural effusion with a component of atelectasis. There is hyperlucency in the left lung which may due to technique. Cardiomegaly. | 1. ET tube 5 cm above the carina. 2. Near complete opacification of the right lung likely due to a layering pleural effusion with a component of atelectasis. Hyperlucency in the left lung may due to technique. Please see subsequent report. |
Generate impression based on medical findings. | Male, 47 years old.Evaluate endotracheal tube position Endotracheal tube tip approximately 2 cm above the carina, unchanged. Right sided central venous catheter with tip in the SVC.Decreased lung volumes with interval increase in retrocardiac consolidation/atelectasis. No large pleural effusions or pneumothorax. | 1.ET tube tip 2 cm above the carina. 2.Interval increase in retrocardiac consolidation/atelectasis |
Generate impression based on medical findings. | 67-year-old female with history of squamous cell cancer of the tongue. LUNGS AND PLEURA: Right apical bulla. Scattered calcified micronodules most likely reflect prior granulomatous infection. Few 1- to 2-mm micronodules are also most likely post inflammatory. No suspicious masses or nodules. No focal consolidation, edema or pleural fluid.MEDIASTINUM AND HILA: Cardiac size is normal. Mild coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: Right-sided Port-A-Cath with distal tip in the SVC.UPPER ABDOMEN: Nonspecific hypodense lesion in the dome of the liver on axial image 76/139 is nonspecific and probably represents a benign cyst. Scattered liver calcifications again likely reflect prior granulomatous infection.Lateral limb of the left adrenal gland is thickened measuring 1.1 x 2.0 cm on axial image 95/139. This finding is nonspecific but is more likely benign than metastatic disease.Borderline enlarged gastrohepatic lymph nodes. A reference node measures 1.5 x 1.2 cm on axial image 85/139. Again, these findings are unlikely to represent metastatic disease.Subcutaneous gas in the anterior abdominal wall with inflammation tracking to the anterior gastric wall correlates with history of recently displaced G-tube.Atherosclerotic calcifications affect the distal abdominal aorta and iliac arteries.Significant degenerative disease affects the spine. | 1.No evidence of metastatic disease to the chest. No acute pulmonary abnormalities.2.Borderline enlarged gastrohepatic nodes of uncertain clinical significance but more likely to represent local gastric inflammation rather than metastatic disease. |
Generate impression based on medical findings. | Preoperative planning for a cystic lesion in the left cerebellar pontine angle. There is a cystic lesion in the left cerebellopontine angle cistern that measures up to approximately 25 mm. There is associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere. There is a small developmental venous anomaly in the right inferior frontal gyrus. There is scattered mild mucosal thickening in the paranasal sinuses. There is a small amount of fluid signal in the right mastoid air cells. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Limited preoperative planning MRI demonstrates a left cerebellopontine angle cistern cyst that measures up to approximately 25 mm with associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere. |
Generate impression based on medical findings. | Male, 66 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases. | No significant abnormality. |
Generate impression based on medical findings. | Left knee pain MENISCI: There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some signal abnormality extends to the tibial articular surface indicating superficial fraying. No fluid-filled tear is evident. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the median eminence of the patella. There is a linear focus of low signal intensity within the articular cartilage of the femoral trochlea, centrally, likely representing a partial-thickness articular cartilage cleft. There is relatively sparing of the articular cartilage of the medial and lateral compartments.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is increased signal abnormality within the mid substance fibers of the patellar tendon which may reflect mild tendinosis. No fluid-filled tear is evident.ADDITIONAL | Large loculated fluid collection within the subcutaneous tissue along the anterior aspect of the patellar tendon which appears most consistent with a hemorrhagic subcutaneous infrapatellar bursitis, although the inferior extent of this collection is not included in its entirety on this examination. Other findings as described above. |
Generate impression based on medical findings. | Male, 29 years old.ETT placement, ARDS and pancreatitis. Endotracheal tube terminates 4 cm above the level of the carina. Other tubes and lines unchanged.Bilateral airspace opacities about the same. Left pleural fluid collection increased in volume. Small volume of pleural fluid on the right probably unchanged. | ETT 4 cm above carina. No significant change in pulmonary opacities. Increase in volume of pleural fluid on the left. |
Generate impression based on medical findings. | Male, 64 years old.Reason: ETT History: lethargy Diffuse airspace almost nodular opacities have not significantly changed except for some worsening in the retrocardiac region, consistent with infection or aspiration.Given the patient's history of renal cell cancer, rapid progression of metastases are also in the differential diagnosis.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.Right subclavian catheter, tip in SVC. | Unchanged pulmonary opacities consistent with infection or aspiration. |
Generate impression based on medical findings. | 79-year-old male post intubation Right IJ venous catheter tip in the SVC. ET tube 4 cm above the carina Dobbhoff tube tip in the stomach.Slight interval improved aeration of the right lung with persistent perihilar and basilar opacities likely combination of aspiration and pleural effusion with atelectasis. Increasing left basilar opacity compatible increasing pleural effusion with adjacent atelectasis/consolidation.Stable cardiomediastinal silhouette. | Slight interval improved aeration of the right lung with persistent pleural effusion and atelectasis. Increased left pleural effusion with adjacent atelectasis/consolidation. |
Generate impression based on medical findings. | Reason: eval lung fields History: s/p MVR Small lung volumes with basilar subsegmental atelectasis, not significantly changed.Heart size about upper normal or mildly enlarged with evidence of recent median sternotomy.No pneumothorax or other acute change. | Basilar atelectasis with no acute change. |
Generate impression based on medical findings. | Reason: pvad History: pvad New right jugular catheter extending to the area of the SVC though its tip is not visible.Pacemaker leads and cannulae unchanged.Large bilateral pleural effusions with underlying atelectasis.No other significant change. | New catheter with no complications. |
Generate impression based on medical findings. | Reason: pulm edema History: o2 req Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly, mediastinal widening, moderate effusions and basilar atelectasis, not significantly changed.No specific evidence of pulmonary edema on the current radiograph. | Pleural effusions and atelectasis unchanged with resolution of interstitial edema. |
Generate impression based on medical findings. | Male, 52 years old.Reason: evaluate parenchyma fibrosis History: mixed connective tissue dies ease Query mild interstitial pulmonary edema. Mild bibasilar subsegmental atelectasis or scarring. Mild cardiomegaly. Cardiac leads terminate in the expected location of the right atrial appendage and RV apex. | Question of mild interstitial pulmonary edema. Patchy bibasilar atelectasis and/or scar. |
Generate impression based on medical findings. | Clinical question: Rule out stroke. Signs and symptoms: Slurred speech. Nonenhanced brain MRI:No detectable acute intracranial process and negative diffusion weighted series.Large focus of encephalomalacia extensively involving the right frontal, right basal ganglia and right anterior parietal lobe consistent with a large chronic ischemic stroke with resultant ex vacuo dilatation of the right lateral ventricle is noted.Minimal periventricular and subcortical foci of FLAIR hyperintensity consistent with mild chronic small vessel ischemic strokes are noted.Unremarkable intracranial contents otherwise.Signal void of major intracranial arterial branches are identified.Images through posterior fossa demonstrate a focus of encephalomalacia in the inferior aspect of right cerebellum with mild bulge of CSF signal in density at this site through a bony defect in the right paramedian occipital which is identical to prior head CT exam from 2013. | 1.No acute intracranial process and negative diffusion weighted images.2.Large chronic right MCA territory ischemic stroke and minimal chronic small vessel ischemic strokes.3.Stable right median small right occipital calvarial defect and an underlying right cerebellar focus of encephalomalacia since prior head CT exam from 2013. |
Generate impression based on medical findings. | Female, 15 years old, with left occipital simple partial seizures, right inferior quadrantanopsia, fluctuating area of left T2/FLAIR hyperintensity reported and MRIs. Again seen is ill-defined T2 hyperintensity involving the left paramedian occipital lobe cortex and subcortical white matter. No parenchymal destruction or significant distortion is seen. No associated pathologic enhancement is detected.The extent of this abnormality appears approximately similar to that seen on 08/10/16. It is noted, however, that over the patient's multiple prior examinations, the intensity of the signal has fluctuated. Single and multi voxel short TE spectroscopy was performed over the lesional tissue and compared to areas of normal parenchyma. The lesional tissue demonstrates significant reduction in the NAA peak, very slight elevation of the choline peak, and perhaps minimally elevated lipid relative to normal appearing parenchyma.Redemonstrated is evidence of ex vacuo dilatation of the left frontal horn which largely reflects loss of the caudate nucleus. No other significant areas of signal abnormality or parenchymal lesions are seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Except as above the ventricular system is within normal limits. | Redemonstrated is ill-defined T2 hyperintensity involving the cortex and subcortical white matter of the left paramedian occipital lobe. No focal or masslike lesion is seen. MR spectroscopy demonstrates reduced NAA which generally reflects neuronal injury or loss, as well as a mild elevation of choline and perhaps minimally elevated lipid which are nonspecific findings. There are no features to suggest a high-grade neoplastic process.This type of ill-defined signal abnormality can be seen in parenchyma which has sustained severe prolonged seizure activity. In this scenario, the findings are considered to be the result of the seizure rather than the cause. As to the actual underlying cause, no definite or specific findings are seen. The differential would include inflammation from an infectious, inflammatory or autoimmune etiology; a subtle cortical dysplasia; gliosis from prior insult or injury; or perhaps a very subtle low-grade neoplastic process.Also noted is chronic loss of the left caudate nucleus which results in ex vacuo dilatation of the left frontal horn. This is of uncertain etiology but could indicate a remote ischemic insult, potentially even prenatal or perinatal. |
Generate impression based on medical findings. | 56-year-old female history of recurrent cervical cancer. Patient received chemo 4/08 -- 5/08 with ICRT 6/09. Evaluate for disease. Patient will be starting chemotherapy protocol. Patient is status post librt biopsy. Also complaining of low back pain and buttock pain and swelling left leg. Rule out metastases. CHEST:LUNGS AND PLEURA: Several lung lesions have increased in size. Index lesion in the right middle lobe series 5 image 50, 1.3 x 1.3 cm. In particular some of the lesions at the left lung base have increased significantly in size (see series 5 images 77 -- 81). Other micronodules stable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypoattenuating lesions consistent with metastases seen in the liver several of which have increased in size. Lesion in segment 7 measured on series 2 image 99, 2.6 x 2.3 cm. Several of the lesions have also increased in size. No evidence of biliary obstruction. No evidence of hepatic or portal venous thrombosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left kidney with thinning consistent with vascular compromise. Several nonspecific lesions that are bright in the cortical nephrogram phase. These could be evaluated better with delayed images.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal implants redemonstrated some of which have increased in size. Implant on the ventral surface of the left lobe of the liver seen on series 3 image 105 measures 1.3 x 0.8 cm. (On the June 10 study series 2 image 106 it measured .4 x .3 cm.)Lesion in the mesentery in the left abdomen series image 125 measures 2.5 x 1.6 cm. there are several other scattered lesions. A small amount of free fluid. The bowel is distorted but not obstructed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: The soft tissue masses in the pelvis likely peritoneal in nature rather than lymphatic. No discrete measurable nodes. See description of bowel below. Small nodes right inguinal area and a hypodense center suspicious for metastatic noted.BOWEL, MESENTERY: Ostomy seen right lower quadrant. Second ostomy left lower quadrant. Evaluation limited by streak artifact from a right hip prosthesis but there are multifocal implants scattered throughout the pelvis which is increased in size particularly in the cul-de-sac and along the left pelvic wall. These distort but do not obstruct the adjacent bowel. There is loss of fat plane to the presacral space and left pelvic sidewall invasion of adjacent muscle and vessels is likely.The soft tissue masses with rim enhancement extends caudally along the left paracervical and pararectal fat. See series 3 image 188-192.BONES, SOFT TISSUES: Right hip prosthesis.OTHER: There is no evidence of edema in the perineum or thigh. However the clinically described swelling of the left leg is likely related to compression of the left external iliac vasculature and possibly left internal iliac vasculature and there is may be nerve involvement in the sacrosciatic notch which may cause buttock pain. The gluteus muscles per se and subcutaneous lack of fat and peritoneal fat are normal. | Progression of disease in the lungs, liver and peritoneum. Involvement of left pelvic sidewall and sacrosciatic notch likely explain patient's symptoms of buttock pain and left leg swelling. Other findings as above. |
Generate impression based on medical findings. | Male, 77 years old.Extubated. Interval removal of endotracheal tube. Redemonstration of left pleural effusion and retrocardiac opacity. Additionally, right-sided basilar atelectasis and interstitial opacities are seen on the left. Bilateral abdominal drains and enteric tube with tip in the gastric body remain. Status post cholecystectomy. | Persistent left pleural effusion and retrocardiac opacity |
Generate impression based on medical findings. | Age: 85 yearsGender: FemaleReason for Study: Reason: eval infectious source History: hypotension New right central venous catheter placed with its tip in the SVC.Previous right IJ venous catheter with its tip in the RA.Stable cardiomediastinal silhouette.Increasing interstitial opacities compatible with edema.Left retrocardiac consolidation/atelectasis similar to the prior exam.Mild increase in pleural effusions.Again noted are bilateral nephrostomy tubes. | tInterval increase in pulmonary edema and pleural effusions compatible with volume overload/CHF. |
Generate impression based on medical findings. | Male, 65 years old.History of malignant pleural effusion. Follow-up after Pleurx removal. Right subclavian pacemaker, left subclavian chest port, and left IJ catheter are unchanged.Stable mild cardiomegaly, improved since the prior exam.Low lung volumes with small left pleural effusion and left basilar opacities, unchanged. No new pulmonary opacities. | Small left pleural effusion is unchanged. |
Generate impression based on medical findings. | Prostate cancer CHEST:LUNGS AND PLEURA: 5-mm nodule in the right middle lobe on image number 44, series number 4 is unchanged. Mild emphysematous changes in the lungs are unchanged.MEDIASTINUM AND HILA: Left thyroid lobe nodule is unchanged. Small right are retrocrural node is unchanged.CHEST WALL: Sclerotic foci in the left rib and T7 vertebral body are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter lesion in the right kidney and left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Index para-aortic lymph node measures 1.4 x 1 .4 cm on image number 122, series number 3, unchanged. Other retroperitoneal enlarged lymph nodes are also grossly unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic vertebral body focus unchanged. Left flank posterior subcutaneous lesion is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post postvasectomy. Soft tissue density in the left prosthetic bed has changes configuration appears more inferior and measures 4.5 x 2.8 cm on image number 192, series number 3.BLADDER: No significant abnormality notedLYMPH NODES: Index right anterior internal iliac node measures 2.6 x 1.8 cm on image number 153, series number 3, not significantly changed.Right external iliac lymph node measures 1.2 x 1.2 cm on image number 166 on series number 3, slightly smaller.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion in the left iliac bone is unchanged.OTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on medical findings. | Age: 58 yearsGender: MaleReason for Study: Reason: 58yr old male with history of MM; pre-auto sct evaluation History: evaluate Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.Redemonstration of T6 kyphoplasty.Fracture deformity involving the anterior aspect of the left sixth rib. | No acute cardiopulmonary abnormalities identified without interval change. |
Generate impression based on medical findings. | Male, 53 years old.Reason: S/P Esophageal Perforation History: S/P Esophageal Perforation Two left chest chest tubes unchanged with a small amount of pleural air medially in the right costophrenic angle.Unchanged basilar opacities.Right PICC, tip in the SVC.Tracheostomy tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach. | No change in two left chest tubes, basilar opacities and a small amount of pleural air. |
Generate impression based on medical findings. | Reason: r/o acute chest History: sob Heart size upper normal with no sign of CHF.Mild scarring at the left base and no acute findings. | No acute abnormalities. |
Generate impression based on medical findings. | Reason: Patient with IABP, please evaluate placement History: As above Balloon catheter tip about 2 cm below the top of the aortic arch and catheter tip at the SVC/R junction.Perihilar interstitial and airspace opacity compatible with edema or aspiration, not significantly changed.No new findings. | Balloon catheter tip in the proximal descending aorta. |
Generate impression based on medical findings. | Male, 76 years old.Reason: intubated History: intubated Patchy pulmonary opacities with pleural effusions are unchanged.Moderate cardiomegaly is stable, status post valve replacement.ET tube tip approximately 6 cm above the carina.A Dobbhoff tube terminates in the stomach. An NG tube terminates in the stomach.Left subclavian ICD, leads unchanged in position.Stable right jugular introducer. | Patchy pulmonary opacities consistent with edema and aspiration or infection. |
Generate impression based on medical findings. | Female, 23 years old.Reason: r/o infiltrate History: chest pain. VP shunt catheter tubing courses down the right neck and thorax, entering the abdomen close to midline and terminating beyond the field-of-view.No focal air space opacity.No pneumothorax, pulmonary edema, or significant pleural effusion.Unremarkable cardiomediastinal silhouette.Left and right curves of the thoracolumbar spine are noted. | No specific evidence of infection. |
Generate impression based on medical findings. | Male, 60 years old.Mental status changes. Unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.Pigtail catheters noted in the abdomen. | No acute cardiopulmonary abnormality. |
Generate impression based on medical findings. | Female, 63 years old.Reason: PTX History: PTX Interval extubation. No definite right-sided pneumothorax is noted. Pneumoperitoneum is also less apparent. No new focal lung consolidation. Unchanged heart size. | No definite right-sided pneumothorax or pneumoperitoneum is present though the current study is of lower quality than the previous study. |
Generate impression based on medical findings. | Male, 65 years old.Reason: eval for new infiltrate, consolidation History: hypoxic, minor hemoptysis, sob Numerous bilateral pulmonary nodules and reticular opacities in the right lung, compatible with known metastases and lymphangitic spread.Small right effusion.Mild increase in right lung consolidation.Stable cardiomediastinal silhouette. | Mild increase in right lung consolidation which may reflect infection or hemorrhage. |
Generate impression based on medical findings. | Female, 61 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Lines and tubes are unchanged. Unchanged diffuse pulmonary opacities. Moderate-sized loculated pleural effusions again noted. Unchanged cardiomegaly. No pneumothorax. | Unchanged pulmonary edema pattern with loculated pleural effusions. |