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Generate impression based on findings. | Male, 71 years old, history of relapsed stage IVB follicular non-Hodgkin's lymphoma. Lymphadenopathy is again noted involving levels 1 through 5 and the bilateral axillae, not significantly changed from the prior examination. Reference lymph nodes are as follows:*Right level 2 lymph node measures 1.6 x 1.6 cm (series 6 image 34), unchanged. *Right supraclavicular node measures 1.3 x 1.0 cm (series 6 image 44), unchanged. *Left level 2 node measures 1.0 x 0.8 cm (series 6 image 38), unchanged.The aerodigestive mucosa is within normal limits. The salivary glands and thyroid are free of focal lesions. Cervical vessels remain patent. No concerning bony lesions are noted.There is a new right pleural effusion; please see separate chest CT dictation for complete discussion of thoracic contents. | 1.Stable lymphadenopathy.2.There is a new right pleural effusion; please see separate chest CT dictation for complete discussion of thoracic contents. |
Generate impression based on findings. | 42-year-old male with intercranial hemorrhage Redemonstrated are bihemispheric supratentorial and infratentorial multifocal regions of subarachnoid hemorrhage as well as left frontal lobe superior frontal gyrus intracranial hemorrhage. Other than some minimal redistribution, there has been no significant interval change in the extent of hemorrhage. There is no evidence of interval new hemorrhage. The ventricles, sulci, and cisterns remain unremarkable. There is no mass effect or midline shift. | Other than some minimal redistribution, there has been no significant interval change of multifocal bihemispheric supratentorial and infratentorial hemorrhages. |
Generate impression based on findings. | Female; 61 years old. Reason: persistent colonic dilatation s/p BE, now w/ ventral hernia, rule out obstruction History: persistent colonic dilatation s/p BE, now w/ ventral hernia, rule out obstruction Streak artifact from retained barium limits evaluation in the right lower quadrant.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Lobulated hypodense lesion in segment 5, best seen on image 36 of series 3, is unchanged when compared to prior exams and represents a benign cyst. Scattered other subcentimeter hypodensities in liver are too small to characterize, but are unchanged. The gallbladder is unremarkable.SPLEEN: No significant abdominally noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered cortical scarring about the right kidney. The left kidney appears normal. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Residual barium is present in the cecum creating streak artifact in the right lower quadrant. Narrow mouthed ventral hernia immediately inferior to the umbilicus, best seen on image 61 of series 3, containing an edematous loop of small bowel and surrounding small fluid collection, suspicious for mesenteric vascular insufficiency. Multiple loops of mildly dilated bowel are noted. No evidence of complete obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: NG tube with tip at the antrum.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right inguinal lymphadenopathy.BOWEL, MESENTERY: Extensive artifact from retained barium limits evaluation of the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large enhancing, loculated fluid collection in the posterior pelvis, best seen on image 106 of series 3, measures 11.8 x 4.8 cm in greatest dimensions. There is no apparent communication with the bowel and no foci of air or contrast is seen in it to suggest a bowel leak. | 1.Narrow-mouthed ventral hernia containing an enhancing loop of bowel and surrounding edematous fluid suspicious for mesenteric vascular insufficiency.2.Large loculated fluid collection with enhancing wall located in the posterior pelvis.These results were discussed with Dr. Abbo by Dr. Masse on 12/27/13 at 1420. |
Generate impression based on findings. | Reason: h/o HNC/CRT, compare to previous, measurements pls History: none LUNGS AND PLEURA: No pulmonary or pleural metastases.MEDIASTINUM AND HILA: No evidence of lymphadenopathy.Right jugular port catheter, tip at SVC level.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral renal cysts are unchanged. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 58-year-old female. Reason: h/o met HNC, compare to previous, measurements pls History: none. CHEST:LUNGS AND PLEURA: Interval increase in size of all previously identified pulmonary metastases. No definite new metastases are identified.A right apical nodule measures 35 x 22 mm (image 26, series #4), from previously 26 x 19 mm. A lingular nodule measures 33 x 31 mm (image 55, series #4), from previously 27 x 25 mm.A left lower lobe nodule measures 18 x 15 mm (image 72, series #4), from previously 13 x 12 mm.New diffuse, scattered bilateral centrilobular groundglass opacities, with resolution some previously seen mild ground glass opacities, consistent with aspiration.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. A reference, subcarinal lymph node measures 9 mm (image 48, series #3), unchanged. Normal heart size. Stable small pericardial effusion. Right-sided chest wall port catheter terminates in the right atrium.CHEST WALL: Suture material in the left chest wall and subcutaneous fat unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter right lobe hypodensity is too small to characterize, though unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Absent right kidney. Unchanged hypodensities of the left kidney, likely representing simple cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches, without focal ectasia.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Contrast-filled balloon type gastrostomy tube is noted.BONES, SOFT TISSUES: Multiple nodules in the subcutaneous fat of soft tissue attenuation are likely sequelae of injections.OTHER: No significant abnormality noted. | 1.Increase in size of lung nodules, with no new nodules identified.2.New diffuse, scattered bilateral centrilobular groundglass opacities, with resolution some previously seen mild ground glass opacities, consistent with aspiration. |
Generate impression based on findings. | Male 71 years old; Reason: history of relapsed stage IVB follicular lymphoma, diagnosed originally in 2010 History: history of relapsed stage IVB follicular lymphoma, diagnosed originally in 2010 CHEST:LUNGS AND PLEURA: Interval development of a right-sided pleural effusion with nodular pleural thickening. Minimal change change in the two nodular masses seen in the lung parenchyma. Largest of these is in the lingula and measures 16 x 1 .4 cm, (series 4, image 75) previously 2.5 x 1.8-cm. The groundglass right upper lobe nodule (series 4, image 44) measures 0.7 x 0.5 cm, unchanged. No new nodules, masses or infiltrates are seen. MEDIASTINUM AND HILA: Prior noted mildly enlarged mediastinal and left internal mammary lymph nodes are seen, slightly larger in size. For example, periaortic node now measures 1.2 cm in short axis (series 3 image 33), previously 0.8-CM. No new foci of lymph node enlargement are seen.CHEST WALL: Bilateral axillary prominent lymph nodes are again seen, and larger than previously noted. For example, the referenced right axillary lymph node (series 3, image 13) measures 2 x 2.5 cm , previously 1.9 x 2.5 cm. Another lesion more inferiorly measures 1.7 cm in short axis, previously 1.1 cm. Remaining lymph nodes appear subjectively, mildly larger.ABDOMEN:LIVER, BILIARY TRACT: No change in the benign hypodense small liver lesions dating back to October/2012, and, presumably representing cysts. No new lesions are seen. Portal venous, and hepatic venous structures appear normal. Gallstones again seen in the gallbladder without complication and no other abnormalities in the, biliary tract.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Hepatoduodenal ligament and retroperitoneal, periaortic, lymph nodes are essentially unchanged in their distribution and size. The prior referenced left periaortic lymph node (series 3, image 129) measures 1.8 x 0.9 cm compared with 2.0 x 1.2 cm previously. The numerous other clusters of small and slightly enlarged lymph nodes throughout are relatively stable. 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: Diffuse pelvic lymphadenopathy is again seen with slight improvement in measurements in most regions as reflected in the. Reference measurements below:Right external iliac lymph node (series 3, image 161) measures 1.3 x 3.3 cm, previously 1.9 x 3.6 cm).Left external iliac lymph node (series 3, image 187) measures 1.9 x 3.7cm, previously 4.6 x 2 .3 cm.Bilateral inguinal lymph nodes show similar mild decreases in size, with the referenced right inguinal lymph node (series 3, image 195) measuring 1.3 x 1.1-CM, previously1.4 x 1 .2 cm.No new lymphadenopathy or other masses are seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval development of a right pleural effusion.2. Interval enlargment of the mediastinal and axiliary adenopathy.3. Lingular subpleural nodule, and small right upper lobe ground glass nodule are stable. No new thoracic lesions are identified. 4. Stable diffuse retroperitoneal and pelvic adenopathy as measured above. |
Generate impression based on findings. | Reason: T3N2c M0 BOT SCCA.Completed therapy on 8/3/12. Please re-eval and compare History: as above CHEST:LUNGS AND PLEURA: Scattered benign appearing punctate micronodules are unchanged.There is no sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy noted.Mild coronary artery calcifications are present.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable multiple large cystlike hypodensities.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several small renal cysts are present.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Reason: h/o HNC, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No pulmonary or pleural metastases noted.Stable scarring and groundglass opacities with bronchial wall thickening may be from chronic aspiration.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.A right jugular port catheter terminates at the SVC/RA junction level.Minimal corner artery calcification is present.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic cyst like hypodensity, too small to characterize but likely benign. The gallbladder wall appears thick but it is contracted. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cystlike hypodensities are present.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Female 61 years old Reason: pt with metastaic breast cancer please assess disease status and compare to previous imaging History: MBC CHEST:LUNGS AND PLEURA: There is reticulation with associated traction bronchiectasis and bibasilar honeycombing consistent with fibrosis, likely related to the patients history of scleroderma. There is paraseptal emphysema with an upper lobe predominance.MEDIASTINUM AND HILA: Reference right hilar lymph node now measures 1.1 x 1 .0 cm, previously 1.1 x 0.9 cm (image 48, series 3) and appears unchanged dating back to 2008, and is therefore likely benign in etiology. There are no new pathologically enlarged lymph nodes. The heart size is normal and there is no pericardial effusion.CHEST WALL: There is diffuse sclerotic and lytic lesions seen scattered throughout the axial and proximal appendicular skeleton. These findings are consistent with osseous metastatic disease and appear largely stable since the prior examination. There is no evidence of pathologic fracture. Surgical clips are seen in the left axilla consistent with prior lymph node dissection. The patient is status post left mastectomy. Note is made of multiple punctate calcifications within the right breast which appear unchanged when compared to the prior study dating back to September 2013, but were not definitively present previously. These findings are nonspecific and correlation with recent mammography could be considered.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of intrahepatic biliary ductal dilatation or focal mass lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A left-sided nephroureteral stent is again seen and appears unchanged in position. There is no evidence of hydronephrosis. Again seen is a soft tissue attenuation mass encircling the distal left ureter which appears similar to the prior study and is suspicious for metastatic disease. RETROPERITONEUM, LYMPH NODES: There is no evidence for retroperitoneal lymphadenopathy. Vascular calcifications of the aorta and its branches.BOWEL, MESENTERY: There is no evidence of mesenteric lymphadenopathy.BONES, SOFT TISSUES: Diffuse osseous metastatic disease affects the axial and proximal appendicular skeleton, appearing similar to the prior study.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There are large heterogeneous uterine masses which contain internal calcification consistent with a leiomyomatous uterus.BLADDER: The distal end of the left-sided nephroureteral stent is seen within the bladder.LYMPH NODES: There is no evidence of pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous metastatic disease affects the axial and proximal appendicular skeleton. OTHER: There is persistent body wall edema. | 1.Diffuse osseous metastatic disease affecting the axial and proximal appendicular skeleton, consistent with the stated history of metastatic breast carcinoma. Persistent soft tissue mass encircling the distal left ureter which is also suspicious for metastatic disease. 2.Stable fibrotic changes in the lung bases bilaterally likely related to the patient's history of scleroderma.3.Persistent body wall edema.4.No new foci of metastatic disease are identified. |
Generate impression based on findings. | Male 50 years old; Malignant neoplasm of the face, head and neck. CHEST: Exam is limited by body habitus.LUNGS AND PLEURA: Paraseptal and centralobular emphysema noted. Vascular congestion seen.MEDIASTINUM AND HILA: Large submandibular lesion measuring 5.5 x 7.3 cm is incompletely characterized on the CT chest. A 1.6 x 2.1 cm supraclavicular node (series 701 image 13) is noted. A few non-pathologically enlarged mediastinal lymph nodes are noted with a reference prevascular region measuring 1.3 cm in short axis.CHEST WALL: Numerous chest wall lesions are noted the with a reference right rib expansile lytic lesion measuring 2.7 x 4.6 cm (series 701 image 60)OTHER: ABDOMEN: The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. The patient also has his arms on his abdomen, which also limits evaluation. Given these limitations, the following observations were made:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nonobstructive renal stone noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive metastatic expansile lytic lesions in the sacrum and left iliac fossa are noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right common iliac node measures 2.8 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive metastatic expansile lytic lesions in the sacrum and left iliac fossa are noted.OTHER: No significant abnormality noted | Extremely limited exam given body habitus and positioning as well as lack of contrast materiel. Otherwise:1.Large left submandibular lesion with extensive osseous and nodal metastatic disease as referenced above. |
Generate impression based on findings. | 55-year-old male with T3Nc M0 base of the tongue squamous cell carcinoma. Visualized intracranial contents are unremarkable. Previously demonstrated mucosal thickening in the left maxillary sinus as present.The aerodigestive tract is free of suspicious mass lesions or pathologic enhancement. It previously demonstrated thin retropharyngeal effusion is less apparent.No pathologically enlarged lymph nodes are detected by CT size criteria. A previously referenced left level 3 node measures 3 mm short axis, not significantly changed (series 6 image 42).The salivary glands are free of focal lesions as is the thyroid. Cervical vessels are unremarkable. Lung apices clear (please see separate chest dictation for complete discussion of thoracic contents). A sclerotic focus within the posterior elements of C2 is unchanged. No new or suspicious bony lesions are detected. | Stable examination with no evidence of recurrent disease in the neck. |
Generate impression based on findings. | 58 year old female. Reason: metastatic thyroid ca to lungs, on therapy, eval for disease, compare to previous with measurements. CHEST:LUNGS AND PLEURA: The previously seen right apical micronodule is again not visualized and is presumed to be resolved. No suspicious pulmonary nodules identified. Left upper lobe calcified nodule, consistent with granulomatous disease.MEDIASTINUM AND HILA: Tracheostomy tube is noted. Postsurgical changes of the lower neck are unchanged. Mild atherosclerotic calcification of the aorta and coronary are noted.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy. Multiple punctate calcifications in the liver, consistent with prior granulomatous disease.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing 7-mm right renal stone. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged ventral hernias containing only omental fat. Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 20-month-old male with abdominal distention ABDOMEN:LUNG BASES: Dependent, bibasilar atelectasis.LIVER, BILIARY TRACT: There is a multiloculated cystic mass measuring 10.4 x 14.3 x 16.1 cm with enhancing septa arising from the liver or perhaps abutting the liver. Mass appears to be situated in the region of the falciform ligament and wedges the right and left liver apart. Contents of the mass measure slightly greater than water density. No calcifications are present. The mass displaces the abdominal viscera towards the left and downwards. The gallbladder is displaced posteriorly. No evidence of gallbladder sludge or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys measure slightly large for patient's age with no evidence of cystic lesions to raise concern for autosomal recessive polycystic kidney disease, although it cannot entirely be excluded.RETROPERITONEUM, LYMPH NODES: Aorta is displaced towards the left. The infrahepatic IVC cannot be evaluated due to timing of contrast. BOWEL, MESENTERY: Bowel is displaced leftward and inferiorly. No evidence of bowel obstruction.BONES, SOFT TISSUES: Small umbilical hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended urinary bladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Bowel is displaced leftward and inferiorly. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted. | Large multiloculated cystic intra-abdominal mass with enhancing septa as described above. Differential includes mesenchymal hamartoma if the mass is of hepatic origin or mesocolon/mesenteric cyst (lymphangioma). |
Generate impression based on findings. | Reason: Persistent pain after treatment for right base of tongue cancer History: as above CHEST:LUNGS AND PLEURA: Benign-appearing micronodules, with no sign of pulmonary or pleural metastases.Mild subpleural reticulation is present in the upper lung zones and there is lung zone bronchial wall thickening.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted. Scattered hepatic cysts like hypodensities too small to characterize are stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative abnormalities affecting the lumbar spine are stable.OTHER: No significant abnormality noted. | No evidence of metastatic disease, or other significant abnormality. |
Generate impression based on findings. | 64-year-old male. Reason: 63M with NSCLC s/p RT. CHEST:LUNGS AND PLEURA: Right lower lobe linear opacities are unchanged from prior exam and most compatible with postradiation changes. High density suture material is again noted.The previously noted new right-sided micronodules most prominent in the lower lobe are unchanged from the prior exam (MIP images 41 to 49).Redemonstrated mild centrilobular emphysema.MEDIASTINUM AND HILA: Normal heart size. Mild coronary artery and aortic atherosclerotic calcifications. Calcified mediastinal lymph nodes consistent with prior granulomatous disease, unchanged. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: A heterogeneous, segment II left hepatic lobe mass is redemonstrated, unchanged since at least 2011.A small peak in the contour of the right dome or midportion of the right hemidiaphragm is seen immediately adjacent to the surgical/radiation bed in the right lung (coronal image 64), and may represent a resolving subcapsular hematoma versus postsurgical scarring of the diaphragm. SPLEEN: Numerous punctate calcifications consistent with prior granulomatous disease.ADRENAL GLANDS: A left adrenal nodule measures 23 x 19 mm, unchanged in size and appearance from 5/2/2011.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches, without focal ectasia.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Unchanged post surgical/radiation changes in the right lower lobe.2.Stable micronodules with no new suspicious nodules identified in the lungs. Clustered micronodules in the right mid lung may represent atypical infection versus metastases. |
Generate impression based on findings. | 58 year-old male with metastatic renal carcinoma and pancreatic microadenoma. Status post open left radical nephrectomy, distal pancreatectomy, and splenectomy complicated by pancreatic leak further complicated by intra-abdominal abscess. Now status post stent and drain removal. Assess for a repeat fluid collection. ABDOMEN:LUNG BASES: Small left pleural effusion with underlying atelectasis, appearing similar to the prior examination. There is interval resolution of the previously described foci of gas density within the pleural fluid.LIVER, BILIARY TRACT: Possible fatty infiltration of the liver.SPLEEN: Post splenectomyPANCREAS: Status post distal pancreatectomy. There is interval removal of the left posterior percutaneous drain. Multiple surgical clips are identified in the surrounding area.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Since the prior exam, the posterior drain has been removed. There is residual soft tissue density and fat stranding within the surgical bed of prior left nephrectomy, appearing similar to the prior study. There is no residual or recurrent fluid collection to suggest abscess formation. Small right renal cyst.RETROPERITONEUM, LYMPH NODES: IVC filter in place.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is interval development of a fluid collection along the entire length of the left rectus muscle measuring 8.9 x 3.3 cm in the transverse dimension and 13.7 cm in the craniocaudal dimension. There are no additional signs of infection such as fat stranding or phlegmon in the surrounding area, however, there is an associated enhancing rim. While these findings are suspicious for abscess formation/infection, a prior rectus sheath hemorrhage/hematoma could also be considered, in the correct clinical setting. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval development of a large loculated fluid collection along the left rectus muscle with an associated enhancing capsule. While these findings are suspicious for abscess formation/infection, a prior rectus sheath hematoma/hemorrhage could also be considered in the correct clinical setting. 2. Small left pleural effusion with underlying atelectasis. 3. No evidence of recurrent fluid collection in the surgical bed of prior left nephrectomy, as clinically questioned. |
Generate impression based on findings. | 71 year-old female. Early lung cancer status post SBRT in left lung. History of left upper lobe NSCLC status post definitive RT completed 3/2013. CHEST:LUNGS AND PLEURA: Left upper lobe opacity with an elongated configuration suggestive of scarring and subsegmental atelectasis measures 17 x 25 mm, not significantly changed (series 80236, image 46). Faint focal area of cystic and reticular opacity with a small solid component is slightly increased in opacity since 10/2013 and not significantly changed from immediate prior CT (series 4, image 42), remains somewhat concerning for an indolent primary adenocarcinoma. New adjacent 4 mm nodule with surrounding groundglass (series 5, image 119) may be post-infectious/inflammatory.Unchanged most likely benign 5 mm nodule in right lower lobe (series 4, image 65). MEDIASTINUM AND HILA: Small paratracheal lymph nodes without significant interval change. Moderate coronary artery calcifications.CHEST WALL: Mild degenerative arthritic changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes, not significantly changed. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative arthritic changes of the lumbar spine.OTHER: No significant abnormality noted. | Stable left upper lobe scarring/subsegmental atelectasis and possible left upper lobe indolent adenocarcinoma with no new sites of disease. |
Generate impression based on findings. | Neoplasm of uncertain behavior of other specific sites. No additional information is provided. Review of prior radiology consultation form from 5 -- 19 -- 13 indicates history of juvenile nasal angiofibroma. Enhanced Medtronic fusion sinus CT:Since prior exam there is evidence of significant interval decrease size of previously noted enhancing mass in the right nasopharynx and right pterygopalatine fossa with subtle extension into the inferior aspect of right chamber of the sphenoid sinus. There is also evidence of new surgical clips since prior exam at this site.On the current exam there is a symmetrical enhancement of the soft tissue immediately anterior to lateral to the right lateral pterygoid plate. On prior exam this enhancement was present at the site and was contiguous with the tumor and the venous plexus at this site. The remaining enhancement is best appreciated on axial images 38 through 42. I cannot be certain whether this finding represents residual tumor or venous plexus.Examination also demonstrates a small focus of enhancement immediately lateral to the surgical clip at the site (axial image 41 and 42).Minimal erosive changes of the right pterygoid bone is difficult to appreciate as well due to streak artifact from surgically placed clip at the site.There is better pneumatization of the sphenoid sinus with small residual because of thickening.Extensive residual mucosal thickening in the right maxillary sinus is again identified however with slight interval improvement in pneumatization of the sinus since prior exam.Images from intracranial space including cavernous sinuses demonstrate no convincing evidence of pathology. | 1.Interval near complete resolution of previously noted enhancing tumor in the right nasopharynx consistent with patient's known juvenile angiofibroma.2.Very ill-defined tiny residual enhancement is noted immediately lateral to the right pterygoid plate and minimally lateral to a surgically placed clip at the site is identified. Findings likely represent venous plexus and postop changes however possibility of minimal residual tumor cannot be entirely excluded.3.Slight interval better visualization of the sphenoid sinus and the right maxillary sinus since prior exam. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Stable calcified and noncalcified micronodules.No new suspicious pulmonary nodules or masses.No pleural effusions..Mild upper lobe predominant emphysema.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable small hypodensities too small characterize, but most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: pancreatic cancer staging History: pancreatic cancer staging LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules compatible compatible with a prior granulomatous disease. No suspicious pulmonary nodules or masses.No pleural effusionsMEDIASTINUM AND HILA: Calcified hilar mediastinal lymph nodes, compatible. The prior granulomatous disease.No evidence of hilar or mediastinal lymphadenopathy.Cardiac size is normal and evidence of pericardial effusion.Moderate coronary artery calcification.No evidence of an esophageal or paraesophageal mass.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology.Mass in the head of the pancreas is incompletely visualized. Stent is identified in the distal common bile duct with a significant amount of debris within the stent.Dilatation of the pancreatic duct is similar to the prior abdominal CT.There is evidence of pneumobilia with interval reduction in the intrahepatic biliary duct dilatation .Enlarged peripancreatic lymph nodes without interval change.A hypodensity in the right lobe of the liver (images 106, series 3) in segment 5 is suspicious of metastatic disease and was present on the prior exam. An additional hypodensity (image 96, series 3) segment 4 was present on the prior exam and has a more benign appearance. | 1.No evidence of intrathoracic metastatic disease.2.Interval placement of a biliary stent with pneumobilia and reduction in intrahepatic biliary dilatation.3. Small hypodensity in segment 5, which in retrospect was present on the prior exam is suspicious of an hepatic metastasis. Magnetic resonance imaging of the liver with an hepatic specific contrast agent is recommended if it is clinically significant in establishing the presence of hepatic metastatic disease.4. Partially visualized mass in the head of the pancreas with stable enlarged peripancreatic lymph nodes.. |
Generate impression based on findings. | Female; 76 years old. Reason: evaluate for response. History: sarcoma. CHEST:LUNGS AND PLEURA: Centrilobular emphysema is unchanged. Right upper lobe nodular opacity, but seen on image 21 of series 5, measures 2.2 x 1.2 cm, previously 1.7 x 1.5 cm. Left pleural effusion is unchanged.MEDIASTINUM AND HILA: Extensive mediastinal lymphadenopathy again noted. Reference precarinal lymph node, best seen on image 34 of series 3, measures 5.8 x 2.7 cm, previously 5.8 x 2.6 cm.CHEST WALL: Heterogeneous thyroid with multiple nodules, appearing similar to the prior. Bilateral axillary lymphadenopathy with reference lymph node, best seen on image 34 of series 3, measuring 2.1 x 1.4 cm, previously 1.7 x 1.0 cm. Sclerotic left sixth rib lesion is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensities in the liver are stable in size and appearance. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple small hypodense lesions are noted bilaterally. Reference left upper pole lesion or, best seen on image 74 of series 3, measures 1.4 x 1.0 cm, previously 1.4 x 1.1 cm. Reference right lower pole lesion, best seen on image 115 of series 3, measures 1.7 x 1.6 cm, previously 1.6 x 1.5 cm. These lesions are relatively unchanged when compared to 2011.RETROPERITONEUM, LYMPH NODES: Reference left common iliac lymph node, best seen on image 147 of series 3, measures 1.6 x 1.1 cm, previously 1.9 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Chronic T11 anterior compression fracture again noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable metastatic disease in the thorax without significant change.2.Stable renal lesions bilaterally.3.Chronic compression fracture of T11. |
Generate impression based on findings. | 87 year-old female. Cough, diaphoresis since September 2013 with no real change in symptoms. CXR with questionable pneumonia in October, RLL superior segment nodule/infiltrate seen. Treated with antibiotics. LUNGS AND PLEURA: 6.5 x 2.3 cm wedge shaped consolidation with air bronchograms and a few coarse calcifications in the right lower lobe abuts and does not distort the major fissure (series 8020, image 16), not significantly changed from recent CT and roughly unchanged from 10/2013 CXR. Scattered micronodules.MEDIASTINUM AND HILA: Ectatic ascending aorta measures 4.3 cm in AP dimension. No mediastinal or hilar lymphadenopathy. High density smoothly marginated 1 x 2.1 cm lesion abutting the right heart border is unchanged, likely a pericardial cyst. CHEST WALL: Severe degenerative changes of the thoracic spine. Levoscoliosis of the lumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. | Right lower lobe 6.5 x 2.3 cm wedge shaped consolidation with air bronchograms. Given it appears roughly stable from 10/2013 CXR and its configuration, chronic consolidation/atelectasis is the likely etiology. No other pulmonary or pleural abnormalities identified. |
Generate impression based on findings. | 71-year-old female. Reason: massive PE History: SOB. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. Massive filling defect in the distal main pulmonary artery extending through the entire right pulmonary arterial system and slight extension into the left pulmonary artery, similar in appearance to the prior exam. LUNGS AND PLEURA: Numerous bilateral pulmonary nodules, right greater than left, suspicious for metastatic disease. Subpleural nodules also seen. No significant interval change, with no new nodules identified.MEDIASTINUM AND HILA: Flattening of the interventricular septum is grossly unchanged. No mediastinal or hilar lymphadenopathy is seen. Scattered small non-enlarged lymph nodes are stable.CHEST WALL: Degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Unchanged massive, extensive filling defect in the main and right pulmonary arteries. Stable associated flattening of the interventricular septum.2.Numerous bilateral pulmonary nodules, unchanged though suspicious for metastatic disease. |
Generate impression based on findings. | 67-year-old male with history of chronic lymphoid leukemia, on ofatumumab, for reevaluation. Scattered adenopathy seen on the prior examination, involving all spaces of the neck as well as the sub-pectoral and axillary regions, has improved with reference measurements as follows:1. Right submental (series 7 image 33): 8 x 7 mm, previously 9 x 8 mm.2. Right level 2/3 (series 7 image 35): 9 x 4 mm, previously 13 x 7 mm.3. Left level 3 (series 7 image 40): 10 x 6 mm, previously 12 x 8 mm.The aerodigestive mucosa is unremarkable. Salivary glands and thyroid are within normal limits. Cervical vessels remain patent. No concerning osseous lesions are seen.Limited intracranial views are unremarkable. Right maxillary sinus mucosal thickening is again noted.Please see separate chest CT dictation for complete discussion of thoracic contents and adenopathy. | Continued improvement of cervical lymphadenopathy. |
Generate impression based on findings. | Clinical question: History low grade 3 anaplastic astrocytoma on therapy. Signs and symptoms: Headache and blurry vision. Rule out bleed or progression. Unenhanced head CT:Examination demonstrate no evidence of acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is interval complete resolution of previously noted focus of hemorrhage in the left posterior frontal -- parietal region and its surrounding vasogenic edema. There is resultant significant better visualization of cortical sulci and ex vacuo dilatation of the left lateral ventricle since prior study.At the site of previously noted hemorrhage and edema there remains normal attenuation of brain parenchyma with linear increased density of the adjacent cerebral cortex consistent with mineralization. In addition note is also made of interval or position of right hemispheric cortical sulci as well as a slight interval increased size of right lateral ventricle and prominence of basal cisterns.For more accurate assessment for tumor MRI examination is recommended.Calvarium no straightened small craniectomy in the left posterior temporal region sites of previous surgical approach for biopsy and unremarkable otherwise.All visualized paranasal sinuses and bilateral mastoid air cells, middle ear cavities remain well pneumatized.Limited images through the orbits are unremarkable. | 1.No detectable acute intracranial process.2.Interval complete resolution of previously noted left hemispheric hematoma and decreased previously seen edema.3.There is interval better visualization of cortical sulci and ex vacuo dilatation of the left lateral ventricle.4.Residual parenchymal attenuation and adjacent cerebral cortical mineralization at the sites of previously seen hemorrhage.5.There is also slight interval better visualization of right hemispheric cortical sulci, right lateral ventricle and basal cisterns. |
Generate impression based on findings. | 45-year-old female with venous thrombosis There has been partial resolution of previously demonstrated right internal jugular vein thrombosis, now demonstrating recannulation along its superior aspect, with venous flow enhancement evident from the skull base to the level of the thyroid cartilage. Below this level, there continues to be lack of lumenal enhancement to its confluence with the right subclavian vein. The previously demonstrated diffuse stranding within the adjacent fat planes has significantly decreased. The major cervical arteries are patent. There are bilateral tonsilloliths. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. The imaged portions of the intracranial structures are orbits are unremarkable. The imaged portions of the lungs are unremarkable. | There has been partial resolution of previously demonstrated right internal jugular vein thrombosis, now demonstrating recannulation along its superior aspect, with venous flow enhancement evident from the skull base to the level of the thyroid cartilage. Below this level, there continues to be lack of lumenal enhancement to its confluence with the right subclavian vein. |
Generate impression based on findings. | Critical portion: History of head and neck cancer and CRT. Compared to prior exam and provide measurements. Signs and symptoms: None. Enhanced neck CT:There is no measurable soft tissue thickening/tumor in the supraglottic larynx which remains stable since prior exam.The following reference nodes artery measured after comparison with prior study.1.Right level 2a lymph node axial image 35 measuring an a 8.3 x 9.7-mm and smaller than prior measurements of 8.8 x 16.4.2.Right level 3 lymph node (axial image 35) measuring at 3.3 x 7.7-mm compared to prior measurement of 9 x 11.3.Left level 2a node on axial image 30 measures at 10.4 X 6.6-mm compared to prior study measurement of 8.8 x 16.4-mm.4.Left level 3 lymph node on axial image 37 measuring at 9.6 x 5.8-mm compared to prior measurement of 12.5 X8.3-mm.Revisualization of stable minimal sclerotic changes of right thyroid cartilage which has remained stable and could represent result of tumor involvement. There is no evidence of any new lymph nodes by CT size criteria.Unremarkable vasculature of the neck.Unremarkable thyroid gland.Interval placement of a right-sided central line with patent right internal jugular vein.No convincing evidence of any lytic or sclerotic bony changes of the region of the exam. | 1.No measurable soft tissue thickening/tumor.2.Interval decreased size of all previously known/measured reference nodes in bilateral neck as detailed/measured above. |
Generate impression based on findings. | 69-year-old female patient with history of ovarian cancer, currently receiving treatment. Please evaluate for disease progression/response. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. The reference right hilar lymph node measures 1.1 by 1.0 cm, previously 1.0 x 1.0 cm (series 701 image 30).CHEST WALL: Left-sided chest port with catheter tip at the cavoatrial junction. Status post left mastectomy.ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe cyst, stable.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: Reference aortocaval lymph node measures 1.3 x 0.7 cm, previously 1.5 x 0.8 cm (series 701 image 72), stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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. | Stable examination with no significant interval change in reference nodes. |
Generate impression based on findings. | 63 -year-old M with lung cancer s/p resection. Additional history: Left upper lobe resection. CHEST:LUNGS AND PLEURA: No suspicious nodules identified. Interval resolution of dense focal left upper lobe airspace opacity. Postsurgical volume loss from left upper lobe resection. Mild centrilobular emphysema.MEDIASTINUM AND HILA: Previously identified AP window large lymph node measures 10 mm in its short axis (series number 73, image 38), from previously 13 mm.Post surgical changes are noted in the left hilum. Atherosclerotic calcification and stenting of the coronary arteries and mild calcification of the aorta. Stable hypodense left thyroid nodule.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal hypodensity is too small to characterize though stable. Trace amount of right perinephric fluid.PANCREAS: Diffuse pancreatic calcifications favor benign etiology, likely from chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative changes of the thoracolumbar spine most prominent at L4/L5.OTHER: No significant abnormality noted. | 1.Resolution of left upper lobe infection.2.Decrease in lymphadenopathy with no new sites of disease. |
Generate impression based on findings. | 62 year-old female with history of anaplastic thyroid cancer. Small interhemispheric fissure lipoma. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Hypertrophy of the right inferior turbinate. Examination again shows postoperative findings related to recent thyroidectomy and bilateral neck dissection. The drainage tubing within the surgical bed has been removed. There is stranding of the regional fat planes, but no discrete fluid collection. There is also mucosal edema within the left supraglottic region with associated partial effacement of the piriform sinus. There appears small amount of soft tissue in the right thyroid bed (image 51-54; series 7), which is nonspecific. no definite evidence of residual tumor or cervical lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The parotid and submandibular glands are unremarkable. The major cervical flow voids appear to be patent, with the termination of the left internal jugular vein as part of the vertebral vein superiorly. The osseous structures are unremarkable. Please refer to dedicated CT chest for pulmonary findings. | 1. Status post thyroidectomy. Small amount of soft tissue in the right thyroid bed, which is nonspecific. Continued followup is recommended. 2. No cervical lymphadenopathy. 3. No intracranial metastasis. |
Generate impression based on findings. | Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Stable granulomasMEDIASTINUM AND HILA: Stable reference right paratracheal lymph node best seen on image 28 measuring 1.6 x 1.9 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: Stable pancreatic tail subcentimeter cystic focus.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: Stable reference portacaval lymph node best seen on image 98 measuring 1.8 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent 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. | Stable examination. No new adenopathy. |
Generate impression based on findings. | 60 yo M with asthma and incidentally noted R LL nodule. LUNGS AND PLEURA: No suspicious nodules identified. Scattered micronodules, some calcified, favor benign etiology.Focal linear scarring in the periphery of the right middle lobe extending from the pleura (coronal image 89).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No suspicious pulmonary nodules identified. |
Generate impression based on findings. | 62 year old female. h/o anaplastic thyroid ca, lung lesion, compare to previous, measurements. CHEST:LUNGS AND PLEURA: Bilateral pulmonary emboli at the bifurcation of both the right and left pulmonary arteries.The previous identified right lower lobe nodule is now cavitated with a thin rim measuring 10 mm, consistent with treatment response (image 67, series #5).New right lower lobe micronodule measures 3 mm (image 61, series #5), suspicious for new metastasis. Two areas of focal pleural thickening with adjacent ground glass opacity not previously seen are also suspicious for metastatic disease (image 58 and 72, series #5).Resolved bilateral basilar atelectasis.MEDIASTINUM AND HILA: Small hiatal hernia noted. Right-sided chest wall port catheter tip in the inferior SVC. Status post thyroidectomy with surgical clips versus calcification in the surgical bed.CHEST WALL: Partial chronic collapse of T7 vertebral body.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Contracted gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.New bilateral pulmonary emboli identified extending to the segmental branches of the right and left pulmonary arteries.2.Cavitation of a previous identified right lower lobe nodule is consistent with treatment response.3. New micronodule suspicious for new metastasis. Continue follow-up is recommended. 4. Findings were relayed to Dr. DeSouza at 5:37 p.m. on December 27, 2013 via telephone. |
Generate impression based on findings. | Male; 56 years old. Reason: Evaluate for interval change History: Metastatic esophageal adenocarcinoma with known brain lesions. Now presents with nausea, vomiting and vision changes (issues with depth perception). The patient is s/p right frontoparietal craniotomy, with near-complete interval resolution of postsurgical changes including pneumocephalus and extraaxial fluid/blood. There is a small amount of residual high density fluid just under the craniotomy flap. Vasogenic edema in the right posterior frontal lobe and parietal lobe is not significantly changed. New region of vasogenic edema is now noted in the left parieto-occipital lobe, which surrounds a hyperdense left occipital lobe mass measuring approximately 8 x 8 mm (series 4, image 21). Edema causes effacement of adjacent sulci but no appreciable midline shift. The ventricles and cisterns are symmetric and unremarkable. There is no evidence of acute territorial ischemia or acute hemorrhage. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable vasogenic edema in the right frontoparietal lobe, with interval development of vasogenic edema in the left parieto-occipital lobe associated with a hyperdense left occipital mass. While this finding presumably represents progression of metastatic disease, MRI can be obtained for further characterization. 2.Interval near-complete resolution of postsurgical changes s/p right frontoparietal craniotomy as described above. |
Generate impression based on findings. | 68 year-old female who febrile, evaluate for sinusitis The orbits are unremarkable. The limited view of the brain parenchyma show a surgical clip in the right side suprasellar region, likely represent a aneurysm clip, and craniotomy change. The maxillary sinuses are clear as are ostiomeatal units. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, and sphenoid sinuses are well developed and clear. Fluid is present within bilateral mastoid air cells (left greater than right) as well as within the left middle ear cavity. However, this is a common finding in the intubated patient. The cribriform plate, lateral lamellae, fovea ethmoidalis and lamina papyracea appear normal. A nasogastric tube is in place via the right nares and the patient is intubated. | 1.Clear paranasal sinuses.2.Fluid is present within bilateral mastoid air cells (left greater than right) as well as within the left middle ear cavity. However, this is a common finding in the intubated patient. |
Generate impression based on findings. | 68-year-old female with altered mental status and sidebar with unknown source. Evaluate for infection. History of lung cancer. CHEST:LUNGS AND PLEURA: Status post left upper lobectomy with volume loss in the left lung with similar appearance to prior chest CT examination. Left pleural effusion and atelectasis again seen. Right pleural effusion has substantially decreased with only minimal residual and bibasilar atelectasis, left greater than right. No evidence of aconsolidation or foci to suggest infection. Calcified micronodules seen, consistent with prior granulomatous disease. MEDIASTINUM AND HILA: Diffuse calcified lymph nodes are seen consistent with prior granulomatous disease. Cardiomegaly and atherosclerotic change is seen. NG tube traverses the esophagus with expected appearance. Endotracheal tube is seen with tip of the tube right at the carina. Left cardiophrenic angle lymph node (series 4 image 66) is enlarged, as described on prior examination, but has not changed.CHEST WALL: Sternotomy changes. Numerous left axillary enlarged lymph nodes worrisome for metastatic disease. The prior described large anterior left chest wall mass extending into the anterior mediastinum (series 4, image 47) measures 2.5 x 7 .1 cm, essentially unchanged. No apparent liquefaction is seen to suggest abscess. ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, following observations can be made:LIVER, BILIARY TRACT: Multiple solid appearing space-occupying lesions are seen in the liver, largest in segment 4 (series 4, image 76) measuring 3.9 x 3.9 cm and multiple inferiorly in the right lobe (series 4, image 129). These are worrisome for metastases although without IV contrast they remain nonspecific in appearance. Gallbladder and biliary tract show no diagnostic abnormalities..SPLEEN: No spleen identified -- probable prior splenectomyPANCREAS: 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: Gastrointestinal contrast rapidly progresses through normal appearing stomach and small bowel, without evidence of obstruction or intrinsic abnormality. Colon is moderately distended and fluid-filled. Small to moderate amount of ascites is seen diffusely without loculation to suggest abscess..BONES, SOFT TISSUES: Diffuse anasarca and subcutaneous edemaOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable prior hysterectomy without other significant abnormality noted.BLADDER: Foley catheter in bladder with large amount of air in the bladder -- no apparent inflammatory changes are seen to suggest an ectatic -- cystic fistula and this may relate to some catheter manipulations. No other abnormalities are seen..LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrointestinal contrast rapidly progresses through normal appearing stomach and small bowel, without evidence of obstruction or intrinsic abnormality. Colon is moderately distended and fluid-filled. Small to moderate amount of ascites is seen diffusely without loculation to suggest abscess..BONES, SOFT TISSUES: Diffuse anasarca and subcutaneous edema. Lytic lesions are seen in multiple locations in the iliac bones bilaterally with soft tissue destruction consistent with metastatic disease. OTHER: No significant abnormality noted. | 1. Persisting left pleural effusion with basilar atelectasis and near resolution of right pleural effusion with minimal atelectasis. 2. Multiple foci of bony metastases involving the left anterior chest wall and the iliac bones, as described above. 3. Probable liver metastases. 4. Multiple enlarged left axillary lymph nodes, worrisome for metastases. 5. Ascites. 6. Endotracheal tube tip located just at the carina. 7. Diffuse body edema/anasarca. 6. No site of infectious origin seen. |
Generate impression based on findings. | 86 year old female. Reason: assess for PE History: tachcardia, sob. PULMONARY ARTERIES: Respiratory motion artifact severely degrades exam quality. No pulmonary embolus identified in the main or lobar pulmonary arteries.LUNGS AND PLEURA: Moderate right and small left pleural effusion with associated compressive atelectasis. Dependent bibasilar atelectasis .MEDIASTINUM AND HILA: Moderate to severe cardiomegaly.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nodular liver contour is compatible with cirrhosis. | 1.Exam severely limited by respiratory motion artifact. No central or lobar pulmonary embolism.2.Cardiomegaly with bilateral pleural effusions, right greater than left. |
Generate impression based on findings. | 52 year old female. Reason: assess for pe History: hx multiple PE's, sob, recent immobilization. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. No pulmonary embolus identified.LUNGS AND PLEURA: Scattered calcified micronodules consistent with prior granulomatous disease. Mild posterior bilateral pleural thickening and nodularity, slightly increased from the prior exam.MEDIASTINUM AND HILA: Calcified subcarinal and right hilar lymph nodes consistent with prior granulomatous disease. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism or other pathology to explain shortness of breath. |
Generate impression based on findings. | 66 year old female with chest pain. PULMONARY ARTERIES: Technically adequate examination for evaluation of pulmonary embolism. No pulmonary embolus identified.LUNGS AND PLEURA: Masslike consolidation in the lingula measures 32 x 19 cm (series #9, image 91), could represent atelectasis, however, malignancy cannot be excluded.Mild bilateral basilar scarring/discoid atelectasis. Focal area bronchiectasis in the right middle lobe.Slight elevation of the left hemidiaphragm.MEDIASTINUM AND HILA: A right hilar lymph node measures 14 mm in its short axis (series #6, image 138). Another prominent right hilar node is identified. Other scattered nonenlarged mediastinal and hilar lymph nodes seen. Small hiatal hernia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. | 1.No pulmonary embolism identified.2.Masslike consolidation in the lingula may represent atelectasis, though malignancy cannot be excluded. Recommend follow-up examination in 3 months. |
Generate impression based on findings. | Male; 54 years old. Reason: abscess perineum History: abscess PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is moderately distended with diffuse wall thickening likely secondary to chronic inflammation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: In the perineal subcutaneous tissues, there is a loculated fluid collection tracking up to the right ischial tuberosity with surrounding inflammatory changes, best seen on image 95 of series 3, measuring 3.0 x 1.9 cm. There is no discrete evidence of fistulous communication with the bowel, although CT is insensitive in detecting such abnormalities. | 1.Perineal abscess as described above. If there is clinical concern for fistulous communication with bowel, consider MRI for further evaluation. |
Generate impression based on findings. | Female; 39 years old. Reason: r/o obstruction and location of GJ-Tube History: diffuse abd pain Lack of intravenous contrast enhancement limits the evaluation of solid organ parenchyma and vascular structures. Given these limitations, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter hypodense lesions in the right lobe is too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastro-jejunostomy tube present with tip coiled and possible knotted in the jejunum. Additionally, there is new minimal dilatation of the bowel proximal to the tube tip without discrete transition point, which may represent an ileus versus partial obstruction. No evidence of perforation or abnormal fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Coiled/knotted gastrojejunostomy tube and mild proximal small bowel dilatation. Ileus is favored over partial obstruction. |
Generate impression based on findings. | Female; 32 years old. Reason: evalute for acute abdomen, possible cholecystitis History: abd pain ABDOMEN:Lack of intravenous contrast enhancement limits the evaluation of solid organ parenchyma and vascular structures. Given these limitations, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Significant cholelithiasis and choledocholithiasis. Questionable gallbladder wall thickening. No pericholecystic fluid. The common bile duct is minimally dilated measuring 9 mm. No intrahepatic ductal dilatation.SPLEEN: Persistent mild splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable inflammatory changes in the right perirenal fat. No evidence of hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Nonpathologic sized retroperitoneal and mesenteric lymphadenopathy, likely reactive in etiology.BOWEL, MESENTERY: No pneumoperitoneum, pneumatosis, or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: IUD in uterus. Right adnexal calcifications are unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Resolution of previously identified abscess. | 1.Cholelithiasis and choledocholithiasis with possible gallbladder wall thickening. An inflammatory process of the gallbladder cannot be excluded. Consider an abdominal ultrasound for further evaluation.2.Minimal common bile ductal dilatation. |
Generate impression based on findings. | Clinical impression: Evaluate for intracranial hemorrhage; compared to prior exam. Signs and symptoms: Alteration of mental status. Nonenhanced head CT:Small focus of hemorrhage in the left cerebellum is again identified and without appreciable change.Focus of parenchymal hemorrhage and subarachnoid hemorrhage with several surrounding edema in the left posterior parietal -- occipital region is again identified and unchanged since prior study.Focus of parenchymal hemorrhage and surrounding edema in high convexity left anterior frontal shows no convincing evidence of interval change in size or extent.Multiple small scattered foci of subarachnoid hemorrhage in bilateral cerebral hemispheres more noticeably in the right anterior frontal also remains similar to prior study.There is no evidence of any new foci of hemorrhage.Ventricular system remains within normal size and midline is maintained. Very small amount of hemorrhage in the dependent portion of right occipital horn remains also stable since prior exam. | 1.Stable multiple foci all parenchymal and subarachnoid hemorrhage some with minimal surrounding edema and subtle regional mass-effect since prior exam.2.No convincing evidence of any new focus of hemorrhage.3.Tiny hemorrhage in the dependent portion of right occipital lobe remains also stable.4.Normal size of ventricular system and maintained midline. |
Generate impression based on findings. | Reason: 80 M with interstitial infiltrates on cxr History: hypoxic LUNGS AND PLEURA: Moderate to severe centrilobular and paraseptal emphysema.Basilar predominant traction bronchiectasis and probable honeycombing compatible with UIP.Diffuse groundglass opacities with basilar areas of consolidation/atelectasis.Scattered calcified granulomas.No pleural effusions..MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Enlargement of the pulmonary artery, compatible with pulmonary arterial hypertension. There is cardiac enlargement without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense masses in the right kidney compatible with cysts. However, there is a solid appearing mass emanating from the upper pole right kidney. Dedicated renal imaging is recommended for further evaluation.Distended gallbladder with cholelithiasis | 1.Evidence of basilar predominant moderate to marked interstitial lung disease in a UIP pattern. In addition, there is concomitant emphysema.2.Groundglass opacities and basilar areas of consolidation suggests a superimposed acute process including infection, edema, or possibly aspiration.3.Cardiomegaly with marked prominence of the pulmonary artery and ectasia of the aorta.4. Right renal mass extending from the upper pole of the right kidney. Recommend dedicated CT imaging of the kidneys. |
Generate impression based on findings. | Female; 56 years old. Reason: obstruction History: abdominal pain, emesis 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: Subcentimeter right lower pole hypodensity is too small to characterize, but unchanged from prior.RETROPERITONEUM, LYMPH NODES: Scattered nonpathologic sized retroperitoneal lymphadenopathy likely reactive in etiology.BOWEL, MESENTERY: Ostomy in right lower quadrant is patent with no evidence of parastomal hernias or complications. Moderately dilated loops of distal small bowel without evidence of discrete transition point to suggest obstruction, although we cannot exclude a partial obstruction at the stoma. The proximal jejunum is collapsed likely secondary to NG tube decompression. No evidence of pneumoperitoneum or pneumatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of free fluid in the pelvis. | Moderately dilated loops of distal small bowel without evidence of discrete transition point to suggest obstruction, although a partial obstruction at the stoma cannot be excluded. An ileus is favored over an obstruction.These results were discussed with Dr. Bishop on 12/28/13 at 0930. |
Generate impression based on findings. | Clinical question: Cognitive decline. Signs and symptoms: Cognitive decline. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation for patient's stated age of 77.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.All visualized paranasal sinuses and bilateral mastoid air cells are pneumatized. | Negative nonenhanced head CT. |
Generate impression based on findings. | 44-year-old female with moyamoya and intracranial hemorrhage. Postsurgical changes s/p right craniectomy for cerebral edema decompression and associated mild transcranial herniation are again noted. As before there is diffuse right hemispheric edema with loss of gray-white interface due to prior infarction. Effacement of right hemispheric sulci and basal cisterns again noted. There has been minimal interval enlargement in left lateral ventricular size, now measuring 10 mm in CC dimension, previously 8 mm (series 80257, image 28). Leftward midline shift is stable at approximately 7 mm. No significant interval change in size of right basal ganglia hemorrhage as well as extent of SAH. Mild dilatation of the left temporal horn is unchanged. The paranasal sinuses and mastoid air cells are clear. | 1.Postsurgical changes s/p right craniectomy for diffuse cerebral edema decompression, with stable mild transcranial herniation and 7 mm leftward midline shift. 2.Minimal interval enlargement in size of left lateral ventricle.3.No significant interval change in right basal ganglia and subarachnoid hemorrhage. |
Generate impression based on findings. | Female; 30 years old. Reason: assess for ovarian cyst, or other intra-abd process History: 10/10 LLQ pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well-visualized and unremarkable. The remainder of the bowel is normal in caliber. No evidence of obstruction or pneumoperitoneum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No evidence of adnexal cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Minimal amount of free fluid in the pelvis, likely physiologic in etiology. | No radiographic evidence to account for the patient's symptoms. |
Generate impression based on findings. | 73-year-old female patient with proximal humerus fracture. There is a comminuted fracture of the proximal humerus, as seen on recent radiographs, that includes a complete transverse fracture through the surgical neck. The fracture plane extends into the inferior aspect of the glenohumeral joint, and there just over 1 cm of anteromedial displacement of the diaphyseal fragment in relation to the humeral head fragment. The fracture also extends through the inferior aspects of the greater and lesser tuberosities. Multiple additional small fracture fragments are noted There is no frank glenohumeral dislocation, although there is perhaps minimal posterior subluxation of the humeral head in relation to the glenoid. The distal humerus, scapula and clavicle appear intact. There is atrophy of the supraspinatus and infraspinatus muscles, which may represent chronic rotator cuff tear. | Proximal humerus fracture as described above. |
Generate impression based on findings. | 73-year-old male. Reason: assess known LV clot burden History: assess clots. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. No pulmonary embolus identified. Previously seen clot in the lateral segmental branch of the right middle lobe is not identified on this exam.LUNGS AND PLEURA: Trace right sided effusion, decreased from prior exam. Unchanged mild to moderate left pleural effusion. Groundglass opacities in the right apex are now resolved. Scattered micronodules, some calcified. No suspicious nodules identified.MEDIASTINUM AND HILA: No evidence of right heart strain. Status post CABG. No pericardial effusion. Stable moderate cardiomegaly.Interval removal of right-sided central venous catheter. Atherosclerotic calcification of the thoracic aorta and aortic valve. Mild calcifications of the coronary arteries is noted. No mediastinal or hilar lymphadenopathy. CHEST WALL: Median sternotomy fixation, unchanged. Degenerative changes of the thoracolumbar spine are noted, most prominently at T8, T9. Partially imaged T12 hardware unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasiss. Previously seen small volume ascites in the upper abdomen is no longer evident. | 1.Previously identified pulmonary embolus in right middle lobe lateral segmental branch is resolved.2.Decreased right and unchanged left pleural effusions.3.Ascites no longer seen. |
Generate impression based on findings. | Clinical question: Brain vasculature. Signs and symptoms: Left MCA stroke. Nonenhanced head CT:The examination redemonstrates a subacute nonhemorrhagic left MCA territory stroke involving the left temporal, left frontal and left basal ganglia. No significant change since prior exam in its extent, associates or mass effect on the left lateral ventricle and effacement of adjacent cortical sulci.Chronic large right pica territory cerebellar stroke. Stable ventricular system which are mildly dilated and with maintain midline.Neck CTA:The visualized aortic arch and the origins of major vessels remain unremarkable.Brachial cephalic and bilateral subclavian arteries are patent and unremarkable.Right common carotid, right internal and external carotid arteries are patent. Minimal atherosclerotic disease is present.Left common carotid, left internal and external carotid arteries are widely patent. Minimal atherosclerotic disease is present.Bilateral vertebral arteries are patent through their entire cervical segment. On reformatted images there is apparent short segmental vascular lumen compromise of proximal left vertebral artery. This is an artifactual finding and on axial source images there is filling of opacified vein at this site that parallels the left vertebral artery and results in artifactual appearance on 3-D reformatted images. 2-D MIP images demonstrate patency of the vertebral artery.Head CTA:Examination demonstrates patent bilateral vertebral arteries across the skull base and either intracranial segments.Right pica branches identified and unremarkable. A left aica/pica common trunk is identified.Mass or artery and its distal branches are unremarkable.Right internal carotid artery is patent across the skull base and in its supraclinoid portion.Right anterior and middle cerebral arteries are visualized and unremarkable. Normal anterior communicating artery is identified and representing an anatomical variation.Left internal carotid artery is widely patent across the skull base and in the supraclinoid segment. Left anterior cerebral artery is visualized are unremarkable.Left middle cerebral artery demonstrate near complete occlusion at its distal M1 segment. Several of the distal left MCA braches beyond the stenosis however are identified in the left sylvian fissure. | 1.Nonenhanced head CT demonstrate stable subacute nonhemorrhagic large left MCA territory ischemic stroke without interval change. Chronic right cerebellar ischemic stroke and unremarkable head CT otherwise and stable since prior study.2.Enhanced neck CTA is unremarkable for any significant mass permanent compromise. Please see above comments.3.Enhanced head CT demonstrate near complete occlusion of distal left M1 segment of middle cerebral artery. Several of the left MCA branches beyond this region are identified within the left sylvian fissure. Unremarkable head CTA otherwise. |
Generate impression based on findings. | Reason: question right lower lobe aspiration pneumonia on cxr, immunocompromised, sputum productoin History: question right lower lobe aspiration pneumonia on cxr, immunocompromised, sputum productoin LUNGS AND PLEURA: Scattered areas of ground glass with basilar predominant septal thickening, compatible with edema.Mild bilateral pleural effusions with overlying atelectasis. No specific evidence of the infection or aspiration.MEDIASTINUM AND HILA: Prominent right lower paratracheal lymph node without definite evidence of hilar or mediastinal lymphadenopathy.Hypodensity in the left lobe of the thyroid gland.Cardiac size is minimally enlarged without evidence of a pericardial effusion.Extensive aortic calcification. CHEST WALL: Severe degenerative changes throughout the thoracic spine with accompanying kyphosis.Median sternotomyUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Are atherosclerotic changes. | Bilateral pleural effusions with predominantly interstitial pulmonary edema compatible with CHF. Mild basilar atelectasis without specific evidence of acute infection or aspiration. |
Generate impression based on findings. | Male 49 years old; Reason: S/P LVAD. Eval for fluid collection or occult focus with blood cultures positive History: Bacteremia The exam is not sensitive detecting lesions in the solid organs are vasculature due to the lack of intravenous contrast. Streak artifact in the upper abdomen due to Cardiac Assist device. Given those limitations, the following observations made:ABDOMEN:LUNG BASES: A ventricular assist device is seen. Lung bases clear.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric bilateral perinephric fat stranding. Correlate clinically to rule UTI or bilateral pyelonephritis. No evidence of hydronephrosis. Small exophytic lesion off the lower pole the right kidney consistent with a cyst.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild atherosclerotic calcifications iliac arteries. No evidence of aneurysm. | Nonspecific perinephric fat stranding bilaterally correlate clinically to rule out UTI or bilateral pyelonephritis. |
Generate impression based on findings. | Male 60 years old Reason: re-evaluate disease status after additional systemic therapy. compare to previous and provide bi-dimensional measurements TY History: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Patchy opacities with some groundglass character is seen multifocally in the right upper lobe left upper lobe, and areas of more dense opacity with some areas of having a nodular character is seen in the left lower lobe. This may upper lobe concerning for infection or related to therapy. The left lobe lesions could represent infection however superimposed metastatic disease cannot be excluded. These can be followed.MEDIASTINUM AND HILA: Right anterior mediastinal focal fluid consistent with pericardial cyst or loculated fluid unchanged from the prior examinations.No pathologic size lymph nodes. Minimal coronary artery calcifications.CHEST WALL: Postsurgical changes consistent with lymph node dissection in the right axilla. No evidence of subcutaneous masses or pathologic sized lymph nodes in the axilla.ABDOMEN:LIVER, BILIARY TRACT: Gallstones layering in the gallbladder unchanged. No biliary dilatation. No focal liver lesions.SPLEEN: Cyst the spleen noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications without evidence of aneurysm. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New multifocal areas of airspace opacity concerning for infection or chemotherapy effect. Some of the lesions in the left lower lobe other nodular character and can be followed from the possibility of metastases. No suspicious lesions seen anywhere else.Cholelithiasis. |
Generate impression based on findings. | Male 73 years old Reason: baseline exam prior tostartin new systemic therapy History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Multifocal lung nodules of increased in size and number. For baseline purposes a lesion in the right upper lobe medial aspect, series 5 image 38 measures 1.3 x 0.9 cm. On the previous exam it measured 0.9 x 0.6 cm on image 41.The right lower lobe pulmonary artery is compressed by the metastatic lesion and some debris and peripheral bronchi. Possibly some pulmonary vein thrombus but no definite pulmonary artery thrombus.MEDIASTINUM AND HILA: Please mediastinal adenopathy particularly in the right and left hilum and subcarinal areas. Large right parahilar mass as measured on soft tissue windows, series 3 image 61/2021, 2.9 x 2 cm. Previously 2.3 x 1.9 cm series 2 image 60.Coronary artery calcifications. CHEST WALL: Median sternotomy.Possible lytic focus in the inferior aspect of the right scapula best seen on coronal image 40/131. This can be followed. No other suspicious bone lesions are seen.ABDOMEN:LIVER, BILIARY TRACT: Several hypoattenuating lesion in the right lobe of the liver and abutting the right hepatic vein near the confluence, series 3 image 89, estimated at 2.3 x 1.7 cm.Subtle calcification along the capsule the liver dome best seen on coronal image 82, unchanged there is no soft tissue mass associated with this calcification however.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Large heterogeneous right adrenal mass with hypodense center suggestive of necrosis compresses the liver and inferior vena cava. Its medial margin is ill defined. It measures approximately 6.5 x 5.4 cm on series 3 image 109. Previously measured 6.1 x 5.7 cm on series 2 image 109/121.The left adrenal gland is surgically absent. KIDNEYS, URETERS: Left kidney is surgically absent. No masses are seen in the right kidney.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications. No evidence of aneurysm. No pathologic size nodes.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: Scattered colonic diverticulosis. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Bilateral hip prostheses.Large lucent poorly marginated area in the right sacrum series 3 image 170 suspicious for metastasis.OTHER: No significant abnormality noted | Metastatic lesions in the lungs, mediastinal nodes, bones, right adrenal gland and liver. Progression of disease. Other findings as above. |
Generate impression based on findings. | For IRB 12-2221, must use water only for oral contrast prep. Must include arterial phase Chest and Upper Abdomen. Call HIRO for questions 2-9172. Re-evaluate disease status following new systemic therapy compared to prior scan and provide bi-dimensional Signs and Symptoms: stage iv metastatic melanoma. CHEST:LUNGS AND PLEURA: Index lesion in the lingula 1.7 x 1.5 cm series 11 image 50. Previously 1.7 x 1.6 cm.Other scattered nodules or again seen with no new foci. Several other non-index lesions have increased in size. For example the lesion in the left lung abutting the lateral pleural surface on series 11 image 60 measures 1.5 x 1 cm previously 1 x 0.7 cm on series 9 image 61.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Nodule in the right breast measures 1.2 x 0.9 cm series 7 image 49. Previously 1.1 x 0.9 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic mass 7.4 x 7 cm, series 9 image 93. Previously 6.4 x 6.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral foci too small to characterize likely cysts.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic calcifications. No aneurysm. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Redemonstration of a right sacral Tarlov cyst. Bilateral hip prostheses.OTHER: No significant abnormality noted. | Interval increase in some of the lung lesions and splenic lesion. No new sites of disease. |
Generate impression based on findings. | Male 52 years old; Reason: 52 year-old male with possible ventral hernia vs approximately 1 cm palpable lipoma or mass (located 3-4 cm superior to and 1 cm to the right of the umbilicus) History: as above ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Multiple accessory right renal artery is noted. One of these originates from the right common iliac artery.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sub-mucosal fat deposition is seen in the terminal ileum and there is some mild wall thickening and another loop of distal ileum (see coronal image 70/102). No mesenteric fat stranding or fluid. No sinus tracts or fistulas. Correlate clinically for any history that might suggest inflammatory bowel disease.BONES, SOFT TISSUES: The area of interest described in the clinical history around the umbilicus is evaluated and no mass is evident. Specifically no lipoma is seen in the subcutaneous tissues abdominal wall musculature or peritoneal cavity.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fluid density structure noted in the distribution of the right epididymis measuring about 2 x 1.4 cm on coronal image 79. There are present epididymal cyst or hydrocele. Some prominent vessels seen in the inguinal canals correlate for varices and testicular symptoms. | 1.Some subtle signs raising the question of a past history of inflammatory bowel disease.2.No mass evident around the umbilicus.3.Possible right epididymal cyst and varices in the inguinal canals, correlate for testicular symptoms. |
Generate impression based on findings. | Diagnosis: Abdominal pain, unspecified site. Clinical question: Eval for obstruction, free fluid, pyelo, cyst. Signs and Symptoms: diffuse pelvic pain Limited by body habitus.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 amount of fat stranding and fluid is seen in the right paracolic gutter for example series 2 image 46. Etiology uncertain. Some mildly dilated loops of jejunum but no definite evidence of bowel obstruction intramural air or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Some unopacified loops of bowel in the pelvis questionable fluid in the peritoneal cavity or abutting the uterus. Correlate clinically. Some of the bowel loops abut the anterior abdominal out possibly suggesting postsurgical nonobstructive adhesions.BONES, SOFT TISSUES: Postsurgical changes anterior pelvic wall midline scar.OTHER: No significant abnormality noted | Small amount of fluid in the pelvis and in the left paracolic gutter of uncertain etiology. Correlate clinically as to need for transvaginal ultrasound. If symptoms significantly worsen follow up exam may be obtained. Possible non-obstructing adhesions pelvic loops of bowel. |
Generate impression based on findings. | 43-year-old male. Diagnosis: Melanoma of skin, site unspecified. Examination of participant in clinical trial. Clinical question: For IRB 12-2221, must use water only for oral contrast prep. Must include arterial phase Chest and Upper Abdomen. Call HIRO for questions 2-9172. Re-evaluate disease status following new systemic therapy compared to prior scan and provide bi-dimensional.Signs and Symptoms: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: A lobulated mass or conglomerate masses previously described in the left upper lobe is a located in the superior segment of the left lower lobe, seen on series 9 image 40 to measure 2.8 x 1.6 cm. It previously measured 2.5 x 1.4 cm.Lingula nodule series 9 image 48 probably unchanged.Large right lower lobe mass measures 5.4 x 4.4 cm series 9 image 57. Previously 4.8 x 3.7 cm.Postoperative changes right lower lobe. No new nodules. No effusions.MEDIASTINUM AND HILA: Hilar lymph nodes. Index nodes are medial to the right main bronchus measures 1.9 x 0.9 cm, series 8 image 46. Previously 1.3 x 0.6 cm.No new nodes.CHEST WALL: Old rib fractures. No axillary nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. Accessory spleen noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Increased in size of index lesions. No new sites of disease. |
Generate impression based on findings. | Male 65 years old; Reason: assess for abscess, sbo History: abd pain, vomiting Exam is not sensitive for detecting lesions in the solid organs of vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Contrast in the collecting system from prior IV contrast attempt. The parenchyma however is not enhanced and given limitation of no IV contrast no focal lesions seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild to moderate ascites increased since prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Contrast in urinary bladder presumably from prior attempts at IV contrast exam is documented by the radiology resident on call stat consult.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval healing left ischio fracture. Right ischio evulsion fracture, probably chronicOTHER: No significant abnormality noted. | 1.Limited exam. Increase in ascites. No evidence of bowel obstruction. Other findings as above. |
Generate impression based on findings. | Male 41 years old; Reason: Abd pain, ascites, known liver failure History: above ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cirrhotic morphology. Varices. No definite focal lesions. Perihepatic ascites. No obvious biliary dilatation. The gallbladder is distended but there is no wall thickening or obvious gallstones given limitation of CTSPLEEN: Mild splenomegaly 15.1-cm coronal image 48.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A few varices are seen in the retroperitoneum. No pathologic size lymph nodes. Normal caliber aorta and normal flow seen in the SMA and celiac artery and their branches.BOWEL, MESENTERY: There is marked diffuse submucosal edema involving the right:, transverse colon and descending colon. This degree of submucosal edema is concerning for colitis. Correlate clinically. No evidence of intramural air or free air.There is also mild dilatation and marked bowel wall thickening involving a long segment of duodenum and proximal jejunum but no thickening seen in the ileum. Some loops of jejunum are thickened up to 1.5 cm in wall thickness as measured on series 3 image 50. No intramural air or free air. No evidence of thrombi in the mesenteric arteries or veins. The focality and severity of this finding raises the question of ischemia are infection. Hypoproteinemia usually is less marked and more diffuse small bowel wall thickening absent in this case.Peritoneal and anterior abdominal wall varices consistent with portal hypertension.BONES, SOFT TISSUES: Anterior abdominal wall varices.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascites small to moderate in volume.BONES, SOFT TISSUES: Anterior abdominal wall varices.OTHER: No significant abnormality noted. | 1.Cirrhosis, varices, ascites and splenomegaly.2.Severe colonic wall thickening concerning for colitis.3.Severe duodenal and proximal jejunal wall thickening concerning for ileitis or ischemia. Correlate clinically. No definite findings of bowel necrosis. |
Generate impression based on findings. | Clinical question: Eval for mets, pyelo. Signs and Symptoms: flank pain. Tech Comments: pt has a neobladder+R Flank Pain 1 month. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Rotatory scoliosis and degenerative changes.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: Status post cystectomy and neobladder.LYMPH NODES: Small nonpathologic sized nodes. Surgical clips are right iliac distribution.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: The two scoliosis and degenerative changes. Postsurgical scar anterior abdominal wall.OTHER: No atherosclerotic changes. No aneurysm. | No findings to explain patient's symptoms. Expected postsurgical changes. |
Generate impression based on findings. | Diagnosis: Fitting and adjustment of other gastrointestinal appliance and device. Clinical question: r/o bowel obstruction. The exam is not sensitive for detecting lesions in the solid organs or vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are madeABDOMEN:LUNG BASES: Extensive atelectasis or consolidation right lower lobe. Rule out aspiration pneumonia. Small right pleural effusion.Left lung bases clear. Atherosclerotic calcifications coronary arteries.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: Diffusely prominent aorta to 2.6 cm transverse as measured on coronal image 63. Diffuse atherosclerotic calcifications.BOWEL, MESENTERY: NG tube tip in stomach. Diffuse marked dilatation of the proximal half of the small bowel with relatively collapsed ileum. It is difficult to determine exact transition zone but this is concerning for high grade but incomplete small bowel obstruction. No intramural air or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent. Pessary noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Heavy atherosclerotic disease. Diffuse and multifocal dilatation particularly of the right common iliac artery which proximally measures 2.4 cm on coronal image 63 and more distally measures 2.4 cm on coronal image 57. There is less marked mild prominence of the left common iliac artery with a diameter of 1.4-cm. | Findings consistent with high-grade but incomplete small bowel obstruction. Atherosclerotic disease with aneurysms as above. Limitations of no IV contrast.Concern for right lower lobe pneumonia. |
Generate impression based on findings. | Diagnosis: Universal ulcerative (chronic) colitis. Clinical question: Leukocytosis. Signs and Symptoms: Leukocytosis ABDOMEN:LUNG BASES: Atelectasis right lower lobe.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: Minimal atherosclerotic calcifications aorta and proximal renal arteries.BOWEL, MESENTERY: Postsurgical changes consistent with subtotal colectomy and end ileostomy. Pneumoperitoneum consistent with recent surgery the radiology resident on call stat consult note right lower quadrant ileostomy. Small amount of ascites.A short segment thrombus in the mesenteric vein is seen in the right abdomen. For example please see series 3 image 91. There is also a long segment partial thrombus in the inferior mesenteric vein. This is best seen on coronal image 41/84.BONES, SOFT TISSUES: Air in the subcutaneous tissues consistent with recent surgery. Midline staples. Right lower quadrant ileostomy.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Ileocolic anastomosis seen in the distribution of the left lower quadrant. Relatively collapsed loops of ileum in the pelvis. Small to moderate amount of ascites.Mild diffuse thickening the rectum and residual rectosigmoid and distal sigmoid colon.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted | Dilated small bowel concerning for early postoperative obstruction due to adhesions. Correlate for possibility of early ischemia given short segment thrombus in the mesenteric vein and partial long segment thrombus in and inferior mesenteric vein. Small to moderate amount of ascites. Pneumoperitoneum consistent with recent surgery. Correlate with exact duration since surgery. |
Generate impression based on findings. | Clinical question: patient with hx of cancer of unknown origin (colon vs cervix) admitted for amsSigns and Symptoms: patient with hx of cancer of unknown origin (colon vs cervix) admitted for ams ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The contour of the liver is lobular. I believe the scout appearance is moral likely related to carcinomatosis scalloping the liver however correlate clinically further possibility of coincident cirrhosis. No evidence of portal or hepatic vein thrombus. No biliary dilatation.SPLEEN: Multifocal hypoattenuating masses in the periphery of the spleen near its hilus likely represent impression by peritoneal implants. For baseline purposes the largest lesion is measured on series 4 image 24, 2.9 x 2 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate bilateral hydronephrosis and hydroureter probably related to compression by the carcinomatosis.RETROPERITONEUM, LYMPH NODES: Atherosclerosis without evidence of aneurysm.BOWEL, MESENTERY: Diffuse ascites and carcinomatosis. Carcinomatosis scallops the liver and spleen.BONES, SOFT TISSUES: Marked scoliosis and degenerative changes. Severe diffuse anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse carcinomatosis and ascites. Maximal thickness of carcinomatosis 4.2 cm AP as measured on series 4 image 84. Large loculated fluid density collection compressing bowel in the right lower quadrant measures 8 x 7.7 cm.Midline pelvic mass with central hypoattenuation possibly necrosis measured on series 4 image 93, 6 by 5-cm.The bowel is compressed but not obstructed.BONES, SOFT TISSUES: Marked scoliosis and degenerative changes. Severe diffuse anasarca. Lipoma right gluteus muscle.OTHER: Atherosclerotic disease. | Findings consistent with carcinomatosis. Severe anasarca. Scalloped liver contour cirrhosis versus carcinomatosis. Splenic lesions most likely related to carcinomatosis.Bilateral hydronephrosis and hydroureter.Other findings as above. |
Generate impression based on findings. | Male 30 years old; Reason: assess spleen History: mass found on xray ABDOMEN:LUNGS BASES: No significant abnormality noted.No evidence of any healed rib fractures to suggest trauma to the left upper quadrant given the splenic finding.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Noncalcified 7.3-cm fluid density lesion in the spleen consistent with a splenic cyst. These are most likely congenital or posttraumatic in origin. No septations are seen within the lesion. No other lesion seen. Splenic artery and vein are patent. No evidence of any peri-splenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Large calcified splenic cyst. |
Generate impression based on findings. | Clinical question: obstruction? diverticulitis? Signs and Symptoms: diverticulosis, colostomy, p/w emesis/nausea/abd pain, no flatus or BM for 2 days. The exam is not sensitive at detecting lesions in the solid organs or vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Choledochoenteric anastomosis with persistent biliary dilatation and reflux of gas and oral contrast into the biliary tree. Persistent biliary dilatation. No definite focal liver lesions given limitation of no IV contrast.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease chest and aorta with irregular areas of focal dilatation of the aorta. Proximal abdominal aorta the 2.5-cm as measured on coronal image 47.BOWEL, MESENTERY: Moderately dilated bowel throughout the upper abdomen and in the large left-sided hernia with relatively collapsed small bowel exiting the hernia. This suggests incomplete mechanical obstruction. No intramural air or, free air or ascites in the peritoneal cavity or the hernia sac to suggest ischemia.BONES, SOFT TISSUES: Scoliosis and degenerative changes. Generalized osteoporosis. Some loss of height of vertebral bodies.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: Foley catheter in place. A focus measured on the2009 CT scan and the urinary bladder is no longer present.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Spinal stimulation device in the subcutaneous tissues of the right abdomen. Fatty replacement back and pelvic musculature. Generalized osteoporosis.OTHER: Heavy atherosclerotic calcification. | Incomplete small bowel obstruction possibly at the hernia neck. Other chronic findings as above. |
Generate impression based on findings. | 57 year old female. Clinical question: h/o abdominal pain, vomiting, nausea; c/f diverticulitis. Additional history from prior exam indicates history of non-Hodgkin's lymphoma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cystectomy clips. No biliary dilatation. No focal liver lesions. There is a large area fatty replacement on the surface of the medial segment of the left lobe. This is a new finding.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: The previously measured cluster of nodes in the left common iliac distribution and now separated by fat and represent two separate nodes the largest of which is bilateral and measured on series 3 image 74 is 0.9 x 0.7 cm.BOWEL, MESENTERY: Distorted and angulated loops of bowel in the pelvis apparently adherent to the anterior abdominal wall suggestive of nonobstructive adhesions. Some loops in this area might be mildly thickened or incompletely opacified. There is no evidence of intramural air or free air. No free or loculated intraperitoneal fluid.Surgical clips in the cul-de-sac likely dropped clips. Few scattered colonic diverticula.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted | Signs of adhesions in the loops of small bowel in the pelvis with some areas that might be thickened raising the question of a low-grade ischemia but no frank obstruction intramural air or free air.No pathologic size lymph nodes.New area of focal fatty deposition in medial segment left lobe of the liver. |
Generate impression based on findings. | 53 year old female. Clinical question: Eval for sbo, internal hernia. Signs and Symptoms: abdominal pain and distention ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel wall thickening or dilatation. Suture lines consistent with prior gastric surgery and jejunal suture line. Loops of proximal jejunum appear nonobstructive but infused into the abdominal wall in the left upper quadrant.Of note that oral contrast is seen in both the main body of the stomach and what appears to be gastric sleeve. Correlate clinically to insure that this is an expected finding.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal. Small loculated fluid collection series image 73 measures 4.7 x 2 cm. Tracks related to prior drains and small foci of gas consistent with surgery are subcutaneous injections noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of fluid in the dependent portion of the pelvis.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted | Probable nonobstructive adhesions. Small amount of free fluid. Focal postsurgical collection in the subcutaneous tissues of the left abdominal wall is nonspecific. Correlate clinically to rule out infection. Also correlate regarding expected gastric postsurgical anatomy. |
Generate impression based on findings. | Female 75 years old Reason: rule out PE, new right sided heart strain PULMONARY ARTERIES: The study is technically adequate. The main pulmonary artery measures 3.0 cm in maximal diameter, which is greater than the upper limit of normal and can be seen in the setting of pulmonary arterial hypertension. Reflux of contrast material into the hepatic veins with a associated cardiomegaly is suggestive of elevated right heart pressure. No filling defect identified within the pulmonary arterial vasculature to suggest pulmonary embolus.LUNGS AND PLEURA: There has been interval placement of a right-sided chest tube and near complete resolution of the previously seen right-pleural effusion. There is a small anterior pneumothorax and scattered subcutaneous emphysema associated with the chest tube tract. There is right-sided volume loss secondary to a prior right middle lobectomy. Calcified nodules in the left lower lobe are compatible with prior granulomatous disease.MEDIASTINUM AND HILA: There is marked cardiomegaly and marked atherosclerotic calcifications of the coronary arteries, aortic valve, thoracic aorta and its branches. A large heterogeneous hypodense thyroid nodule is again identified in the right thyroid lobe. CHEST WALL: Diffuse body wall edema is again present, appearing similar to the previous examination.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodense lesion in the right lobe of the liver is unchanged and most compatible with a hepatic cyst. Other scattered subcentimeter hypodense lesions in the hepatic parenchyma are too small to characterize. There is marked atherosclerosis of the abdominal aorta and its branches. | 1.No evidence of pulmonary embolus as clinically questioned.2.Enlarged main pulmonary arteries, which is nonspecific but can be seen in the setting of pulmonary arterial hypertension.3.Cardiomegaly and suggestion of elevated right heart pressure.4.Interval placement of a right-sided chest tube with near complete resolution of a right-sided pleural effusion.5.Small anterior dependent pneumothorax.Findings communicated to referring service by the radiology resident on call at the time of exam. |
Generate impression based on findings. | Male 20 years old Reason: persistent tachycardia, rule out PE PULMONARY ARTERIES: The study is technically adequate. No filling defects within the pulmonary arterial vasculature are evident. The pulmonary artery measures 2.4 cm maximal diameter.LUNGS AND PLEURA: There has been moderate interval improvement in the right lower lobe consolidation, but development of multifocal areas of patchy consolidation throughout the right middle and lower lobes. These new areas of consolidation may represent aspiration, endobronchial spread of pneumonia, or less likely acute chest.MEDIASTINUM AND HILA: There is an enlarged right hilar lymph node measuring 1.2 cm in short axis, likely reactive in etiology.Mild cardiomegaly without evidence of pericardial effusion.Previously described hypodense material at the cavoatrial junction is not identified on this examination.CHEST WALL: Mottled sclerosis of the thoracic spine with central endplate compression deformities compatible with sickle cell disease. Axillary lymphadenopathy unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Atrophic heterogeneous spleen compatible with autoinfarction secondary to sickle cell disease. Suggestion of hepatomegaly. | 1.No evidence of pulmonary embolus as clinically questioned.2.Mild improvement of the right lower lobe consolidation though there has been development of multifocal patchy consolidation throughout the right middle and lower lobes, may be related to aspiration, endobronchial spread of pneumonia, or less likely acute chest.3.Sequelae of the sickle cell disease as detailed above. |
Generate impression based on findings. | Clinical question: Fall, unknown last of consciousness.Signs and symptoms: Syncope. Nonenhanced head CT:Examination demonstrate subarachnoid hemorrhage primarily in the basal cistern, right sylvian fissure and prepontine cistern and to lesser degree throughout the bilateral cerebral hemispheres (right greater than left). Findings highly suggestive of hemorrhage from an aneurysm and recommend follow-up with CTA examination.There is no detectable posttraumatic parenchymal or extra axial hemorrhage.The ventricular system remain within normal size and midline is maintained. No convincing evidence of an ischemic stroke. Calvarium and soft tissues of the scalp are unremarkable and without evidence of posttraumatic findings.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.Subarachnoid hemorrhage most noticeable in the basal cistern, prepontine cistern and right sylvian fissure and to a lesser degree throughout bilateral cerebral hemispheres. Finding highly suspected of aneurysmal rupture and recommend follow-up with CTA.2.Essentially unremarkable nonenhanced head CT otherwise reticular no evidence of posttraumatic calvarial or soft tissues of the scalp findings and no extra-axial collection. |
Generate impression based on findings. | Female 58 years old Reason: Patient progressively hypoxic with known acute DVT and IVC filter, rule out PE PULMONARY ARTERIES: The study is technically adequate. The main pulmonary artery measures 2.5 cm in maximal diameter. No filling defects within the pulmonary arterial vasculature to suggest pulmonary embolus.LUNGS AND PLEURA: There are small bilateral pleural effusions right greater than left with associated compressive atelectasis. Areas of patchy consolidation with surrounding groundglass opacities in the superior segments of the bilateral lower lobes may represent severe pulmonary edema, aspiration or developing pneumonia. There is diffuse septal thickening and multifocal groundglass opacities compatible with pulmonary edema.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy.Heart size is normal and there is no evidence of pericardial effusion.The trachea and mainstem bronchi are patent.CHEST WALL: There is moderate/severe body wall edema.Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The liver is cirrhotic in appearance and there is moderate volume ascites. There is suggestion of splenomegaly. | 1.No evidence of pulmonary embolus is clinically questioned.2.Patchy consolidation in the superior segment of the bilateral lower lobes may present severe pulmonary edema, aspiration or developing pneumonia.3.Bilateral small pleural effusions and associated bibasilar compressive atelectasis.4.Findings compatible with pulmonary edema.5.Cirrhosis and moderate volume ascites. |
Generate impression based on findings. | Clinical question: Subarachnoid hemorrhage. Signs and symptoms: Headache. Unenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.Unremarkable all visualized paranasal sinuses and bilateral mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Alteration of mental status. Signs and symptoms: AMS. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute non-hemorrhagic ischemic stroke.Revisualization of a large left PCA territory chronic cortical stroke and tiny focus of low-attenuation in the right thalamus likely presenting a chronic lacunar infarct. Mild prominence of left hemispheric sulci likely secondary to above described chronic left PCA stroke remain similar to prior exam.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No detectable acute intracranial process since prior study.2.Stable changes of chronic strokes as detailed. |
Generate impression based on findings. | Male 40 years old Reason: pulmonary embolus History: chest pain, cough, tachycardia PULMONARY ARTERIES: Evaluation for pulmonary embolus is adequate to the proximal segmental arteries as poor contrast opacification and motion artifact limit the examination. Given these limitations, no large filling defect is evident. The main pulmonary artery is enlarged, measures 3.0 cm in maximal diameter, which is a nonspecific finding but may be seen in the setting of pulmonary arterial hypertension.LUNGS AND PLEURA: There is subsegmental atelectasis in the inferior segment of the left upper lobe. There is moderate bronchial wall thickening suggestive of bronchitis. The trachea and mainstem bronchi are patent, and there is a small amount of dependent material seen within the trachea compatible with inspired material.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy.The heart size is normal and there is no paracardial effusion.There is a small hiatal hernia.CHEST WALL: Moderate degenerative changes affect the thoracic spine. There is no evidence of axillary, subpectoral, internal mammary or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Limited examination, but no large filling defect evident centrally. Evaluate of segmental branches is nondiagnostic.2.Moderate bronchial wall thickening suggestive of bronchitis.Findings communicated to ED by radiology resident on call at the time of exam. |
Generate impression based on findings. | Male 54 years old Reason: pulmonary embolus History: Tachycardic and shortness of breath PULMONARY ARTERIES: Technically adequate study. The main pulmonary artery measures 2.7 cm in maximal diameter. There is no evidence of pulmonary embolus. Reflux of contrast into the hepatic veins is a nonspecific finding but may suggest elevated right heart pressures.LUNGS AND PLEURA: There are small bilateral pleural effusions left greater than right, with fluid seen tracking into the left major fissure. Left pleural thickening.There is severe centrilobular and paraseptal apical predominant emphysema. There is moderate bronchial wall thickening compatible with bronchitis. There is bibasilar dependent atelectasis.There are multiple subpleural solid pulmonary nodules, the largest is within the right middle lobe and measures 1.1 cm (image 88, series 11). There is also a 1.1 cm subpleural nodule in the left upper lobe which demonstrates both solid and ground glass components. These nodules are nonspecific but malignancy cannot be excluded and close CT follow up is recommended.MEDIASTINUM AND HILA: There is an enlarged right hilar lymph node measuring 1.7 cm in short axis (image 140, series 8). There are prominent mediastinal lymph nodes, not pathologically enlarged by size criteria.There is mild cardiomegaly without evidence of pericardial effusion.CHEST WALL: There is no axillary, subpectoral, internal mammary and cardiophrenic lymphadenopathy.Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is a 1.2-cm indeterminate left adrenal nodule (image 14, series 8). | 1.No evidence of pulmonary embolus identified as clinically questioned.2.Reflux of contrast into the hepatic veins is nonspecific but may suggest elevated right heart pressures.3.Multiple roughly 1 cm solid pulmonary nodules as well as a groundglass and solid nodule. Right hilar lymphadenopathy. Though the findings are nonspecific, malignancy cannot be excluded. Given the high risk nature in this patient with severe emphysema short term CT follow up in 3 - 6 months is recommended, and PET scan can be considered as clinically warranted.4.Mild cardiomegaly5.Bronchial wall thickening suggestive of bronchitis. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT: No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, cisterns spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.On images through the orbits.All visualized paranasal sinuses, bilateral mastoid air cells and middle ear cavities remain well pneumatized. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Altered mental status. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 81.Unremarkable calvarial and soft tissues of the scalp, unremarkable visualized orbits, paranasal sinuses and mastoid air cells | No acute intracranial process. |
Generate impression based on findings. | Clinical question : Follow up exam for subdural hematoma. Signs and symptoms: Follow-up exam. Nonenhanced head CT:There is no evidence of any new hemorrhage since prior exam. The previously known left-sided small subdural hematoma is barely identifiable on the current exam. There is trace midline shift to the right without significant change since prior study.There is no evidence of parenchymal hemorrhage or edema.Generalized paucity of cortical sulci and a small CSF spaces/cisterns remains fairly similar to prior exam. This appearance may be minimal for patient stated age however possibility of subtle cerebral edema cannot be entirely excluded. Correlate with symptoms and consider MRI if deemed necessary. | 1.No evidence of acute new finding since prior exam.2.A previously seen very small left-sided acute subdural is barely identifiable on the current exam.3.Trace midline shift to the right and paucity of cortical sulci and CSF spaces/cisterns remain identical to multiple prior studies. 4.No change in the normal size of ventricular system. |
Generate impression based on findings. | Clinical question: Follow-up on shift, swelling of right hemisphere and new ischemia on the left hemisphere. Signs and symptoms: As above. Nonenhanced head CT:Unremarkable images through posterior fossa and stable since prior exam.There is no convincing areas of any appreciable interval change in the size of right chemistry acute hematoma.A very large right hemispheric subacute ischemic stroke with significant mass effect and its transcranial herniation through a large right-sided craniectomy contains very similar to prior exam. Midline shift to the left at the level of the septum pellucidum measures approximately 8.8 mm.Mildly dilated left lateral ventricle and minute amount of blood in its dependent portion shows no appreciable change.A smaller focus of hemorrhage in the interhemispheric aspect of right anterior frontal lobe remains stable since prior exam. Nearly complete effacement of basal cisterns and crowding of right temporal lobe at the level of right perimesencephalic cistern remain also similar to prior study. | No convincing evidence of any significant change in the constellation of findings of a very large right hemispheric hemorrhagic stroke, its associated mass effect and midline shift to the left, size of hemorrhage within the stroke, mildly enlarged left lateral ventricle and with minute amount of blood in its dependent portion. |
Generate impression based on findings. | Clinical question: Evaluate for progression of intracranial hemorrhage. Signs and symptoms: As above. Unenhanced head CT:Stable focus of acute hemorrhage in the posterior medial aspect of left cerebral with minimal associate is surrounding edema and no appreciable mass-effect.Poorly visualized a small residual hemorrhage in the right occipital region with evidence of associated parenchymal edema.Stable size of acute hematoma in the left posterior parietal with associated subarachnoid hemorrhage and parenchymal edema since prior exam. There is however subtle interval decrease in the density of acute hematoma at the site.Stable acute hematoma and is surrounding edema in the left anterior frontal lobe with associated subtle regional mass-effect since prior exam.Residual subarachnoid hemorrhage in the right frontal region demonstrate decreased density and extent.Tiny scattered additional foci of subarachnoid hemorrhage still remaining.Ventricular system remains within normal and with maintained midline.No detectable new palpable abnormality. | 1.No evidence of new hemorrhage since prior exam.2.Subtle interval decreased density of the left posterior parietal acute proximal hemorrhage all were without change in its size.3.Interval decrease in density and extent of right frontal subarachnoid hemorrhage since prior exam.4.Stable multiple small additional foci of subarachnoid hemorrhage as detailed. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: Right-sided weakness. Nonenhanced head CT:Examination demonstrates no evidence of acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Dense right hemiplegia. CTA of neck:The visualized superior aspect of the aortic arch as well as the origins of the major vessels are unremarkable.Brachiocephalic and bilateral subclavian arteries are unremarkable.Right common carotid artery, right internal and external carotid arteries are widely patent and unremarkable.Left internal carotid artery, left internal and external carotid right chest are widely patent and unremarkable.Bilateral vertebral arteries are symmetrical in size. They remain widely patent through the neck and including their origins.Intracranial CTA:Normal appearing bilateral intracranial vertebral arteries, basilar artery and its distal branches.Patent bilateral internal carotid arteries across the skull base and in their supraclinoid segments.Bilateral ophthalmic arteries are visualized and unremarkable.Bilateral posterior communicating arteries are visualized and unremarkable (left greater than right). Bilateral anterior cerebral arteries and anterior communicating artery is well visualized and unremarkable.Unremarkable bilateral middle cerebral arteries and their bifurcations. | 1.Negative neck CTA.2.Negative head CTA. |
Generate impression based on findings. | Female 58 years old; Reason: eval for acute inflammatory process History: nausea, diarrhea, abdominal discomfort, gap acidosis ABDOMEN:LUNGS BASES: Distal aspect of the central line catheter is noted in the cavoatrial junction.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: Few too small to characterize hypodensities, likely cysts. The kidneys are atrophicRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Patient has a leiomyomatous uterus. BLADDER: Foley catheter decompresses bladder with foci of air in the lumen, likely iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patient is status post left hip rods and screws. Streak artifact limits evaluation.OTHER: No significant abnormality noted. | 1.No acute intra-abodimal process detected.2.Likely fibroid uterus. Ultrasonographic evaluation advised for full characterization of gyne pathology. |
Generate impression based on findings. | Male, 79 years old, unresponsive, pupils fixed. A large holohemispheric right subdural collection is evident showing areas of variable density and septations likely representing acute on chronic hemorrhage. At its point of maximum thickness laterally the collection measures 3.1 cm. Hemorrhage tracks along the right aspect of the falx and the tentorium. There are also thinner low density collections along the left aspect of the falx and along the anterior left temporal lobe.Severe generalized mass effect results in subfalcine, uncal and transtentorial herniation. Midline structures herniate 2.8 cm leftward below the falx. The right lateral ventricle is effaced. The left lateral ventricle body is effaced and the atrium/temporal horn are slightly prominent compatible with obstruction. The basilar cisterns are obliterated. Dilatation of the left superior ophthalmic vein likely indicates increased intracranial pressure.Vague hypodensity is seen in the inferior frontal lobes, the anterior temporal lobes, and the brainstem. This could represent edema, ischemia or perhaps artifact.The calvarium is intact. The paranasal sinuses are clear. | Large acute on chronic right holohemispheric subdural hemorrhage. Associated mass effect results in subfalcine, uncal and transtentorial herniation. Findings are also present suspicious for developing edema or ischemia in the frontal lobes, temporal lobes, and brainstem. |
Generate impression based on findings. | Headache. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: pe? History: elevated dimer, pleuritic cp PULMONARY ARTERIES: The quality of this examination is excellent. No pulmonary is identified to the subsegmental level.LUNGS AND PLEURA: Dependent groundglass opacities favor subsegmental atelectasis in this partial expiratory phase. Focus of consolidation in the left posterior costophrenic sulcus could be the sequela of sickle cell crisis. Lower in the differential is pulmonary infarct from prior pulmonary embolus (not visualized on today's examination).MEDIASTINUM AND HILA: Heart size is upper limits normal. No pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: Right port catheter terminates deep in within the right atrium.No axillary lymphadenopathy. Small, nonspecific subpectoral lymph nodes.Osseous changes reflecting sickle cell disease. T4 low-density focus suggestive of vertebral hemangioma. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small hiatal hernia. Low density within the anterior cortex right midpole compatible with a cyst. Lymph node measures 8 mm (image 221 series 7) immediately superior to the left adrenal gland. Small nodularity arises from the lateral limb of the left adrenal, measuring 5 mm. Status post cholecystectomy. | No pulmonary embolus.Dependent ground glass opacities favor subsegmental atelectasis. Focus of consolidation posterior left costophrenic angle may represent sequela of sickle cell crisis. Lower in the differential is resolving pulmonary infarct from prior pulmonary embolus, not visualized on today's examination. |
Generate impression based on findings. | 23-year-old female. Reason: Please assess for PE, SOB/cough, positive D dimer History: chest pain, SOB, cough. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: No parenchymal opacities to suggest infection. No pleural effusions. Mild bronchial wall thickening is seen.MEDIASTINUM AND HILA: Mildly dilated and air-filled esophagus. No mediastinal or hilar lymphadenopathy. Heart size normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism.Mild bronchial wall thickening is consistent with asthma in the appropriate clinical setting. |
Generate impression based on findings. | 55-year-old male patient with significant drainage and purulence on exam. Evaluate for abscess/collection. Note that the examination is limited by the lack of intravenous contrast. There is skin thickening posteriorly with opacification of the underlying subcutaneous fat compatible with edema. The edema extends to the lower sacrum and coccyx without specific imaging findings of osteomyelitis. There is no discrete fluid collection. The bilateral gluteus maximus muscles are edematous without discrete fluid collection. There is a small midline skin defect below the level of the coccyx containing high attenuation that may represent packing material. Degenerative arthritic changes affect bilateral hips, sacroiliac joints and lower lumbar spine.Peritoneal dialysis catheter incompletely imaged in the left lower quadrant. Extensive vascular calcifications and calcification of the seminal vesicles noted. | Posterior soft tissue edema and other findings as described above without discrete fluid collection given limitations of lack of intravenous contrast. If there is continued clinical concern for fluid collection or osteomyelitis, MRI may be considered for further evaluation.Findings discussed with ER resident via telephone at 15:15 hrs on 12/29/2013 by Dr. Nimarta Singh. |
Generate impression based on findings. | 59-year-old male with gross hematuria. ABDOMEN:LUNG BASES: Bibasilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral calculus are identified. There is no hydronephrosis or hydroureter. The entire right ureter is visualized on delayed sequences. The midportion of the left ureter is not visualized on the delayed sequences. However, no filling defects or focal mass lesions are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fecalization of the terminal ileum is nonspecific, but can be seen in delayed transit.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Metal streak artifact from left total hip arthroplasty device somewhat limits evaluation of the lower pelvis.PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: Foley catheter in place. Foci of gas density within the bladder, likely related to recent instrumentation. Mild concentric wall thickening of the bladder, likely related to chronic outlet obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small umbilical hernia containing a loop of small bowel without evidence of destruction or strangulation.BONES, SOFT TISSUES: Left total hip arthroplasty in place, without evidence of hardware complication.OTHER: No significant abnormality noted | No findings to account for patient's symptoms. |
Generate impression based on findings. | Left tonsil squamous cell carcinoma, (stage T2N2B, S/P 5 cycles of TFHX that ended in 2009), history of recurrent right jaw osteomyelitis and bacteriemia from line infection s/p 2 weeks of gentamycin (completed 11/27) admitted with sepsis likely from permacath. Head: Streak artifact from bullet fragments within the right occipital region limits evaluation of the posterior fossa. In addition, the the lack of intravenous contrast limits sensitivity for metastases. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. Neck: There are postoperative findings related to segmental left mandibulectomy, left neck dissection, and flap reconstruction. Streak artifact in the left parapharyngeal region obscures surrounding anatomy. In addition, the lack of intravenous contrast limits sensitivity for metastases and infection. With in these limitations, there is no definite evidence of tumor recurrence or significant cervical lymph adenopathy. There is no significant interval change in the appearance of the residual portions of the left mandible, with areas of mixed sclerosis and lucency in the ramus. The remaining salivary glands appear unchanged. There is a partially imaged cyst lesion in the subcutaneous tissues of the right chest wall. There is an unchanged left ocular prosthesis and implant. There is a left internal jugular venous catheter. | The lack of intravenous contrast limits sensitivity for metastases and infection. With in these limitations, there is no definite evidence of tumor recurrence or change in the sequela of chronic osteomyelitis involving the remaining portions of the left mandible. |
Generate impression based on findings. | 55 year old female with a history of regional enteritis. Status post duodenectomy, and ilio colon resection for complex fistula, now with leukocytosis. Please evaluate for fluid collection. ABDOMEN:LUNG BASES: Moderate -sized bilateral pleural effusions with underlying atelectasis/consolidation.LIVER, BILIARY TRACT: Hypodensity in the right lobe of the liver is incompletely characterized, but may represent a hemangioma. Mild wall thickening of the gallbladder without evidence of gallstones. No intra-or extrahepatic biliary ductal dilation.SPLEEN: Subcentimeter hypodensities in the spleen are too small to characterize.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities in the kidneys are too small to characterize, but likely represent simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with the stated history of duodenum and ileocolic resection.BONES, SOFT TISSUES: Anasarca.OTHER: Free intraperitoneal air, likely related to the patient's recent surgical history. Note is made of a moderate amount of abdominopelvic ascites. There are foci of high density material layering posteriorly within the left hemiabdomen within an apparent loculated fluid collection suspicious for early abscess formation. Enhancement of the peritoneum is nonspecific but can be seen in peritonitis. PELVIS:UTERUS, ADNEXA: Bilateral adnexal cystic lesions the largest measuring 3.6 cm in the left adnexa. Further evaluation with a dedicated pelvic ultrasound could be considered if clinically indicated.BLADDER: Foci of gas density within the bladder may be related to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Postoperative changes with a moderate amount of abdominopelvic ascites. There is associated enhancement of the peritoneum and loculation of the aforementioned fluid collection in the left hemiabdomen with foci of internal high density debris. These findings are suspicious for peritonitis with early abscess formation.2. Bilateral pleural effusions. |
Generate impression based on findings. | Female 56 years old; Reason: Eval for SBO, abscess History: abdominal pain ABDOMEN:LUNGS BASES: 5-mm nodule in the right middle lobe. Otherwise, no other nodule or mass detected. Bibasilar atelectasis.LIVER, BILIARY TRACT: Patient is status operative in nature cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic without focal lesion detectedADRENAL GLANDS: Left adrenal gland nodule measuring 13 Hounsfield units is incompletely characterized. The right adrenal gland unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Air in the vaginal cuff with surgical sutures are noted. This is likely postoperative in nature. No specific soft tissue attenuation suggestive of recurrence detected.BLADDER: No significant abnormality noted.LYMPH NODES: Status post lymph node resection in the bilateral inguinal regions. No evident pathologic enlarged nodes detected.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No findings to suggest bowel obstruction or abscess as clinically questioned. No specific area of recurrence seen, however PET/CT is a more sensitive modality.2.5mm nodule in the right lung base, CT chest advised for full characterization.3.1cm nodule in the left adrenal gland which is nonspecific but likely an adenoma. Dedicated adrenal CT or MR advised for full characterization. |
Generate impression based on findings. | 68 year-old male. History of prostate cancer with abnormal CXR, bone metastases. LUNGS AND PLEURA: Scattered micronodules. No suspicious pulmonary nodules or masses. Bilateral apical pleural thickening with fine, curvilinear calcifications, most likely post-inflammatory. More nodular focus of thickening in the right apex measures 9 x 17 mm (coronals, image 36), suspected to also be post-inflammatory and follow-up in 6 months recommended to confirm stability. MEDIASTINUM AND HILA: Small mediastinal lymph nodes. No mediastinal/hilar lymphadenopathy. Severe coronary artery calcifications.CHEST WALL: Median sternotomy. Nonspecific sclerotic focus right inferior endplate of T3. Degenerative changes of thoracic spine. Mild compression deformity of T11. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Biapical pleural thickening with calcifications, most likely post-inflammatory. More nodular focus of thickening in the right apex is suspected to also be post-inflammatory; follow-up CT in 6 months recommended to confirm its benignity. 2. No evidence of lung metastases. 3. Nonspecific sclerotic focus right inferior endplate of T3. |
Generate impression based on findings. | 74-year-old female with nausea and abdominal pain.. ABDOMEN:LUNG BASES:Mild left basilar atelectasis and/or scarring. Stable right lower lung lobe cyst. No pleural effusion.Vascular calcifications of the aorta.Small hiatal hernia.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified tortuous splenic artery without evidence of an aneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small mesenteric lymph nodes without grossly enlarged nodes identified.BOWEL, MESENTERY: Note is made of multiple dilated loops of small bowel measuring up to 4.3 cm in diameter with an apparent transition point in the right hemiabdomen (90; series 3). Oral contrast is noted within the proximal small bowel. There is fecalization of the ileum in the surrounding area. The distal small bowel is collapsed. There is no evidence of free intraperitoneal air, pneumatosis intestinalis, or portal venous gas.Surgical suture in the right lower abdominal quadrant.BONES, SOFT TISSUES: Stable small fat-containing umbilical hernia.Degenerative disease affects the thoracolumbar spine.OTHER: Extensive calcification of aorta, branches of the aorta and both iliac arteries indicate atherosclerosis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of multiple dilated loops of small bowel measuring up to 4.3 cm in diameter with an apparent transition point in the right hemiabdomen (90; series 3). Oral contrast is noted within the proximal small bowel. There is fecalization of the ileum in the surrounding area. There is no evidence of free intraperitoneal air, pneumatosis intestinalis, or portal venous gas. Colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Small bowel obstruction with apparent transition point in the right hemiabdomen. |
Generate impression based on findings. | 73 years old Female. Reason: eval hardware History: difficulty with grasping obj; generalized weakness especially of right hand following surgery Soft tissue detail, particularly involving the C3-4 level, is limited by metallic streak artifact.There is reversal of the normal cervical lordosis. Alignment, including grade 1 anterolisthesis of C4 on C5 and grade 1 retrolisthesis of C5 on C6, are similar to prior. Also apparent is grade 1 anterolisthesis of C3 on C4, which is likely accentuated by positioning on current exam.Interval placement of anterior plate with screws entering the C3 and C4 vertebral bodies with intervening interbody graft. No evidence of acute fracture or hardware failure. Subtle apparent streaky hyperdensity within the ventral central bony canal and right neural foramen at the C3-4 level is highly favored to represent artifact opposed to true post-operative collections as they appear noncontiguous. Gas foci, soft tissue stranding, and high density fluid/blood products along the left greater than right anterior neck are expected given recent intervention.3 mm nodule in the left lung apex is nonspecific.Multilevel degenerative changes are similar to prior. Level specific osseous degenerative changes are as follows:C1/2: No significant central canal stenosis or neuroforaminal narrowing.C2/3: Left facet hypertrophy. No significant central canal stenosis or neuroforaminal narrowing.C3/4: Postoperative changes and streak artifact limited soft tissue evaluation. Limited evaluation of probable mild-to-moderate residual central canal stenosis given the ligamentous thickening. Facet hypertrophy contributes to moderate bilateral neural foraminal stenoses. C4/5: Posterior disk osteophyte complex, facet hypertrophy, and left uncovertebral joint hypertrophy result in severe left and moderate right neural foraminal stenosis.C5/6: Posterior disk osteophyte complex and uncovertebral joint hypertrophy result in moderate central canal stenosis, moderate to severe right neural foraminal, and moderate left neural foraminal stenosis.C6/7: Posterior disk osteophyte complex and uncovertebral hypertrophy resulting in moderate to severe right neuroforaminal narrowing and mild to moderate central canal stenosis. C7/T1: No significant central canal stenosis or neuroforaminal narrowing. | 1. Post-operative appearance without acute change in alignment, evidence of hardware failure, or fracture. Fine detail at the C3-4 surgical level is limited by streak artifact. Streaky hyperdensity along the ventral bony central canal at this level is highly favored to be artifact opposed to true post-operative collections. MRI can be considered for further evaluation if there remains high clinical concern. 2. Stable multilevel degenerative changes. |
Generate impression based on findings. | 10-year-old female with right-sided abdominal pain, biliary emesis and fever ABDOMEN:LUNG BASES: Lung basesLIVER, BILIARY TRACT: A no focal hepatic lesions. No biliary ductal dilatation. Gallbladder is normal.SPLEEN: Normal in appearance.PANCREAS: Normal appearanceADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: No focal renal lesions. No hydronephrosis or stones.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Appendix is normal in appearance without periappendiceal inflammatory changes. Scattered enlarged mesenteric lymph nodes, most predominant in the right lower quadrant, are nonspecific. No bowel wall thickening or dilatation.BONES, SOFT TISSUES: No significant osseous abnormalities.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid may be physiologic | 1.No evidence of appendicitis. |
Generate impression based on findings. | 65 year-old female with left flank pain. Lack of intravenous contrast limits evaluation of solid organs. Lack of enteric contrast limits evaluation of bowel.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The gallbladder is distended. There is an apparent punctate gallstone in the neck of the gallbladder. Further evaluation of the right up quadrant ultrasound could be considered.SPLEEN: No significant abnormality notedPANCREAS: Note is made of a mass with peripheral calcification adjacent to the head of the pancreas measuring 3.7 x 3.6 cm in the transverse dimension by 4.5 cm in the craniocaudal dimension which is incompletely characterized on this noncontrast examination. There is fat stranding in the surrounding area. These findings may represent necrotic lymphadenopathy, although a pancreatic mass lesion cannot be excluded.ADRENAL GLANDS: The left adrenal gland nodule density measures less than 10 Hounsfield units, which may represent a benign adrenal adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 2.5-cm left adnexal cystic lesion is poorly characterized on CT examination. Further evaluation with a dedicated pelvic ultrasound could be considered if clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 4.5 cm mass with peripheral calcification adjacent to the head of the pancreas which is incompletely characterized on this noncontrast examination. There is fat stranding in the surrounding area. While this may represent necrotic lymphadenopathy, a pancreatic mass lesion cannot be excluded. These findings were discussed with Dr. Demeter via phone call at 9:25 am on 12/30/13 |
Generate impression based on findings. | 56 year-old female. Metastatic breast cancer. Known liver metastases. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Scattered ground-glass opacities with architectural distortion and traction bronchiectasis in both lungs consistent with radiation pneumonitis, unchanged. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. CHEST WALL: Right chest wall lesion likely reflecting post-surgical changes/scarring measures 1.7 x 3.1 cm, previously 2.2 x 3.1 cm (series 3, image 54). Sternal, rib, and thoracic spine sclerotic bone metastases, similar to prior exam.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe lesion measures 3.9 x 2.3 cm, unchanged (series 3, image 66). No new lesions identified.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged small calcification left renal hilum, represents either vascular or small nonobstructive renal stone. No hydronephrosis. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive sclerotic metastasis in thoracolumbar spine and partially visualized ilium, not significantly changed.OTHER: No significant abnormality noted. | Stable examination with no significant interval change in right hepatic lobe lesion. No new sites of disease identified. |