instruction
stringclasses 1
value | input
stringlengths 15
6.12k
| output
stringlengths 3
2.67k
|
|---|---|---|
Generate impression based on medical findings. | History of 1 cm right-sided prostate nodule on digital rectal examination. PSA most recently 1.69 ng/mL. The patient is seeking a second opinion regarding recommendation for MRI fusion biopsy. PELVIS:PROSTATE:Prostate Size: 4.7 x 3.6 x 4.7 cm.Peripheral Zone: There is diffusely decreased T2 signal within the peripheral zone which somewhat limits evaluation and may be related to prostatitis. There is an area of decreased T2 and ADC signal within the right mid gland (series 23, image 18) measuring 1.1 x 0.6 cm which demonstrates mildly increased early enhancement. There is an additional questionable focus of decreased T2 and ADC signal within the left mid gland (series 23, image 16).Central Gland: Multiple nodules of varying signal intensity on T2-weighted imaging consistent with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The aforementioned signal abnormality in the right peripheral zone mid gland is associated with mild bulging of the capsule (23/18), raising the possibility of extraprostatic extension. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing umbilical hernia. Moderate left hydrocele. | 1.Area of signal abnormality within the right peripheral zone mid gland suspicious for neoplasm, with possible extraprostatic extension.2.Additional, smaller area of signal abnormality within the left peripheral zone mid gland may also reflect neoplasm. |
Generate impression based on medical findings. | Evaluate left renal mass. History of chronic kidney disease and hypertension. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion, or biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: 9.6 x 9.5 cm homogeneously T2 weighted hyperintense lesion with a very hypointense mural nodule (may represent calcification) is nonspecific but demonstrates no postcontrast enhancement, and is likely benign.PANCREAS: No focal lesion or main pancreatic ductal dilatation.ADRENAL GLANDS: Subcentimeter right adrenal lateral limb nodularity.KIDNEYS, URETERS: Several punctate T2 hyperintense and hypointense subcentimeter right renal lesions are too small to characterize, likely benign cysts.Left renal superior pole 9.9 x 8.1 cm lesion demonstrating T2 weighted intermediate hyperintensity and T1-weighted hyperintensity with ill-defined hypointense margins and a heterogeneous mural nodule. There is equivocal wall enhancement and suspected enhancing mural nodularity (series 102, image 38). Additional T2-weighted markedly hyperintense lesions including an inferior pole exophytic 8.6 x 5.6 cm lesion without suspicious enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.The left renal superior pole predominantly cystic 9.9 cm hemorrhagic lesion has equivocal wall enhancement and suspected enhancing mural nodularity.2.Additional large left inferior pole cystic lesion demonstrates no suspicious post-contrast enhancement.3.Additional bilateral simple cysts, minimally complex cysts and too small to characterize renal lesions. |
Generate impression based on medical findings. | Dizziness and giddiness Other convulsions. Please follow MRI STEALTH PROTOCOL for surgical planning. Thank you. There is a ring-enhancing lesion measuring 23 x 18 mm axial dimensions located in the right parietal lobe. It is associated with surrounding T2 and FLAIR signal hyperintensity. This T2 and FLAIR signal hyperintensity was also present on the prior exam and is of similar extent.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucous retention cysts which are unchanged since the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Ring-enhancing lesion in the right parietal lobe in general appears to be stable compared to the prior exam.2.Examination was obtained for surgical planning |
Generate impression based on medical findings. | Pain, clicking in left knee. Evaluate for meniscal tear. MENISCI: The menisci appear normal. I see no tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the femoral trochlea centrally and inferiorly extending along the anterior margin of the medial femoral condyle, with cyst formation and edema-type signal in the underlying subchondral marrow. The articular cartilage of the patella appears intact. The articular cartilage of the tibiofemoral compartments likewise appears intact. There is mild edema-type signal within the medial femoral condyle posteriorly at the level of the physeal scar, perhaps simply representing mild enthesopathic changes near the origin of the medial head of the gastrocnemius.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Mild enthesopathic changes are noted at the insertion of the distal quadriceps tendon on the patella, not necessarily of any clinical significance.ADDITIONAL | Full-thickness cartilage degeneration involving the femoral trochlea and anterior margin of the medial femoral condyle. I see no meniscal tear. Other findings as above. |
Generate impression based on medical findings. | A 57 year old female hospitalized because of chest pain, positive troponin, ST segment elevation on the EKG, a left catheterization showed apical ballooning and no coronary artery disease. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function with mild apical hypokinesis. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are significantly increased (~1100-1150ms). While the global relative enhancement ratio and the T2-STIR edema ratio are increased, the extracellular volume fraction is in the upper normal limit. No myocardial iron overload was seen.No intracavitary thrombus was seenGlobal Relative Enhancement4.1Normal <4T2 STIR Edema Ratio (ER)3.4Normal <2T1 MOLLI Pre contrast myocardium1233Normal <1,050msT1 MOLLI Pre contrast blood pool1668Extracellular volume fraction29.7normal 20-30%Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. There is mild apical hypokinesis without late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. These findings support the diagnosis of Takotsubo's cardiomyopathy.2. The right ventricle is normal in size and systolic function, the RVEF is 50%. 3. There is mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Reason: assess left foot dorsal first toe mass History: pain/swelling A marker was placed along the dorsal aspect of the skin surface dorsal to the first metatarsal head. There is a moderate hallux valgus deformity with mild to moderate osteoarthritis of the first MTP joint. There is enhancement of the first MTP joint indicating a synovitis with a synovial recess extending dorsomedially along the head of the first metatarsal, perhaps representing the palpable mass. This presumed synovial recess shows peripheral rim enhancement, but its contents are of low signal intensity on all sequences which may reflect debris rather than fluid, but we see no blooming artifact on gradient echo sequences to suggest pigmented villonodular synovitis. There are small erosions along the inferior margin of the first metatarsal head as well as mild subchondral edema within the first metatarsal head. Note is made of a bipartite medial sesamoid bone. The signal intensity of the phalanges of the great toe appears normal. The remaining visualized bones and soft tissues are unremarkable. | Hallux valgus deformity with osteoarthritis and synovitis of the first MTP joint. |
Generate impression based on medical findings. | This exam is degraded by motion artifact. There is a focus of decreased diffusion and T2 hyperintensity centered within the right hemi-pons. There are scattered additional foci of T2 hyperintensity throughout the supratentorial white matter. There is a fluid signal intensity well-defined lesion within the pineal cistern that measures up to 18 mm. There is no midline shift or herniation. The vertebrobasilar flow voids are relatively inconspicuous. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a left lens implant. | 1. Acute right brainstem infarct without evidence of hemorrhagic transformation, but the vertebrobasilar flow voids are relatively inconspicuous. Dedicated vascular imaging is recommended.2. Mild chronic small vessel ischemic disease. 3. Pineal cyst. |
Generate impression based on medical findings. | Clinical question: Evaluate for lesion. Signs and symptoms: Neuropathy. Pre and post enhanced brain MRI:Negative diffusion weighted series.There is no evidence of congenital anatomical anomaly of the brain.There is also normal signal intensity of brain parenchyma on all MRI sequences.There is however prominence of bilateral hemispheric cortical sulci and cerebellar-vermian folia as well as mild to moderately enlarged ventricular system for patient's stated age of 28 concerning for underlying parenchymal volume loss.Anatomical variation of midline cisterna magna is detected.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Calvarium demonstrate normal signal intensity and without abnormal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern. | 1.Examination demonstrates generalized prominence of cortical sulci, ventricular system and mildly of the cerebellar/vermis folia for patient's stated age of 28 and concerning for underlying parenchymal volume loss.2.There is however no detectable signal abnormality of the brain on any of the MRI sequences and no detectable abnormal enhancement.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. |
Generate impression based on medical findings. | Clinical question: Evaluate for etiology of seizure. Signs and symptoms: Suspected seizures, as is right temporal and parietal hypodensities on CT. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a chronic healed depressed right parietal calvarial fracture as was noted on prior head CT. There is a small focus of underlying cortical and subcortical hemorrhagic encephalomalacia of the right parietal lobe. This finding measures approximately at 19 times 15-mm in largest transaxial dimensions.Additionally there is a larger focus of encephalomalacia in the inferior aspect of right anterior/mid temporal lobe confined primarily to the periventricular white matter of right temporal and extending inferiorly to the cortex. There is no evidence of hemorrhagic changes with this finding. It measures at least at 27 x 19 x 19-mm in size. There is mild ex vacuo dilatation of right temporal horn. This findings are best appreciated on coronal T2 and flair series 901 and 1001. The anatomical morphology of the brain is otherwise within normal and with normal signal intensity on all MRI sequences. The ventricular system and disuse of the spaces remain within normal and with maintained midline. The signal void of major intracranial arterial branches are identified and unremarkable.Post enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate a single retention cyst in the dependent portion of the left maxillary sinus and unremarkable otherwise. | 1.No acute intracranial process.2.Small focus of right parietal superficial hemorrhagic encephalomalacia under a chronic healed depressed skull fracture as detailed.3.Larger focus of nonhemorrhagic encephalomalacia along the inferior surface of right anterior/mid temporal lobe involving the white matter and the cortex. Finding results in mild expansion of right temporal horn. 4.Unremarkable pre-and post enhanced brain MRI otherwise. |
Generate impression based on medical findings. | Low back pain x14 years. Patient has difficultly lying flat due to pain, but is willing to try for this test. The less time the better. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a diffuse disk bulge at this level. There is T2 signal hyperintensity within the posterior half of the disk. Disk material minimally abuts the nerve root sleeve at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a broad-based small central disk protrusion at this level. There is T2 signal hyperintensity within the disk protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Incidental note is made of fatty filum distally. | There is degenerative disk disease present in the lower lumbar spine which is worse at L5-S1 without significant compromise to the spinal canal or nerve roots as detailed above. |
Generate impression based on medical findings. | Patient with history of BPH and urinary symptoms, PSA on 11/29/2016 was 2.04, no pathology report available but does not appear to have prior biopsy based on medical records. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.2 x 4.5 cmPeripheral Zone: Diffuse patchy T2 signal abnormality with mild restricted diffusion in the peripheral zone, likely representing areas of prostatitis.Central Gland: Central gland hypertrophy with multiple hyperplastic nodules, some extending into the bladder.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Diffuse patchy T2 signal abnormality of the peripheral zone, likely representing areas of prostatitis.2.Benign prostatic hypertrophy. |
Generate impression based on medical findings. | Chiari malformation: headaches, choking on food, and back pain. The images are generally degraded by patient motion artifact. The cerebellar tonsils extend up to 12 mm inferior to the foramen magnum and have pointed morphologies. There is also impeded flow of cerebrospinal fluid across the foramen magnum. There appears to be a very short segment 1 mm diameter syrinx in the upper cervical spinal cord. The rest of the spinal cord displays normal signal and morphology. The conus medullaris is located at the L1 level and there is no evidence of fibrofatty filum terminale. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | 1. Findings compatible with Chiari type 1 malformation, including cerebellar tonsils that extend up to 12 mm inferior to the foramen magnum, with pointed morphologies, and impeded flow of cerebrospinal fluid across the foramen magnum. 2. Apparent very short segment 1 mm diameter syrinx in the upper cervical spinal cord. |
Generate impression based on medical findings. | 71 year old man with CAD s/p CABG in 1998 (LIMA-LAD, SVG-D1), with recent PCI to SVG in 11/15 and again in 2/16 for ISR, referred fo revaluation of chest pain. MEDICATIONS: ASA, PLavix, Cilostozol, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect in the basal anterior wall and antero-lateral wall. In the mid-ventricle has a perfusion defect involving the inferoseptum, anteroseptum, anterior, and anterolateral walls. The overall ischemia score is 8 out of a possible 32. Approximately 25% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 34 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 85 g. There is mild concentric LVH. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 126 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. There is mild systolic anterior motion of the mitral valve leaflets causing mild flow acceleration in the left ventricular outflow tract. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. During hyperemia, there is a large perfusion defect as described above. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 69%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | A 59 years old male with non-ischemic cardiomyopathy, severe systolic dysfunction, diabetes mellitus, hypertension, colon cancer with chemotherapy. Diagnosed on 12/2014 with a right atrial clot associated to a catheter that was removed and then the clot was not seen in the following echocardiography. Now referred to MRI for further evaluation including etiology of the myocardial dysfunction. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 377 ml (normal range 142+/-34), the LV end systolic volume index is 108 ml/m2 (normal range 25+/-9), the LVESV is 276 ml (normal range 47+/-19), the LV mass index is 97 g/m2 (normal range 85+/-15), and the LV mass is 249 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is a mid-wall stripe late gadolinium enhancement in the interventricular septum which is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing process. The pattern is most commonly described in patients with dilated cardiomyopathy. Right VentricleThe right ventricle is severely dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 322 ml (normal range 142+/-31), the RV end systolic volume index is 87 ml/m2 (normal range 31+/-9), and the RVESV is 223 ml (normal range 54+/-17).AtriumThe left atrium is severely dilated. The right atrium is moderately dilated.No interatrial shunt was noted. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is a diastolic mitral regurgitation noted.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is mildly dilated (46mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated in size (41mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsMild bilateral pleural effusion was noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is severely dilated with severe systolic dysfunction, LVEF 27%. There is a mid-wall stripe of late gadolinium enhancement involvement the interventricular septum. The finding is atypical for prior myocardial infarction and suggests the presence of underlying fibrosis as might be seen in dilated cardiomyopathy.2. The right ventricle is severely dilated with moderate to severe systolic dysfunction, RVEF 31%.3. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. 4. The left atrium is severely dilated. The right atrium is moderately dilated. No interatrial shunt was noted. 5. There is mild to moderate aortic regurgitation.6. There is mild mitral regurgitation.7. The ascending aorta is mildly dilated8. The main pulmonary artery is severely dilated in size (41mm).9. Mild bilateral pleural effusion was noted. |
Generate impression based on medical findings. | Unspecified cerebral artery occlusion with cerebral infarction The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam.There is redemonstration of small foci of signal hyperintensity on T2 and FLAIR MRI in the cerebellar hemispheres as well as the brainstem which were also present on the prior exam and remain unchangedThe lateral ventricles are fairly large. The biventricular diameter currently measures 44 mm and previously measured the same.Several punctate foci of a signal loss and susceptibility imaging are present along the left temporal lobe subcortical white matter a couple of which were present on the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.The exam is stable compared to the July 2014 exam.2.Punctate periventricular and subcortical white matter as well as cerebellar and brainstem lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Old lacunar infarcts are present in the cerebellar hemispheres4.There are several microhemorrhages present in the left temporal lobe subcortical white matter which are nonspecific |
Generate impression based on medical findings. | Neck pain Alignment is anatomic without subluxation. The marrow signal is benign. Vertebral body heights are maintained. The cervicomedullary junction is normal. Spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No intraspinal hematoma or mass. The visualized paraspinal contents are unremarkable. Major cervical vasculatures with normal flow voids. Mild multilevel degenerative disease. C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing. C3/4: Mild disc osteophyte complex without significant spinal canal stenosis. No significant foraminal narrowing.C4/5: Mild disc osteophyte complex with mild spinal canal stenosis. Uncovertebral arthropathy resulting in moderate bilateral foraminal narrowing.C5/6: Mild disc osteophyte complex with mild spinal canal stenosis. Uncovertebral arthropathy resulting in severe left and moderate right foraminal narrowing.C6/7: Mild to moderate disc osteophyte complex with mild-to-moderate spinal canal stenosis. Uncovertebral arthropathy resulting in severe left and moderate right foraminal narrowing.C7/T1: No significant spinal canal stenosis or foraminal narrowing. | Multilevel degenerative spondylosis most severe at C6-7 level with mild-to-moderate spinal canal stenosis and severe left and moderate right foraminal narrowing. |
Generate impression based on medical findings. | Follow-up evaluation of mass. Evaluate for ventricles history of normal pressure hydrocephalus and mass anterior to pons. Implanted defibrillator. Status post VPS placement Nonenhanced CT of brain:There is revisualization of a left sided extra axial mass in the left cerebellopontine angle with extension across the midline posterior to the clivus. The mass superiorly reaches the dorsum sella. There is subtle mass effect on the pons. There is no detectable in edema of brain parenchyma. On this non-infused study this lesion remains similar in size and density.Findings a brief to represent a meningioma. Fourth ventricle is normal in size and unchanged since prior exam.Images through supratentorial space demonstrated enlargement of supratentorial ventricles with a right sided ventricular catheter. The measurements of lateral ventricles demonstrate a very subtle interval decrease in their size. There is better visualization of subarachnoid space surrounding the knee to high complexity of brain parenchyma compared to prior exam. I suspect a small nonhemorrhagic subdural in these locations. This can be only definitively diagnosed with an MRI examination or a post infused CT of brain. The thickest portion of this collection measures approximately 5 mm. | 1.Stable extra-axial left cerebellopontine and prepontine mass to represent a meningioma.2.Slight interval decrease in the size of the supratentorial ventricular system.3.Better visualization of extra-axial CSF in the midpole hypodensity bilateral frontal -- parietal regions which suspect the extra-axial subdural nonhemorrhagic collections. |
Generate impression based on medical findings. | Thigh pain. Look for narrow for impingement. There is a mild, broad-based leftward convex lumbar curvature. Alignment is also notable for minimal anterior subluxation of L4 relative to L5 associated with facet proliferative disease. The intervening disc shows moderate loss of height and decreased T2 signal. In addition to uncovering, there is right paracentral disc protrusion. The marrow adjacent to the endplates show degenerative signal. The canal is moderately narrowed. Marrow signal is notable for fat-containing foci in the T11, T12, L3 and S1 bodies. It homogeneously suppresses on the STIR imaging.T12-L1 and L1-L2: There is no central or foraminal stenosis.L2-L3: Facet proliferative change is present but no central or foraminal stenosis.L3-L4: Disc bulge is associated with left paracentral sequestration and left foraminal protrusion. The sequestered fragment cranially migrates resulting in severe left subarticular recess stenosis while the protrusion causes severe left foraminal stenosis. Facet proliferative change and ligamenta flava buckling result in mild to moderate central canal narrowing as well.L4-L5: The subluxation is associated with disc uncovering and a cranially migrating central/right paracentral extrusion that results in severe right subarticular recess and right foraminal stenoses. There is mild left foraminal narrowing. Facet proliferative changes are slightly more pronounced on the left with excess joint fluid. Ligamenta flava thickening is also moderate to severe. Central narrowing is moderate.L5-S1: Severe bilateral facet productive changes result in severe bilateral foraminal stenosis. Ligamenta flava thickening mild. There is no central narrowing. | 1.Multilevel degenerative disc disease and posterior element hypertrophy in the lower lumbar spine is most significant at L3-L4 (left sequestered paracentral disc fragment and left foraminal protrusion) and L4-L5 (central/right paracentral disc extrusion) and L5-S1 (foraminal stenoses) as described above.2.There is also multilevel spinal canal narrowing moderate at the L4-L5 and mild to moderate at L3-L4. |
Generate impression based on medical findings. | There is no evidence of intracranial hemorrhage. There has been an interval increase in size of the confluent patchy regions of T2 hyperintensity and T1 hypointensity throughout the supratentorial white matter. In addition, there are more prominent and confluent regions of decreased diffusion throughout the supratentorial cortex as well as the basal ganglia and thalami. The ventricles and sulci have slightly increased in prominence, likely due to global volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the bilateral mastoid air cells. | Finding most compatible with severe hypoxic ischemic injury with interval evolution since the prior exam. |
Generate impression based on medical findings. | Altered mental status. The exam is markedly degraded by patient motion. There appears to be a punctate focus of restricted diffusion in the left paracentral lobule. There is mild nonspecific periventricular white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. | The exam is markedly degraded by patient motion. Possible punctate focus of recent infarction in the left paracentral lobule versus artifact. |
Generate impression based on medical findings. | Previous MRI with possible left sided arteriovenous malformation: seizures. MRI: there is a subcentimeter curvilinear area of T2 hyperintensity, enhancement, and susceptibility effect in the posterior limb of left internal capsule. Otherwise, there is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or aneurysm. | 1. A lesion in the posterior left internal capsule likely represents a small developmental venous anomaly.2. No evidence of arteriovenous malformation, within the limits of MRA. |
Generate impression based on medical findings. | 42 years Male (DOB:12/18/1973)Reason: 42 yo with hx of brain aneurysm s/p clipping and coils, admitted for w/u for retinal artery occlusion History: decreased visual acuity in R visualPROVIDER/ATTENDING NAME: VENKATESAN RAM KRISHNAMOORTHI VENKATESAN RAM KRISHNAMOORTHI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small focus of of encephalomalacia in the left precuneus. The previous noted punctate focus of diffusion restriction in the left thalamus has disappeared.On susceptibility images are multiple punctate foci of signal loss in the left hemisphere more than the right but also in the cerebellum and vermis.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The distal right internal carotid artery and proximal right middle cerebral artery and posterior cerebral artery are obscured by metal artifact from an aneurysm clip.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left P1 segment is slightly larger than the left posterior communicating artery. There is extracranial origin of the right posterior inferior cerebellar artery. | 1.No evidence for cerebrovascular occlusive disease to the extent of visualization. The distal right internal carotid artery, proximal right middle cerebral artery and proximal right anterior cerebral artery as well as the proximal right posterior cerebral artery are obscured by artifact. Please note that the exam was performed on 1.5 T MR which is less sensitive than the 3 Tesla MRI.2.No evidence for intracranial aneurysm recurrence.3.No evidence for acute ischemic cerebral infarction.4.Small focus of encephalomalacia in the left precuneus. 5.Multiple microhemorrhages in the posterior circulation as well as the left subcortical and periventricular white matter and to a lesser degree right subcortical and periventricular white matter. This was also present on the 2014 exam.6.Please note the ophthalmic arteries are not well evaluated on this exam predominantly because this is a 1.5 Tesla MR unit rather than a 3 Tesla MR. |
Generate impression based on medical findings. | There is redemonstration of relative ventral positioning of the thoracic spinal cord with no significant interval change in contour of the cord. Slight differential CSF pulsation is again suggested dorsal to the cord with visualization of traversing vessels and nerve roots along the anterior aspect of the area of differential signal within the thecal sac. This again measures up to 7 mm in greatest thickness on sagittal images. There is again question trace flattening of the dorsal lateral cord bilaterally. The previously seen midline linear possible fibrous strands are not as well delineated on MRI as they were on myelogram.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. There is again a very large amount of stool within the enlarged rectum, including a large rounded area of low signal intensity measuring 4.5 x 5.0 cm, likely compacted fecal debris. | 1. No significant interval change in appearance of ventral positioning of the thoracic cord with mild contour flattening, with again question of an intradural extramedullary CSF signal intensity collection. Differential remains unchanged, including idiopathic anterior spinal cord herniation/adhesion versus arachnoid cyst, as a cyst could fill in a delayed manner depending on the timing of myelogram following non-radiology service instillation of intrathecal contrast.2. Large amount of fecal debris within the enlarged rectum, including a large stool ball. |
Generate impression based on medical findings. | 37-year-old female with suspicious enhancing focus within the left central breast on recent MRI study. Family history is positive for breast cancer in mother diagnosed in her late 30s. Patient presents for MRI directed ultrasound evaluation and biopsy. A targeted left ultrasound was performed for the patient’s area of concern within the left central breast. There is no solid or cystic mass identified.Please disregard the two images with annotated measurements in the retroareolar breast. FInding on these two images do not correlate to previously identified left central breast focus on previous MRI breast study of 7/11/2016. | No sonographic evidence for malignancy. No sonographic correlate for suspicious finding on recent MRI breast study of 7/11/2016. Planned ultrasound-guided biopsy was therefore canceled. Findings discussed with the patient, MRI guided biopsy planned on 7/26/2016.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Brainstem lesion and post operative changes status post choroid plexus papilloma resection. There are postoperative findings related to suboccipital craniotomy. There is a persistent lobulated enhancing mass within the inferior portion of the fourth ventricle that measures up to 23 mm. There is confluent T2 hyperintensity in the posterior medulla, pons, and medial portions of the cerebellum, as well as scattered patchy areas of intrinsic T1 hyperintensity, enhancement, and susceptibility effect along the surgical approach and margins. There is a prior right transfrontal ventricular catheter track with surrounding T2 hyperintensity, susceptibility effect, and enhancement. There is a left transfrontal ventricular catheter that terminates in the third ventricle, slightly indenting the right thalamus. Artifact related to the surgical hardware otherwise obscures surrounding anatomy. There is no appreciable interval change in size of the ventricular system, which does not appear to be particularly dilated. There is a persistent left cerebral convexity extra-axial fluid collection that measures up to 3 mm in thickness associated with prominent smooth, diffuse dural enhancement. There is no evidence of acute cerebral infarction. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. There is an apparent disconjugate gaze. | 1. Postoperative findings in the posterior fossa with residual fourth ventricular choroid plexus tumor with probable vasogenic edema in the surrounding cerebellum and brainstem, as well as scattered areas of blood products, hemostatic material, and probable granulation tissue along the surgical approach, but no evidence of an acute territorial infarct.2. Unchanged appearance of the shunted ventricular system.3. Persistent left cerebral convexity extra-axial fluid collection that measures up to 3 mm in thickness associated with diffuse dural enhancement reaction. |
Generate impression based on medical findings. | Prior ACL repair 16 years ago now with instability. Evaluate ACL graft and meniscus. MENISCI: There is complex tearing of the posterior horn and body of the medial meniscus. Additionally, there is blunting of the anterior horn of the medial meniscus. There is a complex tear of the posterior horn/body junction of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There are postsurgical changes of an ACL reconstruction. The femoral and tibial tunnels appear to be within normal limits of alignment when compared to the MR equivalent of the Blumensaat line.There is heterogeneity of the articular cartilage of the weight-bearing portion and posterior portion of the lateral femoral condyle. No full-thickness chondral defects are identified. The articular cartilage of the medial femoral condyle and extensor compartment are intact.LIGAMENTS: The ACL graft is intact. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: There is a defect within the central portion of the patellar tendon which is presumably related to the ACL graft donor site.ADDITIONAL | 1. Intact ACL graft.2. Complex tearing of the medial and lateral menisci.3. Loose body adjacent to the ACL graft. |
Generate impression based on medical findings. | Structural abnormality as well as birth HIE: diplegia + right hemiplegia. There is mild volume loss and high T2 signal in the white matter adjacent to the left lateral ventricle, which is asymmetrically enlarged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebellum and brainstem appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Findings suggestive of mild periventricular leukomalacia in the right cerebral hemisphere, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | Female, 59 years old, with bilateral hand and arm weakness. Alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics are within normal limits. No pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. No pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild facet hypertrophy. Otherwise unremarkable. C5-6: Mild facet hypertrophy. Left uncovertebral hypertrophy. Central disk extrusion extending both above and below the level of the disk space. Effacement of the ventral thecal sac with minimal flattening of the ventral cord, but no frank cord compression and no pathologic cord signal. Moderate left foraminal narrowing. C6-7: Mild facet hypertrophy. Mild uncovertebral hypertrophy and disk osteophyte formation. Slight effacement of the ventral thecal sac. No significant spinal canal stenosis. Moderate left foraminal narrowing. C7-T1: Unremarkable. | 1.Disk extrusion at C5-6 resulting in mild deformation of the ventral cord but no significant cord compression or evidence of cord edema. The left neural foramen is at least moderately narrowed at this level secondary to facet and uncovertebral hypertrophy.2.Mild disk osteophyte formation at C6-7 without significant spinal canal stenosis. The left neural foramen is at least moderately narrowed at this level secondary to facet and uncovertebral hypertrophy. |
Generate impression based on medical findings. | Female, 33 years old, with multiple sclerosis and leg numbness. Spinal cord caliber and morphology are within normal limits. As on the prior examination, there remains some questionable vague T2 hyperintensity involving the central portion of the cord at mid to lower thoracic levels. It is unclear if this represents a real finding or an imaging artifact. In any event, it has not significantly changed from prior. No evidence of any focal spinal cord lesion is seen. No definite pathologic cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are normal. Intervertebral disk morphology is unremarkable. No significant spinal canal or neuroforaminal stenosis is seen. | Questionable vague signal abnormality involving the central portion of the mid to lower thoracic spinal cord is redemonstrated. It is unclear if this represents a real finding or an imaging artifact, and in any event, there has been no significant change. If this were to represent a real finding, it would be atypical for MS. No evidence of any classic MS-type lesions is seen and there is no pathologic enhancement. |
Generate impression based on medical findings. | 47 year old who is status post right lumpectomy at outside hospital. The reason for the surgery or the results were not provided. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is a seroma cavity at posterior lower outer quadrant with maximum diameter of 65 mm. A drainage tube is identified near the seroma. Diffuse edema with mild enhancement, and some smaller seromas are seen in the lower outer quadrant in the right breast. In addition, there is an oval shaped seroma in the right axilla, with maximum diameter of 33 mm. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region. | Probable post surgical changes in the right breast. Mild enhancement in the right breast is likely due to surgical changes. As the details of the right lumpectomy are unknown, precise interpretation cannot be made. No MR evidence for malignancy in the left breast.BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | 47 year old male with decreased LVEF on recent nuclear stress test and subsequent normal coronary angiogram, MRI done to evaluate etiology Left VentricleThe left ventricle is normal in size with mildly decreased function. The overall LV ejection fraction is 42%. The LVEDV is 230 ml (normal range 142+/-34), the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVESV is 132 ml (normal range 47+/-19) and the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9). The LV mass is 134 g (normal range 164+/-36) and the LV mass index is 62 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with mildly decreased function. The overall RV ejection fraction is 34%. The RVEDV is 148 ml (normal range 142+/-31), RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVESV is 98 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPersistent elevation of the right hemidiaphragm. Probable bilateral renal cysts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. Mildly decreased left ventricular systolic function with LVEF of 43%2. Mildly decreased right ventricular systolic function with EF of 34%3. No late gadolinium enhancement is noted in the myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Female, 16 years old, with diagnosis of PRES, lupus, with altered mental status and seizures, on steroid treatment. Previously seen areas of cortical and subcortical T2 hyperintensity along the cerebral watershed zones and the occipitotemporal regions have completely or nearly completely resolved. A few scattered foci of periventricular T2 hyperintensity are seen, along with mild T2 cuffing of the ventricular atria. No diffusion restriction is seen. No evidence of significant parenchymal edema or mass effect is detected. There are no findings to indicate acute or chronic intracranial hemorrhage. Ventricular size and morphology are stable. No pathologic intracranial enhancement is detected. | Complete or near complete resolution of scattered cortical and subcortical signal abnormality which was compatible with PRES. Small areas of residual periventricular signal abnormality may reflect pre-existing chronic lesions perhaps related to the patient's diagnosis of lupus. |
Generate impression based on medical findings. | 51-year-old with history of right breast excisional biopsy that showed mixed mammary carcinoma in situ. History of MR biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. There is globally increased enhancement within the right breast compared to the left. Scattered simple and complicated cysts are present.There is increased enhancement throughout the right breast, most notably near the site of prior MRI guided biopsy in the upper inner breast. Clip artifact is seen in the anterior aspect of an area of non-mass enhancement that now measures 3.7 x 1.4 x 2.9 cm, previously 3.1 x 1.6 x 1.9 cm. Additionally, scattered areas of focal and linear enhancement are present in the right breast, asymmetric when compared with the left. This includes two adjacent areas of linear enhancement in the upper inner breast measuring 1.3 and 1.7 cm, and another 1.2 cm area. Foci of left breast enhancement are not significantly changed, including a 5 mm focus in the left inner breast.No new abnormal axillary lymph nodes are identified in either axillary region. No change in previously noted right axillary lymph nodes. Subcentimeter high T2 signal hepatic lesions are most like cysts or hemangiomas. | Asymmetric enhancement of the right breast compared to the left, most notably in the upper inner breast. Routine diagnostic mammogram and right breast MRI directed ultrasound for this area is recommended. If no suspicious correlate is seen sonographically, MRI guided biopsy should be performed. Note that additional focal and non-mass enhancement is present on the right, and additional MRI biopsy could be considered depending on management plans for the breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 78-year-old man with history of chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Mild extrahepatic biliary duct dilatation appears stable. There is no intrahepatic biliary duct dilatation. The gallbladder appears normal.SPLEEN: The spleen is normal.PANCREAS: The pancreatic region, is atrophied and there is stable, irregular pancreatic ductal dilatation. Additionally, there is a new ductal calcification (series 10, image 19) in the body of the pancreas. No pancreatic masses identified.Sequences obtained following secretin administration demonstrate diminished compliance of the main pancreatic duct with at least one ectatic side branch. The duodenum is seen opacifying to the ligament of Treitz.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Multiple simple renal cysts are seen bilaterally, unchanged from prior exams.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appears normal. Multiple varices are again noted with occlusion of the SMV near the portal confluence.BONES, SOFT TISSUES: There is a hemangioma in the L2 vertebral body.OTHER: No significant abnormality noted. | Findings compatible with chronic pancreatitis including main pancreatic duct dilatation, decreased compliance shown status post secretion administration, and ductal calcifications. No focal pancreatic mass identified. |
Generate impression based on medical findings. | 40 year-old male, distention, right lower quadrant pain, flank pain evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable bilateral adrenal mass lesions. Right adrenal mass measures 4.6 x 4 .1-cm on image number 34. Left adrenal mass measures 9.9 x 5.1 cm image number 36.KIDNEYS, URETERS: Right nephrectomy site is clear. Irregular left kidney is unchanged. Possible photocell carcinoma cannot be excluded. Left renal vein is again distended suspicious for tumor thrombus. If there is a clinical concern to evaluate the left renal vein and the left kidney MRI may be helpful.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No change in the right paracolic cutter metastases measuring 5.8 x 2.6 cm image number 71.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: Inflammatory changes and small fluid Colette since adjacent to the sigmoid colon consistent with diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Metastatic renal cell cancer. New diverticulitis with small fluid collections in the pelvis. |
Generate impression based on medical findings. | A 59 year old male with personal history of tonsil carcinoma, s/p chemotherapy, dysphagia and recurrent aspirations, hypothyroidism, with progressive dyspnea and newly diagnosed heart failure with severely reduced systolic function and positive troponin. Referred to cardiac MRI for further evaluation MEDICATIONS: aspirin, atorvastatin, furosemide, levothyroxine, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of replacement fibrosis and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. The native myocardial T1 times are moderately increased (1100-1150ms), which suggest the presence of interstitial fibrosis. No evidence of cardiac amyloidosis or myocardial iron overload. Left VentricleThe left ventricle is severely dilated with moderately to severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 290 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 200 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 150 g. There is severe global hypokinesis with regional variation and desynchrony.Left AtriumThe left atrium is severely dilated (161ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate bilateral pleural effusions and bilateral intersitial lung infiltrates. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | Cardiac MRI study is most consistent with diagnosis of non-ischemic cardiomyopathy with a very small concomitant myocardial infarction. 1. No perfusion defects/ "ischemia" present during hyperemia. 2. There is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of fibrosis, inflammation, or infiltration and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. 3. The left ventricle is severely dilated with moderate to severely reduced systolic function (LVEF 31%). 4. The right ventricle is normal in size with normal systolic function (RVEF 54%).5. Severe biatrial dilation. 6. There is mild mitral and tricuspid regurgitation.7. There is a small pericardial effusion.8. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Clinical question: 70-year-old female is status post aortic valve replacement, here with recurrent syncopal episodes. Signs and symptoms: Hypoglycemia versus seizure. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates scattered periventricular and subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres and minimally within the pons and bilateral cerebellar hemispheres. Findings are highly suggestive of chronic small vessel ischemic strokes of moderate degree. There is suggestion of mild interval progression of disease since prior exam from 2014.Slight prominence of cortical sulci and ventricular system demonstrate no significant change since prior exam.The signal void of major intracranial arterial branches are identified.There is no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium, scalp or the orbits.The signal intensity of intracranial venous sinuses are within normal and normal pattern of enhancement. | 1.No acute intracranial process.2.Moderate chronic small vessel ischemic strokes in the bilateral subcortical and periventricular white matter as well as pons with slight interval progression since 2014 exam.3.Bilateral small (R>L) chronic cerebellar ischemic strokes.4.No detectable abnormal enhancement. |
Generate impression based on medical findings. | History of grade 1 left breast IDC, status post lumpectomy and radiation therapy. BRCA carrier. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post operative distortion and volume loss are noted in the left upper outer breast.No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. Given her personal and genetic history, annual mammography and MRI follow up are both recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Clinical question: Evaluate for growth of AA. Status post surgery, RT/TMZ. Now off all treatment. Signs and symptoms:AA. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Diffuse focus of flair hyperintensity in the high convexity left posterior frontal and parietal region is again identified and extends from the cortex to the ventricular wall of the left lateral ventricle. The extent of findings remains identical to prior exam. Within this region there is an irregular thin linear and focus of enhancement which appears nearly identical to prior exam. This focus of enhancement measures 27-mm in its longest AP axis and 22-mm in transverse axis identical to prior study. There is no appreciable mass effect with the above findings. There is mild expansion of trigone of left lateral ventricle similar to prior exam. There is no detectable pneumatosis RAO parenchymal signal abnormality or abnormal enhancement. | Stable left hemispheric large focus of flair hyperintensity and internal irregular thin linear enhancement at the site of previously treated tumor. |
Generate impression based on medical findings. | 19 year-old female, with pain along third, fourth, and fifth metatarsals, evaluate for fracture Foot: There is mild soft tissue swelling and edema along the dorsum of the foot underlying the skin marker at the patient's site of symptoms. There is no significant bone marrow edema within the metatarsals to indicate a stress fracture. The bone marrow signal is normal throughout the foot.Ankle: Moderate tibiotalar joint effusion. The ATFL is not visualized and likely torn. The PTFL and calcaneofibular ligaments are intact. The inferior tibiofibular ligaments appear intact. There is edema within the medial talus and medial malleolus without discrete fracture line. There is also edema within the soft tissues along the medial and lateral aspect of the ankle beneath skin markers presumably placed at the site of patient's symptoms without underlying osseous abnormality. The extensor and flexor tendons including the Achilles tendon appear normal. | 1. ATFL tear with marrow edema in the medial talus and medial malleolus, which may represent contusions as well as soft tissue swelling about the ankle.2. Soft tissue edema along the dorsum of the foot without evidence of fracture/bone marrow edema. |
Generate impression based on medical findings. | Female, 46 years old, with right temporal epilepsy. Presurgical planning exam. Sensorimotor cortical activity maps as expected along the pre- and post-central gyri. All tested language paradigms produced reliable language related activity with the exception of the object naming paradigm. Language is left dominant. Broca's area maps to its expected location in the left inferior frontal lobe (pars opercularis and triangularis). Wernicke's area maps to its expected location along the posterior aspect of the left superior temporal gyrus. Mild right sided Broca's area contributions are also seen with certain language tasks which is a common finding. | Successful functional MRI for surgical planning purposes. Sensorimotor cortical activity maps as expected along the pre- and post-central gyri. Language is left dominant with Broca's and Wernicke's areas mapping to their expected locations. |
Generate impression based on medical findings. | Clinical question: Newly diagnosed small cell cancer. Signs and symptoms: SOB. Discussion Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates normal anatomical development, morphology and with normal signal intensity of brain parenchymal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for age.There is no detectable abnormal parenchymal or leptomeningeal enhancement.Normal signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement. Next line unremarkable images through the orbits and including axial fat sat post enhanced series.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns. | Unremarkable pre and post enhanced brain MRI. |
Generate impression based on medical findings. | Clinical question: Patient has memory impairment, evaluate for brain atrophy. Signs and symptoms: Memory impairment. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a few punctate nonspecific subcortical and periventricular low-attenuation white matter which are nonspecific. Considering patient's stated age possibility of minute chronic nonhemorrhagic small vessel ischemic strokes considered.There is mild prominence of parietal cortical sulci and unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for patient's stated age of 77.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Findings suggestive of very minimal chronic nonhemorrhagic small vessel ischemic strokes.3.Mild prominence of parietal cortical sulci which may be at the upper limits of normal and unremarkable brain MRI otherwise for patient's stated age |
Generate impression based on medical findings. | 78 years Female (DOB:6/5/1937)Reason: evaluate for radiculopathy History: right sciatica, chronic and severePROVIDER/ATTENDING NAME: REEM H JAN DAVID L PITRAK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of vertebral body height at L2 and L1. There is some superior endplate compression at L2. These mild compressions were also present on the CT of the abdomen from 11/25/2014 and do not appear to have changed. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is encroachment of the nerve roots at the lateral recesses. There is narrowing of the neural foramina as a result of disc material which is worse on the right side where there is encroachment of the right-sided exiting nerve roots within the neural foramina. There are endplate reactive changes at this level which are bright on T2 and dark on T1 suggestive of subacute change.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge. There are endplate reactive changes which are bright on T1 and T2 at this level. This suggests chronic change. There is bilateral facet and ligamentum flavum hypertrophy at this level. There is effacement of the fat at the lateral recesses bilaterally at this level. Overall there is a moderate degree of spinal stenosis present. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. Is no significant compromise to the spinal canal or neural foramina. There is mild narrowing of the spinal canalAt L2-3 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes at this level. There is some mild loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cysts present in both kidneys. Some of them have low signal intensity on T1 and some are heterogeneous. | 1.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L4-5 and encroachment of the right-sided exiting nerve roots at L5-S1. There are subacute endplate reactive changes present at L5-S1.2.There is mild loss of vertebral body height at L2 and L3 which has been present on prior exams3.Multiple renal cystic lesions are present. Some are suspected to contain blood products. Please refer to ultrasound from 3/29/2016 for further comments. |
Generate impression based on medical findings. | Evaluate lymph nodes in neck prior to scheduling surgery for lesion removal on right ear: mass to right ear in patient with history of angiosarcoma. There an exophytic nodule along the inferior right auricle that measures up to 15 mm. The tumor appears to be confined to the auricle, without evidence of invasion of the underlying temporal bone. There is no evidence of significant cervical lymphadenopathy. The salivary glands, thyroid, and upper aerodigestive tract are unremarkable. There are bilateral retropharyngeal internal carotid arteries. There appears to be a small defect in the inferior right orbit, with herniation of orbital fat. There is a right maxillary sinus retention cyst. There is patchy white matter T2 hyperintensity in the pons and bilateral cerebral hemispheres, which may represent chronic small vessel ischemic disease. | Right auricle tumor. No evidence of significant cervical lymphadenopathy. |
Generate impression based on medical findings. | 13-year-old male with anterior hip pain overlying the proximal quadriceps. Evaluate for muscular injury. ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the acetabular labrum, the labrum appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of linear increased signal abnormality traversing the right AIIS at the site of the insertion of the rectus femoris indicating a nondisplaced fracture/avulsion injury. There is increased bone marrow signal abnormality within the AIIS. The tendon of the rectus femoris appears intact.SOFT TISSUES: There is mild peritrochanteric inflammation bilaterally, right greater than left. The remainder of the imaged musculature is normal in appearance.ADDITIONAL | Nondisplaced fracture/avulsion injury of the right AIIS at the insertion site of the rectus femoris. |
Generate impression based on medical findings. | There is no evidence of acute infarct. There are patchy foci of T2 hyperintensity throughout the supratentorial white matter in the subcortical and deep regions as well as a more prominent focus of T2 hyperintensity and volume loss in the right anterior temporal lobe that are unchanged compared with the 3/27/2012 exam. There are linear and punctate foci of susceptibility effect within the subarachnoid space, most prominent within the right frontal lobe, that are unchanged back to 7/19/2013 (our earliest susceptibility weighted imaging). The patchy enhancement within the right temporal lesion and the linear enhancement within the left frontal lesion is unchanged dating back to 6/22/2012 (our earliest postcontrast exam). The areas of somewhat linear enhancement within the left superior parietal lobule and the posterior left frontal lobe are less prominent and faintly visualized on today's exam. There is no elevated perfusion in the regions of signal abnormality or enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants. | 1.Multiple patchy regions of signal abnormality are unchanged dating back to March 2012. The enhancement within some of these lesions is either unchanged or less prominent (although this may be technical) dating back to June 2012. The differential diagnoses include again includes inflammatory or granulomatous lesions with neoplasm felt less likely due to the long-term stability.2.Unchanged superficial siderosis of unclear etiology. |
Generate impression based on medical findings. | Male; 24 years old. Reason: history of Crohn's disease s/p ileocecectomy. assess for stricture at anastomosis and active disease History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy with patent anastomosis. Minimal bowel wall thickening and enhancement of the neoterminal ileum, equivocal for active inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Patent ileocecostomy anastomosis with findings equivocal for active inflammatory bowel disease of the neoterminal ileum. |
Generate impression based on medical findings. | Limited evaluation of the cervical spine with sagittal T1 and STIR sequences per cord compression protocol demonstrates evidence of diffuse metastatic disease. No compression fractures. No obvious epidural tumor. No evidence of cord compression.THORACIC SPINE | 1. Diffuse osseous metastatic disease in the cervical, thoracic, and lumbar spine. 2. There are multiple compression fractures throughout the thoracic and lumbar spine with osseous retropulsion and epidural tumor as detailed above. Findings are worst at the T6 level where there is impression and deformity of the thoracic cord related to retropulsion and epidural tumor. No associated cord signal abnormality. Mild spinal canal narrowing is seen at T8, T9, T12 and L3. Allowing for differences in technique, osseous retropulsion and spinal canal narrowing appears similar to prior CT from 10/29/2014.3. Epidural tumor extending into the neural foramina is seen at multiple levels, relatively more prominent at the T6-T7, T12-L1 levels as well as the left L3-L4 level. |
Generate impression based on medical findings. | Reason: Hx of HCC post-resection History: hx of HCC ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a liver transplant. Portal and hepatic veins are patent. The hepatic artery is patent. Small saccular aneurysm at the hepatic artery anastomosis is not significantly changed, measuring 0.7 x 0.5 centimeters (series 11 image 48). No intrahepatic or extra hepatic biliary ductal dilatation. No focal hepatic lesion.SPLEEN: Mild splenomegaly, measuring 14.2 cm (series 9 image 21), unchanged. No focal splenic lesion.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. | 1.Postsurgical changes of a liver transplant.2.Stable focal hepatic artery secondary aneurysm at the arterial anastomosis.3.No new or suspicious focal hepatic lesions. |
Generate impression based on medical findings. | Female 54 years old Reason: eval for lumbar spine abnormality History: Hx of Von Hippel Lindau w/ new right sided back pain There is mild kyphosis at the thoracolumbar junction. The vertebral body heights are preserved. Minimal disc desiccation and loss of height of L3-4 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and terminates at the L1-L2 level. There are innumerable, partially visualized cystic lesions replacing the kidneys bilaterally, some with fluid-fluid levels. Partially imaged cystic lesion in the pelvis, likely left adnexa. Multiple (greater than 10) enhancing nodules along the surface of the conus, from T12 to L1, as well as along the cauda equina nerve roots bilaterally (also present on prior MRI from 2012). The relatively larger nodules along the conus surface are similar to the prior exam (up to approximately 5 mm in diameter), but punctate additional lesions appear new or more prominent, which may be related to technique/contrast timing.Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is a small right paracentral protrusion, minimally smaller compared to the prior exam, without significant compromise to spinal canal or neural foramina.L2-L3: Minimal disc bulge without significant compromise to spinal canal or neural foramina. L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is a minimal central protrusion without significant compromise to spinal canal or neural foramina. | 1.Multiple, greater than 10, enhancing nodules along the surface of the conus and along the bilateral cauda equina nerve roots which are consistent with multiple hemangioblastomas in the setting of vHL. The relatively larger nodules measuring up to 5 mm are similar to prior MRI from 2012 while some of the smaller punctate lesions appear new or more prominent in the interval. The subtle differences may be related to contrast timing although minimal enlargement remains a possibility.2.Minimal degenerative change without significant spinal canal or neural foraminal stenosis at any level.3.Partially visualized cystic lesions of the native kidneys and left adnexa. |
Generate impression based on medical findings. | 40yoF with congenital nystagmus, episodical tinnitus, history of 3.5 month prematurity presenting with dizziness episodes and has upper motor neuron signs on The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. The pituitary stalk measures up to 2 mm in thickens. There is no diffusion abnormality. There is no acute intracranial hemorrhage. No extra-axial fluid collection is identified.The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal. The bilateral vestibulocochlear nerves are intact. | 1. Normal non contrast brain MR.2. The meatal loop of the right anterior inferior cerebellar artery extends far into the right internal auditory canal.3. The pituitary stalk is at the upper limit of normal for thickness. |
Generate impression based on medical findings. | 48-year-old female with pain and weakness. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is subtle increased bone marrow signal abnormality and deformity of the superolateral humeral head suggestive of a Hill-Sachs fracture deformity. There is also linear increased signal abnormality and heterogeneity traversing the anterior and inferior glenoid labrum and glenoid consistent with a bony Bankart lesion. There is also heterogeneity of the posterior labrum which may represent degeneration/tearing. There are subchondral cysts within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL | 1. Tendinosis of the supraspinatus without evidence of full-thickness rotator cuff tear.2. Findings consistent with a Hill-Sachs fracture deformity and osseous Bankart lesion as described above.3. Osteoarthritis of the acromioclavicular joint. Other findings as described above. |
Generate impression based on medical findings. | Malignant neoplasm of frontal lobe [C71.1], Reason for Study: ^Reason: 34 yo M with recurrent GBM s/p prior surgeries and chemoRT, planning scan for re-RT planning History: none Previously seen tissue defect on the left frontal lobe appears to be slightly shr inked since prior scan.Enhancing lesions on the left frontal lobe adjacent to the excision cavity as well as caudate nucleus is again seen, grossly unchanged since prior scan.Prominent dural enhancement on the right frontal and part of the left frontal lobe reflects postoperative changes.There is no other abnormal enhancing lesion on this scan.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Postoperative expected changes with residual enhancing lesions along the resection margin, no gross interval changes since prior scan. |
Generate impression based on medical findings. | Left sided proptosis; history of left eyelid melanoma excision. Orbit: There is mild left proptosis associated with bowing of the posterolateral wall of the orbit secondary to an arachnoid cyst in the anterior portion of the left middle cranial fossa. Otherwise, there is no evidence of intraorbital mass lesions and the globes and ocular adnexa are intact. Brain: The arachnoid cyst in the anterior portion of the left middle cranial fossa measures up to 18 mm in width with associated remodeling of the overlying skull. There is no evidence of acute intracranial hemorrhage or abnormal enhancement. There is a 9 mm wide left choroid fissure cyst. The ventricles are otherwise normal in size and configuration. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and a left sphenoid sinus retention cyst. There is minimal fluid signal in the right mastoid air cells. | Mild left proptosis associated with bowing of the posterolateral wall of the orbit secondary to an arachnoid cyst in the anterior portion of the left middle cranial fossa. No evidence of intraorbital or intracranial tumors otherwise. |
Generate impression based on medical findings. | Male 56 years old Reason: Right knee pain, medial and anterior evaluate for meniscus tear, chondral injury History: Right knee pain MENISCI: There is a thin longitudinal, vertically orientated tear through the peripheral fibers of the posterior horn of the medial meniscus near its root. This was not clearly evident on prior study. It is present on at least two consecutive sagittal images. There is intrasubstance degeneration within the body of the medial meniscus. There is also mucoid degeneration resulting in a globular collection of intermediate signal within the anterior horn of the medial meniscus at its root which is new from prior study.Also seen is maceration of the anterior horn of the lateral meniscus with degeneration and extrusion of the body of the lateral meniscus that appears similar to prior. There is a new complex tear consisting of a complete longitudinal component involving the posterior horn of the lateral meniscus seen on several consecutive sagittal images.ARTICULAR CARTILAGE AND BONE: There is full thickness cartilage loss along the lateral tibial plateau anteriorly with underlying subchondral type edema and cysts which appear similar to prior study. There is also full-thickness cartilage loss along the lateral femoral condyle which appears similar to prior study. There is near full thickness to full-thickness degeneration along the far medial rim of the medial femoral condyle, similar to prior study. There are also subchondral cysts in the anterior aspect of the medial tibial plateau with degeneration of the overlying cartilage which appears to have progressed slightly compared to prior study. Relatively mild degeneration affects the cartilage of the patellofemoral joint which is similar to prior study. Tricompartmental osteophytes are noted.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament appear unremarkable. There is thickening of the lateral capsular ligament, unchanged in appearance compared to prior study.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Severe degenerative arthritic changes of the right knee with new tears of the posterior horn of the medial meniscus and posterior horn of the lateral meniscus and other findings as described above. |
Generate impression based on medical findings. | History of primary biliary cirrhosis. Evaluate for hepatocellular carcinoma or suspicious lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver with nodular surface contour. There is a reticular pattern of increased T2 signal throughout the hepatic parenchyma indicating a component of fibrosis. There are a few scattered subcentimeter foci of early arterial enhancement, however these do not demonstrate washout on the delayed images. No focal suspicious enhancing lesion.The hepatic veins, hepatic arteries, and portal veins are patent.Cholelithiasis without evidence of cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of numerous prominent perihepatic lymph nodes likely related to the patient's chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites. | 1.Cirrhotic morphology of liver with dysplastic nodules, but no evidence of hepatocellular carcinoma.2.Stable mildly prominent perihepatic lymph nodes likely related to the patient's chronic liver disease.3.Cholelithiasis. |
Generate impression based on medical findings. | Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticusClinical question: h/o intractable epilepsy; preop planning for depth electrodes The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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. | MRI of the brain is within normal limits to the extent of visualization. Please note that this is a limited exam performed for guidance during treatment. |
Generate impression based on medical findings. | Reason: abnormality History: spinal stenosis with radiculopathy Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There is right-sided facet hypertrophy with narrowing of the right neural foramen at this level.At C3-4 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord creating a mild/moderate degree of spondylostenosis. There is narrowing of the neural foramina right worse than left with encroachment of right-sided exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disk space height, disk desiccation and uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots in the neural foramenAt C5-6 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord with a mild degree of spondylostenosis. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level and a mild to moderate encroachment of the exiting nerve roots.At C6-7 there is disk desiccation and diffuse disk bulge associated with uncovertebral osteophytes and encroachment of the exiting nerve roots bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height, disk desiccation, diffuse disk bulge and some endplate reactive change at this level. There is narrowing of the neural foramina as a result of disk bulge with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is also some partial effacement of the fat at the left lateral recess with some mild encroachment of the nerve roots of the left lateral recess at this level .At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and diffuse disk bulge at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There are multilevel degenerative changes in the cervical spine with mild to moderate spinal stenosis at C3-4 and neural foramina encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 , the left side at C4-5 and on the right side at C3-4.2.There are degenerative changes present in the lower lumbar spine with some encroachment of the exiting nerve roots bilaterally at L5-S1 |
Generate impression based on medical findings. | Dizziness No evidence of acute ischemic or hemorrhagic lesion.Scattered patch high signal intensity lesions on bilateral periventricular white matter and brainstem on FLAIR imaging indicate minimal nonspecific small vessel ischemic disease.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/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Minimal nonspecific small vessel ischemic disease as described above.No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on medical findings. | 60 years Female (DOB:2/14/1956)Reason: back and leg pain History: back and leg painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and a small right paramedian broad-based disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy present at this level. There is mild disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level. There is mild disc desiccation at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots.2.No compromise to lumbar spinal canal or neural foramina. |
Generate impression based on medical findings. | Lower extremity weakness, concern for cord compression. Compared to 12/29/2014, there is interval increase in destructive changes at the C6-C7 disc level including the adjacent C6 and C7 vertebral bodies with loss of vertebral body height. T2 hyperintensity involving the disc space and bone marrow compatible with edema is stable to minimally increased in the interval. There is a dorsally projecting osteophyte/osseous retropulsion which results in flattening of the cord which is worse since prior. There is also increased T2 hyperintensity in the cord compatible with edema. There is mild edema involving the prevertebral soft tissues which appears overall decreased since 12/29/2014, but is slightly increased at the C6-C7 level.There is T2 hyperintensity in the ventral epidural space extending from C5 to C7 which is favored to represent engorged epidural venous plexus.Diffuse low T1 and T2 bone marrow signal may be related to renal osteodystrophy and/or chronic anemia. Individual levels as below:C2/3: Minimal posterior osteophyte disc complex without spinal canal or neural foraminal stenosis.C3/4: Posterior osteophyte complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is moderate spinal canal stenosis and mild bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild right facet hypertrophy. There is moderate spinal canal stenosis and mild to moderate bilateral neuroforaminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C6/7: See above. There is severe spinal canal stenosis at this level which has progressed with also new T2 cord signal abnormality. There is severe right and moderate to severe left neural foraminal stenosis..C7/T1: No significant spinal canal or neural foraminal stenosis. | 1. Examination is compared to 12/29/2014. Again seen are endplate destructive changes with edema centered at the C6-C7 level with interval worsening of height loss of the C5 and C6 vertebral bodies and worsened osseous retropulsion. Associated spinal canal stenosis has also worsened and is now severe. There is also new T2 hyperintensity in the cord at the C5-C6 level likely representing edema related to compression. Extent of osseous destruction and retropulsion may better assessed on CT.2. T2 hyperintensity involving the subligamentous anterior epidural space from C5 to C7 is favored to represent engorged venous plexus. Epidural abscess seems less likely based on the morphology although postcontrast images would be helpful. Differentials for the above destructive process include dialysis-related spondyloarthropathy and chronic infection.3. Multilevel cervical spinal canal stenosis and neural foraminal stenosis at additional levels is similar to prior and detailed above. |
Generate impression based on medical findings. | Persistent neck pain not relieved by physical therapy Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal anterolisthesis of C4 on C5 and minimal retrolisthesis of C5 on C6 and C6 on C7. There is also mild anterolisthesis of C7 on T1. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. Neural foramina are patent. C4-5: Disc osteophyte complex with uncovertebral hypertrophy and right-sided facet arthropathy. There is mild spinal canal stenosis. There is moderate to severe right neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy and facet arthropathy, worse on the right than the left. There is severe right and moderate left neural foraminal stenosis. Fairly mild spinal canal narrowing.C6-7: Disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. Uncovertebral hypertrophy and bilateral facet arthropathy contribute to moderate bilateral neural foraminal stenosis.C7-T1: Disc uncovering related to grade 1 anterolisthesis and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild left and moderate to severe left neural foraminal stenosis related to facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Diffuse opacification of the bilateral mastoid air cells. | 1. Multilevel degenerative changes throughout the cervical spine with mild degree of spinal canal stenosis from the C3-C4 to the C7-T1 levels, relatively worse at the C3-C4, C6-C7 and C7-T1 levels. No cord signal abnormality. There is also significant multilevel neural foraminal stenoses as detailed above. 2. Diffuse opacification of the bilateral mastoid air cells. |
Generate impression based on medical findings. | 24 years Female (DOB:2/16/1992)Reason: Eval tumor progression vs ischemia History: R sided numbness, changes in CT scan, ho anaplastic astrocytomaPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD SERVICES ANCILLARY There is redemonstration of a cystic appearing lesion centered in the left parietal lobe and measuring 31 x 32 mm axial dimensions and 45 x 27 mm sagittal dimensions. It is associated with diffusion restriction present in the adjacent periventricular white matter as well as the corpus callosum. There is vasogenic edema present within the left occipital lobe, parietal lobe and temporal lobe as well as external capsule and internal capsule and the posterior aspect of the frontal lobe. There is associated mass effect with compression of the left lateral ventricle. Since the prior exam the area of diffusion restriction appears to have enlarged. It now measures 36 x 14 mm axial dimensions were as it previously measured 26 x 12 mm axial dimensions. The vasogenic edema has also increased and extended compared to the prior exam.On susceptibility imaging there is redemonstration of numerous punctate foci of signal loss within the area of diffusion restriction but also in the thalami and white matter surrounding the lesion. Another focus of diffusion restriction is centered in the pons which on T2 and T1 imaging has a popcorn-like appearance. This measures approximately 8 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.Since the prior exam the area of diffusion restriction and the associated vasogenic edema located in the posterior aspect of the corpus callosum and in the deep white matter deep to the cystic cavity in the left parietal lobe has expanded. One possibility is that this is related to treatment effect. While another possibility in the context of antiangiogenic therapy may reflect tumor growth despite lack of contrast enhancement.2.There is redemonstration of a cerebral cavernous malformation located in the pons |
Generate impression based on medical findings. | Ms. Racelis-Paradiso is a 52 year old female with recently diagnosed multicentric malignancy of the left breast (12:00 - IDC/ALH, 2:00 - ILC/LCIS). She presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the left superior breast, 12:00 location, there is an irregular enhancing mass identified measuring approximately 1.5 x 1.7 x 1.5 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with biopsy-proven IDC/ALH. In the left upper outer breast, 2:00 location, there is an additional irregular enhancing mass identified measuring 1.4 x 0.8 x 1.1 cm. Susceptibility artifact from biopsy marker clip is seen immediately anterior to this lesion, compatible with biopsy-proven ILC/LCIS. The distance between the 2 clips measures approximately 5 cm in the AP dimension and 5.7 cm in the AP oblique dimension. There is no additional abnormal enhancement seen in the left breast.There is no abnormal enhancement seen in the right breastNo abnormal lymph nodes are identified in either axillary or internal mammary region. | (1) Multicentric malignancy of the left breast. Biopsy marker clips are separated by approximately 5.7 cm in the AP oblique dimension.(2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 35-year-old with history of melanoma with focal nodular hyperplasia on prior exam. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of the patient's known left lobe mass which measures 6.3 x 5.6 cm (series 9 image 65), previously 6.5 x 6.0 cm. There is avid early arterial enhancement with delayed filling of a central scar. The lesion becomes isointense to the background liver and have increased in density on the delayed hepatobiliary phase images. Findings are again compatible with focal nodular hyperplasia.There is an additional lesion in segment 4 which has similar imaging characteristics and is also not significantly changed in size measuring 1.5 x 1.1 cm (series 9 image 62), previously 1.4 x 1.0 cm.There are additional smaller foci of arterial enhancement (series 9 image 65 and series 9 image 69) that appear similar to prior and also likely represent additional small foci of focal nodular hyperplasia. No new suspicious lesions.The liver parenchyma is normal in signal and morphology. The hepatic veins, hepatic arteries, portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple foci of focal nodular hyperplasia which are not significantly changed from prior. No evidence of metastatic disease. |
Generate impression based on medical findings. | 72-year-old woman with history of right radicular leg pain. Five lumbar type vertebral bodies are present on this study. The vertebral body heights are within normal limits. There is slight exaggeration of the lumbar lordosis which may be positional. Lumbar spinal alignment is otherwise normal. Small, scattered foci of T1 and T2 hyperintensity may represent hemangiomata or areas of focal fat. The bone marrow signal is benign. The conus medullaris is normal in position.There is mildly increased signal in all of the intervertebral discs suggesting desiccation. Multilevel degenerative changes are seen, as described below:L1-L2: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L2-L3: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L3-L4: There is minimal disc bulge, eccentric to the right. Additionally, there is mild ligamentum flavum thickening. Minimal right neural foraminal narrowing. There is no spinal canal or left neural foraminal stenosis.L4-L5: There is a mild bulge, eccentric to the right. A small focus of increased T2 signal suggests a mild posterior annular fissure on the right. Additionally, there is mild bilateral facet arthropathy with ligamentum flavum thickening. There is mild effacement of the right lateral recess with minimal contact with the L5 descending nerve but no evidence of impingement. Minimal right neural foraminal narrowing also without clear evidence of impingement. There is no spinal canal or left neural foraminal stenosis.L5-S1: There is a mild bulge, eccentric to the right. Additionally, there is mild bilateral facet arthropathy with ligamentum flavum thickening. There is no spinal canal or neural foraminal stenosis.Small bilateral cystic lesions at the S1 level are compatible with perineural cysts.The paraspinous soft tissues are within normal limits. | Mild multilevel degenerative changes without spinal canal stenosis or clear evidence of nerve root impingement. Please see comments above. |
Generate impression based on medical findings. | Migraine and bipolar disorder with an acutely worsened headache over the past month. History of DVT and weight issues. MRI: There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, and scalp soft tissues are grossly unremarkable. There are secretions in the right posterior ethmoid sinus.MRV: The right transverse sinus, sigmoid sinus and proximal intracranial jugular vein are asymmetrically enlarged with regional transosseous venous collaterals. There is narrowing of the internal right jugular vein more inferiorly in the upper neck, which is partially imaged, but possibly related to thrombosis. The left transverse sinus is hypoplastic. The remainder of the imaged cerebral venous drainage system is within normal limits, without evidence of intracranial venous thrombosis. | 1.Nonspecific partially empty sella, which may be a manifestation of pseudotumor cerebri, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2.Enlarged right transverse sinus, sigmoid sinus and right proximal jugular vein with right transosseous venous collaterals likely related to narrowing of the right extracranial internal jugular vein more inferiorly, which may be related to thrombosis. A venous Doppler ultrasound of the neck may be useful for further evaluation. |
Generate impression based on medical findings. | Male, 57 years old, with benign neoplasm of the pituitary gland. The 2 mm hypoenhancing lesion seen on the prior examination within the anterior aspect of the pituitary gland is no longer clearly visualized. The pituitary is otherwise unchanged in appearance. No new mass lesions are suspected. No suprasellar abnormality is observed. The visualized optic apparatus is unremarkable. | A small lesion seen previously in the anterior pituitary gland is no longer distinctly visualized. No new pituitary lesions are identified. |
Generate impression based on medical findings. | Pain In Right Leg [M79.604] / Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: R/O compressed or irritated nerve root History: Right lateral leg pain numbness, originally starting in the lower back now mostly involving the leg For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. There is about 6mm sized renal cyst on the right kidney.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, Schmorl's node on the inferior endplate of the L1 vertebral body. minimal to mild facet joint hypertrophy (left worse than right). no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, bilateral ligamentum flavum thickening, no neuroforaminal narrowing. L4-L5: grade 1 anterolisthesis of L4 on L5 with pseudobulging of disc with disc dessication results minimal to mild spinal canal stenosis. There is 4.4mm x 9.7mm sized fluid filled lesion on the lateral aspect of the right L45 facet joint which may indicate degenerative change related synovial cyst.L5-S1: disc dessication with exuberant osteophytes on bilateral facet joints indicating degenerative facets bilaterally. | 1. Grade 1 anterolisthesis of L4 on L5 with minimal to mild spinal canal stenosis at the level.2. Multilevel various degree degenerative changes of intervertebral discs and facet joints as described above including L45 right side synovial cyst. |
Generate impression based on medical findings. | Pain in left knee, evaluate meniscus MENISCI: There is blunting of the free edge of the body of the medial meniscus as well as the posterior horn near its root. There is also a defect of the undersurface of the inner half of the posterior horn of the medial meniscus. There is a small focus of low signal intensity situated beneath the periphery of the body of the medial meniscus between the MCL and the underlying tibial plateau. These findings indicate a complex tear of the medial meniscus with displacement of meniscal tissue into the medial gutter. The anterior horn of the medial meniscus appears intact. The lateral meniscus also appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial tibial plateau beneath the torn meniscus. We suspect this is degenerative in etiology although this finding could conceivably represent a developing subchondral stress fracture. We see no fluid-filled articular cartilage defects involving the medial tibiofemoral articular compartment. There is full thickness degeneration of the articular cartilage of the femoral trochlea centrally and inferiorly with a cleft extending through the articular cartilage of the medial facet of the femoral trochlea. There is perhaps mild thinning of the articular cartilage of the patella inferiorly. Mild heterogeneity of the articular cartilage of the lateral tibial plateau posteriorly suggesting mild degeneration.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL | Complex tear of the medial meniscus with displaced flap fragment and other findings as described above. |
Generate impression based on medical findings. | 9-year-old male with ALL on steroids, rule out AVN Right ankle: Confluent increased T2 and decreased T1 signal within the proximal aspect of the cuboid without discrete fracture line may represent a healing nondisplaced fracture or stress reaction. Multiple additional scattered foci of increased STIR signal within the marrow of the distal tibia, talus, calcaneus, and tarsal bones as well as the visualized portions of the metatarsals are normal for the patient's age. The tibiotalar joint is normal. The medial and lateral collateral ligaments are intact. The extensor and flexor tendons appear normal.Left ankle: Scattered foci of mildly increased STIR signal within the marrow are normal for the patient's age. There is no evidence of fracture or malalignment. The tibiotalar joint is normal. The medial and lateral collateral ligaments are intact. The extensor and flexor tendons appear normal. | Signal abnormality involving the right cuboid, which may represent a healing nondisplaced fracture or stress reaction. Right foot radiographs may be considered to evaluate for healing if clinical warranted. |
Generate impression based on medical findings. | History of lumbar lipomyelomeningocele repair and hemangioma on the back. Assess for hydrocephalus and cord tethering. BRAIN: The ventricular system is not enlarged. There are foci of susceptibility effect in the posterior right inferior temporal sulcus, left collateral sulcus, and right cerebellar tonsil. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. In particular, there cerebellar tonsils are not low-lying. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. SPINE: Thee are postoperative findings related to lipomyelomeningocele surgery with overlying incision plane that may contain a small amount of residual fluid. There is a lipomatous mass in the posterior spinal canal at the L1 through L4 levels, measuring 1.6 AP x 1.5 RL x 3.9 CC cm. The lipomatous mass abuts and mildly deforms the caudal spinal cord. The tip of the conus medullaris is situated at the L4 level. The lower spinal cord does not appear to shift in position from prone to supine. There is a linear high T2 and low T1 signal band in the midline posterior subcutaneous tissues at the L5 level, which extends from the spinal canal to the skin surface, where there appears to be a flat cutaneous lesion. There is no evidence of syrinx. The vertebral column alignment is anatomic. The vertebral body heights are intact, but there is apparent deficiency of the posterior elements at multiple levels of the lumbar spine, which may represent dysraphism or surgical alterations. | 1.No hydrocephalus, acute intracranial hemorrhage, or acute infarct. Tiny foci of susceptibility effect involving the temporal lobes and the right cerebellar tonsil may represent cortical mineralization from previous ischemia, infection, or hemorrhage. 2.Postoperative findings related to repair of the lipomyelomeningocele. The residual lipomatous mass, or caudal lipoma, is attached to the deformed caudal spinal cord and the tip of the conus medullaris lies at the L4 level.3.Suggestion of a possible sinus tract in the posterior subcutaneous tissues at the L5 level, perhaps with associated with a overlying cutaneous hemangioma. Otherwise, no evidence of a residual meningocele. |
Generate impression based on medical findings. | 46-year-old male with posterior medial knee pain. Evaluate for meniscus or chondral injury. MENISCI: There is increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying subchondral signal abnormality likely degenerative in etiology. There is a near full-thickness cleft of the articular cartilage, along the lateral facet, centrally. There is near full-thickness articular cartilage degeneration along the medial facet of the femoral trochlea, appearing progressed when compared to the prior study. There is full-thickness articular cartilage degeneration, centrally, affecting the femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | Articular cartilage degeneration most pronounced along the patellofemoral joint which has progressed slightly when compared to the prior study. |
Generate impression based on medical findings. | 55 year old with strong family history of breast cancer, brother with breast cancer at age 56, mother with breast cancer at age 84, and paternal grandmother with breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There are a few cysts in left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | 47-year-old female with shoulder pain for weeks and limited range of motion. Evaluate for rotator cuff tear versus adhesive capsulitis. ROTATOR CUFF: There is increased signal abnormality within the supraspinatus indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild degenerative changes of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for detailed evaluation of the glenoid labrum, there is linear increased signal abnormality traversing the posterior superior glenoid labrum raising the possibility of a tear. The glenohumeral joint alignment is anatomic.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL | 1. Supraspinatus tendinosis without evidence of a full-thickness rotator cuff tear. 2. Findings suspicious for a posterosuperior labral tear. This could be further evaluated with a dedicated MRI arthrogram if clinically warrented. |
Generate impression based on medical findings. | Elevated PSA. No pathology available.October of 2015 was found to have a PSA of 36 ng/mL. In November it was repeated and found to be 41 ng/mL. In September of 2015, he underwent a transrectal ultrasound-guided biopsy which showed no evidence of cancer. Hesubsequently underwent an MRI on November 25, 2015, which suggested an abnormality measuring approximately 2 cm at the right base and mid portion of his prostate within the transition zone and extending anteriorly into the periprostatic space. An MR-guided biopsy at that point suggested 16 mm ofGleason 8 cancer at the right mid, 5 mm of Gleason 8 cancer at the right apex, 5 mm of Gleason 8 cancer at the left mid. PELVIS:PROSTATE:Prostate Size: 3.9 x 5.3 x 4.6 cmPeripheral Zone: The peripheral zone is relatively T2 weighted hyperintense with several band like linear regions of hypointensity. There is also nearly diffuse T1-weighted hyperintensity of the peripheral zone, findings compatible with blood product, and limiting evaluation. Bandlike focal thickening in the right lateral apex measuring 1.0 x 0.6 cm (series 301/53) demonstrating low T2 weighted signal intensity, likely related to blood product. Ill-defined region of low ADC and T2-weighted signal in the left mid-gland (series 403/184 and series 601, image 15) may represent a site of disease.No additional discrete abnormality. Central Gland: Centered in the right mid gland is 2.1 x 2.0 x 2.1 cm T2-weighted mildly hypointense poorly defined lesion (series 801 /14) with associated restricted diffusion (series 403/264). The lesion demonstrates avid relatively early enhancement (series 1 401/2 337).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The mass centered in the right mid gland transitional zone appears to extend anteriorly where it obscures the right anterolateral prostatic margin suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Dominant 2.1 cm lesion in the mid-portion of the right mid-gland with suspected right anterolateral extraprostatic extension. |
Generate impression based on medical findings. | Spinal stenosis lumbar region. Neurogenic claudication. Idiopathic scoliosis and kyphoscoliosis. There is straightening of lumbar lordosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate narrowing of the L2-L3 through L4-L5 discs with disc desiccation. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is increased dorsal epidural fat throughout the lumbar spine contributing to spinal stenosis. Multilevel degenerative changes are seen, as described below. L1-L2: There is left far lateral disc protrusion which is similar compared to the previous exam. No definite foraminal stenosis. No central spinal canal stenosis.L2-L3: There is eccentric left disc bulge causing partial narrowing of the left neural foramen. There is right paracentral disc bulge indenting the thecal sac anteriorly. Mild to moderate central canal stenosis is evident. There is facet arthropathy and ligamentum flavum thickening.L3-L4: Severe endplate degenerative changes are present. There is diffuse disc bulge slightly prominent to the right side causing mild to moderate right foraminal narrowing and mild to moderate left foraminal narrowing. There is moderate central spinal canal stenosis at this level. These findings are likely progressed compared to the previous exam. There is facet arthropathy and ligamentum flavum thickening.L4-L5: Severe endplate degenerative changes are present. Prominent left disc bulge is noted. There is mild central spinal canal stenosis. There is facet arthropathy and ligamentum flavum thickening. Lateral recess narrowing is again noted greater on the left.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is facet arthropathy and ligamentum flavum thickening.Paraspinous soft tissues are within normal limits.Rounded T2 hyperintensities are noted in the bilateral kidneys which are nonspecific but most likely represent cysts. | 1.Multilevel lumbar spondylotic changes with findings most conspicuous and minimally progressed at L3-L4 resulting in moderate central spinal canal stenosis as well as mild to moderate left and mild right foraminal stenosis.2.Rounded T2 hyperintense areas in the bilateral kidneys statistically representing cysts. Ultrasound of the abdomen can be obtained if further indicated. |
Generate impression based on medical findings. | Ataxia There is focal low signal intensity lesion on both T1 and T2 weighted images on the left cerebellar hemisphere with surrounding FLAIR high signal intensities indicating associated encephalomalacia. The gradient echo images were non diagnostic to characterize this lesion due to significant metallic artifacts. Comparing to prior MRI in 2003, the lesion's MR characteristics have not changed. The possibility of this lesion is likely to be chronic hemorrhagic lesion such as cavernoma or calcifications.There are extensive patch high signal intensities on FLAIR imaging on periventricular white matter brainstem, and bilateral cerebral hemispheres indicating moderate to severe nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is multilobulated relatively well circumscribed mass on the right parotid gland superficial lobe, the size was measured around 13.8 mm x 24.6 mm x 21 mm. The lesion shows high signal intensity on T2 and low signal intensity on T1 weighted images. Diagnostic possibility is benign parotid gland lesion such as pleomorphic adenoma. | 1, Moderate to severe nonspecific small vessel ischemic disease, as described above.2, No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Left cerebellar hemispheric lesion, either cavernoma or calcifications, no change since 2003.4, Benign appearing right parotid gland superficial lobe mass lesion most likely representing pleomorphic adenoma. |
Generate impression based on medical findings. | History of hepatitis C. Multiple liver lesions previously characterized as multifocal hepatocellular carcinoma on imaging. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology.Since the prior study there has been significant increase in size of the previously measured liver mass and multiple new and enlarging liver masses infiltrating the right hepatic lobe. The reference lateral segment confluent mass measures approximately 17.9 x 8.9 cm compared to 14.3 x 6.4 cm previously.The portal vein is poorly demonstrated. Gallstones within a normally distended gallbladder.SPLEEN: The spleen measures 11.2 cm in length without a focal lesion.PANCREAS: Pancreas divisum. No pancreatic ductal dilatation or focal lesion. No stigmata of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple appearing cyst. Punctate hyperintensities bilaterally are too small to characterize, likely cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume abdominal pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis. | Interval increase in the large lateral segment reference mass and increase in size and number of numerous additional liver masses compatible with progression of multifocal hepatocellular carcinoma.The portal vein is poorly demonstrated. If there is clinical concern for occlusion an ultrasound may be considered.Cholelithiasis without cholecystitis. |
Generate impression based on medical findings. | History of IPMN status post distal pancreatectomy and splenectomy. Evaluate for recurrence. 11/25/2009 Pathology demonstrated side-branch IPMN and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Lobular dilatation of the common bile duct is not significantly changed in caliber or morphology. No filling defect, stricture or mass lesion is evident. Mild central intrahepatic biliary ductal dilatation.Normally distended gallbladder without gallstones.The liver is normal in morphology, size and signal intensity without a focal suspicious lesion.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The main pancreatic duct is irregularly dilated up to 6 mm, increased from the prior study. No focal lesion or filling defect is evident. This may be related to chronic pancreatitis and chronic stricturing (series 7, image 127).There are several punctate cystic foci in the pancreatic head the largest of which measures 4 mm, compared to 6 mm previously.There is intrinsic low T1-weighted signal intensity of the hepatic parenchyma with relatively mild postcontrast enhancement, compatible with stated history of chronic pancreatitis. There is no peripancreatic fat stranding, fluid collection or vascular stigmata of pancreatitis. ADRENAL GLANDS: Stable small left lipid rich adrenal adenoma.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. | 1. Interval increase in residual pancreatic ductal dilatation, now measuring up to 6 mm without a focal lesion evident. This may be related to chronic pancreatitis and worsening stricturing although a main duct IPMN cannot be entirely excluded. 2. Stable to decreased size of punctate cystic pancreatic parenchymal foci. |
Generate impression based on medical findings. | Anaplastic oligodendroglioma, WHO grade III status post treatment: surveillance. There are postoperative findings related to subtotal right frontal tumor resection, with a 5 mm wide extra-axial residual fluid collection anteriorly. There is interval increase in size of heterogeneously enhancing tumor with punctate foci of susceptibility effect along the resection cavity margins, which measures up to approximately 35 mm in thickness. There is also increased extensive surrounding non-enhancing confluent T2 hyperintensity with up to approximately 10 mm of midline shift to the left, as well as subfalcine herniation and partial effacement of the right lateral ventricle. There is no acute territorial infarct. The major cerebral flow voids are intact. The orbits are grossly unremarkable. | Postoperative findings related to subtotal right frontal tumor resection with interval increase in size of tumor along the surgical margins, as well as the extensive surrounding edema and/or non-enhancing tumor infiltration with approximately 10 mm of midline shift. |
Generate impression based on medical findings. | The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. LUMBAR | 1. Stable lipomyelomeningocele within the spinal canal at L3-L5 levels.2. Unchanged cystic lesion along the right lateral spinal canal at L3-L4.3. Stable ventral motion of the thoracolumbar spinal cord at T11-L2, below which distal cord and conus is tethered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | History of left temporal lobe from meningioma resection, auditory and visual hallucinations, suspicious for encephalitis. No evidence of acute ischemic or hemorrhagic lesion.There is about 4mm sized intensely enhancing area (series 901, image 113/300) on the right basal ganglia, likely globus pallidus on enhancement. However, this is the only abnormal enhancement on this scan. Therefore, it is likely to be a vascular enhancement such as focal dilated venous structure. Possibility of arterial aneurysm is low.Therefore, if clinically indicated, follow up MRI with contrast enhancement can be considered.Redemonstration of left temporal lobe anterior aspect large resection cavity with the surrounding gliosis indicating postoperative changes. These are showing no interval changes since prior scan.Patch high signal intensities on FLAIR images on bilateral periventricular white matter indicating minimal to mild nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. No evidence of acute ischemic or hemorrhagic lesion. 2. Focal intensely enhancing area on the right basal ganglia which likely represent vascular structure such as dilated venous structure. 3. Post resection status of the left temporal area meningioma with post operative changes, no interval change since prior exam.4. Non specific small vessel ischemic disease. No change since prior exam. |
Generate impression based on medical findings. | The left face arm and leg weakness and paresthesia with rapid improvement. No evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy high signal intensities on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% of luminal narrowing on the right MCA proximal M1 segment and more than 50% of luminal narrowing on the left distal ICA. Bilateral PCAs are fetal origins. It appears to be that there is one large ACA indicating Azygos ACA. Left ACA A1 segment is hypoplastic. Acom artery is patent. No evidence of intracranial aneurysm. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multifocal intracranial arterial luminal stenosis, right MCA proximal M1 (less than 50% stenosis) and left distal ICA (more than 50% stenosis). 3. Normal extracranial craniocervical arterial system. Comment: although the patient appears to be asymptomatic on the left distal ICA stenosis, bilateral various degreed intracranial arterial luminal stenosis indicate intracranial atherosclerosis. Therefore, precise evaluations and management are suggested. If indicated, clinical follow up through Dr.Brorson of Neurology is suggested. |
Generate impression based on medical findings. | Right knee pain No fracture or malalignment. No joint space narrowing. Moderate to large joint effusion. Please see recent prior knee MRI for details. | No fracture or malalignment. |
Generate impression based on medical findings. | 10-week-old female with a history of nonaccidental trauma resulting in large subdural hematoma, parenchymal hemorrhage, and possibility of hypoxic ischemic follow-up. There are diffuse areas of T2 hyperintensity and gyriform T1 hyperintensity throughout much of the left cerebral hemisphere and in the right occipital and parietal lobe with areas of mild volume loss, particularly in the posterior portions of the cerebral hemispheres. There is diffusion restriction throughout the corpus callosum, along the left posterior internal capsule, and in the left temporal stem. The cerebellum and bilateral deep grey nuclei appear to be spared. There are predominantly T2 and T1 hyperintense subdural fluid collections with areas of more intermediate T1 and low T2 signal along the bilateral temporal and posterior cerebral and cerebellar convexities, which are unchanged in size. There is an underlying T1 hypointense and T2 hyperintense subdural collection along the rest of the left cerebral convexity. Likewise, there is unchanged prominence of the right frontal convexity subarachnoid spaces. There is unchanged 4 mm of rightward midline shift. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. Extensive areas of infarction involving the left greater than right cerebral hemispheres, which are likely late subacute to chronic, with associated cortical laminar necrosis and early Wallerian degeneration throughout the corpus callosum, along the left posterior internal capsule, and in the left temporal stem. The distribution of the infarcts suggests a strangulation type of nan-accidental trauma and dedicated vascular imaging of the neck may be useful, if clinically warranted.2. Acute to early subacute subdural hematomas along the bilateral temporal and posterior cerebral and cerebellar convexities superimposed upon a chronic left subdural hematoma and enlargement of the subarachnoid spaces, which are unchanged and associated with mild midline shift to the right.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 55 year-old female. Knee pain, instability, falls. MENISCI: Complete radial tear of the medial meniscal body with 4 mm of medial extrusion . Globular signal abnormality within this meniscus consistent with underlying degeneration. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Full thickness cartilage loss of the medial femoral condyle. Near full thickness to full thickness articular cartilage loss of the medial tibia. Diffuse cartilage thinning of the lateral tibiofemoral compartment with no focal defect. Patellofemoral compartment cartilage is markedly thinned with fraying in the medial lateral facet. Small degenerative cyst in the lateral facet. Tricompartmental osteophytes. Patchy edema signal in the distal femur and proximal tibia, most likely degenerative in etiology.LIGAMENTS: ACL and PCL are intact.EXTENSOR MECHANISM: Intact.ADDITIONAL | 1. Complete radial tear of a degenerated medial meniscus with associated extrusion.2. Moderate osteoarthritis most severe in the medial tibiofemoral compartment with areas of full thickness cartilage loss.3. Moderate knee joint effusion. |
Generate impression based on medical findings. | Neck pain. Postop cervical laminoplasty. There are postsurgical changes of cervical laminoplasty, resulting in overall increase of caliber of the spinal canal from C3 to C7. Small pockets of air, fluid density, and soft tissue edema related to the recent surgery are noted.Residual degenerative disease with disk -osteophyte complexes are again noted at C3 - C4 to C6-C7 level. Neuroforaminal narrowing is again noted at C3 - C4 and C4 - C5 level. | Expected postsurgical changes, and residual degenerative disease of cervical spine as described above. |
Generate impression based on medical findings. | 58 years Male (DOB:8/3/1958)Reason: AA. s/p resection in 2013, then RT/TMZ. History: AA.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient is status post right frontal lobe surgery for tumor removal. There is local gliosis and volume loss at the right frontal lobe surgical site which involves superior frontal gyrus and to lesser degree middle frontal gyrus. There is no interval change relative to the previous exam. No abnormal enhancement is appreciated at the surgical site. Cerebral blood volume is low in the tumor bed. There are some susceptibility effect within the surgical site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | There is no evidence for local recurrence of the patient's right frontal lobe neoplasm on the current exam. |
Generate impression based on medical findings. | Reason: Gall stone pancreatitis History: Pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity, likely a cyst. Common bile duct appears normal without stones.SPLEEN: No significant abnormality noted.PANCREAS: There is a multiloculated cystic lesion within the lesser sac along the lesser curvature which measures 3.4 x 2.8 cm (501/29), previously 3.4 x 3.1 cm. This lesion demonstrates low ADC and peripheral enhancement. There is a sinus tract approaching the main pancreatic duct, however no definite communication is evident.There is focal dilatation of the mid pancreatic duct up to 5 mm with narrowing within the head, likely representing a structure.The body and tail the pancreas demonstrates low T1 signal, increased T2 signal and mild peripancreatic edema consistent with acute pancreatitis. No evidence of necrosis. Portal venous system is intact. No pseudoaneurysms.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. | 1.Pseudocyst formation within the lesser sac, similar to the prior CT.2.Abnormal signal and adjacent edema in the pancreatic tail is suggestive of acute pancreatitis.3.Focal narrowing in the pancreatic head with associated ductal dilatation, likely representing a stricture. |
Generate impression based on medical findings. | Internuclear ophthalmoplegia. There are numerous, greater than 10, T2 hyperintense white matter and thalamic lesions, including a lesion in the posterior midbrain, around the midline, and left paramedial posterior pons. Many of the lesions display low T1 signal, but no associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is flattening of the pituitary gland. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. Findings compatible with demyelinating lesions suggestive of multiple sclerosis with involvement of the medial longitudinal fasciculus, which could account for the internuclear ophthalmoplegia.2. Nonspecific flattening of the pituitary gland, which can be a manifestation of pseudotumor cerebri. |
Generate impression based on medical findings. | Chronic neck pain with intermittent numbness in the upper extremities. Follow-up cervical spondylosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is kyphosis of the cervical spine with apex at C5-C6 similar to prior. There is also minimal C4 on C5 anterolisthesis as before. Bone marrow signal is benign. There is multilevel disc height loss, severe at the C6-C7 level but similar to prior.The cervical spinal cord has normal signal characteristics.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes which are suboptimally evaluated. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Uncovertebral hypertrophy and facet arthropathy on the left contribute to mild to moderate left neural foraminal stenosis, stable to minimally worse in the interval with motion degradation limiting assessment. No significant spinal canal or right neural foraminal stenosis.C4-5: There is facet arthropathy on the right with suggestion of partial ankylosis. No significant spinal canal or neural foraminal stenosis. C5-C6: Small disc osteophyte complex including left-sided uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing. C6-C7: There is a disc osteophyte complex with suggestion of component of disc extrusion, but similar to prior. There is partial effacement of the ventral thecal sac. Otherwise no significant spinal canal stenosis. Neural foramina are also patent. C7-T1: Minimal disc osteophyte complex without spinal canal or neural foraminal stenosis.Paraspinous soft tissue structures appear grossly unremarkable. | 1. Mild to moderate multilevel degenerative changes throughout the cervical spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level.2. Motion degradation on the current study somewhat limits assessment however there is no gross change since prior MRI from 6/7/2012.3. Additional details as above. |
Generate impression based on medical findings. | Reason: sah. eval for aneursym History: sah . Diabetes, Chronic renal insufficiency, hypertension, peripheral vascular disease. patient states he has had issues with the LUE in terms of weakness. MRI of the brainSeveral foci of punctate sized diffusion restriction are present one is located in the right centrum semiovale in the frontal lobe and one is located in the left occipital lobe cortex at the level of the cuneus. There are couple of small foci of diffusion restriction present in the left cerebellar hemisphere.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 1.5mm right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.A small 1.5 mm infundibulum is present at the anterior communicating artery on the right side associated with the origin of a perforator.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is larger than the left vertebral artery. The origin of the left vertebral artery is partially obscured by artifact. | 1.There is a small right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.2.There are several punctate foci of cerebral infarction scattered in multiple territories as detailed above which includes left cerebellar hemisphere, left occipital lobe and right frontal lobe.3.There is subarachnoid blood present along the high convexities of the right hemisphere without an obvious cause identified on this exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.6.Findings were discussed with Dr Awad at the time of the exam. |
Generate impression based on medical findings. | Pituitary tumor surveillance and history of prior infarcts. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is an enhancing mass arising from the pituitary that measures up to 19 mm in craniocaudal dimension, previously 16 mm. The tumor protrudes into the left cavernous sinus, but there is no encasement of the carotid artery flow voids. There is also thickening of the infundibulum, which measures up to 6 mm in width. The tumor abuts the right prechiasmatic optic nerve. There is mild mucosal thickening in the sphenoid sinuses.Brain: There are subcentimeter foci of encephalomalacia in the right pons and basal ganglia. There is also an area of encephalomalacia in the right cerebellar hemisphere. There is a background of scattered T2 hyperintense foci in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration, with a cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. | 1. Interval increase in size of the pituitary macroadenoma.2. Chronic right pons, right cerebellar hemisphere, and right basal ganglia lacunar infarcts superimposed upon a background of chronic small vessel ischemic disease. |
Generate impression based on medical findings. | 49-year-old woman with history of recurrent urinary tract infections, please evaluate for urethral diverticula. PELVIS:UTERUS, ADNEXA: Retroverted, retroflexed uterus. The junctional zone is thickened measuring up to 18 mm. Small nabothian cysts noted (601/60).BLADDER: No significant abnormality noted. Specifically, there is no evidence of urethral diverticulum.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Punctate foci of susceptibility artifact in the anterior lower abdominal soft tissues likely from prior surgery.OTHER: No significant abnormality noted. | 1.No urethral diverticulum or finding to explain the patient's symptoms.2.Thickened uterine junctional zone which can be seen in adenomyosis. |
Generate impression based on medical findings. | Images are limited by extensive patient motion and areas of incomplete fat saturation on post contrast imaging. There is asymmetric thickened and enhancing posterior hypopharyngeal soft tissue from the upper C3 to C3-C4 levels more prominent to the right of midline, at the approximate level of the anterior hyoid bone. This extends from to the pharyngeal mucosal surface, with grossly intact prevertebral musculature. This measures approximately 1.8 cm transverse by 1.0-cm AP by approximately 1.7 cm CC. There is slight mass effect upon the adjacent piriform sinus which remains aerated. Associated T2 hyperintensity is noted in this location. Preservation of the retropharyngeal fat plane is difficult to determine on this limited MRI, but there may be violation suggested on the sagittal post-contrast images.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are otherwise unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. There is heterogeneous enhancement and T2 hyperintensity in the left lobe of thyroid gland which is mildly enlarged. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: The visualized intracranial structures are unremarkable. There is redemonstration of anteromedial right apical pulmonary opacity which is partially visualized, with similar configuration to that of the prior CT. There is mild-moderate mucosal thickening throughout the paranasal sinuses. There is focal opacity on the coronal images in the anterior right upper lobe consistent with an area of hypermetabolism on the prior PET CT. Evaluation for interval change in size is difficult due to differences in technique. Degenerative changes are again seen involving the cervical spine especially at C3-C4 and C4-C5, where there may be a posterior osteophyte disk complex with possible additional ossification of the posterior longitudinal ligament. There is flattening of the ventral cord and likely at least mild to moderate central spinal canal stenosis C3-C4. There may be moderate to moderate severe bilateral foraminal narrowing at these levels. | 1. Severely limited exam due to extensive patient motion and areas of incomplete fat saturation. Abnormal signal and enhancement within the right paracentral and midline posterior hypopharyngeal soft tissues extending to the mucosal surface at the C3 to C3-C4 level. This correlates with previous area of increased uptake on PET CT, but does not appear to involve the prevertebral space, as normal musculature is visualized. This could relate to an additional primary neoplasm or inflammatory process. A follow-up contrast-enhanced CT of the neck may be helpful to evaluate for retropharyngeal involvement, and correlation with direct inspection is recommended given apparent involvement of the mucosal surface.2. Heterogeneous enhancement and abnormal signal in the left lobe of the thyroid gland which is enlarged. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.3. Partially visualized cervical spondylotic changes which may be further evaluated with dedicated MRI of the cervical spine if clinically indicated.4. Partially visualized pulmonary findings previously seen on PET/CT system patient's known malignancy, with direct comparison difficult due to differences in technique. |
Generate impression based on medical findings. | 46-year-old female who had abdominal wound breakdown 4 months ago. Presenting with increasing pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone, unchanged from previous study. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described metallic density is unchanged and is located in the hepatic flexure. This likely represents a metallic structure impacted in colon. Correlation with history of previous capsule study history is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical changes at result. Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the anterior pelvic wall has almost completely resolved. Small amount of fat stranding persists.There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.OTHER: No significant abnormality noted | Interval resolution of postsurgical changes in the pelvis and anterior abdominal wall. There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.Persistent metallic linear density in the hepatic flexure. Correlation with previous ingestion of capsule or other metallic structures recommended. |
Generate impression based on medical findings. | SCLC s/p resection and WBRT. The images are degraded by patient motion. There are postoperative findings related to left occipital craniotomy and lesionectomy. There is newly apparent subcentimeter enhancement along the anterior medial aspect of the surgical cavity. There is persistent confluent high T2 signal surrounding the resection cavity. There is also unchanged confluent cerebral white matter T2 hyperintensity elsewhere, particularly in the corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small left maxillary sinus retention cyst. The orbits are unremarkable. | Post-treatment findings with newly apparent subcentimeter enhancement along the anterior medial aspect of the surgical cavity, which may represent tumor recurrence or treatment effects. |
Generate impression based on medical findings. | Chiari malformation, concern for syrinx. The cerebellar tonsils have a pointed morphology and extend up to 20 mm inferior to the foramen magnum. There is interruption of cerebrospinal fluid flow across the foramen magnum. However, the spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. | Low-lying cerebellar tonsils compatible with Chiari I malformation, but no evidence of cervical syrinx. |