There is no evidence of intracranial hemorrhage or mass. There is an unchanged punctate lesion in the right thalamus, encephalomalacia in the left peritrigonal region, and diffuse patchy periventricular and subcortical white matter hypoattenuation. These are stable compared to the prior exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The deformity of the anterior and lateral walls of the left maxillary sinus are only partially visualized and better visualized on the previous exam from 9/25/2015.
clinical findings_fin: {'intracranial hemorrhage': {'clinical finding': 'intracranial hemorrhage', 'cf_snomed': {'intracranial hemorrhage': 1386000}, 'existence': 'neg_dx', 'descriptive_term': 'intracranial', 'observation': 'hemorrhage'}, 'mass': {'clinical finding': 'mass', 'existence': 'neg_dx', 'observation': 'mass'}}anatomical entity_fin: {'right thalamus': {}}location descriptor_fin: ['left']clinical findings_fin: {'unchanged punctate lesion': {'clinical finding': 'unchanged punctate lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'unchanged punctate', 'observation': 'lesion', 'strength_term': 'unchanged', 'change_term': 'unchanged'}, 'encephalomalacia': {'clinical finding': 'encephalomalacia', 'cf_snomed': {'encephalomalacia': 58762006}, 'existence': 'pos_dx', 'observation': 'encephalomalacia'}, 'diffuse patchy periventricular and subcortical white matter hypoattenuation': {'clinical finding': 'diffuse patchy periventricular and subcortical white matter hypoattenuation', 'existence': 'pos_dx', 'descriptive_term': 'diffuse patchy periventricular and subcortical white matter', 'observation': 'hypoattenuation'}}clinical findings_fin: {'these are stable compared to the prior exam': {'clinical finding': 'these are stable compared to the prior exam', 'change_term': 'stable'}}clinical findings_fin: {'ventricles and basal cisterns are normal in size and configuration': {'clinical finding': 'ventricles and basal cisterns are normal in size and configuration'}}location descriptor_fin: ['midline']clinical findings_fin: {'herniation': {'clinical finding': 'herniation', 'existence': 'neg_dx', 'observation': 'herniation'}}anatomical entity_fin: {'orbits': {}, 'skull': {}, 'paranasal sinuses': {}, 'scalp': {}}clinical findings_fin: {'orbits , skull , paranasal sinuses , and scalp soft tissues are grossly unremarkable': {'clinical finding': 'orbits , skull , paranasal sinuses , and scalp soft tissues are grossly unremarkable'}}anatomical entity_fin: {'walls': {'location descriptor': 'lateral'}, 'maxillary sinus': {'location descriptor': 'left'}}location descriptor_fin: ['anterior', 'lateral', 'left']clinical findings_fin: {'deformity': {'clinical finding': 'deformity', 'cf_snomed': {'deformity': 417893002}, 'existence': 'pos_dx', 'observation': 'deformity'}}
<s>[INST] Write the finding section for a radiology report based on the following information: clinical findings_fin: {'intracranial hemorrhage': {'clinical finding': 'intracranial hemorrhage', 'cf_snomed': {'intracranial hemorrhage': 1386000}, 'existence': 'neg_dx', 'descriptive_term': 'intracranial', 'observation': 'hemorrhage'}, 'mass': {'clinical finding': 'mass', 'existence': 'neg_dx', 'observation': 'mass'}}anatomical entity_fin: {'right thalamus': {}}location descriptor_fin: ['left']clinical findings_fin: {'unchanged punctate lesion': {'clinical finding': 'unchanged punctate lesion', 'cf_snomed': {'lesion': 52988006}, 'existence': 'pos_dx', 'descriptive_term': 'unchanged punctate', 'observation': 'lesion', 'strength_term': 'unchanged', 'change_term': 'unchanged'}, 'encephalomalacia': {'clinical finding': 'encephalomalacia', 'cf_snomed': {'encephalomalacia': 58762006}, 'existence': 'pos_dx', 'observation': 'encephalomalacia'}, 'diffuse patchy periventricular and subcortical white matter hypoattenuation': {'clinical finding': 'diffuse patchy periventricular and subcortical white matter hypoattenuation', 'existence': 'pos_dx', 'descriptive_term': 'diffuse patchy periventricular and subcortical white matter', 'observation': 'hypoattenuation'}}clinical findings_fin: {'these are stable compared to the prior exam': {'clinical finding': 'these are stable compared to the prior exam', 'change_term': 'stable'}}clinical findings_fin: {'ventricles and basal cisterns are normal in size and configuration': {'clinical finding': 'ventricles and basal cisterns are normal in size and configuration'}}location descriptor_fin: ['midline']clinical findings_fin: {'herniation': {'clinical finding': 'herniation', 'existence': 'neg_dx', 'observation': 'herniation'}}anatomical entity_fin: {'orbits': {}, 'skull': {}, 'paranasal sinuses': {}, 'scalp': {}}clinical findings_fin: {'orbits , skull , paranasal sinuses , and scalp soft tissues are grossly unremarkable': {'clinical finding': 'orbits , skull , paranasal sinuses , and scalp soft tissues are grossly unremarkable'}}anatomical entity_fin: {'walls': {'location descriptor': 'lateral'}, 'maxillary sinus': {'location descriptor': 'left'}}location descriptor_fin: ['anterior', 'lateral', 'left']clinical findings_fin: {'deformity': {'clinical finding': 'deformity', 'cf_snomed': {'deformity': 417893002}, 'existence': 'pos_dx', 'observation': 'deformity'}} [/INST] There is no evidence of intracranial hemorrhage or mass. There is an unchanged punctate lesion in the right thalamus, encephalomalacia in the left peritrigonal region, and diffuse patchy periventricular and subcortical white matter hypoattenuation. These are stable compared to the prior exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The deformity of the anterior and lateral walls of the left maxillary sinus are only partially visualized and better visualized on the previous exam from 9/25/2015. </s>