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Generate impression based on findings. | There is a comminuted fracture of the lateral wall of the right orbit extending into the right zygoma and adjacent greater wing of the sphenoid. There is diastasis of the right frontozygomatic suture. There is a fracture of the anterior wall of the right maxillary sinus with minimal hemorrhage. There are punctate hyperdensities in the soft tissues just below the right globe, which may represent bony fragments or foreign bodies. There is extensive soft tissue injury with laceration and contusion involving the right temporoparietal region. Subcutaneous emphysema is present along the visualized right frontal, temporal and parietal bones and right masticator space. There is right periorbital soft tissue swelling extending to the lateral aspect of the lateral rectus muscle. The lateral aspect of the right globe is attenuated, suspicious for injury to the right globe. | 1. Extensive soft tissue injury and laceration to the right periorbital and temporoparietal region.2. Comminuted fracture of the right lateral orbital wall, right zygoma and adjacent greater wing of the sphenoid with diastasis of the right frontozygomatic suture. 3. Mildly displaced anterior wall fracture of the right maxillary sinus. Punctate bony fragments or foreign bodies in the soft tissues just below the right globe.4. Injury to the lateral aspect of the right globe and lateral rectus suspected. Please correlate with physical examination.Findings discussed with Dr. Kniepkamp at the time of the study by the radiology resident on call. |
Generate impression based on findings. | 46-year-old female with right hip pain, evaluate for FAI MEASUREMENTS: CAM location : Right femoral head-neck junction.Alpha angle : Approximately 69 degreesCoronal center-edge angle : 20 degreesSagittal center-edge angle : 58 degreesFemoral neck-shaft angle : 136 degreesAcetabular version (1 o’clock) : 19 degreesAcetabular version (2 o’clock) : 20 degreesAcetabular version (3 o’clock) : 21 degreesFemoral version angle (+anteverted, -retroverted) : +12 degreesMcKibbin index : 21 + 12 AIIS width : 14.2 cmDistal base of AIIS to acetabular rim : 5.3 cm | 1. Findings consistent with again CAM deformity and femoral acetabular impingement including subchondral cysts and prominence of the femoral head-neck junction.2. Measurements provided above. |
Generate impression based on findings. | There is no intracranial hemorrhage. There are no areas of abnormal attenuation. The ventricles and sulci are within normal limits for the patient's age. There is no midline shift or mass effect. There is no extraaxial fluid collection. Patchy hypoattenuation throughout the periventricular and subcortical white matter is nonspecific but most compatible with age indeterminate small vessel ischemic disease. There is a small defect in the inner table of the calvarium of the right frontal bone. This is nonspecific but likely represents a benign process such as a prominent vascular space or pacchionian granulation. A lytic lesion such as a metastasis is considered less likely. There is complete opacification of the right sphenoid sinus with sclerosis of the sphenoid wall and mild mucosal thickening within left sphenoid sinus. There is trace fluid in a few right mastoid air cells. The imaged portions of the remaining paranasal sinuses and mastoids/middle ears are grossly clear. | 1.No evidence of an acute intracranial abnormality. Please note that CT is insensitive for the detection of early nonhemorrhagic stroke. If clinical concern remains high, further evaluation with MRI is recommended.2.Nonspecific small defect in the inner table of the calvarium of the right frontal bone likely represent a benign process such as a prominent vascular space or pacchionian granulation. A lytic lesion such as metastasis is considered less likely. Correlation with a history of primary malignancy is recommended. |
Generate impression based on findings. | 64-year-old male with enlarged calf, no DVT, rule out mass or other pathology Alignment is within normal limits. There is soft tissue swelling about the calf without underlying osseous lesion. Osteoarthritic changes are noted affecting the knee. Vascular calcifications are present in the soft tissues. | Soft tissue swelling about the calf without underlying osseous lesion. |
Generate impression based on findings. | 59 years old, Male, Reason: cholangiocarcinoma History: weakness, fatigue ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Extensive bilobar hepatic hypodensities consistent with known history of cholangiocarcinoma. There is an exophytic mass in the dome of the liver. The right anterior portal vein appears obstructed. Gallbladder appears contracted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky confluent mass encasing the abdominal aorta and many of its vascular branches (series 5, image 32). The celiac axis, SMA, and IMA appear patent at their ostia. The IVC appears to be encased and may be invaded by tumor. The IVC is severely narrowed at the level of the renal veins. It appears patent more superiorly.Separate slightly more superior mass appears to encase the hepatic artery (series 5, image 23).A mass just posterior to the right diaphragmatic crura abuts the abdominal aorta at the level of the celiac axis (series 5, image 21).BOWEL, MESENTERY: No evidence of obstruction, pneumatosis, or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a moderate amount of perihepatic ascites as well as free fluid within the pelvis suggestive of peritoneal tumor involvement.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mild urinary bladder thickening may represent underdistention versus possible cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Innumerable hepatic lesions consistent with known cholangiocarcinoma.2.Diffuse retroperitoneal metastases encasing the vasculature and narrowing of the IVC.3.Moderate amount of ascites suggestive of peritoneal metastasis.4.Mild urinary bladder thickening may represent cystitis versus under distention. |
Generate impression based on findings. | 64-year-old male with persistent fevers, evaluate for septic joint Right shoulder: Mild osteoarthritis affects the shoulder. Glenohumeral alignment is within normal limits. No fracture is noted.Left shoulder: No humeral alignment is within normal limits. Mild osteoarthritis affects the shoulder.Right elbow: Alignment is within normal limits. A small olecranon spur is noted with overlying soft tissue swelling. Vascular calcification are present in the soft tissues. No joint effusion is identified.Left elbow: There is marked soft tissue swelling about the elbow involving the olecranon bursa. The cortex of the lateral condyle is indistinct and possibly eroded. No elevation of the fat pads to suggest effusion. No fracture is visualizedRight wrist: There are scattered erosions involving the distal radius and base of the fifth metatarsal and to a lesser extent the carpal bones. The radiocarpal joint is narrowed and there is widening of the scapholunate angle. Extensive vascular calcifications are noted.Left wrist: There is erosion of the ulnar styloid and narrowing of the radiocarpal joint. Vascular calcifications are present in the soft tissues. Alignment is within normal limits. | 1. Constellation of findings including scattered erosions involving the wrists and left elbow as described above in an atypical distribution, consider underlying systemic disorder such as gout.2. Findings consistent inflammation of the left olecranon bursa. |
Generate impression based on findings. | Female 72 years old; Reason: evaluate dobhoff placement History: evaluate Dobbhoff placement Enteric tube projects in the left upper abdomen in the region of the gastric body.Pulmonary parenchymal opacities and central venous catheters are better evaluated on the chest radiograph. | 1.Enteric tube terminates in the region of the gastric body. |
Generate impression based on findings. | Female 51 years old; Reason: R/O diverticulitis vs. obstruction History: Abd pain, nausea, vomiting ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney enhances homogeneously. No nephrolithiasis or hydronephrosis. Probable small subcentimeter cortical cysts.Left kidney is enlarged with areas of poor/patchy enhancement predominantly near the upper pole. There is mild to moderate left hydronephrosis due to a obstructing left proximal ureter 7-mm calculus. This infiltration of the fat planes surrounding the left ureter and left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Colon is unremarkable. The appendix is without diagnostic abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is enlarged with multiple hypoattenuating masses likely representing uterine fibroids.BLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.7-mm left proximal ureter obstructive calculus with mild to moderate left renal hydronephrosis and patchy cortical enhancement most suspicious for pyelonephritis. |
Generate impression based on findings. | 41 year-old male with wound, evaluate for osteomyelitis The exam is limited due to inability to optimally position the patient due to contraction. There is a soft tissue ulcer adjacent to the greater trochanter of the left hip. The cortex of the underlying greater trochanter is not clearly distinct which given the deep overlying ulceration is concerning for early osteomyelitis within this limited exam. | Soft tissue ulcer adjacent to the greater trochanter with indistinctness of the underlying cortex concerning for osteomyelitis. Further evaluation with serial imaging or MRI may be considered if clinically warranted. |
Generate impression based on findings. | Male 78 years old; Reason: assess Dobbhoff placement History: as above Enteric tube partially coiled in the region of the gastric body.Bowel gas pattern is nonobstructive.Postsurgical changes in the right hip, partially imaged | 1.Enteric tube terminates in the region of the gastric body. |
Generate impression based on findings. | Female 37 years old; Reason: improvement of ileus? History: ileus Enteric tube projects over the region of the gastric body. Additional peritoneal catheter terminates in the left upper abdomen. Bladder catheter projects over the pelvis.Ingested enteric contrast now resides within the ascending and transverse colon. There is mild distention of the colon. The small bowel gas pattern is nonobstructive. No definite free intraperitoneal air.Multiple parenchymal opacities are noted in the left lower lobe with a probable left pleural effusion.Chronic changes in the hips and lumbar spine. | 1.Mild distention of the colon suggestive of a colonic ileus. Small bowel gas pattern is nonobstructive. |
Generate impression based on findings. | Female 12 years old Reason: PNA? History: Needs supplemental oxygenVIEW: Chest AP (one view) 1/3/15 at 851 hours Central line tip is at the RA/SVC junction. Cardiac silhouette size is top normal. Worsening in bibasilar patchy opacities. Interval development of small right-sided pleural effusion. No pneumothorax. | Top normal cardiac silhouette size.Worsening in patchy bibasilar opacities. Interval development of small right-sided pleural effusion. |
Generate impression based on findings. | Female 56 years old; Reason: 56 y/o woman with metastatic breast cancer receiving chemotherapy. Evaluate extent of disease and treatment response. History: Bone and pelvic mets. No new symptoms. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions. Post radiation changes in the left upper lobe, anteriorly.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Thickening of the fascia planes of the anterior mediastinum, unchanged.CHEST WALL: Postsurgical changes in the left breast and left chest wall.Extensive osseous metastatic disease with sclerotic and lytic changes.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal hepatic lesions have developed. The hepatic and portal veins are patent. There is perihepatic ascites adjacent to the left lobe of the liver, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate to severe right hydronephrosis which has being decompressed by a right ureter stent. Left kidney enhances homogeneously. No hydronephrosis in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall. Diffuse metastatic disease to the spineOTHER: Pockets of upper abdominal ascites with slight enhancement of the fluid pockets most suggestive of peritoneal disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Right pelvic sidewall mass measures 6.2 x 4.8 cm (image 168/series 3) previously, 6.6 x 4.6 cm.Right iliac lymph nodes have increased in size.BOWEL, MESENTERY: Small bowel is normal in caliber. Colon is not obstructed. This enhancing fluid in the cul-de-sac with peritoneal nodularity compatible with peritoneal carcinomatosis. The findings appear stable from prior.BONES, SOFT TISSUES: Diffuse bony metastatic disease.OTHER: No significant abnormality noted. | 1.Stable to slight decrease in the size of the right pelvic side wall mass causing the right ureter obstruction.2.Pockets of upper abdominal and pelvic ascites with peritoneal nodularity compatible with peritoneal carcinomatosis.3.Osseous metastatic disease. |
Generate impression based on findings. | Female; 34 years old. Reason: Evaluate for mandible fracture. History: Fell and hit chin on concrete w/ mandible pain mostly left sided. No acute fracture or malalignment.The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. The maxilla, mandible, sphenoid boned, nasal bones, zygoma, hard palates, pterygoid plates, visualized cervical spine and TMJs are intact, without fracture. The third molars are partially impacted and the right third molar projects into the right maxillary sinus. The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, sphenoid sinuses, and maxillary sinuses are well developed. Polyps/mucous retention cysts are seen within the maxillary sinuses bilaterally, the remaining paranasal sinuses are clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates are normal. The nasal septum is deviated to the right. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable. | 1.No acute fracture or malalignment.2.Partially impacted third molars with right third molar projecting into the maxillary sinus. |
Generate impression based on findings. | Male, 84 years old, status-post drain removal, history of subdural hemorrhage. The previously seen drain has been removed from the right sided subdural space. There remains a small amount of hyperdense extra-axial blood product subjacent to the burr hole, similar to prior. The right subdural space is expanded by fluid which is hypodense to brain measuring up to 16 mm in thickness, unchanged. No new intracranial hemorrhage is detected.Mass-effect on the brain is unchanged with a midline shift to the left of approximately 5 mm, stable. No loss of gray-white distinction is seen. The right lateral ventricle remains mildly effaced. | Stable right-sided subdural collection status post removal of the drainage catheter. No new bleeding is seen. |
Generate impression based on findings. | Female 68 years old; Reason: assess for progression of ileus History: distention Enteric tube terminates in the region of the distal gastric body. Additional enteric tube terminates in the region of the proximal gastric body.Bowel gas pattern is non-obstructive.Bilateral pulmonary opacities and pleural effusions | 1.Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Motion artifact and suboptimal patient position degrade image quality. There is an area of hemorrhage measuring approximately 20 x 9 mm in the medial right thalamus with surrounding edema and local mass effect on the third ventricle. There is no evidence of intraventricular extension of hemorrhage. There is sequela of remote left thalamic hemorrhage with ex vacuo dilatation of the left lateral ventricles. There is subtle gyriform hyperattenuation of the right occipital lobe, likely reflecting laminar necrosis, and less likely blood. There are scattered foci of hypoattenuation within the subcortical and periventricular white matter, consistent with age indeterminate small vessel ischemic changes. There is a small mucus retention cyst in the right sphenoid sinus. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.CTA HEAD | 1. Medial right thalamic hemorrhage with edema and local mass effect, but without intraventricular extension.2. Moderate narrowing of the left P2 segment. Additional scattered narrowing of the distal anterior and middle cerebral arteries could be related to motion, but cannot exclude additional stenosis. No evidence of intracranial aneurysm.3. No flow-limiting stenosis of the bilateral internal carotid arteries. The cervical vertebral artery demonstrates thready opacification which may reflect atherosclerotic disease or simply very small calibre. |
Generate impression based on findings. | There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no calvarial fracture. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial abnormality and no significant interval change. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | Male, 66 years old, with subdural hemorrhage status post drain removal. The previously seen right-sided subdural drain has been removed. A subdural collection is redemonstrated on the right which is isoattenuating to brain. This collection has decreased in thickness in some areas by 1 or 2 mm. There is a small amount of extra-axial hyperdense blood products adjacent to the parietal burr holes.A smaller hypoattenuating collection along the left cerebral hemisphere is redemonstrated showing no significant change. This collection measures 7 to 8 mm in thickness.No new hemorrhage is seen. Mass-effect on the brain has not significantly changed with midline shift to the left of approximately 6 mm. Patchy periventricular hypoattenuating lesions are redemonstrated similar to prior. The right lateral ventricle remains smaller than the left but it may have reexpanded slightly from the prior exam. | Status post right subdural drain removal. The right-sided subdural collection may be slightly smaller. The small left-sided subdural collection is unchanged. |
Generate impression based on findings. | Female 58 years old; Reason: abdominal distention, tympanic exam, constipation, eval bowel gas pattern History: see above Bilateral pulmonary parenchymal opacities better evaluated on the chest radiograph. The enteric tube terminates in the region of the distal gastric body/antrum. There is mild gaseous distention of the small bowel loops measuring up to 3.1 cm with mild bowel wall thickening. There are additional vascular catheters are projected over the pelvis. | 1.Mild nonspecific small bowel gaseous distention. |
Generate impression based on findings. | There has been significant interval improvement in cortical thickening and T2 hypersensitivity in the frontal lobes, cingulate gyri, and right parietal lobe. A small area of curvilinear T2 hyperintensity in the subcortical white matter of the left temporal lobe was not clearly seen on the prior study. There are no other areas of new abnormal signal. No evidence of associated restricted diffusion, susceptibility artifact, or pathological enhancement is seen.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1.Significant interval improvement in gyriform signal abnormalities seen on the prior MRI.2.Small, curvilinear T2 hyperintensity in the subcortical white matter of the left temporal lobe was not clearly seen on the prior study. No other new areas of abnormal signal. |
Generate impression based on findings. | Female 58 days old Reason: line placement History: concern for line movement, pulmonary edema. Abdominal distention.VIEW: Chest and abdomen AP (two views) 01/3/15 at 915 hours NG tube is in the stomach. Left upper extremity PICC terminates at the left axillary/subclavian vein.Cardiac silhouette size is normal. Minimal diffuse lung haziness with no focal opacities, effusions or pneumothorax.Disorganized, less distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Minimal diffuse haziness with no focal opacities.Disorganized, less distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is encephalomalacia in the right cerebellar hemisphere and left thalamic region, related to chronic infarcts. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no pathological enhancement. There is no diffusion abnormality. There is a focus of susceptibility artifact in the left cerebellar hemisphere, consistent with hemosiderin deposition. No extra-axial fluid collection is identified. There is a left maxillary sinus mucus retention cyst. Incidentally noted is a partially empty sella. | 1. No evidence of acute infarct.2. Chronic right cerebellar and left thalamic infarcts. Mild chronic small vessel ischemic changes. |
Generate impression based on findings. | Female 54 years old; Reason: Dobbhoff tube placement History: Dobbhoff tube placement Enteric tube terminates in the antropyloric region. The upper abdominal bowel gas pattern is not obstructive | 1.Enteric tube terminates in the antropyloric region |
Generate impression based on findings. | Male 39 years old; Reason: assess for pancreatitis History: elevated lipase ABDOMEN:LUNG BASES: Trace left effusion. Minimal subsegmental atelectasis. Small area of focal consolidation in the right pleural lobe has improved.LIVER, BILIARY TRACT: Liver is normal in morphology. No solid hepatic lesions. The hepatic and portal veins are patent.The biliary tree is normal in caliber. Gallbladder is not distended.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas remains normal in morphology. Pancreatic parenchyma enhances homogeneously without areas of necrosis. No peripancreatic inflammation or fluid collections. There is attenuation of the splenic vein near the portal splenic confluence which is new.ADRENAL GLANDS: Adrenal glands are nodular.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous catheter terminates within the stomach lumen near the gastric body. No upper abdominal bowel obstruction. Few scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No CT evidence of acute pancreatitis. No peripancreatic fluid collections.2.Attenuation of the splenic vein near the SMV is new.3.Improvement in the basilar consolidations. |
Generate impression based on findings. | Male 44 years old; Reason: pt is s/p 2 cycles Temodar please assess response to therapy and compare to previous imaging History: met melanoma CHEST:LUNGS AND PLEURA: There are multiple pulmonary metastatic deposits.Reference left lower lobe mass measures 3.2 x 1.7 cm (image 46/series 4) previously, 3.5 x 2.5 cm.The right middle lobe lung mass measures 6.3 x 5.1 cm (image 65/series 4) previously, 6.6 x 5.7 cm.Remainder of the medications are stable. No definite new lesions.Post surgical changes in the right lower lobe.MEDIASTINUM AND HILA: Index right subcarinal lymph node measures 1.4 x 0.8 cm (image 52/series 3) previously, 1.4 x 0.9 cm.Heart size is normal. No pericardial effusion.CHEST WALL: Chronic post operative right rib changes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense focus in segment 8 of the liver. No new solid hepatic lesions. The hepatic and portal veins are patent.SPLEEN: Subtle hypoattenuating lesion within the spleen seen on image 92/series 3 is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Colon is not obstructedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic changes in the anterosuperior aspect of the femoral heads compatible with avascular necrosis. No CT evidence of femoral head collapse.OTHER: No significant abnormality noted | 1.Decrease in the size of the reference pulmonary lesions without new definite sites of disease. |
Generate impression based on findings. | Reason: h/o HNC/CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Interval resolution of patchy ground glass opacities in the right upper lobe.Stable appearance of scattered. Scattered peri-fissural nodules, compatible with intrapulmonary lymph nodes.No new pulmonary nodule/masses.MEDIASTINUM AND HILA: Stable appearance of multiple subcentimeter mediastinal lymph nodes.Heart size is normal, without significant pericardial effusion.Moderate coronary artery calcifications.The main pulmonary artery is of normal caliber.CHEST WALL: Unchanged appearance of T10 vertebral body hemangioma.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable left hepatic lobe hemangioma.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcification of the abdominal aorta and its branches.Subcentimeter upper abdominal lymph nodes are not significant changed.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the spine.OTHER: No significant abnormality noted. | Interval resolution of right upper lobe ground glass opacities, which were likely related to aspiration/infection. No new suspicious nodule/mass. |
Generate impression based on findings. | There is a linear fracture of the right parietal bone extending from the anterior fontanelle to the lambdoid suture with approximately one bone width offset of the fracture edges. There is a thin, hyperdense extra axial collection in the right parietal lobe underlying the fracture measuring approximately 3 mm in maximum thickness. No evidence of intraparenchymal hemorrhage. The ventricles and sulci are within normal limits. There is no mass-effect or midline shift. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.Right parietal bone fracture with up to one bone width offset of the fracture edges. 2.Thin right parietal extra-axial hematoma. |
Generate impression based on findings. | Reason: 77F with new diagnosis of lung adenocarcinoma. History: staging CT CHEST:LUNGS AND PLEURA: Large, heterogeneous, lobulated and mildly spiculated soft tissue density mass in the right middle lobe measures 34 x 37 mm (series 3, image 56), compatible with primary lung cancer.The mass extends into the right hilum encasing the right the pulmonary veins (series 3, image 45), and possibly the inferior aspect of the right main pulmonary artery, and also abuts the anterior margin of the right middle lobe, pleural invasion cannot be excluded.Multiple solid bilateral nodules are suspicious for metastatic foci.A reference right middle lobe nodule measures 10 x 7 mm (series 5, image 42). A reference nodule in the left lower lobe measures 6 x 6 mm (series 5, image 71).A part-solid ground-glass opacity in the right upper lobe is more compatible with synchronous primary carcinoma than metastatic disease (series 5, image 25).MEDIASTINUM AND HILA: Multiple enlarged and partially necrotic mediastinal and hilar lymph nodes, which displayed hypermetabolic activity on recent PET exam. For reference, a right pretracheal node measures 21 mm in short axis (series 3, image 30).A prominent high left paratracheal node measures 8 mm in short axis (series 3, image 15), and was also hypermetabolic on recent PET/CT.Heart is of normal size without significant pericardial effusion.Aberrant right subclavian artery.Severe coronary artery calcifications.The main pulmonary artery is of normal caliber.Moderate hiatal hernia.CHEST WALL: No significant axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe thoracolumbar scoliosis and degenerative disease of the spine.OTHER: No significant abnormality noted. | 1. Heterogeneous, lobulated and mildly spiculated mass in the right middle lobe is compatible with primary lung cancer. The mass abuts the anterior margin of the right middle lobe and pleural invasion cannot be excluded. Multifocal metastatic disease including: right hilar involvement with vascular encasement, bilateral pulmonary nodules, necrotic mediastinal lymphadenopathy, and left high paratracheal lymph node.2. Part-solid groundglass density in the right upper lobe is more consistent with synchronous primary than metastatic disease.3. Apparent right subclavian artery.4. Severe coronary artery and aortic calcifications. |
Generate impression based on findings. | Female 89 years old; Reason: eval stool burden, free air History: see above A stent projects over the left ilium.There is mild gaseous distention of the colon with average amount of stool at the level of the rectum. The bowel gas pattern is nonobstructive.Enteric tube projects over the left upper abdomen. | 1.Average stool burden. |
Generate impression based on findings. | Female 44 years old; Reason: pna? liver abscess? History: hypoxia, abdominal pain CHEST:LUNGS AND PLEURA: Mild bilateral lung emphysematous changes. There are bilateral subcentimeter nodular opacities in a random distribution. Minimal basilar atelectasis/consolidation.No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are nonspecific mildly enlarged mediastinal lymph nodes.CHEST WALL: Coarse calcification in the right thyroid lobe.ABDOMEN:LIVER, BILIARY TRACT: Extensive areas of tissue necrosis and pockets of gas/fluid in the liver the two largest in the left lateral segment and segments 8/5 of the liver.The confluent right hepatic lobe collection measures 11.6 x 6.1 cm (image 71/series 3). There is mild intrahepatic pneumobilia. Metallic common bile duct stent terminates within the duodenum.The portal vein is severely attenuated. It is likely occluded near the porta hepatis.SPLEEN: Spleen is mildly enlarged at 13 cm.PANCREAS: Pancreatic head is enlarged. There is confluent soft tissue mass surrounding the vessels of the aorta. The superior mesenteric vein is thrombosed. The splenic vein is thrombosed.ADRENAL GLANDS: Adrenal glands are enlarged bilaterally.KIDNEYS, URETERS: Enlargement of the left kidney possibly due to infection. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is thrombus within the infrarenal IVC (image 120 /series 3)BOWEL, MESENTERY: Pockets of upper abdominal fluid adjacent to the liver and nodularity of the peritoneum. The fluid is adjacent to the liver may represent bile or infected fluid from capsule perforation adjacent to the hepatic abscess. There is there borderline enlarged mesenteric lymph nodes.Small bowel is normal in caliber. There is mild colonic wall thickening about the hepatic flexure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent. Pelvic soft tissue likely represent ovarian tissue as seen on image 160/series 3BLADDER: Bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis of the lumbar spine. Sclerotic lesion in L3 vertebral body suspicious for metastatic disease.OTHER: Deep venous thrombosis in left common iliac vein.Right common femoral venous catheter terminates in the right common iliac vein. | 1.Findings of extensive abscess or biloma formation within the liver.2.Masslike enlargement of the pancreatic head with infiltrative soft tissue about the aorta with thrombosis of the superior mesenteric vein and splenic vein compatible with a pancreatic adenocarcinoma.3.Thrombus in the IVC and left common iliac vein.4.Multiple small pulmonary nodular opacities may represent metastatic disease.5.Peritoneal nodularity and ascites compatible with peritoneal carcinomatosis. |
Generate impression based on findings. | There is a right frontal approach ventricular shunt catheter with tip in the right frontal horn. There is unchanged prominence of the ventricles with ex vacuo dilatation and loss of cerebral white matter, better evaluated on prior MR. Agenesis of the corpus callosum redemonstrated. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. A mucus retention cyst is present in the left maxillary sinus. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is debris filling the bilateral external auditory canals. | 1. No acute intracranial process.2. Right frontal approach ventricular shunt catheter with tip in the right frontal horn. Unchanged size and configuration of the enlarged ventricular system.3. Agenesis of the corpus callosum. |
Generate impression based on findings. | Female 48 years old; Reason: 48 yo female with recurrent granulosa cell ovarian cancer History: abdominal bloating CHEST:LUNGS AND PLEURA: Left upper lobe juxtapleural mass measures 1.8 x 1.1 cm (image 32/series 5) previously, 1.6 x 0.9 cm.The reference left lower lobe pulmonary nodule measures 6-mm (image 38/series 5) previously, 5 The right anterior juxtapleural mass measures 1.8 x 0.6 cm (image 55/series 3) previously, 1.7 x 0.9 cm.MEDIASTINUM AND HILA: There is a large left cardiophrenic lymph node. Which is increased in size from prior and now extends to the pericardium and invades the left hemidiaphragm.CHEST WALL: There are multiple left chest wall nodules. The lesion adjacent to the serratus anterior muscle measures 2.3 x 1.6 cm (image 53/series 3) previously, 2.2 x 1.3 cm.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is a new segment 5 lesion measuring 2.7 x 2.4 cm (image 89/series 3). The hepatic and portal veins are patent.SPLEEN: The spleen is normal in size. There are multiple peri-splenic lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node mass has increased in size now measuring 3.9 x 2.8 cm (image 106/series 3) previously, 2.3 x 1.3 cm.BOWEL, MESENTERY: Paracolic gutter mass on the right has decreased in size measuring 3.0 x 2.2 cm (image 143/series 3) previously, 4.0 x 3.1 cm.The left paracolic gutter mass has increased in size measuring 3.2 x 3.2 cm (image 147/series 3) previously, 1.7 x 1.7 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. Left pelvic mass measures 2.1 x 1.8 cm (image 172/series 3) previously, 2.3 x 1.6 cm.BLADDER: No significant abnormality noted.LYMPH NODES: There are multiple enlarged pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right body wall stimulator device with electrodes are unchanged.OTHER: No significant abnormality noted. | 1.Increase in the size of most of the reference lesions.2.New right hepatic lobe metastatic deposit. |
Generate impression based on findings. | The ventricles and sulci are prominent, particularly in the bilateral frontal lobes, which is greater than expected for age. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. There is no diffusion abnormality. There is an extra-axial T2 hyperintense lesion measuring 18 x 29 mm (AP x TR) in the right middle cranial fossa, with scalloping of the overlying bone, most likely representing an arachnoid cyst. A smaller cystic lesion in the left inferior posterior fossa could also represent an arachnoid cyst. There is minimal mucosal thickening of the left frontal and bilateral ethmoid sinuses.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. Prominent ventricles and sulci greater than expected for age, of uncertain etiology. 2. Right middle cranial fossa and possible left posterior fossa arachnoid cysts.3. Scattered punctate foci of T2/FLAIR hyperintensity within the cerebral white matter, which are nonspecific. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is disc dessication and mild loss of disc height at the L5-S1 level. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level.There is no significant disc herniation, spinal canal or foraminal stenosis within the lumbar spine. Additional details by level:T11-T12: Tiny central disc protrusion with effacement of the ventral thecal sac. No significant spinal canal or foraminal stenosis.L4-L5: Tiny cyst at the posterior aspect of the left facet. No significant spinal canal or foraminal stenosis.L5-S1: Disc bulge with superimposed central disc protrusion and annular fissure. No significant spinal canal or foraminal stenosis. | Disc bulge with superimposed central disc protrusion and annular fissure at L5-S1. No significant spinal canal or foraminal stenosis of the lumbar spine. |
Generate impression based on findings. | Male, 68 years old, altered mental status, not waking up appropriately after sedation. Image quality is degraded by motion artifact and mottling. Within this limitation, no large intracranial hemorrhage or abnormal extra-axial collection is seen. No significant mass-effect is suspected. Given the exam limitations, sensitivity for mild edema or other subtle abnormalities is reduced. The ventricles are normal in size and morphology.The osseous structures of the skull are intact. There are fluid levels in the nasopharynx and right maxillary sinus likely related to intubation. | No large intracranial hemorrhage or significant generalized mass effect is suspected. Due to study limitations, subtle abnormalities may not be detected. If clinical concern persists, a repeat examination or MRI can be considered. |
Generate impression based on findings. | THORACIC SPINE: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There are post radiation changes to the T11 and T12 vertebral bodies. There is a mild compression fracture of the T12 vertebral body with underlying metastatic lesion, not significantly changed from CT of 12/4/2014. There is minimal posterior bulge at the left paracentral aspect without significant spinal canal stenosis. There are additional lesions in the T1, T9 and T10 vertebrae and T10 spinous process. The spinal cord is of normal caliber and signal. Comparison with prior CT is difficult due to differences in technique, but at least the T9 lesion was probably present on the prior exam.There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.LUMBAR SPINE: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There are post radiation changes to the L2, L3 and L4 vertebral bodies. Metastatic lesions involving the L2 and L3 vertebral bodies are unchanged. There is a tiny nonspecific lesion anteriorly within the L5 vertebral body. There is depression of the superior endplate of L3, not significantly changed from CT of 12/4/2014. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.There is disc bulge with facet arthropathy at the lower lumbar spine without significant spinal canal or foraminal stenosis at these levels or elsewhere in the lumbar spine. Soft tissue edema in the posterior lower back is noted. | 1. Several lesions throughout the thoracolumbar spine as described, are suspicious for osseous metastases. No gross interval progression, although comparison with prior CT is complicated by differences in technique. The larger lesions at T12 and L3 with associated pathologic compression fractures are not significantly changed from CT of 12/4/2014. No significant retropulsion. Some of the smaller lesions are probably unchanged but an accurate assessment cannot be made due to the differing sensitivity of MRI and CT. 2. Postradiation changes of the lower thoracic and mid lumbar spine.3. Degenerative disc disease. No significant spinal canal or foraminal stenosis. |
Generate impression based on findings. | Female 66 years old; Reason: nephrolithiasis vs. appendicitis History: abdominal pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. Hypoattenuation of the hepatic parenchyma suggests fatty infiltration. Within segment 7 of the liver there is a hypodense mass measuring 4.3 x 3.0 cm (image 31/series 4). The lesion cannot be further characterized by noncontrast CT. There are additional lesions in the left lateral segment. Gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mild right hydronephrosis and hydroureter that extends to the level of the urinary bladder. There is mild right perinephric inflammation. Left kidney has a cyst. No hydronephrosis the left kidney.RETROPERITONEUM, LYMPH NODES: Nonspecific small retroperitoneal lymph nodes.BOWEL, MESENTERY: The appendix is without diagnostic abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent or atrophic.BLADDER: Within the urinary bladder, there is a calculus measuring 1.1 cm possibly near the right ureterovesical junction.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mild right hydroureter with a 1.1 cm stone within the urinary bladder possibly at the UVJ junction.2.Multiple hypodense hepatic lesions. Follow up liver MRI as outpatient is recommended. |
Generate impression based on findings. | Female 43 years old; Reason: concern for SBO History: abdominal pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuation of the hepatic parenchyma suggests fatty infiltration. Status post cholecystectomy. No solid hepatic lesions are evident.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: Small bowel is normal in caliber and course. Contrast has reached the ascending colon. Within the cecum, there is a small filling defect which cannot be further characterized by CT.Appendix is normal in caliber without surrounding inflammatory changes.There are scattered colonic diverticula.BONES, SOFT TISSUES: Postsurgical changes in the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Thickening of the endometrial cavity and enlargement of the cervix with some gas within the vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No bowel obstruction as clinically questioned.2.Enlargement of the cervix with gas within the vagina of unclear etiology. Follow up is suggested to exclude malignancy.3.Polypoid filling defect within the cecum of unclear etiology, follow up is suggested to exclude malignancy. |
Generate impression based on findings. | Female 68 years old; Reason: NHL, initial staging History: newly diagnosed FL CHEST:LUNGS AND PLEURA: Scattered areas of linear atelectasis. No pleural effusions. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathyCHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Spleen is normal in size.PANCREAS: Age-related fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Small bowel is normal in caliber and course. There are scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.BLADDER: Focus of gas within the urinary bladder of unclear etiologyLYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No enlarged lymph nodes in the chest, abdomen or pelvis by CT size criteria.2.Small focus of gas within the urinary bladder of unclear etiology correlate for recent instrumentation.3.Colonic diverticulosis. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with minimal chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | No acute abnormality. Minimal chronic small vessel ischemic changes. |
Generate impression based on findings. | Female 96 years old; Reason: eval Dobbhoff placement History: s/p Dobbhoff Enteric tube projects over the right lower lobe bronchus. There is a right pulmonary opacity and probable pleural effusion. | 1.Enteric tube in the right lower lobe bronchus. Repositioning is suggested.2.Findings discussed with Dr. Verma at the time of dictation |
Generate impression based on findings. | Male 24 years old; Reason: Increased abdominal distention History: abdominal distention Mild gaseous distention of the small bowel and colon suggests an ileus. There are extensive postsurgical changes in the spine. Multiple catheter type devices are projected over the abdomen. | 1.Findings suggestive of an ileus. |
Generate impression based on findings. | Female 57 years old; Reason: free air History: above Previously known free intraperitoneal air seen on CT is not evident by plain film radiograph3 Postsurgical changes with multiple catheters project over the abdomen. | 1.Previously known free intraperitoneal air seen on CT is not evident by plain film radiograph. If there is further clinical concern consider CT scan. |
Generate impression based on findings. | There is an unchanged right transparietal ventriculostomy catheter that terminates in the white matter the right frontal lobe. The right ventricle is dysmorphic, but has decreased in size since April 2014, and now appears partially collapsed. Likewise, the left lateral and third ventricles have decreased in size. The fourth ventricle remains mildly enlarged and dysmorphic due to associated left cerebellar hypoplasia. There is no change in the appearance of right cerebral encephalomalacia. There is thinning of the posterior corpus callosum. There is no acute intracranial hemorrhage or abnormal extra axial fluid collection. The calvarium is diffusely thickened. The paranasal sinuses and mastoids and middle ears are grossly clear. | 1.Interval decrease in size of the shunted supratentorial ventricular system.2.Stable appearance of right cerebral encephalomalacia and hypoplastic left cerebellar hemisphere.3.No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Vertigo. There is mild patchy cerebral white matter hypoattenuation. There is also more focal hypoattenuating areas in the basal ganglia. There is no evidence of acute intracranial hemorrhage or mass. The ventricles are normal in size and configuration. There is no midline shift or herniation. There are carotid siphon calcifications, but there is no definite hyperdense vessel sign. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants. | No evidence of acute intracranial hemorrhage. Mild patchy cerebral white matter hypoattenuation may represent small vessel ischemic disease of indeterminate age and a more focal hypoattenuating areas in the basal ganglia may represent a lacunar infarct of indeterminate age. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | Male, 55 years old, history of base of tongue cancer status post CRT. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Neck:Treatment related findings are redemonstrated including loss of the fascial planes surrounding the carotid sheaths and reticulation of the subcutaneous fat. No mucosal masses are seen. No definite pathologic adenopathy is detected by size criteria.The salivary glands and the thyroid are free of focal lesions. The right IJ vein does not opacify but the remaining cervical vessels are unremarkable. Mild scarring is seen at the right lung apex. No concerning osseous lesions are detected. A hypoattenuating lesion just beneath the skin surface in the left supraclavicular fossa measures about 13 x 10 mm which is not significantly changed from the prior exam. As noted previously, however, this lesion has increased in size slowly over the prior several years. | 1. No evidence of recurrent primary tumor or pathologic adenopathy in the neck.2. A hypoattenuating lesion in the left supraclavicular fossa is unchanged relative to last year's study, but larger when compared to prior years. The lesion is nonspecific and may represent a sebaceous cyst.3. No evidence of metastatic disease to the brain. |
Generate impression based on findings. | History of mandibular fracture status post open reduction, internal fixation, complicated by mandibular nonunion in the left angle area. Left mandibular pain post orthognathic surgery, including two piece LeFort I maxillary osteotomy and repositioning, right sagittal split of mandible with mandibular advancement, and oblique mandibular osteotomy, left angle region, with repositioning. There are interval postoperative findings related to right parasymphyseal mandibulotomy with plates and screw screw fixation and near-anatomic alignment. There are also postoperative findings related to right sagittal split osteotomy, left mandibular angle osteotomy, and LeFort I osteotomy. There are persistent lucencies across the left mandibular angle oblique osteotomy and fracture site with persistent marked hypertrophic bone or callous formation along the margins of the lucency, which apparently impinges upon the adjacent inferior alveolar nerve canal. There is persistent lucency along the right sagittal split osteotomy, with unchanged alignment. There is partial effacement of the right inferior alveolar canal at the margins of the osteotomy. The associated plate and screws appear to be intact, although a screw penetrates tooth # 32. There has been partial healing of the LeFort I osteotomy sites and the associated hardware appears to be intact. There are persistent thin linear lucencies along the vomer and hard palate. Mandibular braces remain in position and there is unchanged mild cross-bite. There is a carious tooth # 22 with periodontal lucency. There is a left maxillary mesiodens. There is persistent mucosal thickening and fluid within the left maxillary sinus. There is diffuse thickening and sclerosis of portions of the bilateral maxillary sinus walls. The mastoid air cells are clear. The imaged portions of the orbits and intracranial structures are unremarkable. | 1. Persistent non-union of the left mandibular angle osteotomy and fracture site with associated hypertrophic bone or callous that impinges upon the inferior alveolar nerve canal and mild cross-bite deformity. 2. Persistent lucency across the right sagittal split osteotomy gap. 3. The right parasymphyseal mandibular fracture has nearly healed and the hardware appears to be intact. 4. Unchanged severe flattening of the bilateral mandibular condyles, left greater than right, which may represent post-traumatic avascular necrosis. 5. Persistent opacification of the left maxillary sinus with findings suggestive of acute upon chronic sinusitis, which may be related to the LeFort I osteotomy.6. Persistent lucency across the right hard palate and vomer fractures. |
Generate impression based on findings. | Female, 77 years old, new diagnosis of lung adenocarcinoma, staging exam. No evidence of mass effect, parenchymal edema or pathologic enhancement is seen to suggest intracranial metastatic disease. No intracranial hemorrhage abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells as visualized are clear. | No evidence of intracranial metastatic disease. |
Generate impression based on findings. | Male, 47 years old, with back pain, status post lumbar instrumentation. Extensive surgical findings are demonstrated including evidence of L3 vertebrectomy with placement of a vertebral body spacer/prosthesis. Resection included the entirety of the L3 posterior elements. Partial laminectomy was performed at L2, and perhaps also at L4.Instrumented posterior spinal fusion has been performed with bilateral pedicle screws placed at L1, L2, L4 and L5. Orthopedic screws are well seated within the pedicles. These are affixed to bilateral stabilization rodsBone graft fragments have been placed along the remaining posterior elements in the fused region. Edema and a small amount of fluid within the posterior soft tissues, as well as left-sided retroperitoneal air and left psoas edema, are within expected limits.The spinal canal is not adequately visualized through the operative region secondary to artifact from the orthopedic instrumentation. Elsewhere, a mild to moderate spinal canal stenosis is suspected at L4-5 secondary to disk bulging and posterior element hypertrophy. Mild disk bulging and posterior element hypertrophy are seen at L5-S1. The L4-5 neural foramina are moderately narrowed and the L5-S1 neural foramen are severely narrowed, particularly on the right.An IVC filter is in place. A large right renal cystic lesion is partially visualized. | Expected findings status post L3 vertebrectomy with partial laminectomy at L2 and perhaps at L4. Instrumented posterior spinal fusion has also been performed from L1 through L5. No instrument complications are suspected.The spinal canal is not well visualized through the operative region due to streak artifact. Elsewhere, a mild to moderate stenosis is suspected at L4-5 due to disk bulging and posterior element hypertrophy. Severe foraminal narrowing is noted at L5-S1, particularly on the right. |
Generate impression based on findings. | Female, 60 years old, acute somnolence and confusion, known PCA stroke. Assess for acute bleed or edema. Redemonstrated is an area of hypoattenuation compatible with recent infarct involving the right PCA territory including the occipital lobe and medial temporal lobe. A small lesion is also seen within the right thalamus. There has been no significant interval change in geographic extent, though the hypoattenuation has become more profound compatible with expected evolution. No frank hemorrhagic conversion is detected. At most, there may be some petechial blood product within the infarcted tissue.Elsewhere, extensive patchy periventricular hypoattenuation along with more focal lucencies in the basal ganglia, are unchanged. No new lesions are detected. The right lateral ventricle remains partly effaced due to mass effect. However, the size and morphology of the ventricular system is not changed. The basal cisterns remain identifiable and no brain herniation is seen. | Evolving right PCA territory stroke with no evidence of geographic expansion or frank hemorrhagic conversion. Mass effect is unchanged and there are no new lesions which would account for the patient's symptoms. |
Generate impression based on findings. | Male, 10 years old, status post VP shunt revision. The right parietal approach ventricular shunt catheter has been revised. The intracranial portion courses medially to terminate within the right lateral ventricle. The extracranial portions appear intact. Scalp swelling and subcutaneous air are compatible with recent instrumentation.Since the prior examination, there has been a significant increase in the caliber of the lateral ventricles. The third and fourth ventricles are also increased but to a lesser degree.No intracranial hemorrhage is detected. No evidence of loss of gray-white distinction is seen. A mildly dysmorphic gyral pattern is again seen, particularly along the right lateral ventricle.With the exception of the right parietal burr hole, and an area of right occipital bone thinning which may be congenital or surgical, the calvarium is intact. The paranasal sinuses and mastoid air cells as visualized are clear. | Interval revision of the right parietal approach ventricular shunt catheter. The ventricular system remains significantly dilated relative to the prior examination. |
Generate impression based on findings. | Female, 25 years old, status post motor vehicle collision with significant damage and loss of consciousness. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. There is no evidence of mass effect or midline shift. The ventricles and basal cisterns are patent and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The bones of the calvarium and skull base are intact. | Unremarkable evaluation of the head. |
Generate impression based on findings. | Male 80 years old; Reason: Evaluate for fracture. History: Hip pain after ground-level fall. Two views of the right hip reveal no fracture or malalignment. Vascular calcifications are noted. There is partially imaged degenerative disease of the lower lumbar spine. | No acute fracture or malalignment. |
Generate impression based on findings. | Male 20 years old; Reason: please assess for bowel caliber, possible obstruction, cause for abd pain History: severe abd pain ABDOMEN:LUNG BASES: Bilateral subsegmental lower lobe atelectasis and small bilateral effusions.Heart size is enlarged. Hyperdense material within the left ventricle represents thrombus.LVAD device and RVAD device are in place.LIVER, BILIARY TRACT: Mildly hyperdense hepatic parenchyma. Cholelithiasis without biliary ductal dilatation.SPLEEN: Spleen is normal in size. Hyperdense material inferior to the spleen near the left paracolic gutter measuring 7.4 x 8.4 centimeters compatible with new acute hemorrhage.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hyperdense material within the renal collecting system likely represents old contrast material. No hydronephrosisRETROPERITONEUM, LYMPH NODES: Status post placement of a intra-arterial balloon pump. The superior marker of the pump is at the level of T9 and the lower marker is at the level of L4. The pump traverses the diaphragmatic hiatus and crosses the superior mesenteric and celiac arteries.BOWEL, MESENTERY: The small bowel remains dilated. It contains debris within it. Its maximal diameter is 4.8 centimeters. Small amount of contrast has reached the colon.BONES, SOFT TISSUES: Diffuse body wall anasarca. Distention of the abdominal wall.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral femoral vascular catheters. | 1.Persistent small bowel dilation.2.Intra-aortic balloon pump as detailed above with position in the abdominal aorta.3.New large perisplenic hemorrhage.4.Distention of the abdominal wall suggestive of abdominal compartment syndrome.5.Findings discussed with Dr. Schneider at the time of dictation. |
Generate impression based on findings. | Female 40 years old; Reason: Left toe pain, evaluate for osteomyelitis. There is soft tissue irregularity along the distal toe/toenail. There is no definite cortical erosion. No fracture or malalignment is seen. Soft tissue swelling is noted about the great toe. | No specific radiographic evidence of osteomyelitis; MRI is more sensitive means of evaluation and should be considered if clinically warranted. |
Generate impression based on findings. | Female, 89 years old, with bilateral posterior headache, assess for intracranial bleed or cervical artery dissection. Non-angiographic findings:Periventricular hypoattenuation is seen, a nonspecific finding which may reflect age indeterminate small vessel ischemic disease. A small region of encephalomalacia in the right frontal lobe may represent a chronic cortical stroke.No evidence of parenchymal edema or loss of gray-white distinction is seen. No mass effect is detected. There is no evidence of intracranial hemorrhage or any abnormal extra-axial collection. Ventricular system is within normal limits for size and morphology.Ground glass opacities in the lung apices along with septal prominence may represent mild edema or an artifact of underinflation. A nonspecific hypoattenuating nodule is present in the left thyroid lobe. Multilevel cervical spondylosis is seen. No destructive osseous lesions are detected.Angiographic findings:Conventional aortic branching is seen. The origins of the carotid arteries are patent. Mild atherosclerotic calcification is seen at the carotid bifurcations without significant stenosis by NASCET criteria.The origins of the vertebral arteries are not well seen. Furthermore, opacification through the vertebral arteries in the neck is thready and discontiguous. The right vertebral artery is overall of smaller caliber than the left. However, the caliber of the vertebral arteries is proportionate to the size of the foramina transversaria which are also small bilaterally.Moderate calcified atherosclerotic disease affects the cavernous ICAs. This results in up to 50% stenosis on the left. The right A1 segment is hypoplastic or absent. The ACOM artery is unremarkable. As in the neck, the intradural vertebral arteries are small, right side more than left. The left vertebral artery is significantly narrowed by calcified atherosclerotic disease just beyond the dura. The basilar artery is small in caliber throughout, but proportionate to the generally small size of the vertebral system. Prominent PCOM arteries are evident bilaterally.Scattered mild to moderate areas of focal vascular stenosis are demonstrated, for example at the junction of one of the M2/M3 segments of the right MCA. The basilar artery also shows generalized irregularity and an area of significant segmental stenosis in its midportion. No aneurysms are detected. | 1. No evidence of acute intracranial hemorrhage or acute infarction. Age indeterminate small vessel ischemic disease and at least one small cortical stroke is suspected.2. The vertebral arteries are generally small in caliber throughout, right side more than left. This is, however, due at least in part to congenital factors as the foramina transversaria are also small and proportionate to the size of the vessels. The basilar artery is proportionately small as well. By way of compensation, prominent PCOM arteries are evident bilaterally. Thready opacification of the vertebral arteries is therefore felt more likely to represent atherosclerotic disease superimposed upon congenitally small vessels, rather than dissection.3. Mild atherosclerotic narrowing is seen at the carotid bifurcations in the neck. Moderate atherosclerotic narrowing affects the cavernous ICAs. Scattered areas of moderate to severe focal and segmental stenosis are seen in the intracranial vessels, particularly the basilar artery. No aneurysms are detected. |
Generate impression based on findings. | Emphysematous bullae due to alpha-1 antitrypsin deficit deficiency, now intubated. Assess for pneumothorax. LUNGS AND PLEURA: Interval intubation with the endotracheal tube tip approximately 3 cm above the carina. There is no pneumothorax or pleural effusion. Redemonstration of extensive emphysema and bulla formation with associated atelectasis, most prominent at the lung bases, with slightly improved atelectasis of the right lower lobe. There is also evidence of tracheomalacia and bronchomalacia. There are no suspicious pulmonary nodules.MEDIASTINUM AND HILA: The heart size is normal. There is no pericardial effusion. No mediastinal or hilar lymphadenopathy. There are mild coronary calcifications.There are multiple subcentimeter hypoattenuating thyroid nodules.CHEST WALL: No axillar lymphadenopathy. There is mild degenerative changes of the spine with a compression deformity of the L2 vertebral body of indeterminate age.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Redemonstration of multiple hypoattenuating lesions throughout the liver, which has a cirrhotic morphology. The enteric tube tip is in the stomach. | 1. Interval intubation without pneumothorax.2. Extensive emphysema with bulla formation and associated atelectasis.3. Hypoattenuating thyroid nodules; if clinically warranted ultrasound may be obtained for further evaluation.4. Age-indeterminate compression deformity of the L2 vertebral body. |
Generate impression based on findings. | Male 17 years old Reason: rule out obstruction History: feverVIEW: Abdomen and chest AP (two views) 1/3/15 at 1017 hrs. There is a broken VP shunt catheter at the level of the neck. The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette size is normal. Right lower lobe opacity, likely atelectasis or pneumonia with no effusions or pneumothorax.Intraperitoneal BB shunt catheter is coiled in the right upper abdominal quadrant. Mild to moderate fecal accumulation with no evidence of obstruction or free air. | Right lower lobe opacity, likely atelectasis or pneumonia.Broken VP shunt catheter. Findings were communicated to and acknowledged by RN Bahl on 1/4/15 at 830 hours. |
Generate impression based on findings. | History of lung and throat cancer, radiation pneumonitis/fibrosis admitted with melena. Now with fever, cough, increased shortness of breath. Question of infection. LUNGS AND PLEURA: There is interval increase in right middle lobe reticulonodular/groundglass opacities which may represent infection. There are new scattered right apical peripherally located nodular opacities which are nonspecific.There are unchanged postoperative findings related to a left upper lobectomy and post radiation findings of right paramediastinal fibrosis with bronchiectasis and architectural distortion.The left lower lobe pulmonary nodule measures 2.6 x 2.1 cm (image 76, series 5), previously 2.5 x 1.6 cm, consistent with biopsy proven primary lung cancer.A small to moderate right pleural effusion is unchanged.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. There is a prominent left paratracheal lymph node measuring 11 mm in the short axis (image 47, series 4), previously 8 mm. There is no definite hilar lymphadenopathy. There are moderate coronary artery calcifications.CHEST WALL: There is no axillary lymphadenopathy. There are unchanged sclerotic foci within the posterior right eighth rib and the T12 vertebral body.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Interval increase in right middle lobe reticulonodular/groundglass opacities which may represent infection and/or aspiration.2. Increased size of the left lower lobe pulmonary nodule.3. Increased size of mild enlarged left paratracheal lymph node.4. Unchanged small to moderate right pleural effusion. |
Generate impression based on findings. | Male 56 years old; Reason: 56M s/p prostatectomy with evidence of urine leak. Assess for source of leak, NEED DELAYED IMAGES ONLY. History: urine leak s/p prostatectomy ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive subcutaneous body wall emphysema.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy. BLADDER: Urinary bladder is decompressed by Foley catheter. No extravasation of contrast to suggest a leak. The ureters distally are normal in caliber. No extravasation of contrast.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right body wall drain terminates within the pelvis. No surrounding fluid collections. Extensive body wall emphysema.OTHER: Trace presacral fluid. | 1.No evidence of a urinary leak as clinically questioned.2.Extensive body wall emphysema, likely postprocedural. |
Generate impression based on findings. | Female 7 months old Reason: intubated, pre-extubation status post liver transplant.VIEW: Chest AP (one view) 1/4/15 at 547 hours. ET tube tip is below the thoracic inlet. Feeding tube , central line , IVC vascular stent , and right upper abdominal quadrant drain again noted. Cardiac silhouette size is top normal or might be enlarged. Small lung volumes with increase in lung vascular markings. Interval improvement in left lower lobe atelectasis. | Interval improvement in left lower lobe atelectasis. |
Generate impression based on findings. | The ventricles and sulci are mildly prominent, greater than expected for age. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is minimal residual encephalomalacia related to prior bilateral frontal lobe infarcts and prior associated hemorrhage, which is best seen on sagittal images. There are multiple scattered old cerebellar infarcts and a right parietal infarct. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. There is no extraaxial fluid collection. There is new mild mucosal thickening of the left anterior ethmoid air cells and left maxillary sinus. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial hemorrhage.2. Multiple, scattered old bilateral frontal, right parietal and cerebellar infarcts.3. Mild chronic small vessel ischemic changes. |
Generate impression based on findings. | Male 57 years old; Reason: eval for acute abnormality History: RUQ/epigastric pain, fever, vomiting, diarrhea ABDOMEN:LUNG BASES: Multiple lower lobe pulmonary micronodules largest in the right lower lung measuring 7 millimeters (image 1/series 10241)LIVER, BILIARY TRACT: Liver parenchyma is hypodense suggestive of fatty infiltration. No biliary ductal dilatation. Hepatic and 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: Small bowel is normal in caliber and course. Colon is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. The appendix is not identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Etiology for the patient's epigastric pain is not evident.2.Seven millimeter right lower lobe pulmonary nodule for which follow up is suggested. |
Generate impression based on findings. | Left wrist injury.VIEWS: Left wrist AP, lateral and oblique and left forearm AP and lateral 1/3/15 (5 views) Soft tissue swelling with no evidence of fracture, malalignment or joint effusion. | Soft tissue swelling with no fracture. |
Generate impression based on findings. | There are postoperative findings related to a suboccipital craniectomy with a partially visualized intrathecal catheter entering at the interspace between C1 and occiput. The radiopaque portion of the shunt catheter is intact. The ventricles are unchanged in size and configuration. The sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial abnormality or change in ventricular size. |
Generate impression based on findings. | Male 56 years old; Reason: p/w pancreatic necrosis s/p IR drainage bowel ischemia with rising lactate History: Bowel ischemia with rising lactate ABDOMEN:LUNG BASES: Bilateral small pleural effusions. Near complete atelectasis of the lower lobes.Portions of the pleural effusion is loculated anteriorly.LIVER, BILIARY TRACT: Liver is diffusely hypodense compatible with fatty infiltration. The hepatic and portal veins are patent.No intrahepatic blue ductal dilatation. There is gas and fluid within the gallbladder which is not distended.SPLEEN: Foci of poor enhancement within the spleen highly suggestive of small areas of infarction.PANCREAS: The pancreas is necrotic without significant residual pancreatic parenchyma. Collection that replaces the pancreatic parenchyma measures 21 x 6.4 cm (image 70/series 11) and has decreased in size. A percutaneous drain terminates within the collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Retroperitoneal collection posterior to the colon on the right has decreased in size. It is drained by a catheter.The celiac and superior mesenteric arteries are widely patent however, mesenteric branches are slightly irregular suggesting spasm.BOWEL, MESENTERY: The small bowel is collapsed. The wall is mildly thickened in certain areas.Omental nodularity likely due to acute pancreatitis and saponification.BONES, SOFT TISSUES: Diffuse body wall anasarca.OTHER: Multiple pockets of fluid throughout the abdomen and pelvis with foci of gas. The gas may be due to the indwelling catheters or infection.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above; rectal tube is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Hypodense filling defect within the right common femoral vein compatible with deep venous thrombosis. It is unchanged from prior. | 1.Decrease in the size of the pockets of fluid some with foci of gas possibly from catheter placement but infection of the collections are not excluded. Sampling of the fluid is suggested2.Gas within the gallbladder unchanged the etiology for which is not evident on the current exam. It may be from prior ERCP.3.Small foci of infarction within the spleen. Possibly the cause of elevated lactate.4.Suboptimal evaluation of the small bowel due to its underdistention. There is small bowel wall thickening.5.Filling defect in the right common femoral vein compatible with deep venous thrombosis. 6.Complete necrosis of the pancreas with no definite identifiable pancreatic tissue. |
Generate impression based on findings. | There is evidence of prior left frontal craniotomy with chronic left frontal lobe and left basal ganglia encephalomalacia and ex vacuo dilatation of the ventricle, likely representing post-operative and post-treatment changes related to patient's reported remote resection of an oligodendroglioma. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There has been progression of scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, pons and the right middle cerebellar peduncle, consistent with mild to moderate age-indeterminate small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial intracranial hemorrhage, mass effect or midline shift. 2. Post-operative and post-treatment changes of the left frontal lobe, related to patient's remote resection of oligodendroglioma. No definite evidence of tumor.3. Progression of age-indeterminate mild to moderate chronic small vessel ischemic changes, with new hypoattenuating foci in the brainstem compared to 5/26/2010. |
Generate impression based on findings. | Female 23 years old Reason: please assess for pyelo, nephrocalcinosis. liver. free fluid History: c/o flank pain, immunocompromised now with fevers, transaminitisEXAMINATION: Sonogram abdomen 1/3/15 LIVER:No significant abnormality noted.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: No significant abnormality noted. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal examination. |
Generate impression based on findings. | Male, 63 years old, acute left central vision blurriness. Non-angiographic findings:An region of hypoattenuation is seen within the left inferior frontal lobe. Within this region, there may be an area of nodular more hyper attenuating tissue. A faint blush of ring enhancement is seen in this area on the angiographic images. This finding is new relative to the prior examination.Elsewhere brain morphology is within normal limits. There may be minimal periventricular hypoattenuation compatible with age indeterminate microvascular ischemic disease. Otherwise, no significant mass-effect is detected. No evidence of intracranial hemorrhage is seen. A small focal lucency within the right cerebral peduncle is unchanged and of uncertain significance and could reflect a small lacunar stroke or even a prominent perivascular space.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear.Angiographic findings:Calcified atherosclerotic plaque is evident at the level of the second genu of the left ICA narrowing the vessel lumen by 40 to 50%. The left ophthalmic artery origin is small but it is visualized. The possibility that some atherosclerotic disease affects this vessel cannot be excluded. However, more distally, the ophthalmic artery enhances normally.The right ICA and ophthalmic artery are unremarkable. The right A1 segment is hypoplastic or absent. The ACOM artery is unremarkable. A small left PCOM artery may be present. The right PCOM artery is not clearly seen.No significant vascular stenosis or occlusion is evident elsewhere intracranially. No evidence of aneurysm is seen. | 1. Hypoattenuation is seen within the inferior left frontal lobe. There appears also to be a nodular region of tissue within this hypoattenuation which seems to show faint rim enhancement on the angiographic images. Findings are concerning for a metastatic lesion and should be further evaluated with contrast enhanced MRI. Discussed with ED attending (Dr. Tataris) at 9:30 AM on 1/4/15.2. Angiographic evaluation is unremarkable with the exception of moderate atherosclerotic plaque at the carotid ICA on the left. This plaque is close to the origin of the left ophthalmic artery and could potentially be affecting flow through the artery, though more distally, normal ophthalmic artery opacification is seen. |
Generate impression based on findings. | Tachycardia. Question pulmonary embolism. PULMONARY ARTERIES: Technically adequate study without evidence of an acute pulmonary embolism. The main pulmonary artery is not enlarged. The pulmonary arteries and the left paramediastinal region are attenuated due to consolidation and fibrosis.LUNGS AND PLEURA: There is interval increase in interstitial opacities including interlobular septal thickening and thickening of the fissures which is suspicious for edema. There is unchanged left paramediastinal consolidation and fibrosis compatible with postradiation changes. Left lung basilar scarring and volume loss is unchanged. There is mild to moderate centrilobular and paraseptal emphysema. There is no pneumothorax or pleural effusion.MEDIASTINUM AND HILA: The heart size is normal. There is no evidence of right heart strain. There is no pericardial effusion. There is no mediastinal or hilar lymphadenopathy.There is common origin of innominate and left common carotid artery off the aortic arch.CHEST WALL: The right chest port catheter tip is at the superior atriocaval junction. Minimally displaced left-sided rib fractures are again noted. There are mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter right renal hypodensity is too small to characterize, but likely represents a cyst. High density pills noted within the stomach. | 1. No evidence of pulmonary embolus.2. Findings suspicious for early edema without pleural effusion. PULMONARY EMBOLISM: PE: No acute pulmonary embolus.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Wrist painVIEWS: Chest AP lateral and oblique 1/3/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Status post fracture.VIEWS: Right shoulder AP 1/3/15 (one views) Proximal gas or fracture of the metaphysis of the right humerus is seen near-anatomic alignment. | Transverse fracture of the proximal humerus unchanged. |
Generate impression based on findings. | Female 5 years old Reason: prox hum fx, other fx? VIEWS: Right shoulder AP in internal and external rotation and right humerus AP and lateral. 1/3/15 (4 views) There is a nondisplaced transverse fracture of the proximal metaphyses of the right humerus. No evidence of shoulder dislocation. | Right humerus fracture as described. |
Generate impression based on findings. | Motion artifact somewhat degrades image quality. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is mild mucosal thickening of the right maxillary sinus and bilateral ethmoid sinuses. There is partial opacification of the right mastoid air cells. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. |
Generate impression based on findings. | Female 15 years old Reason: R/O Fracture History: Pain and swellingVIEWS: Right foot AP, lateral and oblique 1/3/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 5 days old Reason: evaluate contrast History: s/p UGI studyVIEW: Chest and abdomen AP (two views) 1/4/15 418 hours NG tube terminates in the stomach. UVC terminates at the IVC. Residual contrast material is visualized in the lower esophagus stomach and proximal small bowel loops on a background of bowel distention with no evidence of obstruction. No pneumatosis intestinalis or portal venous gas. No ascites.Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Interval progression of contrast material as described. Persistent , no specific bowel distention. |
Generate impression based on findings. | Female 48 years old; Reason: nausea/vomiting, decreased BS, not passing flatus - r/o obstruction / mass History: nausea/vomiting, decreased BS, not passing flatus ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Appendix located in the right lower abdomen is partially filled with contrast and gas and is normal in caliber. Oral contrast has reached the rectumBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small clips noted in both adnexa. Gas within the vagina. The uterus is absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No bowel obstruction is clinically questioned. Oral contrast has reached the rectum. |
Generate impression based on findings. | There is a right posterior parietal approach ventricular shunt catheter which traverses the right inferior atrium and and terminates along the right thalamus, unchanged in position. There is interval decrease in the size of the ventricular system with the frontal diameter measuring 41 mm, previously 48 mm, and the right trans-atrial diameter measuring 16 mm, previously 23 mm. The radiopaque portions of the catheter system are intact. There is nodularity along the lateral margins of the lateral ventricles, particularly on the left, similar to prior MRI. The sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. Right posterior parietal approach ventricular shunt system, unchanged in position. Interval decrease in size of ventricular caliber. 2. Nodularity along the lateral margin of the lateral ventricles, particularly on the left, similar to prior MRI. |
Generate impression based on findings. | Female 32 years old; Reason: assess R adnexal mass, r/o mets, abscess History: LLQ severe abdominal pain, hx abdominal surgery/LP shunt, R adnexal mass concerning for malignancy ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is enlarged measuring 20 centimeters in craniocaudal dimension. No focal hepatic lesions. The hepatic and portal veins are patent.SPLEEN: Spleen is normal in size. Splenule noted at its hilum.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: Small bowel normal in caliber and course. Colon is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Cystic right adnexal lesion measures 11.7 x 5.5 cm (image 101/series 3) previously, 11.6 x 6.2 cm. There is fluid within the endometrial cavity.The lesion is located adjacent to the tip of the catheter.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventricular peritoneal and lumbar drains are in place. Small ventral fat-containing hernia.OTHER: No significant abnormality noted. | 1.No significant change in the right adnexal lesion ; pelvic sonography is suggested for follow up. |
Generate impression based on findings. | Back painVIEWS: Lumbar spine AP and lateral and lateral view of the sacrum. 1/4/15 (3 views) Vertebral body heights and disk spaces are maintained. No evidence or fracture or malalignment. | Normal examination. |
Generate impression based on findings. | Female 11 months old Reason: SOB, PNA? VIEW: Chest AP (one view) 1/4/15 Cardiac silhouette size is normal. Ill-defined right middle lobe airspace opacity either atelectasis or pneumonia. No effusions or pneumothorax. | Right middle lobe opacity, likely atelectasis or pneumonia. |
Generate impression based on findings. | There is a stable right parietal approach ventriculostomy catheter with tip across midline in the region of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage. Overall, severe ventriculomegaly appears mildly improved. The third ventricle and temporal horns appear minimally decreased in caliber. There is interval resolution of the posterior parietal extra-axial collection seen on the prior exam.The visualized portions of the paranasal sinuses and mastoid air cells are clear. The calvarium is again deformed with overlapping of bones at the sutures. | Overall, severe ventriculomegaly has midly improved. Unchanged position of the right parietal approach ventriculostomy catheter. |
Generate impression based on findings. | There is a linear fracture of the right parietal bone extending from the anterior fontanelle to the lambdoid suture with approximately one bone width offset of the fracture edges. There is a thin, hyperdense extra axial collection in the right parietal lobe underlying the fracture measuring approximately 3 mm in maximum thickness. No evidence of intraparenchymal hemorrhage. The ventricles and sulci are within normal limits. There is no mass-effect or midline shift. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1.Right parietal bone fracture with up to one bone width offset of the fracture edges. 2.Thin right parietal extra-axial hematoma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Off coumadin, history of PE/DVT, IVC filter, with right lower extremity edema/pain, and dyspnea on exertion. Question of PE, pneumonia, and pulmonary edema. PULMONARY ARTERIES: Technically adequate study without evidence of an acute pulmonary embolus. The main pulmonary artery is not enlarged.LUNGS AND PLEURA: There are scattered benign appearing scarlike nodules which are unchanged since 9/11/2009. No new suspicious pulmonary nodules are identified. There is no pleural effusion or pneumothorax. There is bibasilar dependent atelectasis.MEDIASTINUM AND HILA: The heart size is unchanged. There is no pericardial effusion. There is no evidence right heart strain. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: There is no axillary lymphadenopathy. Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered subcentimeter hepatic hypodensities are too small to characterize, however likely represent cysts and are unchanged from the prior study. | 1. No evidence of an acute pulmonary embolus.2. No specific findings to account for the patient's symptoms.3. Unchanged pulmonary nodules which require no follow up at this time. PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | There is a linear fracture of the right parietal bone extending from the anterior fontanelle to the lambdoid suture with approximately one bone width offset of the fracture edges, unchanged. There is a thin, isodense extra axial collection in the right parietal lobe underlying the fracture measuring approximately 2-3 mm in maximum thickness, unchanged. There is a small right subgaleal hematoma.No evidence of intraparenchymal hemorrhage. The ventricles and sulci are within normal limits. There is no mass-effect or midline shift. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. Right parietal bone fracture with up to one bone width offset of the fracture edges. 2. Thin right parietal extra-axial collection, without significant interval change in size. 3. Small right subgaleal hematoma. |
Generate impression based on findings. | Female 34 years old; Reason: eval for abd pathology, SBO - 34 y/o F with h/o abd radiation, SBO History: nausea vomiting, abd pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions in the right hepatic lobe are too small to characterize but are unchanged.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: Small bowel is dilated measuring up to 3.5 centimeters with a transition in the right lower abdomen. The distal ileum is collapsed. No focal mass at the transition point. There is new pelvic ascites. No bowel wall pneumatosis or portal venous gas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings compatible with a severe small bowel obstruction with a transition in the right lower abdomen in the region of the ileum. New pelvic ascites likely a result of the bowel obstruction. |
Generate impression based on findings. | Female 18 years old Reason: increased O2 requirement, eval consolidation/effusion VIEW: Chest AP (one view) 1/3/15 at 1143 hrs. Central lines unchanged. Cardiac silhouette size is top normal. Interval worsening in hazy opacities of both lungs. Question on right-sided pleural effusion versus artifact. No pneumothorax. | Interval worsening in bilateral lung aeration as described |
Generate impression based on findings. | Male 13 days old Reason: is the ett in proper position, are the lungs clear History: trach/vent, rdsVIEW: Chest and abdomen AP (two views) 1/3/15 at 1337 hrs Tracheostomy tube tip is below the thoracic inlet. Left upper extremity central line tip is in the left innominate vein. NG tube terminates at the stomach.Cardiac silhouette size is normal. Interval resolution of right upper lobe atelectasis with persistent mild diffuse lung haziness.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval resolution of right upper lobe atelectasis. |
Generate impression based on findings. | Male 47 years old; Reason: eval for source control of Fournier's gangrene, fistula History: fevers, colonized wounds ABDOMEN:LUNG BASES: Small bilateral pleural effusions. Minimal basilar atelectasis bilaterally.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Probable cyst at the upper pole of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Feeding tube terminates past the ligament of Treitz. Rectal tube is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder is decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post soft tissue debridement in the pelvis including the perineum and genitalia. There multiple anterior abdominal wall clips and a percutaneous drain that terminates within the soft tissues. There is a small pocket of fluid in the left pelvic wall measuring 3.2 x 2.1 cm (image 131/series 3). The foci of gas within soft tissues of the pelvis has decreased. There is a pocket of gas in the left buttock and a smaller pocket of gas within the right buttock. No discrete fistula is identified.OTHER: No significant abnormality noted. | 1.Decreasing soft tissue gas. 2.No discrete fistula is identified ; extensive postsurgical changes within the perineum and pelvis.3.Further evaluation with a pelvic MRI-Crohn's pelvic protocol is suggested for evaluation of a fistula. |
Generate impression based on findings. | Male 1 day old Reason: is the ett in proper position, are the lungs clear History: 39 weeks, MASVIEW: Chest and abdomen AP (two views) 1/3/15 at 1756 hrs UAC terminates at T6. UVC is coiled towards itself in the umbilical or left portal vein. ET tube terminates at the right main stem bronchus. NG tube tip is at the stomach.Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax.Normal, age related abdominal gas pattern. No evidence of obstruction or free air. No pneumatosis intestinalis or portal venous gas. No ascites. | Misplaced UVC and ET tube.Normal, age related abdominal gas pattern. |
Generate impression based on findings. | Male, 59 years old, with right parietal signs and also subacute vertigo for one week with right cerebellar hypodensity. Also left hemianopsia. Non-angiographic findings:Hypodensity and encephalomalacia within the inferior right cerebellar hemisphere is again seen similar to that noted on the prior examination.There may be some very subtle developing hypoattenuation and loss of gray-white distinction in the right operculum, insula and perhaps part of the right temporal lobe. Questionable hypodensity is seen within the right centrum semi-ovale as well. These findings were not clearly seen on the prior exam.Brain parenchymal morphology is otherwise unremarkable. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. The ventricles are normal in size.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear.Angiographic findings:Conventional aortic branching is noted. The carotid vessels in the neck are free of significant stenosis by NASCET criteria. The left vertebral artery is free of significant stenosis in the neck. The origin of the right vertebral artery is identified but contrast opacification ceases just prior to the vessel entering the transverse foramen at the C7 level. From this point on, no opacification is seen within the right vertebral artery until just before the vertebro-basilar junction where there appears to be an intraluminal filling defect around which a small amount of contrast passes. The origin of the right PICA is not visualizedThe intradural left vertebral artery opacifies normally. There may be a small left PICA which arises at the level of the dura. The left AICA is prominent. The basilar artery opacifies normally. The SCAs and PCAs are within normal limits. Moderately-sized PCOM arteries are present bilaterallyMild to moderate atherosclerotic disease affects the cavernous ICAs with 30 to 40% stenosis in the right. The left A1 segment is smaller than the right, likely congenital. The ACOM artery is unremarkable.The M1 segments are symmetric and unremarkable. An abrupt cessation of contrast opacification is seen within the largest of the right M2 branches. This vessel remains nonenhancing for a span of approximately 20 mm but then reconstitutes more distally in the Sylvian fissure. A paucity of MCA vessels is noted on the right. No significant MCA stenoses are seen on the left.No aneurysms are detected. | 1. Hypoattenuation within the inferior right cerebellar hemisphere is again seen suggestive of an acute or subacute infarct. 2. Lack of contrast opacification of the right vertebral artery from just beyond its origin to just before the vertebro-basilar junction where there appears to be an intraluminal filling defect. The origin of the right PICA is not seen. This finding correlates well with the observed acute/subacute stroke in the inferior right cerebellum.3. Abrupt cessation of opacification of one of the M2 branches of the right MCA with reconstitution approximately 20 mm distally. Findings are compatible with intraluminal thrombus. A paucity of MCA vessels is seen on the right. In addition, there appears to be some very subtle developing hypodensity and loss of gray-white distinction in the right MCA distribution compatible with developing ischemia. |
Generate impression based on findings. | There is persistent diffuse sulcal effacement without significant interval change from prior examinations. There are persistent mildly low-lying cerebellar tonsils, somewhat limited in evaluation due to beam hardening artifact. The ventricular system is unchanged in size and configuration. There is no midline shift. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are opacified. | 1. No acute intracranial hemorrhage or midline shift. 2. No significant interval change in findings suggestive of pseudotumor cerebri. |
Generate impression based on findings. | Female 21 years old; Reason: bilateral lower abdominal pain after MVC History: bilateral lower abdominal pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The colon is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant pelvic fluid. | 1.No evidence for abdominal trauma. |
Generate impression based on findings. | Male 69 years old; Reason: AAA? divertics? History: abd pain ABDOMEN:LUNG BASES: Mild right lower lobe bronchiectasis. Basilar interstitial ground-glass opacities.LIVER, BILIARY TRACT: Liver is normal in morphology. There is cholelithiasis with a new stone in the gallbladder neck or cystic duct. There is mild pericholecystic inflammatory changes and gallbladder distention suspicious for developing cholecystitis.The liver appears unremarkable for phase of imaging.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical thinning at the upper pole of the left kidney likely represents a prior infarction. No hydronephrosis in either kidney. Probable vascular calcifications in hilum of the right kidney..RETROPERITONEUM, LYMPH NODES: Status post aortic stent graft placement. Abdominal aorta measures 5.5 x 5.1 cm (image 128/series 8) previously, 5.4 x 5.1 cm. There is a persistent type II endo- leak with contrast seen within the excluded aneurysm sac.BOWEL, MESENTERY: Postsurgical changes in the colon from a right hemicolectomy. Inflammation from the gallbladder fossa extends to near the right colonic resection margin. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No CT evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Cholelithiasis with new stone in the gallbladder neck or cystic duct with mild pericholecystic inflammation highly suspicious for developing acute cholecystitis.2.Abdominal aortic aneurysm status post stent graft repair with persistent type II endoleak. |
Generate impression based on findings. | Redemonstrated is hypoattenuation involving the left superior and middle temporal gyri, and left angular gyrus, representing a late subacute infarct, without significant interval change in size or extent. There is encephalomalacia in the left superior parietal lobule, consistent with chronic infarct. There is no intracranial hemorrhage. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. An endotracheal tube is partially imaged. | 1. Late subacute left MCA temporal infarct without expansion or hemorrhage.2. Small focus of encephalomalacia consistent with chronic left MCA parietal infarct.3. Mild small vessel ischemic changes. If there is continued clinical concern and no contraindication to MR, MRI of the brain is recommended. |
Generate impression based on findings. | Male 1 day old Reason: lines \T\ tubes History: lines \T\ tubesVIEW: Chest and abdomen AP (two views) 1/4/15 at 356 hours. UAC terminates at T7. UVC tip is at the left portal vein. Removal of ET and NG tubes. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval repositioning of umbilical lines and removal of ET and NG tubes.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Female 55 years old; Reason: eval hernia History: painful abdominal mass ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is enlarged and hypoattenuating compatible with fatty infiltration. Biliary tree is normal in caliber. The intrahepatic portal vein and hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the pancreatic duct which measures approximately 3 to 4 millimeters. No discrete mass is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease affects the aorta appearedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing ventral abdominal hernia which contains omental fat extends through a small defect in the rectus sheath adjacent to the prior site of hernia repair. The neck of the hernia measures approximately 8 millimeters with the contents of the hernia sac measuring approximately 2.4 centimeters. There is mild infiltration of the fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophicBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No inguinal or femoral hernia.OTHER: No significant abnormality noted. | 1.No bowel obstruction.2.Small fat-containing anterior abdominal wall hernia as detailed above.3.Hepatomegaly with hypoattenuation of the hepatic parenchyma suggestive of fatty infiltration.4.Nonspecific mild prominence of the pancreatic duct. Further evaluation by M.R.C.P. can be obtained |
Generate impression based on findings. | Patient with sepsis. Please review chest x-ray. CHEST:LUNGS AND PLEURA: There is a large right-sided thickwalled collection of fluid and air which is occupying approximately two thirds of the right hemithorax; this is consistent with a right hydropneumothorax. Air within this collection raises the question of a bronchopleural fistula. There are scattered pleural adhesions, however the fluid collection appears to be continuous. There is redemonstration of focal right diaphragmatic herniation of a portion of the right hepatic lobe, which is unchanged, and does not significantly obstruct access to the right hemithorax via a posterolateral approach. There is no connection of the collection to the colon. There is overlying compressive atelectasis of the right lung. There is left lower lobe atelectasis. There are nodular groundglass opacities within the inferior left upper lobe which may be secondary to aspiration and/or infection. There is no pneumothorax. MEDIASTINUM AND HILA: A tracheostomy tube is in place. The heart is normal in size without pericardial effusion. There are multiple prominent to enlarged right paratracheal, pretracheal, and subcarinal lymph nodes with the largest subcarinal lymph node measuring 14 mm in the short axis (image 39, series 3). There is no definite hilar lymphadenopathy.CHEST WALL: A bullet fragment is noted in the right lateral chest wall. There are multiple hypoattenuating right thyroid nodules with the largest measuring 1 cm. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A gastrostomy tube is within the stomach. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Large right sided air and fluid collection is compatible with a right hydropneumothorax; air within this collection raises the question of a bronchopleural fistula.2. Left lower lobe atelectasis. Patchy left upper lobe groundglass opacities may represent aspiration and/or infection.3. Mediastinal lymphadenopathy. 4. Hypoattenuating thyroid nodules; if clinically warranted, these may be further evaluated with ultrasound. |
Generate impression based on findings. | Female 69 years old; Reason: r/o hydronephrosis, kidney mass, kidney parenchymal abnormalities History: AKI ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating foci in the left kidney may represent cysts but are not fully characterized without contrast.No nephrolithiasis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Colon contains fluid. Appendix is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.No nephrolithiasis or hydronephrosis. |