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Generate impression based on medical findings. | Age: 56 yearsGender: MaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant The cardiomediastinal silhouette is unremarkable.Increased lung volumes compatible COPD.The lungs are clear.There are no pleural effusions. | No acute cardiopulmonary abnormalities are identified. No specific evidence of infection or edema. |
Generate impression based on medical findings. | Age: 65 yearsGender: MaleReason for Study: Reason: ICU survey History: s/p LVAD; HCAP Support devices unchanged.Stable cardiac enlargement.Retrocardiac consolidation/atelectasis similar to prior exam.No new pulmonary opacities identified. | Support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly and left retrocardiac consolidation/atelectasis. |
Generate impression based on medical findings. | Female, 63 years old.Reason: eval pulm edema, pna History: eval for infection, rising white count, hypotension Cardiomegaly.No sign of infection.Stable minimal edema.Right PICC, tip in right innominate vein.Left subclavian ICD, leads unchanged in position. | No sign of infection. Minimal edema. |
Generate impression based on medical findings. | Myelopathic symptoms. The spinal canal appears to be congenitally narrow throughout. There is superimposed multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex and uncovertebral joint hypertrophy bilaterally, which results in considerable compression of the spinal cord and severe bilateral neural foraminal narrowing. There is perhaps a punctate focus of T2 hypertensity in the spinal cord at this level. At C4-5, there is a posterior disc-osteophyte complex and uncovertebral and facet joint hypertrophy bilaterally, which results in slight compression of the spinal cord and severe bilateral neural foraminal narrowing. At C5-6, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally, results in severe bilateral neural foraminal narrowing at this level. At C6-7, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally results in severe bilateral neural foraminal narrowing at this level. A C7-T1, there is uncovertebral and facet joint hypertrophy bilaterally that results in mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At T1-T2, there is a posterior disc-osteophyte complex that results in severe right and mild left neural foraminal stenosis. At C2-3, there is no significant spinal canal or neural foraminal stenosis. There is irregularity of the superior and inferior endplates of C5 and C6. The other vertebral body heights are intact. Aside from degenerative signal alterations are multiple levels, the vertebral bone marrow appears unremarkable. The paravertebral soft tissues are unremarkable. | Multilevel degenerative spondylosis, with spinal cord compression at C3-4 and C4-5. |
Generate impression based on medical findings. | Male 79 years old Reason: Hx of metastatic renal cancer with bilateral pleural effusions : check for worsening right pleural effusion History: shortness of breath There are stable basilar interstitial and airspace opacities and moderate layering pleural effusions, not significantly changed. There is no pneumothorax.There is unchanged mild cardiomegaly. A stent is noted in the right upper quadrant. | Stable basilar interstitial and airspace opacities with associated pleural effusions. |
Generate impression based on medical findings. | Male, 65 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases. | No significant abnormality. |
Generate impression based on medical findings. | Age: 57 yearsGender: FemaleReason for Study: Reason: evaluate for pulmonary edema given history of heart failure History: tachypnea Left-sided ICD and right Port-A-Cath unchanged.Stable cardiac enlargement.The lungs are clear.No pleural effusions. | Cardiomegaly without evidence of infection or edema. |
Generate impression based on medical findings. | Reason: R lung rhonci, cough. h/o Ulcerative coltiis History: cough, rhonchi R lung Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease. | No significant abnormalities. |
Generate impression based on medical findings. | Age: 56 yearsGender: MaleReason for Study: Reason: tachycardia History: chest pain, tachycardia Inferior portion of the chest is not included on the imaging.Stable cardiac mediastinal silhouette.Diffuse interstitial opacities similar in appearance to the prior exam.No new pulmonary opacities identified. | Diffuse interstitial opacities with bronchial wall thickening similar in appearance to the prior exam. CT of the chest may be of value. |
Generate impression based on medical findings. | Female, 75 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Large lung volumes consistent with COPD.No sign of metastases or other significant abnormality.Left subclavian ICD, leads unchanged in position. | No evidence of metastases, or other significant abnormality apart from COPD. |
Generate impression based on medical findings. | Female, 53 years old.Reason: central line placement History: central line placement Moderate to large layering right pleural fluid collection similar in volume. The dependent right lung is atelectatic and consolidated. Additionally, there are hazy opacities in the left base. Placement of central venous catheter with tip in projection of superior vena cava with no evidence of pneumothorax. | 1. No pneumothorax following line position2. Lines otherwise stable as well as the moderate right effusion. |
Generate impression based on medical findings. | Meningioma and left sided headache. There is no significant interval change in the extra-axial left paraclinoid tumor, measures up to approximately 13 mm. There is slight mass effect upon the overlying brain parenchyma, but no evidence of edema. There are scattered nonspecific T2 hyperintensities within the subcortical and periventricular cerebral white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged. | No significant change in the left paraclinoid meningioma. |
Generate impression based on medical findings. | Male, 55 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab New presternal ICD.Left subclavian ICD, leads unchanged in position.Unremarkable appearing lungs. | New presternal ICD, without placement complication. |
Generate impression based on medical findings. | History of rhabdomyosarcoma with new left breast mass. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Heterogeneous mass in the left inner upper quadrant of the left breast measuring 2.8 x 2.2 cm with soft tissue spiculation and restricted diffusion.UPPER ABDOMEN: Probable perfusional anomaly in segment 4A liver. | 2.8 cm left breast inner upper quadrant heterogeneously enhancing solid mass, suspicious for neoplasm, including metastatic disease. |
Generate impression based on medical findings. | Reason: post op, eval lung fields History: s/p CABG Left chest tube in place with no significant pneumothorax. Right jugular catheter tip in the area of the SVC.Cardiomegaly with pulmonary edema, effusions and atelectasis, not significantly changed. | CHF with no acute change. |
Generate impression based on medical findings. | Male, 73 years old.Reason: ? PNA History: Altered mental status Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild interstitial pulmonary edema. No large pleural effusion or pneumothorax. Normal heart size. Stigmata of previous granulomatous disease. | Low lung volumes makes detailed cardiopulmonary assessment difficult. Mild interstitial pulmonary edema. |
Generate impression based on medical findings. | 5 x 6 cm nodule of the left posterior neck, waxing/waning in size, assess depth or if adherent to adjacent structures A subcutaneous T2 hyperintense cystic lesion is seen in the left posterior neck under a vitamin E capsule marker measuring 4.1 x 2.5 cm (image 33, series 901). This measures up to 3 cm in craniocaudal dimension (image 29, series 601). This has minimal mass effect on the underlying left trapezius muscle, however the fat plane between the cyst and muscle is preserved and there is no evidence of muscular invasion. Very thin peripheral enhancement is seen on the postcontrast images, however no internal enhancement is seen. Given its proximity to the skin surface, this may represent a sebaceous cyst. No other masses are identified.No cervical lymphadenopathy is seen. The airway appears patent. The visualized intracranial structures which include the posterior fossa are intact. The paranasal sinuses and mastoid air cells are clear.The parotid, submandibular, and thyroid glands appear intact. The carotid and vertebral vascular flow voids are intact.Degenerative changes are present on the seen in the lower cervical spine with scattered areas of neural foraminal narrowing, however no significant central canal stenosis. | Simple cyst involving the left posterior neck subcutaneous soft tissues. While this is nonspecific, given its proximity to the skin surface, this may represent a sebaceous cyst. No invasion of the underlying musculature. |
Generate impression based on medical findings. | Recurrent/metastatic nasopharyngeal cancer, status post treatment. There are post-treatment findings in the nasopharyngeal region. There is no gross residual right cavernous sinus region tumor. There is persistent enhancement within the right foramen rotundum and Vidian canal, as well as in the right sphenopalatine foramen region. There is no evidence of acute infarct. The brain parenchyma appears unremarkable, aside from minimal, nonspecific, scattered, punctate T2 hyperintense foci in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. No gross residual right cavernous sinus region tumor. 2. Persistent enhancement within the right foramen rotundum and Vidian canal, as well as in the right sphenopalatine foramen region may represent residual treated tumor with perineural extension. |
Generate impression based on medical findings. | 38 year-old female with goiter, fatigue. Family history of thyroid disease RIGHT LOBE MEASUREMENTS: 2.1 cm x 1.5 cm x 6.3-cmLEFT LOBE MEASUREMENTS: 2.1 cm x 1.7 cm x 7.3-cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: Mildly heterogeneous echotexture. Subcentimeter heterogeneous nodule in the upper pole. LEFT LOBE: Mildly heterogeneous echotexture. Dominant heterogeneous nodule at the lower pole measures 2.2 cm x 1.5 cm x 1.4 cm. Additional subcentimeter heterogeneous nodules are seen.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious lymph nodes.OTHER: No significant abnormality noted. | Mildly heterogeneous thyroid gland with bilateral thyroid nodules as above, dominant 2.2 cm mixed solid/cystic nodule in the left lobe would be amenable to FNA if clinically warranted. |
Generate impression based on medical findings. | Male 25 years old Reason: RLE pain, hx of NF1. Right thigh/buttock pain and twitching. Evaluate for plexiform neurofibroma or sarcoma. Right femur: Bone marrow signal is within normal limits. Visualized muscles and tendons are unremarkable. Visualized soft tissues are unremarkable. No T2 hyperintense signal in the muscles in the right thigh. Small joint fluid is noted in the right knee.Pelvis: T2 hyperintense edema signal is seen in the left gluteal musculature. There is scarring in the overlying left subcutaneous soft tissue with a loss of subcutaneous fat. There is a focal area of superficial soft tissue scarring with low signal. No plexiform neurofibromas are identified. No lesions that are suspicious for malignant peripheral nerve sheath tumors are identified. | 1.Left gluteal musculature edema with overlying subcutaneous superficial scarring.2.No plexiform neurofibromas identified, and no lesions that are suspicious for malignant peripheral nerve sheath tumors within limitations of a noncontrast-enhanced examination. |
Generate impression based on medical findings. | Reason: ETT position History: hypovolemic shock, UGIB, intubated for airway protection Interval extubation.Venous catheters unchanged.Left perihilar airspace opacity, questionably increased, likely secondary to aspiration. | Interval extubation with left perihilar opacity suggestive of aspiration. |
Generate impression based on medical findings. | 24 years old Male. Reason: Swan Ganz in place History: Swan Ganz in place. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Stable patchy opacity in the left upper lobe. The Swan-Ganz catheter and AICD electrode is stable in position. | The above findings are consistent with mild CHF. |
Generate impression based on medical findings. | Pituitary lesion; preoperative planning for resection. There is a pituitary lesion with suprasellar extension and mass effect upon the optic chiasm. There is also a subcentimeter extra-axial lesion along the left aspect of the superior sagittal sinus. Fiducial markers are present on the skin. | 1. Preoperative planning MRI demonstrates a pituitary lesion with suprasellar extension, which likely represents a pituitary macroadenoma. Please refer to the prior MRI report for additional details.2. A subcentimeter extra-axial lesion along the left aspect of the superior sagittal sinus may represent a meningioma. Please refer to the prior MRI report for additional details. |
Generate impression based on medical findings. | Female, 79 years old.Reason: eval infection History: AMS Loss of the superior aspect the left heart border without definite correlate on lateral view. Otherwise clear lungs. No pleural effusion pneumothorax. Normal heart size. Aortic atherosclerosis. | Loss of the superior aspect the left heart border without definite correlate on lateral view which could reflect early aspiration or pneumonia. Consider close repeat imaging as clinically indicated. |
Generate impression based on medical findings. | Male, 58 years old.Reason: eval line placement History: TLC Right IJ line terminates at the cavoatrial junction. No pneumothorax. Moderate cardiomegaly again noted. No new focal lung consolidation. No large pleural effusion. | Right IJ line terminating at the cavoatrial junction without evidence of pneumothorax. Cardiomegaly, as before. |
Generate impression based on medical findings. | 73-year-old male with cirrhosis and liver mass status post RFA/TACE ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The examination of the previously seen liver mass is somewhat limited by suboptimal timing of arterial phase scan. This limits the evaluation of the mass because visualization of arterial phase enhancement of mass is difficult.Segment VIII hepatic lesion measures 4.9 x 5.5 cm (Series 14, Image 24), previously measuring 5.3 x 5.6 cm on MRI. The hypodense and radio opaque portions of the mass are unchanged. The liver has a cirrhotic morphology, appearing similar to the prior examination. The hepatic vasculature is patent. No ascites is seen.No intra- or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities are unchanged.RETROPERITONEUM, LYMPH NODES: Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic spine degenerative changes.OTHER: No significant abnormality noted | 1. Liver mass is unchanged with characteristics and measurements described.2. No new sites of disease. |
Generate impression based on medical findings. | Female, 59 years old.Reason: eval pna History: low-grade temp with cough known history of sarcoidosis. Nodular interstitial opacities are unchanged, with some right paratracheal lymphadenopathy, consistent with the known history of sarcoidosis.Chronic elevation right hemidiaphragm.No reliable evidence of pneumonia. | Findings of sarcoidosis, but no reliable evidence of pneumonia. |
Generate impression based on medical findings. | Age: 96 yearsGender: FemaleReason for Study: Reason: please followup prior pneumonia History: improving, persisted ms changes, aspiration risk Cardiac size normal. Ectasia of the aorta.Increased lung vines compatible COPD.Blunting of the left costophrenic angle compatible with a small effusion.The lungs are clear.. | Significant interval improved improvement in the pleural effusions and pulmonary opacities noted on the prior exam. Small left pleural effusion. |
Generate impression based on medical findings. | 68-year-old male with shortness of breath, hypoxia. Evaluate for pulmonary edema. Right IJ venous catheter has been advanced with tip in the right atrium.Patchy left upper lobe opacity similar to prior with new perihilar interstitial opacities, septal lines and probable pleural effusions. No pneumothorax. Mild cardiomegaly. | Left upper lobe pneumonia with likely superimposed pulmonary edema. |
Generate impression based on medical findings. | Male, 59 years old.Reason: eval lung fields History: eval lung fields Cardiomegaly status post median sternotomy.Small pleural effusions and right basilar atelectasis are noted.Prior right jugular Swan-Ganz catheter removed.Left PICC, tip in the SVC.IABP catheter proximal marker projects over the aortic arch. | Unchanged pleural effusions right larger than left, and mild right basilar subsegmental atelectasis. |
Generate impression based on medical findings. | Male, 55 years old. Right jugular catheter tip in the right atrium.No pneumothorax or other complications.ET tube tip approximately 3 cm above the carina. Bilateral nonspecific airspace opacity compatible with infection, not significantly changed. | Catheter tip in the right atrium. |
Generate impression based on medical findings. | Male, 79 years old.Reason: chronic non-productive cough; known GERD; ?h/o asthma Minimal bronchial wall thickening which can be seen in the presence of asthma or bronchitis. No focal consolidation or pleural effusion. Tortuous descending thoracic aorta. Heart size is normal. No pneumothorax. | Bronchial wall thickening which be seen in the presence of asthma or bronchitis. No focal pneumonia. |
Generate impression based on medical findings. | Male 67 years old Reason: eval for PNA or edema History: new shortness of breath Unremarkable cardiomediastinal silhouette.Low lung volumes with bibasilar atelectasis/consolidation.No large pleural effusion or pneumothorax. | No specific evidence of edema or infection. |
Generate impression based on medical findings. | Male, 87 years old.Reason: labored breathing, s/p valvuloplasty yesterday History: labored breathing, s/p valvuloplasty yesterday Unchanged moderate right pleural effusion with overlying atelectasis. Left lung unremarkable.Moderate cardiomegaly. | Unchanged right pleural effusion with overlying atelectasis and cardiomegaly. |
Generate impression based on medical findings. | Hypoxia Endotracheal tube terminates approximately 4 cm above the level of the carina. Right jugular sheath terminates in the distal jugular vein. Right Port-A-Cath terminates in the right atrium.Unchanged moderate cardiomegaly with bilateral pleural effusions and septal thickening. | Unchanged CHF pattern.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Male 25 years old Reason: evaluate cardiopulmonary fields History: fever Cardiomediastinal silhouette is unremarkable.No focal opacity or pleural effusion. | No significant cardiopulmonary abnormality. |
Generate impression based on medical findings. | 52-year-old male with resected no positive for carcinoid. Evaluate for possible recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple nonenlarged mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable benign appearing sclerotic lesion in the right iliac boneOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease in the chest and abdomen. |
Generate impression based on medical findings. | 53-year-old female with history of AICD. Assess left ventricular lead placement. Left-sided AICD/pacemaker is present. Left ventricular lead is directed posteriorly presumably into an epicardial cardiac vein. Cardiac size mildly enlarged. No focal air space opacities, pleural effusions, or pneumothorax. | Left-sided AICD/pacemaker with leads in the expected location. No evidence of postprocedural pneumothorax. |
Generate impression based on medical findings. | Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses. | Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings of spinal cord cavernous malformation. |
Generate impression based on medical findings. | 32 years Female (DOB:6/6/1983)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate to marked degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Many of these are perpendicular to the lateral ventricles. Some extend to the corpus callosum. Additional lesions are present in the internal capsules and brain stem as well as the right cerebellar hemisphere. When compared to the prior exam there is not appear to be a significant interval change. The lesion along the posterior limb of the left internal capsule is less signal hyperintense on the current exam but otherwise unchanged. Other lesions in the midbrain are also less conspicuous. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | Redemonstration of multiple white matter lesions scattered throughout the brain but predominantly the supratentorial brain are stable when compared to the prior exam. Some of the lesions that were more conspicuous on the prior exam are less conspicuous on the current exam. |
Generate impression based on medical findings. | Female, 39 years old.Reason: chest pain,sob Apparent enlarged heart size is likely related to low lung volumes. The lungs are clear. No pneumothorax or pleural effusions. | No acute cardiopulmonary abnormalities. |
Generate impression based on medical findings. | Female, 49 years old.Neutropenic fever. For infiltrate. Right jugular catheter tip at the cavoatrial junction.Unremarkable cardiac and mediastinal silhouette.Calcified right lung granulomas.No evidence of infection or edema. No pleural effusion. | No evidence of infection. |
Generate impression based on medical findings. | Clinical question: Rule out brain metastases. Signs and symptoms: Known spinal cancer. Pre and post contrast brain MRI: Negative diffusion weighted images.Examination demonstrate normal anatomic cord morphology and with normal signal intensity on all MRI sequences. Unremarkable sacral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Normal signal intensity of calvarium and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which does not include axial images and without contrast.Within this limitation there is normal anatomical alignment of vertebral column. There is no evidence of mass effect on the cord or central spinal stenosis at any level.Marrow signal replacement involving the posterior articulating facet of T8 as well as diffusely involving vertebral body of L2, L3 and partial involvement of anterior body of S1 on highly suspected for osseous metastatic lesions. There is mild compression deformity of the superior endplate of L2 with subtle bulge of the compressed vertebra into the spinal canal.The signal intensity and caliber of the cord as well as cauda equina remains within normal and is nonenhanced study.Pre and post enhanced lumbosacral MRI:There is diffuse marrow signal replacement involving the vertebral body of L2 and left pedicle with enhancement consistent with metastatic disease. There is mild compression deformity of superior endplate of L2 and evidence of ventral epidural spread of tumor at this level which also extends into the left neural foraminal with resultant compromise. There is however no spinal stenosis.Metastatic lesion is also noted involving extensively the vertebral body of L3 and left pedicle with enhancement. There is no evidence of fracture or malalignment and no central spinal stenosis or neural foraminal compromise.Small focus of marrow signal replacement with enhancement involves the anterior-inferior aspect of S2 vertebral body consistent with metastatic lesion. No epidural spread of tumor.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Note is also made of marrow signal replacement with enhancement involving the left iliac wing measuring at 13 x 22 and right iliac wing measuring 7 x 6 mm consistent with additional osseous metastatic lesions. | 1.Negative pre and post enhanced brain MRI.2.Nonenhanced cord compression complete spine MRI demonstrate no cord compression. There are however multiple osseous metastatic lesions present. There is metastatic lesion involving L2 vertebrae and with mild compression fracture of superior endplate. Normal signal intensity and caliber of the cord and without evidence of spinal canal compromise or stenosis at any level.3.Pre and post enhanced MRI of lumbar spine demonstrate metastatic lesions involving extensively vertebral body of L2 and L3 and to a lesser degree anterior body of S1 and with lesions in bilateral iliac wings (L>R) as detailed as detailed/measured above. Mild compression fracture of superior endplate of L2 vertebrae with metastases. There is extraosseous spread of tumor into the ventral epidural space at L2 and with extension and compromise of the left lateral recess and left neural foramina at L2-L3 as detailed. No central spinal stenosis or leptomeningeal enhancement. |
Generate impression based on medical findings. | Male, 54 years old.Reason: worsening infection? 54M with ALL with nodular pulm infiltrates on CT 1/17/15 History: neutropenic fever, chills, nodular pulm infiltrates Right upper lobe capacity more extensive than before combo with new foci in the right lower lung zone and basilar atelectasis.Heart size normal.Right jugular catheter, tip in SVC. | Worsening pneumonia consistent with fungal infection. |
Generate impression based on medical findings. | Reason: Pt w/ Hx of CAD, CHF, Cirrhosis h/w ADHF History: B/l LE edema, Abd distention, SOB Moderate cardiomegaly with vascular redistribution but no specific evidence of pulmonary edema.No other significant findings. | Cardiomegaly and vascular redistribution without visible edema or effusions. |
Generate impression based on medical findings. | 56-year-old female with lung cancer. Evaluate response to therapy. CHEST:LUNGS AND PLEURA: A right upper lobe spiculated mass has changed in configuration slightly making direct comparison somewhat difficult. The tumor measures 2.3 x 1.9 cm on axial image 30/111 and is unchanged at this level which is equivalent to that used for the prior measurement. On several more inferior slices, however, the mass does appear fuller than on the prior exam. Previously noted adjacent punctate micro-nodule is no longer evident. A few, scattered new micronodules are evident (axial images 27, 32, 44, and 65/111).No focal consolidation, edema or pleural effusion. Moderate centrilobular emphysema is unchanged.MEDIASTINUM AND HILA: Interval improvement in pretracheal, prevascular, AP window and subcarinal lymphadenopathy. Reference subcarinal node measures 1.7 x 1.1 cm on axial image 46/147 (measured 2.2 x 1.8 cm on 1/23/08).CHEST WALL: Right subpectoral and axillary lymphadenopathy is improved. Reference right axillary lymph node measures 2.1 x 2.6 cm on axial image 21/147 (measured 3.1 x 3.2 cm on 1/23/08). No significant hilar lymphadenopathy.Cardiac size is normal with no significant pericardial effusion.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is contracted containing foci of high attenuation which likely represent gallstones.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Right upper lobe mass has changed somewhat in configuration, and although the reference measurement is stable, the mass appears slightly fuller in certain planes.2.Scattered new pulmonary micronodules.3.Improved axillary and mediastinal lymphadenopathy as above.4.Gallstones. |
Generate impression based on medical findings. | 66-year-old female with history of widened mediastinum. Rule out infiltration. Moderate cardiomegaly. Mediastinal silhouette is within normal limits.Mild basilar atelectasis.Healed rib fractures are again noted. | Mild basilar atelectasis. No specific evidence of pneumonia. |
Generate impression based on medical findings. | Male, 20 years old.Reason: sob History: sob and chest No focal lung opacity, pleural effusion, or pneumothorax. The heart size is normal. Rightward curvature of the thoracolumbar spine. | No acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Female, 61 years old.Reason: swan distance? History: swan in place Swan ganz tip in right interlobar PA. Other findings stable. | Swan ganz tip in right interlobar PA. |
Generate impression based on medical findings. | Ms. Uppal submitted outside study for review. Submitted for review are:-Right breast ultrasound: 7/22/2016-Right breast ultrasound-guided biopsy: 7/29/2016-Bilateral breast MRI: 8/23/2016-Post stereotactic biopsy left breast mammogram: 8/26/2016The right breast ultrasound and right ultrasound-guided biopsy were performed at Advocate Good Samaritan Hospital. The bilateral breast MRI and post-stereotactic biopsy left breast mammogram examinations were performed at Northwestern Memorial HealthCare. RIGHT BREAST ULTRASOUND: Static ultrasound images are submitted for interpretation.At 10:00, 3 cm from the nipple, there is a 1.1 x 0.6 x 1.3 cm hypoechoic lesion with posterior acoustic enhancement, suggestive of a cyst.RIGHT BREAST ULTRASOUND-GUIDED BIOPSY: Static ultrasound images are submitted for interpretation.Previously described hypoechoic lesion in the left breast at 10:00 was targeted for biopsy. Targeting appears appropriate with clip placement.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is extreme fibroglandular tissue in both breasts. There is mild background parenchymal enhancement.LEFT BREAST:There are two vitamin E capsules overlying the outer posterior left breast. There is clumped nonmass enhancement in the central outer left breast that demonstrates mixed enhancement kinetics, spanning approximately 1.6 x 1.5 x 1 cm (TV x AP x CC). No additional areas of suspicious enhancement in the left breast. No left axillary or internal mammary lymphadenopathy.RIGHT BREAST:There are vitamin E capsules overlying the lower inner and upper outer quadrants of the right breast.In the central inner right breast, along the 3:00 radian, there is a 1.4 x 1.3 x 3.2 cm mass with T1 and T2 hyperintense signal and peripheral enhancement, suggestive of hematoma. Per outside pathology report, this area corresponds to the site of prior stereotactic biopsy. There is a focus of susceptibility artifact along the superior aspect of this mass (series 2, image 49), which may correspond to a biopsy marker clip.In the upper outer right breast, there is a focus of susceptibility artifact (series 2, image 53), which may correspond to a biopsy marker clip. Per outside report, this location corresponds to the site of prior ultrasound-guided biopsy.In the outer far posterior right breast, there is a focus of susceptibility artifact (series 2, image 43).In the low right axilla, there is a 5 mm reniform enhancing mass, suggestive of benign intramammary lymph node.POST STEREOTACTIC BIOPSY MAMMOGRAMS, LEFT BREAST: A CC, XCCL, and LM views of the left breast are submitted.There is heterogeneous fibroglandular tissue, which may obscure small masses. There is an hourglass-shaped biopsy clip in the upper outer quadrant of the left breast. There are residual calcifications in the upper outer left breast adjacent to this clip, spanning approximately 3.6 cm on the XCCL view. There are additional calcifications in the lower inner left breast.PER OUTSIDE PATHOLOGY:-Right breast, stereotactic core biopsies, 3:00: DCIS, grade 2, with necrosis and associated calcifications, involving two cores. The carcinoma extends to the edge of the core biopsy fragment.-Right breast, ultrasound guided core biopsies, 10:00: Histiocytic and chronic inflammatory cell reaction consistent with a ruptured duct/cyst. Moderate ductal hyperplasia, columnar cell change, and stromal fibrosis. Negative for malignancy.-Left breast, stereotactic core needle biopsy, upper outer quadrant: DCIS, solid type, nuclear grade 3 | Biopsy-proven DCIS of both breasts. Surgical management is recommended for known malignancy. Submission of all mammograms would be of benefit to see if left lower breast calcifications are stable, document morphology of calcifications on magnification views and to document clip locations in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Female, 82 years old. Right jugular catheter extending to the area of the right atrium.Pacemaker lead from the IVC with its tip projected over the area of the right ventricle, though now directed superiorly, whereas previously it was directed inferiorly towards the apex.Cardiomegaly with interstitial edema and small pleural effusions, unchanged. | 1. Interval change in the position of a temporary pacemaker with its tip now projected superiorly in the right ventricle.2. Right jugular catheter tip in the right atrium. |
Generate impression based on medical findings. | Male 70 years old; Reason: aki evaluate for obstruction History: aki RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 11 cm in length. The cortex is normal echogenicity. No shadowing calculi or hydronephrosis is present. OTHER: Bladder is partially decompressed, but grossly unremarkable. | 1.No hydronephrosis |
Generate impression based on medical findings. | Age: 27 yearsGender: MaleReason for Study: Reason: r/o pneumonia History: SOB, cough, chest pain There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Minimal nonspecific basilar opacities are compatible atelectasis.No focal areas of consolidation.Multiple metallic fragments are identified overlying the left upper hemithorax. | No acute cardiopulmonary abnormalities are identified. No specific evidence of infection. |
Generate impression based on medical findings. | 74-year-old male with history of mesothelioma. Status post presacral to treatment. CHEST:LUNGS AND PLEURA: Irregular pleural thickening in the left hemithorax with associated calcified pleural plaques are similar in comparison to prior study.Reference measurements as below:At the aortic arch (series 3, image 34): 15 mm at the 6 o'clock position (previously 15 mm), 7 mm at 9 o'clock (previously 7 mm)At the pulmonary artery bifurcation (series 3, image 52): 9 mm at 10 o'clock (previously 9 mm)At the left atrium (series 3, image 68): 9 mm at 7 o'clock (previously 10 mm), 10 mm at 11 o'clock (previously 10 mm)Postoperative changes in the left hemithorax are again identified with persistent left hydropneumothorax, partially loculated. The amount of pleural air continues to decrease with continued increase in the fluid component. Interstitial and ground glass opacities in the left lower lobe are unchanged.Numerous micronodules are seen in the right lung, with reference right upper lobe nodule (series 5, image 39) measuring 5 mm in diameter (stable).MEDIASTINUM AND HILA: Soft tissue density continues to extend into the mediastinum at the level of the left anterior descending coronary artery (series 3, image 64) as well as the left ventricle (series 3, image 70).Reference subcarinal lymph node measures 22 x 11 mmand is relatively stable accounting for differences in technique; previously measuring 21 x 10 mm.Heart size is normal without pericardial effusion. Coronary calcifications.CHEST WALL: Displaced left eighth rib fracture is reidentified. Numerous sclerotic foci are again seen throughout the vertebral bodies and remain of indeterminate etiology. ABDOMEN: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: Nonobstructing right renal calculus, unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged gastrohepatic lymph node and mildly enlarged which peritoneal nodes are grossly unchanged. Reference aortocaval lymph node measures 1.2 x 1.5 cm (series 3, image 122); previously measuring 1.2 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic foci are again noted throughout the vertebral bodies, pelvis, and right femoral head.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Borderline enlarged left external iliac lymph node (series 3, image 189) measures 0.9 x 1.6 cm; previously measuring 1.1 x 1.8 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple surgical clips are again seen in the pelvis. | Stable disease as detailed above |
Generate impression based on medical findings. | Reason: eval lung fields History: s/p lobectomy, now in RF ET tube tip approximately 3 cm above the carina.Diffuse nonspecific pulmonary opacity and loculated left pleural effusion without significant change.No new findings. | Nonspecific pulmonary opacity and pleural effusion without significant change. |
Generate impression based on medical findings. | Female, 50 years old.Reason: pulm edema History: sob, missed HD Right-sided central venous catheter tip projects over the cavoatrial junction, unchanged. Low lung volumes. The cardiomediastinal silhouette is within normal limits. No radiographic evidence of edema. | No evidence of pulmonary edema, or other acute cardiopulmonary process. |
Generate impression based on medical findings. | Female, 22 years old.Confirm PICC tip. Require TPN. Left PICC tip at the SVC level. No focal airspace opacities, pleural fluid or pneumothorax. Gastrostomy tube retention device projects over the left upper quadrant. | No acute pulmonary abnormality. Left PICC tip in appropriate position at the level of the superior vena cava. |
Generate impression based on medical findings. | Reason: pneumonia? History: chills and hypoxia with sob Moderate cardiomegaly with a mitral valve prosthesis in place.Diffuse mainly lower zone interstitial and airspace opacity, suggestive of edema, but possibly with superimposed infection. | Findings suggestive of pulmonary edema but possibly with superimposed infection. |
Generate impression based on medical findings. | Male, 76 years old.Reason: progression of PNA History: increased oxygen requirement The cardiac and mediastinal contours are partially obscured.Progressive volume loss of the left upper lobe, which may be secondary to postobstructive atelectasis secondary to left hilar metastatic lymphadenopathy seen on prior study.Coarse reticular heterogeneous opacities involving the right lung associated with chronic malignant right pleural effusion are unchanged.Known metastatic pulmonary nodules previously noted are partially obscured.No pneumothorax. | Progressive volume loss of the left upper lobe which may be secondary to postobstructive atelectasis in the setting of known left hilar metastatic lymphadenopathy, or superimposed pneumonia in the appropriate clinical setting. Correlation with physical exam and patient's symptoms is recommended.No interval change in appearance of known malignant right pleural effusion. |
Generate impression based on medical findings. | Reason: 60 F with hx COPD, CHF, 3 episodes pneumonia, presents with right flank pain, SOB, wheezing r/o CHF exacerbation, PNA History: SOB, diffuse expiratory wheezes, desaturate to 80s when talking Mild cardiomegaly with small lung volumes secondary to obesity.No specific evidence of pulmonary edema or infection. | No acute abnormalities. |
Generate impression based on medical findings. | Reason: shortness of breath, hx L pleural effusion History: dyspnea Status post left upper lobectomy with residual partially loculated left pleural effusion, which may have increased at the left base.Volume loss in the left lung is also slightly more marked than previously.No significant abnormalities in the right lung. | Volume loss in the left lung with partially loculated pleural effusion, questionably increased compared to previous. |
Generate impression based on medical findings. | 71 year old man with history of CAD with known occlusion of the RCA, LV dysfunction, previous stroke, hypertension and peripheral arterial disease referred for cardiac MRI to evaluate cardiac function and assess for scar. Left VentricleThe left ventricle is mildly dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 145 ml (normal range 47+/-19), the LV mass index is 82 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is an irregularity in the basal anterior wall which resembles an outpouching. In this same area there is hypokinesis of the mid anterior wall. The native T1 relaxation time is elevated at 1100ms, which may represent an element of diffuse fibrosis. There is a very small area of late gadolinium enhancement in the apical inferolateral wall which is transmural, and is suggestive of previous infarction. The remainder of the myocardium is viable.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 122 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 58 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. Mildly dilated LV with moderate-severely reduced function (EF 35%). 2. There is an irregularity in the basal anterior wall which resembles an outpouching. In this same area there is hypokinesis of the mid anterior wall.3. There is a very small area of late gadolinium enhancement in the apical inferolateral wall which is transmural, and is suggestive of previous infarction. The remainder of the myocardium is viable.4. Normal size RV with normal systolic function (EF 53%). 5. Mild biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 51-year-old female with sarcoidosis. Cholestatic picture on LFTs. Transjugular liver biopsy demonstrating osteopenia with portal and lobular inflammation and granulomatous, compatible with sarcoidosis. Extremely limited study due to patient refusal of multiple sequences, including lack of IV contrast.ABDOMEN:LUNGS BASES: Fibrotic changes at the lung bases, as seen on prior studies, though better evaluated on prior CTs. No pleural effusions. LIVER, BILIARY TRACT: Hepatomegaly, without focal lesions evident. No biliary ductal dilation. Mild nonspecific gallbladder wall edema.SPLEEN: Splenomegaly, without focal lesions evident.PANCREAS: No significant abnormality noted on the limited sequences performed.ADRENAL GLANDS: No significant abnormality noted on the limited sequences performed.KIDNEYS, URETERS: No significant abnormality noted on the limited sequences performed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted on the limited sequences performed.BOWEL, MESENTERY: Partially imaged non-specific mildly prominent bowel loops.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Significantly limited examination due to patient's refusal of multiple sequences and IV contrast administration.2.Hepatosplenomegaly, without biliary ductal dilation evident. |
Generate impression based on medical findings. | 63-year-old male with head and neck cancer. Compare previous. Measurements for IRB 10334. CHEST:LUNGS AND PLEURA: Mild paraseptal emphysema as seen previously. Trace pleural fluid. Mild pleural thickening consistent with tumor at the level of the right ninth rib metastasis, including a more nodular area of thickening (series 6 and image 62) that is more prominent than on prior study and is FDG avid on PET/CT performed on the same date (please refer to report for that exam).MEDIASTINUM AND HILA: Reference precarinal lymph node (series 4, image 41) measures 10 x 6 mm (stable). Mild cardiomegaly without pericardial effusion.CHEST WALL: Lucency at the sternomanubrial region (series 4, image 25) is new since prior study and is FDG avid on PET/CT performed the same date.Right ninth rib metastasis (series 4, image 66) measures 31 x 13 mm; previously measuring 46 x 22 mm. A new small lytic metastasis is seen medially at the right ninth rib fractures 4, image 60).Healing right eighth rib fracture, unchanged.Right chest port catheter with catheter tip near SVC/RA junction.ABDOMEN: LIVER, BILIARY TRACT: 1 cm hypoattenuating lesion in segment 8 is unchanged. No FDG uptake is seen on PET/CT performed on the same date.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: Atherosclerotic calcifications of the descending aorta and iliac arteries. Chronic dissection and stenosis of the right common iliac artery.BOWEL, MESENTERY: Gastrostomy tube in expected location.BONES, SOFT TISSUES: No significant abnormality noted. | 1. New lytic metastasis in the left manubrium.2. Nodular right pleural thickening posteriorly at the level of the right ninth rib metastasis has increased since prior study and is consistent with tumoral involvement.3. Continued decrease in reference measurements in the right ninth rib metastasis and index precarinal lymph nodee. However, there is a new small lytic lesion in the medial aspect of the right rib adjacent to the pleural reaction. |
Generate impression based on medical findings. | Cervical spine:There has been prior anterior cervical fusion at C5, C6, and C7 better visualized on previous cervical spine CT.Redemonstrated is congenital narrowing of the spinal canal.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Previously demonstrated minimal anterolisthesis is again noted. Mild disc bulge as well as facet and uncovertebral proliferative change is present resulting in moderate left neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy, and facet hypertrophy. There is mild/moderate central and moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the right, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. The cord is flattened both anteriorly and posteriorly, worse on the right anteriorly, demonstrating intrinsic cord T2 hyperintensity of myelomalacia. There is moderate central and moderate bilateral neural foraminal stenosis.C5/6: Right uncinate hypertrophy causes mild-to-moderate right neural foraminal stenosis.C6/7: Bilateral uncinate hypertrophy (right greater than left) and causes mild left and mild-to-moderate right neural foraminal stenosis.C7/T1: Mild bilateral facet are particular without stenosis.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. A benign hemangioma is present within the T11 vertebral body. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates a shallow right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis.T3/4 demonstrates a minimal right shallow paracentral disc protrusion without cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates a shallow central disc protrusion without cord encroachment. T8/9 demonstrates a shallow right paracentral disc protrusion without cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates a shallow right paracentral disc protrusion without cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:As been prior L5 laminectomy with a disc spacer at L5/S1, better demonstrated on previous CT.There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Redemonstrated is grade 1 anterolisthesis L5 on S1, grade 1, minimal retrolisthesis of L2 on L3, minimal retrolisthesis L3 on L4, and grade 1 anterolisthesis L4 on L5. These findings are unchanged.L1/2: Mild bilateral facet hypertrophy without stenosis.L2/3: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L3/4: Mild disc bulge and mild-to-moderate bilateral facet hypertrophy without stenosis.L4/5: Diffuse annular disc bulge, severe facet hypertrophy associated with what appears to be bilateral bone graft material. Residual facets demonstrate bilateral effusions. There is associated reactive marrow edema that extends into the right L4 and L5 pedicles. There is no central stenosis however there is moderate bilateral neural foraminal stenosis.L5/S1:Disc and covering with facet hypertrophy and what appears to be bone graft material. There is no central stenosis however there is mild bilateral neural foraminal stenosis. | 1.Postoperative changes of the cervical lumbar spines as described above.2.C2/3: Moderate left neural foraminal stenosis.3.C3/4: Mild/moderate central and moderate bilateral neural foraminal stenosis.4.C4/5:The cord is flattened both anteriorly and posteriorly, worse on the right anteriorly, demonstrating intrinsic cord T2 hyperintensity of myelomalacia. There is moderate central and moderate bilateral neural foraminal stenosis.5.C5/6: Mild right neural foraminal stenosis.6.C6/7: Mild left and mild-to-moderate right neural foraminal stenosis.7.T2/3 demonstrates a shallow right paracentral disc protrusion causing minimal anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis.8.T3/4 demonstrates a minimal right shallow paracentral disc protrusion without cord encroachment. 9.T7/8 demonstrates a shallow central disc protrusion without cord encroachment. 10.T8/9 demonstrates a shallow right paracentral disc protrusion without cord encroachment. 11.T11/12 demonstrates a shallow right paracentral disc protrusion without cord encroachment. 12.L4/5: Bilateral effusions and reactive marrow edema that extends into the right L4 and L5 pedicles. There is no central stenosis however there is moderate bilateral neural foraminal stenosis.13.L5/S1:Mild bilateral neural foraminal stenosis. |
Generate impression based on medical findings. | Non-Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without biliary dilatation.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: Multiple para-aortic enlarged lymph nodes. A reference left para-aortic adenopathy measuring 20 x 20 mm image number 138/116. BOWEL, MESENTERY: Borderline enlarged mesenteric lymph nodes. A reference node measures 15 x 11 mm image number 131/216.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Mesenteric and para-aortic adenopathy. |
Generate impression based on medical findings. | Female, 45 years old.Reason: eval acute infection History: SOB No significant cardiopulmonary abnormality.No specific evidence of infection. | No significant abnormality. |
Generate impression based on medical findings. | 59-year-old female with a lytic lesions concerning for malignancy CHEST:LUNGS AND PLEURA: Bilateral pleural effusions and dependent atelectasis. Pleural effusions have increased in sizeMEDIASTINUM AND HILA: Cardiomegaly. Bilateral thyroid nodules. Tubular fat density structure along the proximal and mid esophagus it is indeterminate etiology but may represent a lipoma.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter focal lesions, too small to accurate characterize but are more likely to be cysts.High density material within the gallbladder likely representing stones. Gallbladder mass cannot be entirely excluded and ultrasound may be helpful for further evaluation of the gallbladder. Proximal common bile duct is mildly dilated measuring 11 mm. Distal common bile duct is normal in size.SPLEEN: 13 x 10 mm cyst is unchanged. Multiple other, smaller, subcentimeter hypodense lesions in the spleen are better seen on today's contrast enhanced study. Their etiology is unknown.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: A 3.8 x 3.1 cm adenopathy in the left obturator region on image number 17/205. On the right side there is also fullness in the right obturator region with ill-defined soft tissue density likely representing adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fracture of the left ischial bone and pubic bone as well as the mildly displaced left iliac bone fracture.OTHER: A small amount of free fluid in the pelvis. | Left-sided pelvic fractures as described above. Bilateral obturator adenopathy.Possible lipoma in the esophagus.Indeterminate splenic lesions.Ultrasound a helpful for further evaluation of the gallbladder. |
Generate impression based on medical findings. | Female 44 years old Reason: Met Breast Cancer, known spine mets, s/p xrt L2-l4 and L3 kyphoplasty History: lower back pain Again seen are bilateral pars defects with grade 1 anterolisthesis of L5 on S1 which is unchanged compared to the exam from 9/19/2014. The remainder of the alignment of the lumbar spine is within normal limits. Redemonstrated is an L3 compression fracture with approximately 50% loss of height. There is evidence of kyphoplasty material within the vertebral body of L3 which is better seen on the recent CT from 2/2/2016. The remainder of the vertebral body heights are preserved. There is variable disc desiccation and severe loss of disc height involving the L5-S1 level which is unchanged. There is mild loss of disc height at the remainder of the lumbar levels. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2, L2-3: No disc bulge. Mild facet arthropathy. No spinal canal foraminal stenosis.L3-4: No disc bulge. Mild facet arthropathy. With comparison to the prior CT, kyphoplasty cement is visualized in the anterior left epidural region with effacement of the left lateral recess which is unchanged. No significant spinal canal or neural foraminal stenosis.L4-5: No disc bulge. Severe facet arthropathy. No spinal canal or neural foraminal stenosis.L5-S1: Again seen is grade 1 anterolisthesis of L5 on S1 with uncovering of the disc and moderate facet hypertrophy which causes severe bilateral neuroforaminal stenosis. There is mild spinal canal stenosis. | 1.No evidence of new osseous metastatic disease.2.Degenerative changes most severe at the L5-S1 level where there is grade 1 anterolisthesis, severe bilateral neural foraminal stenosis and mild spinal canal stenosis which is not significantly changed from the previous exam.3.Interval kyphoplasty of the L3 vertebral body with no change in the degree of height loss. With comparison to the prior CT, kyphoplasty cement is visualized in the anterior left epidural region with effacement of the left lateral recess, a finding which is unchanged. There is no significant spinal canal or neural foraminal stenosis at this level. |
Generate impression based on medical findings. | Evaluate for rotator cuff tear ROTATOR CUFF: There is a partial tear articular surface of the supraspinatus without contraction. Note is made of muscle atrophy. There is also a partial tear of the infraspinatus at its insertion. Subscapularis is unremarkable. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | Muscle atrophy of the supraspinatus with partial articular surface tear. Also partial tear of the infraspinatus at its insertion. |
Generate impression based on medical findings. | Female, 63 years old. Catheter tip in the SVC.Small lung volumes with mild interstitial opacity compatible with resolving edema.Basilar atelectasis and probable small pleural effusions.Feeding tube doubled back in the stomach. | Catheter tip in the SVC. |
Generate impression based on medical findings. | Male, 58 years old.Reason: OHT History: OHT Status post recent median sternotomy and cardiac transplant. The cardiac silhouette is within normal limits, considering technique.Mediastinal drains are now noted. No residual pneumomediastinum or pneumothorax.Adequate position of new ET tube overlying the mid trachea. There is a right IJ Swan-Ganz catheter with tip overlying the right lower lobe, possibly within a segmental or subsegmental arterial branch. Retraction is recommended.No signs of pulmonary edema.Minimal right basilar discoid atelectasis. | Status post recent median sternotomy and cardiac transplant.Abnormal position of the Swan-Ganz catheter possibly within a subsegmental arterial branch in the right lower lobe; recommend retraction approximately 6 cm.Appropriate position of additional support apparatus.Notification: Treating team is aware of this finding and recommendations. |
Generate impression based on medical findings. | 55-year-old male with history of pleurodesis. A right pleural drain is again noted. There is a moderate-sized right pleural effusion with associated basilar atelectasis. The heart size is mildly enlarged. | Right pleural effusion and associated atelectasis without significant interval change. |
Generate impression based on medical findings. | Age: 70 yearsGender: FemaleReason for Study: Reason: effusion, edema History: SOB Decreased lung volumes with stable cardiac enlargement. Pulmonary vascular redistribution and perihilar/basilar interstitial opacities slightly increased from the prior exam.Median sternotomy is intact with evidence of aortic and mitral valve prosthesis.No large pleural effusions. | Mild interval increase in perihilar/basilar interstitial opacities suggestive of edema and CHF. |
Generate impression based on medical findings. | Shortness of breath, chest pain Mild decreased lung volumes with minimal basilar atelectasis. No distinct effusions or focal discrete airspace process.Moderate nonspecific cardiomegaly with a globular appearance raising concern for a questionable pericardial effusion. | Questionable pericardial effusion |
Generate impression based on medical findings. | Reason: eval infiltrates History: SOB Unremarkable cardiac and mediastinal silhouette. Large lung volumes compatible with COPD.No sign of pneumonia or CHF. | No acute abnormalities. |
Generate impression based on medical findings. | Female 35 years old Reason: Evaluate for gallstones History: RUQ pain LIVER: Mild hepatomegaly, liver measures 20 cm in length. The parenchyma is within normal limits. No focal liver lesion. Main portal vein with normal directional flow, velocity measures 30 cm/sec. BILIARY TRACT: Gallbladder unremarkable. No significant gallbladder distention, wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety due to overlying bowel gas.KIDNEYS: The right kidney measures 13 cm. The left kidney measures approximately 14.2 cm, poles of kidney not well seen secondary to overlying bowel gas. SPLEEN: The spleen measures 12.5 cm. in length. | Mild hepatomegaly. Unremarkable study otherwise. |
Generate impression based on medical findings. | 55-year-old male with non-Hodgkin lymphoma status post auto stem cell transplant. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Unchanged calcified right paratracheal lymph node. No enlarged mediastinal or hilar lymphadenopathy.Left PICC tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: There is a 1.5-cm hypodensity in the spleen (series 3, image 77), which previously measured 1.5 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral unchanged simple renal cysts. There is an exophytic lesion in the inferior pole of the left kidney which appears denser than fluid, and measures less than 5 mm and may represent a complex cyst such as a proteinaceous cyst or hemorrhagic cyst. This finding is unchanged from previous examination.RETROPERITONEUM, LYMPH NODES: There is a 1.6 x 1.5 cm portacaval lymph node (series 3 image 103), previously measuring 1.6 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is a 1.3 x 2.7 cm left para iliac lymph node (series 3, image 147), which previously measured 1.3 x 2.7 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Stable reference lymphadenopathy.2. Stable nonspecific hypodensity in the spleen.3. Unchanged renal cysts.4. No new sites of metastatic disease. |
Generate impression based on medical findings. | 14 years Female (DOB:12/17/2001)Reason: 14 yo F with hx cerebral AVM, s/p coil embolization and craniotomy, eval vasculature History: worsening HA and vomitingPROVIDER/ATTENDING NAME: SANGHYUN MARGARET PAIK STEPHEN THOMAS MRI of the brainThere is redemonstration of encephalomalacia involving the majority of the right frontal lobe. There is associated ex vacuo effect on the right lateral ventricle. There are some foci of susceptibility effect present within the right frontal lobe. Smaller focus of encephalomalacia is present along the medial aspect of the left frontal lobe anteriorly. This appears to have extended since the 6/27/2015 exam but not significantly changed since the 1/6/2016 CT of the head..The patient is status post right frontal craniotomy and embolization of a right frontal lobe vascular lesion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. | 1.Encephalomalacia involving large portion of the right frontal lobe and a small portion of the left frontal lobe. 2.No evidence for intracranial arteriovenous malformation. |
Generate impression based on medical findings. | 72-year-old male with metastatic melanoma CHEST:LUNGS AND PLEURA: A few subcentimeter nodules are identified in both lungs, unchanged. The reference left lower lobe nodule measures 5 mm (series 4; image 85), unchanged in size. MEDIASTINUM AND HILA: A surgical clip is seen in the previous location of the enlarged left supraclavicular lymph node. A right hilar lymph node measures 12 x 10 cm, not significantly changed (series 3; image 45). Calcified mediastinal nodes are again evident.CHEST WALL: Gynecomastia, unchanged.ABDOMEN:LIVER, BILIARY TRACT: The lesion in segment two of the liver is stableSPLEEN: Calcified splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense renal lesions, likely cysts, are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable mild aneurysmal dilatation of the infrarenal abdominal aorta.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval excision of the left supraclavicular lymph node. Otherwise, stable examination. |
Generate impression based on medical findings. | Female, 75 years old.Reason: Is there pneumonia? History: fever Low lung volumes with increased basilar opacities compared to the prior study. This may represent infection or atelectasis.No other interval changes | Increasing basilar opacities may represent infection or atelectasis. |
Generate impression based on medical findings. | Male 58 years old with bladder and prostate cancer. Evaluate liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 15 cm in length and has a smooth contour. There are several T2 hyperintense, circumscribed, nonenhancing lesion in both lobes of the liver compatible with simple cysts. For example, a segment 4a lesion measures 1.3 x 1.2 cm (series 6, image 10). There is no enhancing liver lesion. Hepatic vasculature is patent.The gallbladder is normally distended and there is no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild to moderate bilateral hydronephrosis is markedly improved compared to the prior CT.RETROPERITONEUM, LYMPH NODES: There is a nonspecific 13 x 6 mm left retroperitoneal, periaortic T2 hyperintense focus which may be lymphatic in origin (series 3, image 34).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple T2 hyperintense hepatic lesions with no enhancement are favored to represent cysts. There is no enhancing liver lesion.2.Interval improvement in bilateral hydronephrosis. |
Generate impression based on medical findings. | 70 year-old male with metastatic melanoma evaluate for response to DTIC chemotherapy. CHEST:LUNGS AND PLEURA: Multifocal pulmonary nodules grossly unchanged.Reference pleural-based nodule posterior aspect right lower lobe series 5 image 75 measures 2.2 x 1.1 cm.The reference left upper lobe nodule cannot be separated from surrounding vessel and cannot be measured.MEDIASTINUM AND HILA: A stable small mediastinal nodes. Mild cardiomegaly.Pericardial fluid is decreased.CHEST WALL: Sternotomy. Air in the subcutaneous tissues anterior chest wall. Etiology uncertain correlate clinically. A small in volume and the sex in the muscle planes of the right anterior chest wall. Hiatal hernia.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity is stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partial intrathoracic stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes and through abdominal wall. Some skin thickening along the anterior abdominal wall.OTHER: No significant abnormality noted | No new sites of disease. Measurements as above. |
Generate impression based on medical findings. | Female, 56 years old. Reason: concern for hydronephrosis. History: urinary retention RIGHT KIDNEY: Right kidney measures 10.3 cm in length with mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.2 cm in length with mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Urinary bladder is collapsed with a catheter in place.OTHER: No significant abnormalities noted. | Mildly increased cortical echogenicity bilaterally suggests medical renal disease/parenchymal dysfunction. No hydronephrosis. |
Generate impression based on medical findings. | Further advancing of enteric tube Enteric tube does not appear significantly changed from prior study. Better seen on current study is rounded tubing overlying gastric body, correlate with patient's procedural history. Remainder of exam similar to earlier exam. | Enteric tube does not appear significantly changed from prior study. Better seen on current study is rounded tubing overlying gastric body, correlate with patient's procedural history. |
Generate impression based on medical findings. | Wheezing, increased work of breathing Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal.No pleural effusions or pneumothorax. No focal pulmonary consolidation. Lung volume is increased with diaphragm between 10th and 11th posterior ribs. | Large lung volumes, which may represent bronchiolitis/airway hyperreactivity. |
Generate impression based on medical findings. | 62 years Male (DOB:4/27/1953)Reason: optic nerve atrophy and VF defects both eyes History: decreased visionPROVIDER/ATTENDING NAME: JEFFREY W NICHOLS JEFFREY W NICHOLS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The optic nerves and the optic chiasm are small.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . | 1.Optic nerve atrophy2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | Age: 47 yearsGender: FemaleReason for Study: Reason: free air under diaphragm, micro perf, pneumonia, effusion, cardiomegaly History: hx of gastric band surgery, n/v x multiple episodes, chest pain, warm sensation across chest. The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions. | No acute cardiopulmonary abnormalities identified without interval change. No evidence of free peritoneal air. |
Generate impression based on medical findings. | Clinical question: Evaluate for acute or subacute subdural hematoma. Signs and symptoms: Altered mental status with unclear history. Nonenhanced head CT:Examination demonstrates very extensive subcortical and periventricular low-attenuation white matter which considering patient's age likely are presenting advanced small vessel ischemic strokes of indeterminate age.There is also a focus of low attenuation involving the cortex and subcortical white matter of the left posterior temporal -- and which has the appearance of a cortical stroke or with indeterminate age. Similar larger finding in the right posterior temporal -- occipital region is also present and is suspected of an acute to early subacute ischemic stroke.No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus.Recommend follow-up with an MRI examination. | 1.Advanced small vessel ischemic strokes of indeterminate age.2.Regions of cortical stroke in the bilateral posterior temporal -- occipital regions which are also indeterminate as of their age. Recommend follow up with MRI exam.3.No detectable acute intracranial hemorrhage, midline shift or hydrocephalus. |
Generate impression based on medical findings. | 66 year old female with history of metastatic renal cell cancer. Restaging scans status post 69 cycles of oral TKI . CHEST:LUNGS AND PLEURA: Multiple metastatic lung nodules and masses are reidentified:Reference right upper lobe nodule (series 4, image 15) measures 1.4 x 1.3 cm (stable).Reference right middle lobe mass (series 4, image 36) measures 4.3 x 3.8 cm (stable).MEDIASTINUM AND HILA: Extensive bilateral hilar adenopathy with reference left hilar mass (series 3, image 38) measuring 3.9 x 3.4 cm; previously measuring 4.3 x 3.6 cm. Heart size normal without pericardial effusion.Hiatal hernia.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Subcentimeter hypoattenuating focus in the right hepatic lobe (series 3, image 82) is too small to characterize but is unchanged from prior study from 7/30/2010.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Surgical clips are again seen in the nephrectomy bed without evidence of local recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Two ventral abdominal hernias are reidentified cone at the inferior one again seen containing only mesenteric fat (series 3, image 135). The more superior Richter hernia contains two separate wall segments of the transverse colon (series 3, image 114). No evidence of bowel obstruction or perforation.BONES, SOFT TISSUES: Sclerotic focus in the T8 vertebral body appears similar to prior study (series 3, image 52; series 8024, coronal image 30).PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left thigh intramuscular lipoma is partially seen. | Metastatic disease with reference measurements as above. No new sites of disease. |
Generate impression based on medical findings. | Female, 78 years old.Reason: eval for pna History: copd, hacking cough, night sweats Calcified granulomas again noted within the lungs. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Mild cardiomegaly again noted. No large pleural effusion or pneumothorax. | No acute cardiopulmonary process on radiography. |
Generate impression based on medical findings. | Reason: evaluate for malignancy. Patient with known primary maligancy, leg weakness and radiculopathy. Punctate nodules of enhancement are present along the correlate quinine at that L3-4, L4-5 and L5-S1 levels.Small foci of low signal are reidentified at the L3 and L4 which do not enhance following gadolinium administration.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate to marked degree bilateral facet hypertrophy present at this level. There is a ringlike enhancing adjacent to the right facet joint which has high signal centrally and low signal peripherally on T2 imaging and is hypointense centrally on T1 imaging comparedAt L4-5 there is bilateral facet hypertrophy right more than left with associated hypertrophy of the right-sided ligamentum flavum more than left. There is additional disk bulge present at this level and effacement of the fat of the right lateral recess resulting in encroachment of the nerve roots of the right lateral recess. There some mild encroachment of the exiting nerve root within the right neural foramen at this level. It overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is diffuse disk bulge and mild to moderate facet and ligamentum flavum hypertrophyAt L2-3 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild/moderate spinal stenosis at this level.At L1-2 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild spinal stenosis at this level.There is a large right-sided cystic lesion at the inferior pole of the right kidney which is not entirely included on this exam and appears to measure about 8 cm in size. | 1.Several punctate lesions in the lower cauda equina are present. Differential considerations include leptomeningeal metastases, drop metastases and nerve sheath tumors.2.There are degenerative changes present in the lumbar spine with encroachment of the nerve roots of the right lateral recess at L4-5 related to disk disease and facet disease.3.There are degenerative changes present in the lumbar spine with the mild to moderate spinal stenosis at L2-3. There is mild spinal stenosis at L1-2.4.There appears be a synovial cyst associated with the right L5-S1 facet joint.5.Lesions present at L3 and L4 are suspected to represent sclerotic foci. Lack of contrast enhancement would tend to suggest that these are benign. In patients with prostate cancer. Nuclear medicine exam is more sensitive in detecting spinal metastases.6.There is an 8 cm cystic lesion present along the right kidney. It is not adequately evaluated on this lumbar spine MRI exam. |
Generate impression based on medical findings. | Assess for pneumonia. Low normal lung volumes similar to previous. No focal airspace opacities, pleural fluid or pneumothorax. No specific evidence of pulmonary edema. | No acute pulmonary abnormalities. |
Generate impression based on medical findings. | Dystonia, unspecified [G24.9], Reason for Study: ^Reason: Follow up progression abnormal right external capsule lesion History: left hand dystonia Redemonstration of the right insular cortex and external capsular FLAIR/T2 high signal intensity lesions with mild volume loss with corresponding CSF space dilatation, unchanged since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Right insular cortex and external capsule FLAIR/T2 high signal intensity lesions with volume loss, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on medical findings. | Right wrist mass The exam is limited by motion artifact and inhomogeneous fat saturation. Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is no dislocation or subluxation. There is no joint effusion. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Bone marrow: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions.Soft tissues: A vitamin E marker was used due to indicate the mass in question. Within the ulnar soft tissues of the distal forearm is a well-defined mass which measures 1.4 x 1 x 2 cm in greatest transaxial and craniocaudal dimensions. The mass follows fat signal characteristics on all sequences and following contrast does not demonstrate internal enhancement. Inhomogeneous fat saturation likely accounts for the signal discrepancies on fat saturated sequences. No additional soft tissue masses are identified. | Soft tissue mass within the ulnar soft tissues consistent with simple lipoma. Remaining evaluation of the wrist is otherwise unremarkable. |
Generate impression based on medical findings. | Heart failure The LVAD and left subclavian catheters unchangedMildly improving aeration, correlating with suspected partial resolution of superimposed patchy edema in all 4 quadrants. Small effusions unchanged. Mild cardiomegaly | Moderately decreasing diffuse pulmonary edema |
Generate impression based on medical findings. | Check for edema Essentially unchanged marked CHF with diffuse four-quadrant edema, layered large effusions and mild cardiomegaly. Diminished lung volumesRight subclavian single port unchanged | Severe CHF essentially unchanged |
Generate impression based on medical findings. | Reason: chest tube placement History: s/p redo left thoracotomy repair paraesophageal hernia Left chest tube extending to the apex with no significant pneumothorax.Gastric interposition extending to the right of the mediastinum with an NG tube in place. Bilateral perihilar and lower zone airspace opacities and subsegmental atelectasis, suggestive of aspiration, not significantly changed. | Left chest tube in place with no significant pneumothorax or other acute change. |
Generate impression based on medical findings. | Reason: r/o ptx, pna History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Catheter tip in the upper right atrium appearing | No acute abnormalities. |
Generate impression based on medical findings. | Right shoulder pain and limited mobility ROTATOR CUFF: There is mildly increased signal intensity of the distal fibers of the supraspinatus suggesting tendinosis with perhaps mild bursal surface tearing but we see no fluid-filled full-thickness tear. The supraspinatus muscle is normal. The infraspinatus and teres minor tendons and muscles are normal. There is thinning of the distal subscapularis tendon with probable undersurface tearing. The subscapularis muscle is normal. A cystic focus within the humeral head appears unchanged, of doubtful significance. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is abnormal signal intensity within the superior labrum indicating a SLAP tear with adjacent small paralabral cyst formation. This appears similar to the prior examination. The inferior labrum is intact. There is a trace amount of fluid within the joint but no joint effusion. Alignment of the glenohumeral joint is normal.BICEPS TENDON: The biceps tendon appears slightly perched upon the lesser tuberosity which may be the result of tearing of the overlying subscapularis tendon. The biceps tendon otherwise appears intact.ADDITIONAL | AC joint osteoarthritis, rotator cuff tendinopathy, and superior labral tearing as described above with no evidence of mass. |