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Generate impression based on findings. | Reason: Baseline Chest CT to monitor pulmonary aspergillosis History: pulmonary aspergillosis LUNGS AND PLEURA: Interval tracheostomy tube terminates approximately 6 cm superior to the carina. There are secretions that occupy the superior trachea. Within the superior trachea at the level of T2, approximately 4 o'clock location (series 4 image 9), there is an apparent small defect in the left lateral tracheal wall. Correlation with potential history of traumatic intubation is recommended. Gas tracks within the superior anterior mediastinum that tracks inferiorly to the level of the anterior diaphragm on the left. Gas also tracks along the left pulmonary arterial vasculature into the lung parenchyma. A small amount of subcutaneous emphysema extends to the base of the left neck and left subpectoralis musculature.There is a small, partially loculated right pleural effusion that is new.The previously demonstrated pulmonary fibrosis is partially obscured by increasing ground glass opacity and patchy consolidation, greatest on the left. A component of this represents edema. Given the fluid in within the esophagus and tracheal debris, aspiration is in the differential. Alveolitis or persistent infection is also a consideration, given the history of pulmonary aspergillosis.MEDIASTINUM AND HILA: Fluid occupies the esophagus.Heart size is upper limits of normal. Low density of the blood pool is suggestive of anemia. No significant pericardial effusion. Partially calcified subcarinal lymph nodes indicative of prior granulomatous disease. Stable mildly enlarged mediastinal lymph nodes.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Percutaneous gastrostomy tubing is coiled within the stomach with the inflation balloon noted on the surview radiograph. The gallbladder demonstrates diffuse high density which may represent vicarious excretion from possible prior intravenous contrast or dense sludge. Diverticulosis. | Interval placement of a tracheostomy tube with suspected left lateral tracheal wall defect at approximately 4 o'clock location at the level of T2. There is pneumomediastinum extending from the left anterior and posterior mediastinum which tracks anteriorly and inferiorly to the level of the diaphragm, posterior to the trachea and into the anterior/superior chest wall and subpectoralis musculature.Pulmonary opacities which may be the result of massive aspiration on a background of pulmonary fibrosis or progressive infection.Small, partially loculated right pleural effusion. |
Generate impression based on findings. | Abdominal pain and malaise, evaluate for obstruction/ischemia ABDOMEN: Lack of IV contrast limits evaluation of the viscera.LUNG BASES: Scattered pulmonary micronodules in the right lung base. Elevated right hemidiaphragm is unchanged.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification of the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: Several dilated loops of bowel in the central abdomen and pelvis with a small bowel feces sign and transition point in the right hemipelvis (series 3, image 63). These findings are compatible with a small bowel obstruction. There is no free intraperitoneal air or free fluid.BONES, SOFT TISSUES: Marked scoliosis of the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically removed.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.Small bowel obstruction without evidence of perforation. Evaluation for ischemia is limited by lack of IV contrast. No free fluid. |
Generate impression based on findings. | Female; 33 years old. Reason: Rule out aneurysm History: New onset seizure and headache on 11/22/2013, family history of brain aneurysm. HEAD CT: Thre is a new hyperattenuating focus in the left caudate head. The ventricles, sulci, and cisterns are stable in size and configuration. There are unchanged borderline low lying cerebellar tonsils, extending approximally 4 mm below the foramen magnum. There is no midline shift. The orbits are unremarkable. The osseous structures are unremarkable. There is a right maxillary sinus mucus retention cyst.CTA BRAIN: Angiographic images are degraded by suboptimal contrast timing bolus. The limitations of this exam were discussed with the patient at the time of imaging in person by the dictating resident. There appears to be a network of fine caliber anomalous vessels centered in the left caudate head that measures up to approximately 17 mm with an associated prominent left septal vein. Otherwise, there is no evidence of aneurysm or significant steno-occlusive disease. | New hyperattenuating focus in the left caudate head, which may represent hemorrhage associated with what may represent a vascular malformation, such as a developmental venous anomaly possibly associated with a cavernous malformation versus an arteriovenous malformation centered in the left caudate head that measures up to approximately 17 mm with an associated prominent left septal vein. MR is recommended for further characterization. |
Generate impression based on findings. | 76-year-old male with continued hematuria requiring transfusion despite clot evacuation. Will need upper tract imaging prior to nephrostomy tube placement. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodularity of the adrenal glands.KIDNEYS, URETERS: No renal or ureteral calculi are identified. No evidence of hydronephrosis, hydroureter or perinephric fat stranding. Note is made of a duplicated collecting system bilaterally, which unite at the level of the pelvic brim. There is no convincing filling defect identified within the visualized portions of the collecting systems. No focal mass lesions are identified within the kidneys. There is focal angulation/stenosis of the left renal artery.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Concentric thickening of the bladder with associated infiltration of the perivesicular fat concerning for cystitis. Foci of gas density within the bladder likely related to recent instrumentation. Foley catheter in place. Note is made of high density debris surrounding the superior aspect of the Foley catheter balloon which may represent hematoma/clot formation. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes along the cecum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Debris along the superior aspect of the Foley catheter balloon consistent with the stated history of hematoma/clot formation. Concentric thickening of the bladder with associated infiltration of the perivesicular fat concerning for cystitis.2. Duplicated collecting systems, a normal anatomic variant, as described above. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measruements pls History: none CHEST:LUNGS AND PLEURA: Stable mild centrilobular emphysema. Interval subsegmental atelectasis involving the lingula. Stable opacities. Interval appearance of groundglass entry of the opacities within the bilateral lower lobes and lingula, greatest on the right. The findings are compatible with bronchiolitis likely secondary to aspiration.Surgical clips again noted in the right inferior hilum suggestive of prior inferior lobectomy. No suspicious pulmonary nodules or interval pleural effusion.MEDIASTINUM AND HILA: Small amount of mucus is adherent to the right lateral wall of the central trachea.The heart size is normal. No interval pericardial effusion. Small amount of coronary arterial calcification occupies the LAD. No interval mediastinal or hilar lymphadenopathy.CHEST WALL: Left port catheter terminates in the midsuperior vena cava.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable hypodensities within both kidneys compatible with cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive degenerative changes of the vertebral bodies.OTHER: No significant abnormality noted. | No evidence of metastatic disease.Interval groundglass with tree in bud opacities of bronchiolitis likely related to aspiration. |
Generate impression based on findings. | 27-year-old female with Ewing sarcoma, evaluate for metastases LUNGS AND PLEURA: Small calcified micronodule in the right lower lobe likely represents granuloma (series 4, image 30). No other pulmonary nodules or masses. No pneumothorax or pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. No significant lymphadenopathy.CHEST WALL: Left Port-A-Cath with tip in the SVC. No significant lymphadenopathy. Mild degenerative changes affects the thoracic spine, not significantly changed from prior exam.UPPER ABDOMEN: No significant abnormality noted. | No suspicious nodule or mass to suggest metastasis. |
Generate impression based on findings. | Evaluate neck for abscess, s/p left neck dissection, rim mandibulectomy of left ramus, and free flap reconstruction. There are recent postoperative findings related to left neck dissection, left rim mandibulectomy, laryngectomy with free flap reconstruction, tracheostomy, and voice prosthesis. There is a fluid collection that tracks in the surgical bed anterior to the left carotid sheath, which measures up to 14 AP x 21 RL x 85 SI mm. There is mild associated flattening of the left internal jugular vein. There is a drain that courses through the right neck surgical bed, which terminates across the midline anterior to the neopharynx. A few scattered foci of air are present adjacent to the drain. There are no substantial fluid collection in the right neck. There is hyperemia of the bilateral level 1 lymph nodes that are likely reactive, but otherwise there is no significant lymphadenopathy. There is partial opacification of the bilateral mastoid air cells, including air fluid levels. There is mild to moderate mucosal thickening of the bilateral maxillary sinuses. The partially imaged intracranial structures are grossly unremarkable. There is biapical scarring. | An elongated fluid collection in the left neck surgical bed anterior to the carotid sheath is non-specific, but may represent an infected postoperative collection. |
Generate impression based on findings. | 72-year-old female. Reason: dysphagia, coughing History: dysphagia, coughing. LUNGS AND PLEURA: A right upper lobe branching nodular opacity is most consistent with bronchocele (image 25, series #4) secondary to bronchial obstruction and mucoid impaction. A right upper lobe micronodule is also noted (image 52, series #4). Mild right apical and bilateral basilar scarring.MEDIASTINUM AND HILA:Asymmetric left thyroid enlargement with mild rightward tracheal deviation. No focal esophageal wall thickening or mass is identified.Moderate to severe cardiomegaly. No pericardial effusion.AP window calcified lymph nodes suggest prior granulomatous disease.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No esophageal wall thickening or mass identified.2.Right upper lobe bronchocele is identified, likely of benign etiology, but recommend follow-up CT chest in approximately 6 months to ensure stability.3.Asymmetric left thyroid enlargement, likely represents a goiter. |
Generate impression based on findings. | Reason: evalute for PE History: new right heart strain PULMONARY ARTERIES: The diagnostic quality of this examination is excellent. No pulmonary embolus is identified to the subsegmental level. This was discussed with Lindsay Esch at time of image interpretation.LUNGS AND PLEURA: There is no significant change in the diffuse ground glass opacities, traction bronchiectasis and patchy consolidation in a distribution that is suggestive of radiation reaction and a component of radiation fibrosis. There is stable narrowing of the central right upper lobe bronchus which is encased by right paramediastinal soft tissue. A small amount of mucus is trapped within the segmental narrowing (series 9 image 67).By verbal report, the patient has been treated with antibiotics. There is no interval change; therefore, infection is considered less likely.Right upper lobe spiculated nodule contiguous with the right mediastinum has not significantly changed in size with a reference measurement of 8 x 18 mm on the coronal view (image 50 series 80720).No interval pleural effusion. Centrilobular emphysema remains stable.MEDIASTINUM AND HILA: Moderate coronary artery calcifications are stable. Calcified mediastinal and hilar lymph nodes. No mediastinal or left hilar lymphadenopathy. The heart size is within limits of normal. No interval pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic and splenic calcified granulomata. Two Ill-defined low densities within the anterior cortex of the mid right renal pole not well visualized on prior studies can be further evaluated on subsequent imaging. | No pulmonary embolus to the subsegmental level. Extensive groundglass opacities with traction bronchiectasis and architectural distortion has not significantly changed. This is most consistent with radiation pneumonitis rather than infection.Stable size of right upper spiculated nodule. |
Generate impression based on findings. | History of metastatic cancer, rising PSA CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No pleural effusion.MEDIASTINUM AND HILA: Small mediastinal lymph nodes, some of which are calcified. Mildly ectatic ascending aorta. Marked calcification of the coronary arteries and aorta. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hepatic hypodensities are unchanged, likely cysts.SPLEEN: Multiple nonspecific splenic hypodensities are more conspicuous due to IV contrast.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific left mid pole hypodensity, likely a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia contains a small bowel loop. No evidence of incarceration or bowel obstruction.BONES, SOFT TISSUES: Sclerotic focus involving the T11 vertebral body and pedicle is unchanged from prior exam.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Nondistended.LYMPH NODES: Status-post bilateral pelvic lymph node dissection. No enlarged pelvic lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Grade 1 anterolisthesis of L4 on L5.OTHER: Penile prosthesis with reservoir in the right lower pelvis, unchanged. | Stable CT chest, abdomen and pelvis with an osseous metastasis in the T11 vertebral body. |
Generate impression based on findings. | 72-year-old female with dysphagia. CT Head: There is minimal periventricular and subcortical hypoattenuation consistent with chronic small vessel disease. There is no evidence for acute intracranial hemorrhage, mass effect, or midline shift. The ventricles are normal in size and configuration. There is minimal mucosal thickening of the ethmoid sinuses. The mastoid air cells are well pneumatized and clear.CT Neck: Lack of IV contrast limits evaluation. There is heterogeneous punctate foci of hyperdensity within the right and left lobe of the thyroid which may represent calcifications, with enlargement of the left lobe of the thyroid measuring 3.8 x 4.0 X 4.0 cm. There is mass effect upon the esophagus. The trachea is deviates slightly to the right, without significant narrowing. There is no evidence of significant lymphadenopathy. The parotid and submandibular glands are unremarkable. There is mild multilevel degenerative spondylosis. There is mild centrilobular emphysema and right apical scarring. | Enlarged heterogeneous thyroid, particularly of the left lobe, with mass effect upon the esophagus may represent thyroid goiter. However, assessments is limited by lack of intravenous contrast and a thyroid ultrasound is recommended for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Alcohol withdrawal convulsions. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage, mass, or cerebral edema. However, a brain MRI with contrast is more sensitive for the assessment of seizure foci, if the patient has no contraindications for this modality. |
Generate impression based on findings. | 68 year-old female. Patient with metastatic lung cancer status post 2 cycles of newer chemotherapeutic agents. History of diabetes on insulin. CHEST:LUNGS AND PLEURA: Right small loculated pleural effusion and pleural thickening, unchanged. Improved aeration of the right lung with persistent septal thickening and centrilobular nodularity throughout the right lung. Right middle lobe spiculated nodule measures 22 x 15 mm (series 5, image 59), most likely obscured on prior studies by consolidation.MEDIASTINUM AND HILA: Decreased mediastinal lymphadenopathy; for example nonreference pretracheal lymph node measures 8 mm (series 4, image 32), previously 11 mm on 11/2013. Reference subcarinal lymph node measures 10 mm (series 4, image 49), previously 14 mm on 11/2013 and 20 mm on 8/2013.Small pericardial effusion. Severe coronary calcifications. Large pulmonary artery consistent with pulmonary artery hypertension.CHEST WALL: Left chest port tip at cavoatrial junction. Healed pathologic right T2 anterior rib and left T3 rib fractures, unchanged. Multiple sclerotic foci in thoracic vertebrae consistent with metastasis, unchanged from 11/2013 and progressed from 8/2013. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule, measuring less than 10 HU on prior noncontrast exam, likely a benign adenoma, is unchanged. KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe calcified atherosclerotic calcification of abdominal aorta. No lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multiple sclerotic foci in thoracolumbar vertebrae consistent with metastasis, unchanged from 11/2013 and progressed from 8/2013. OTHER: No significant abnormality noted. | 1. Right middle lobe spiculated nodule, suspicious for a lung malignancy. 2. Increased aeration of the right lung with persistent septal thickening and centrilobular nodularity.3. Decreased mediastinal lymphadenopathy.4. Thoracolumbar spine metastasis, similar to 11/2013 and progressed from 8/2013. |
Generate impression based on findings. | 70 year-old female with questionable esophageal compression from an ectatic aorta noted on esophagram. Rule out aortic dilation/ectasia and compression of the distal esophagus. The patient presents with shortness of breath and cough. CHEST:LUNGS AND PLEURA: Postoperative changes of right lower lobectomy.MEDIASTINUM AND HILA: Note is made of a patulous esophagus which is partially filled with fluid to the level of the upper esophageal sphincter and is dilated to the level of the esophageal hiatus. No evidence of aneurysm or dissection. No mass lesions are identified. Vascular calcifications of the aorta and its branches. Mild coronary artery calcification. Calcified hilar lymph nodes suggestive of prior granulomatous disease. Cardiomegaly.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Patulous esophagus which is partially filled with fluid from the level of the upper esophageal sphincter to the level of the esophageal hiatus. No evidence of an ectatic aorta, aneurysmal dilation or dissection as clinically questioned. |
Generate impression based on findings. | Female 69 years old; Reason: Evaluate for resolution of right retroperitoneal complex cystic mass. History: Complex right RP cystic mass, s/p drainage in IR. Drain removed 12/24. ABDOMEN:LUNGS BASES: Left lower lobe granuloma.LIVER, BILIARY TRACT: Probable cyst in segment 3 of the liver. Status post cholecystectomy.SPLEEN: Scattered splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland lesion with imaging features of an adenoma is unchanged.KIDNEYS, URETERS: Fat-containing right upper pole renal lesion is unchanged. Interval removal of the right body wall drain. No hydronephrosis in either kidney. Small nonobstructive calculi or calcifications in the right kidney.Probable small left exophytic renal cortical cysts.Residual small pocket of (probable) fluid measures 3.1 x 2.6 cm.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta with small focal dissection and displacement of intimal calcifications. Left para-aortic lymph node measures 1.0 x 0.9 cm (image 54/series 4) previously, 1.4 x 1.0 cm.Soft tissue thickening involving the right psoas muscle and right bladder body wall.BOWEL, MESENTERY: Left lower abdominal colostomy. No bowel obstruction is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: The status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes in the rectum and small bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left iliac fossa fluid most likely represents a lymphocele or seroma is unchanged. | 1.Status post removal of the right body wall catheter with small residual pocket of probable fluid. |
Generate impression based on findings. | Prostate cancer, evaluate for solid renal tumors 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: Severe bilateral hydronephrosis. No obstructing lesion or stone noted. Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: TURP defect.BLADDER: Distended and unremarkable.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-operative changes of L3-5 laminectomy.OTHER: No significant abnormality noted. | Severe bilateral hydronephrosis without evidence of obstructing lesion or stone. |
Generate impression based on findings. | 46-year-old female status post laparoscopic cholecystectomy and take back for free air. Now with rising WBC. ABDOMEN:LUNG BASES: There is slight interval increase in small to moderate sized bilateral pleural effusions with underlying atelectasis/consolidation. Bibasilar consolidation may represent compressive atelectasis although aspiration could be considered in the correct clinical setting. LIVER, BILIARY TRACT: Status post cholecystectomy. Probable fatty infiltration of the liver. 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: NG tube tip terminates in the antropyloric region of the stomach. There is near complete interval resolution of the previously described free intraperitoneal air. There is interval development of multiple encapsulated fluid collections along the gastrohepatic ligament, as well as within the right subdiaphragmatic region, parasplenic region, right pericolic gutter, and pelvis, consistent with abscess formation. The gastrohepatic collection measures 6.7 x 5.4 cm (47; series 3). The pelvic collection measures 7.7 x 8.5 cm (153; series 3). Note is made of a small amount of abdominopelvic free fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or surgically absent. BLADDER: Foley catheter in place. Foci of gas density within the bladder may be related to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: | 1. Near complete interval resolution in free intraperitoneal air. There is interval development of multiple encapsulated fluid collections along the gastrohepatic ligament, as well as within the right subdiaphragmatic region, parasplenic region, right pericolic gutter, and pelvis, consistent with abscess formation. 2. Interval increase in small to moderate size bilateral pleural effusions. There is increased bibasilar consolidation, which may represent compressive atelectasis, although aspiration is a differential consideration. |
Generate impression based on findings. | 54 year-old female with metastatic left eye melanoma. CHEST:LUNGS AND PLEURA: Scattered nonspecific bilateral micronodules most pronounced in the left upper lobe. Note is made of a small left sided fat containing Bochdalek hernia.MEDIASTINUM AND HILA: Prominent mediastinal and right hilar lymph nodes, not enlarged by CT criteria.CHEST WALL: No significant abnormality noted.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: Subcentimeter hypodensities in the right kidney are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of a small fat containing umbilical hernia.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 abnormality noted. | No definitive evidence of metastatic disease. Scattered nonspecific pulmonary micronodules. |
Generate impression based on findings. | Male 45 years old Reason: peritoneal mesothelioma, please evaluate for disease and compare with prior scans using the same measurements. Pt is S/P 6 cycles of chemo needing reevaluation. History: peritoneal mesothelioma. ABDOMEN:LUNG BASES: Nonspecific left lower lobe pulmonary micronodule measures 4 mm (series 4, image 20) and is new from the prior exam. Persistent subpleural nodularity at the left base.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality.ADRENAL GLANDS: Soft tissue nodule abuts the left adrenal gland measuring 2.3 x 1.8 cm (series 3, image 41; previously 2.0 x 1.4 cm).KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic lymph node measures 1.7 x 1.4 cm (series 3, image 42; previously 1.5 x 1.0 cm).BOWEL, MESENTERY: Multiple mesenteric soft tissue implants. Reference pericecal mass measures 7.8 x 5.7 cm (series 3, image 91), previously 7.8 x 5.1 cm. Reference soft tissue mass posterior to the stomach measures 4.2 x 3.3 cm (series 3, image 50), unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Surgical clips in the left upper quadrant.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference peritoneal implant the cul-de-sac measures 1.7 x 1.2 cm (series 3, image 127; previously 2.2 x 1.7 cm).New mesenteric soft tissue nodule in the right lower quadrant measures 1.9 x 1.4 cm (series 3, image 125). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.New mesenteric soft tissue implant. 2.Reference mesenteric implants are stable to slightly decreased. |
Generate impression based on findings. | 57-year-old female. Reason: Rule out lymphadenopathy versus edema versus adipose redistribution. Newly diagnosed multiple myeloma now with supraclavicular swelling. History: BIlateral supraclavicular swelling. LUNGS AND PLEURA: No suspicious nodules. MEDIASTINUM AND HILA: Normal heart size. No pericardial effusion. No hilar or mediastinal lymphadenopathy.CHEST WALL: Supraclavicular fossa is only partially imaged on this exam, however no supraclavicular lymphadenopathy is identified.No axillary lymphadenopathy.Lucent lesions in all vertebral bodies with extensive lysis of the vertebral body and erosion of the posterior cortex of T5.Subacute fractures of the left third, fifth, seventh, and eighth ribs and the right ninth rib are noted.Degenerative changes of the thoracolumbar spine are noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No supraclavicular lymphadenopathy identified on this limited view of the supraclavicular fossa.2.Lytic lesions in the thoracolumbar spine are consistent with known multiple myeloma. Posterior cortical erosion of the T5 vertebral body is noted.3.Multiple subacute rib fractures. |
Generate impression based on findings. | Reason: 50 yo F w scleroderma ILD. Worsening cough \T\ SOB. Eval for progression. History: cough, SOB LUNGS AND PLEURA: Lower lobe predominant traction bronchiectasis, architectural distortion, and honeycombing without significant interval change.No evidence of air trapping on the expiration images.Mild upper lobe predominant paraseptal emphysema.Right middle lobe nodule stable.No new suspicious pulmonary nodules.No pleural effusions.MEDIASTINUM AND HILA: Minimally prominent mediastinal lymph nodes, unchanged.Cardiac size is normal without evidence of a pericardial effusion. Mild coronary calcifications.Patulous esophagus redemonstrated.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable ILD presuming secondary to mixed connective tissue disease. |
Generate impression based on findings. | Headache. There are recent postoperative findings related to left frontal craniotomy for resection of a meningioma. There is a small amount of residual pneumocephalus and extra-axial fluid in the region of the craniotomy and a focus of intraparenchymal hemorrhage that measures up to 10 mm in the left superior frontal gyrus with mild surrounding vasogenic edema. There is no significant midline shift. There are unchanged findings related to remote posterior fossa surgery with extensive encephalomalacia in the right cerebellar hemisphere and right middle cerebellar peduncle. There is an associated extra-axial fluid collection that dissects into the occipital bone, which is unchanged. There is an unchanged hyperattenuating focus overlying the lateral right occipital lobe that measures up to 13 mm. The extracranial structures are unchanged. | 1. Postoperative findings related to left frontal meningioma resection with a 10 mm intraparenchymal hematoma in resection bed 2. Unchanged 13 mm focus overlying the lateral right occipital lobe. Further evaluation with MRI may be useful, if there are no contraindications. |
Generate impression based on findings. | 86 years old Female. Reason: Pt w/ s/s of acute stroke History: Left sided neglect. There is parenchymal age-related atrophy. Periventricular and subcortical hypoattenuating foci are suggestive of moderate small vessel ischemic disease of indeterminate age. There is subjective asymmetric decreased sulcal prominence in the right parietal lobe, however this finding is equivocal and grey-white differentiation is maintained. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. Scattered opacification is noted involving the left anterior ethmoidal air cells and nasal passage. | No acute intracranial hemorrhage. Volume loss and probable moderate small vessel ischemic disease of indeterminant age. Please note MRI is more sensitive for detection of acute ischemia. |
Generate impression based on findings. | 59 year-old female. SLE. Cough. LUNGS AND PLEURA: Mild left lung base pleural and parenchymal scarring. Calcified left lung granuloma. No evidence of interstitial lung disease. Airtrapping on the expiratory images.MEDIASTINUM AND HILA: Calcified left hilar nodes consistent with healed granulomatous disease. Main pulmonary artery is 3.7 cm, suggestive of pulmonary artery hypertension.Severe coronary artery calcifications.CHEST WALL: Mild degenerative changes of thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified splenic granulomas. Subcentimeter left hepatic lobe hypodensity too small to characterize. | No evidence of interstitial lung disease. Dilated main pulmonary artery suggestive of pulmonary artery hypertension. |
Generate impression based on findings. | Reason: evaluate extent of bronchiectasis History: productive cough; severe obstruction of PFTs LUNGS AND PLEURA: Moderate bronchiectasis and diffuse bronchial wall thickening involving both lungs. Pleural and parenchymal scarring in the apices and left upper lobe.No focal areas of consolidation.No pleural effusions.Minimal right basilar subsegmental atelectasis and bronchial plugging.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Numerous small mildly prominent mediastinal and hilar lymph nodes.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Moderate bronchiectasis and bronchial wall thickening with scattered areas of bronchial plugging. |
Generate impression based on findings. | 64-year-old male with a history of gastric GIST. Surveillance examination. CHEST:LUNGS AND PLEURA: Stable bilateral granulomas are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Stable bilateral renal cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination. No findings to suggest metastatic disease. |
Generate impression based on findings. | History of ruptured appendix ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Nonspecific hepatic hypodensities, likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No drainable fluid collections in the abdomen/pelvis. No mesenteric fat stranding, free intraperitoneal air, or free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is unchanged.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. | Complete interval resolution of right lower quadrant inflammatory changes. |
Generate impression based on findings. | Right neck SCCa of unknown primary diagnosed in 2007, s/p neck dissection and concomitant cisplatin/XRT, with subsequent right buccal SCCa in 2012, s/p surgical resection with positive margin followed by concomitant cetuximab/XRT from 12/26/12 to 2/15/13, who then developed persistent/recurrent R buccal SCCa diagnosed on 4/9/13, resected on 5/9/13, revealing a 2.1 cm right buccal SCCa with perineural invasion. In 2007, both sides of the neck were treated to 56 Gy with boost to 66 Gy targeting the area of initial presentation. In 2012-13, he received 54 Gy followed by boost to 63 Gy and now is receiving adjuvant TFHX chemoradiation. There are post-treatment findings in the right neck related to flap reconstruction, neck dissection, and radiation therapy. There is persistent supraglottic mucosal edema. However, there is no definite evidence of locoregional tumor recurrence. There is no significant lymphadenopathy by CT size criteria. The remaining major salivary glands and thyroid gland are unchanged. There is an unchanged lucent lesion that measures up to 10 mm within the left mandibular angle, just inferior to the presumed site of dental extraction with associated with defect of the lingual alveolar cortex and mottled sclerosis of the surrounding bone marrow. There is persistent partial opacification of the right maxillary antrum containing sinoliths and sclerosis of the adjacent maxillary walls, consistent with chronic sinusitis. There is a retention cyst within the left maxillary sinus. There are also unchanged polypoid nodular lesions are seen in bilateral superior nasal cavity. There is an unchanged defect within the anterior nasal septum. There is unchanged obliteration of the superior right internal jugular vein. There are unchanged atherosclerotic calcifications of the cervical vasculature without significant stenoses. There is unchanged multilevel degenerative cervical spondylosis. The imaged portions of intracranial structure are unremarkable. There is centrilobular emphysema in the imaged portions of the lungs. | 1. No evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2. Unchanged 10 mm lucent lesion within the left mandibular angle just inferior to the presumed site of dental extraction may be related to chronic or prior osteomyelitis and less likely metastasis. 3. Chronic sinusitis and sinonasal polyposis. |
Generate impression based on findings. | 34 year old female with newly diagnosed CTCL. Please evaluate for lymphadenopathy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Soft tissue density along the superior aspect of the anterior mediastinum likely represents residual thymus tissue.CHEST WALL: No significant abnormality noted.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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 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. | Soft tissue density along the superior aspect of the anterior mediastinum likely represents residual thymus tissue. No convincing evidence of adenopathy. |
Generate impression based on findings. | Left flank pain, evaluate for stone 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: 3-mm stone along the expected course of the distal left ureter with surrounding fat stranding. There is mild upstream left ureteral dilatation. Multiple stones are noted in the renal pelvis bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine IUD.BLADDER: There is a focus of gas anteriorly within the bladder. Correlate with recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 3-mm distal left ureteral stone with surrounding fat stranding. |
Generate impression based on findings. | 63 year-old male. Blood tinged sputum x 1 month. Evaluate for source of hemoptysis. LUNGS AND PLEURA: Motion degradation in left lung base limits evaluation. Very mild upper lobe paraseptal emphysema. Mild left lower lobe bronchiectasis and bronchial wall thickening. Calcified granulomas in left lower lobe. Scattered micronodules consistent with previous infection. No suspicious pulmonary nodule or mass identified.MEDIASTINUM AND HILA: Presternal ICD. No mediastinal or hilar lymphadenopathy. Calcified left hilar nodes consistent with healed granulomatous disease. Moderate coronary artery calcifications and multiple coronary stents. CHEST WALL: Cervical spine fixation hardware. UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild left lower lobe bronchiectasis and bronchial wall thickening. |
Generate impression based on findings. | Multiple myeloma. There is no significant cervical lymphadenopathy or mass lesions in the neck. The major salivary glands and thyroid are unremarkable. The airways are patent. The imaged paranasal sinuses and mastoid air cells are clear. The partially imaged intracranial structures are grossly unremarkable. There is mild multilevel degenerative spondylosis, diffuse osteopenia, and multiple lytic lesions. The imaged portions of the lungs are clear. | 1. No evidence of significant cervical lymphadenopathy.2. Multiple lytic lesions are compatible with known multiple myeloma. |
Generate impression based on findings. | 62-year-old male weight is abdominal pain and anemia. Assess for small bowel abnormality, or mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities in the kidneys are too small to characterize, but likely represents simple cyst.RETROPERITONEUM, LYMPH NODES: Vascular calcifications of the aorta and its branches. Subcentimeter focus of hypoattenuation along the aorta at the level of the left renal vein may represent a cystic node or dilated lymphatic duct and is likely benign, and is of doubtful current clinical significance.BOWEL, MESENTERY: There are numerous prominent mesenteric lymph nodes. No findings to suggest active inflammation. No significant strictures are identified. No dilated loops to suggest obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of stricture or active inflammatory bowel disease. |
Generate impression based on findings. | Hypoxia, right lung infiltrate, please evaluate for possible IVC clot Lack of IV contrast limits evaluation of the mediastinum, lymph nodes, and viscera.CHEST:LUNGS AND PLEURA: Marked interval decrease in size of right hemothorax. Right chest tube is in place with a small pneumothorax. A right upper lobe bronchus communicates directly with the pleural space compatible with a bronchopleural fistula. Persistent multifocal pulmonary consolidation, right greater than left. Small right pleural effusion. MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes. Calcification about the mitral valve annulus. Bilateral internal jugular catheters: the left terminates at the confluence of the brachiocephalic vein and SVC; the right terminates in the proximal SVC. Endotracheal tube terminates just below the thoracic inlet. Enteric tube is coiled in the stomach. CHEST WALL: Right eighth rib fracture.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes. The lack of IV contrast excludes evaluation for IVC thrombus.BOWEL, MESENTERY: Enteric contrast passes into a right lower quadrant ostomy. There is a small pocket of fluid adjacent to the ostomy No evidence of bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter is present.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left femoral catheter. Additional catheter/line projects over the right groin. | 1.Marked interval decrease in size of right hemothorax.2.Right bronchopleural fistula with chest tube in place.3.Multifocal patchy airspace consolidation.4.Enlarged mediastinal and retroperitoneal lymph nodes, possibly reactive in etiology. 5.Lack of IV contrast excludes evaluation for IVC thrombus.6.Right eighth rib fracture. |
Generate impression based on findings. | 23 year old female with abdominal pain. Evaluate for abdominal hernia versus diastases. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction or strangulation. BONES, SOFT TISSUES: No significant herniation. No evidence of obstruction or strangulation. Small focus of fatty replacement of the distal portion of the right rectus abdominus muscle. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction or strangulation. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of diastases of the rectus abdominis muscles or significant herniation. |
Generate impression based on findings. | Evaluate for septal deviation to the right and nasal airway obstruction. There is mild deformity of the nasal bones, particularly in the left with possible slight narrowing of the left upper nasal valve. However, there is no significant nasal septal deviation or spur. The nasal cavity is clear. The paranasal sinuses are also clear. The imaged intracranial structures are grossly unremarkable. | Mild deformity of the nasal bones, particularly in the left with possible slight narrowing of the left upper nasal valve, which is post-traumatic in nature. However, there is no significant nasal septal deviation or spur. |
Generate impression based on findings. | 63 year-old female. Myasthenia on chronic prednisone and azathioprine. Presented with malaise and SOB. CXR found chronic bilateral opacities. Denies cough and sputum production. LUNGS AND PLEURA: Calcified lung granulomas. Mild subpleural reticular opacities, most prominent in the lung bases. Mild basilar linear scarring. No ground-glass opacity or focal airspace consolidation.MEDIASTINUM AND HILA: Severe coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes of thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatic steatosis. Colonic diverticulosis. | Nonspecific subpleural reticular opacities and basilar linear scarring are very mild and may not be related to the patient's symptoms. |
Generate impression based on findings. | Chronic sinusitis with septal deviation. There is no paranasal sinus opacification. The nasal cavity is clear and there is no significant nasal septal deviation or spur formation. The partially imaged intracranial structures are grossly unremarkable. The overlying facial soft tissues are also unremarkable. | Clear paranasal sinuses and nasal cavity without significant nasal septal deviation or spur formation. |
Generate impression based on findings. | 33 year-old female. Pleural mesothelioma status post 4 cycles of chemotherapy. Evaluate for disease and compare to previous. CHEST:LUNGS AND PLEURA: Status post left pneumonectomy with placement of diaphragmatic mesh. Diffuse left pleural thickening and basilar nodularity, not significantly changed. Reference measurements as follows:1. At the level of the aortic arch at the 4 o'clock and 6 o'clock (series 609, image 30), measuring 9 and 8 mm, unchanged.2. At the level of the pulmonary artery (series 609, image 37), the 2 o'clock and 7 o'clock lesions measure 6 and 10 mm, unchanged.3. At the level of the left ventricle (series 609, image 53) at 7 o'clock, measures 6 mm, unchanged.MEDIASTINUM AND HILA: Left chest wall port tip is at the cavoatrial junction. Small and mildly prominent mediastinal lymph nodes measuring up to 12 mm (series 609, image 22), not significantly changed. Left hila surgical clips. Midline sternotomy. CHEST WALL: Multiple soft tissue nodules outside of the ribs in the left chest wall consistent with tumor, not significantly changed (series 609, image 41, 61, and 82), including the previously measured 20 x 10 mm nodule (image 61).ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted..SPLEEN: Mild splenomegaly. ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: Multiple small and mildly prominent retrocrural lymph nodes, not significantly changed. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted. | Stable examination with no significant interval change in left pleural thickening and nodularity. |
Generate impression based on findings. | Patient with a clinical deterioration with worsening of headache and new mental status changes. There is redemonstration of a 35 x 63-mm hematoma centered in the right temporal lobe associated with surrounding edema. The dimensions of this hematoma are unchanged. There is associated mass effect with some compression of the trigone of the right lateral ventricle . The visualized portions of the paranasal sinuses demonstrate minor opacities with a mucous retention cyst in the left maxillary sinus and a small one in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is a right temporal lobe hematoma which is stable when compared to the prior exam. |
Generate impression based on findings. | 15 years old Female. Reason: squamous cell carcinoma of tongue with bilateral neck metastases. Evaluate response to 2 cycles of induction chemo. The right lateral oral tongue has substantially decreased in size, which now measures 6 x 12 mm, previously 46 x 23 mm. There has also been interval decrease in size of heterogeneous cervical lymphadenopathy. For example, the conglomerate right level 2 and 3 lymph node now measures 27 x 52 mm, previously 35 x 66 mm. Likewise, the left level 3 conglomerate lymph node mass, just deep to the left sternocleidomastoid muscle (series 5 image 38) measures 24 x 9 mm, previously 25 x 38 mm. The upper airway is patent. The thyroid gland is unremarkable. The carotid arteries and jugular veins are patent. A right internal jugular venous catheter is in position. The osseous structures are unremarkable. The partially imaged portions of the chest are unremarkable. | Interval decrease in size of the right oral tongue squamous cell carcinoma and cervical metastatic lymphadenopathy, indicating treatment response. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Altered mental status. There is a hypoattenuating focus in the left cerebellar hemisphere, which was not clearly defined on the prior exam. There is no evidence of acute intracranial hemorrhage. The ventricles are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is an enteric tube in position. The skull and extracranial soft tissues are otherwise unremarkable. | A hypoattenuating focus in the left cerebellar hemisphere, which was not clearly defined on the prior exam, may represent an infarct of indeterminate age. MRI of the brain may be useful for further characterization, if there are no contraindiucations. No evidence of intracranial hemorrhage.Discussed with Dr. Fedson at 2:00 PM on 12/31/13. |
Generate impression based on findings. | Status post right partial glossectomy with flap reconstruction for tongue cancer s/p chemo and XRT, now with recurrent tumor. Head: There is no evidence of intracranial mass, or abnormal enhancement. Thre is unchanged mild nonspecific cerebral white matter hypoattenuation. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Neck: There are post-treatment findings related to partial right glossectomy, neck dissection, and tracheostomy. Streak artifact related to dental amalgam obscures portions of the oral cavity. Within this limitation, there is an ill-defined hyperattenuating mass along the lateral aspect of the right oral tongue surgical site that measures approximately 35 x 15 mm. There is no definite osseous invasion. There is persistent supraglottic mucosal edema. The major salivary glands appear unchanged, with radiation-induced hyperemia of the submandibular glands. The thyroid gland is unremarkable. The airways are patent. The right internal jugular vein is not identified, which is unchanged. A cardiac pacing device is in position. | 1. Recurrent right oral tongue tumor that measures up to approximately 35 mm, but no evidence of significant lymphadenopathy.2. No evidence of intracranial metastases. |
Generate impression based on findings. | 70-year-old male with a history of newly diagnosed GE junction cancer. Staging examination. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules. Note is made of bilateral pleural effusions, right greater than left, with underlying atelectasis/consolidation.MEDIASTINUM AND HILA: Vascular calcifications of the aorta and its branches. Marked coronary artery calcifications. No pericardial effusion.Right paratracheal lymphadenopathy measures 17 x 13 mm (38; series 401). Note is made of numerous additional enlarged mediastinal lymph nodes.Paraesophageal lymphadenopathy measures 14 mm in the short axis (69; series 401). Numerous additional enlarged paraesophageal lymph nodes are identified.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Gallstones, without evidence of acute cholecystitis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Note is made of multiple bilateral simple cysts. There are multiple subcentimeter hypodensities are identified in the kidneys, which are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy measures 2.6 x 1.6 cm (93; series 401).BOWEL, MESENTERY: Oral contrast reaches the distal small bowel. No dilated loops of bowel suggest obstruction. No free intraperitoneal air, pneumatosis intestinalis, portal venous gas. Thickening of the cardia of the stomach consistent with the findings of FDG avid tumor on recent PET/CT examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Note is made of a moderate amount of abdominopelvic ascites. There are multiple foci of peritoneal implants consistent with peritoneal carcinomatosis (image 99 and 178 of series 401).PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is incompletely distended, limiting evaluation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Thickening of the cardia of the stomach with associated extensive mediastinal and paraesophageal lymphadenopathy as well as peritoneal carcinomatosis consistent with metastatic disease.2. Bilateral pleural effusions. |
Generate impression based on findings. | 15-year-old female with squamous cell carcinoma of the tongue status post chemotherapy For findings in the neck, please refer to dedicated neck CT performed on the same day.LUNGS AND PLEURA: No consolidation or pleural effusions. Minimal left lower lobe atelectasis.There is a 1.5-cm ill-defined ground glass opacity in the right upper lobe. No suspicious solid nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Right-sided port catheter with tip in the right atrium. Heart size is normal without pericardial effusion. CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: No significant abnormalities noted in the visualized upper abdomen. | 1.Groundglass opacity in the right upper lobe may represent focal infection, atelectasis or postinflammatory changes. Continued follow-up is recommended.2.No definitive evidence of metastatic disease in the chest |
Generate impression based on findings. | 64-year-old male. Reason: hypothermia, leukocytosis History: hypothermia, leukocytosis. CHEST:LUNGS AND PLEURA: Redemonstrated patchy upper lobe consolidation, with slight interval increase in the right upper lobe suggested by increased confluence. Large bilateral pleural effusions are grossly unchanged with associated compressive atelectasis and partially loculated right-sided effusion.Nodular opacity in the posterior right lower lobe may represent rounded atelectasis versus infarct (image 73, series #4).MEDIASTINUM AND HILA:Interval development of small volume anterior pneumomediastinum. Small pericardial effusion is unchanged. Interval placement of right IJ central venous catheter, with tip terminating at the cavoatrial junction. Status post heart transplant. Moderate atherosclerotic calcifications of the thoracic aorta, epicardial pacing wires, median sternotomy, tracheostomy, and thyroid nodules are redemonstrated.CHEST WALL: Mild degenerative changes of the thoracolumbar spine. Anasarca.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the abdominal aorta and its branches, without focal ectasia.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Percutaneous gastrostomy tube is noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Anasarca.OTHER: Extensive ascites and anasarca. | 1.Slight interval increase in upper lobe consolidation.2.Interval development of small volume anterior pneumomediastinum of unclear etiology.3.Unchanged large bilateral pleural effusions, with partial loculation of the right sided effusion.4.Extensive ascites and anasarca. |
Generate impression based on findings. | 60 year-old female. Tongue cancer. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Interval resolution of upper lobe groundglass opacities, basilar atelectasis/consolidation, and small pleural effusions. Lower lobe bronchial and bronchiolar wall thickening.6 mm right lower lobe nodule (series 4, image 130), unchanged dating back to 7/2013, favored to be benign. No new pulmonary nodules identified.MEDIASTINUM AND HILA: Tracheostomy tube in place. Decreased size of previously mildly prominent mediastinal lymph nodes. Left subclavian pacemaker unchanged in position. CHEST WALL: Mild degenerative arthritic changes of thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips. No suspicious hepatic mass identified. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts. Subcentimeter renal hypodensities too small to characterize, but likely also cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.G-tube in place.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1. No specific evidence of intrathoracic metastasis.2. Resolution of upper lobe groundglass opacities and basilar atelectasis/consolidation. 3. Decreased mediastinal lymphadenopathy which probably was reactive. |
Generate impression based on findings. | 75 years old Female. Reason: evaluate for intracranial injury History: unwitnessed fall. Reported prior CVA with residual dysphagia. No acute intracranial hemorrhage. No depressed calvarial fractures. Confluent periventricular and subcortical hypoattenuating foci are suggestive of moderate small vessel ischemic disease of indeterminate age. The gray white matter differentiation is preserved without specific evidence of acute supratentorial large cortical ischemia. Wedge-shaped hypoattenuation involving the inferior right cerebellum which remain slightly greater than CSF density is consistent with age indeterminate infarct, although likely late subacute to chronic in etiology given the low density and minimal volume loss. The paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial hemorrhage.2. Right cerebellar infarction, which is likely subacute to chronic in etiology, however correlation with prior clinical history and outside imaging is recommended. If there is high clinical concern of acute ischemia, MRI is recommended.3. Moderate small vessel ischemic changes of indeterminate age. |
Generate impression based on findings. | 74 year-old male. SOB, hypoxia. Evaluate for PE. PULMONARY ARTERIES: Status post left upper lobectomy. Very poor opacification of left lower lobe pulmonary arterial vasculature, which is probably from decreased perfusion to the left lung rather than acute pulmonary emboli. Technically adequate exam for evaluating pulmonary embolism on the right with no evidence of pulmonary embolism. LUNGS AND PLEURA: Irregular right upper lobe mass is difficult to accurately measure; it appears larger at 7.7 x 6.7 cm, previously 6.7 x 5.5 cm. Several other right upper lobe nodular opacities also appear larger.Nodular consolidation in the right lower and middle lobes, not significantly changed. Post-surgical changes of left upper lobectomy. Severe bronchiectasis/cystic change in left midlung and completely consolidation in left base with a small loculated pleural effusion, not significantly changed. MEDIASTINUM AND HILA: Increased size of mediastinal lymphadenopathy, including a 20 mm node abutting the aortic arch, previously 12 mm (series 9, image 56). CHEST WALL: Deformity and bridging of multiple left-sided ribs, unchanged. Degenerative changes of thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Peripherally calcified nodule in the anterior omentum, unchanged. | 1. No evidence of pulmonary embolism in the right lung. Very poor opacification of the left lower lobe pulmonary artery vasculature, probably from decreased perfusion to the atelectatic left lower lobe rather than pulmonary embolus.2. Increased size of right upper lobe mass and surrounding nodules. 3. Increased mediastinal lymphadenopathy. |
Generate impression based on findings. | 42 years old Male. Reason: evaluate for worsening of intracranial hemorrhage History: evaluate for worsening of intracranial hemorrhage Hyperdense superior left frontal lobe intraparenchymal hemorrhage shows slight decrease in density, consistent with expected evolution. The surrounding vasogenic edema is stable. Bilateral supratentorial and infratentorial scattered subarachnoid hemorrhage also demonstrate continued interval decrease in density, consistent with evolving hemorrhage. No new hemorrhage. No intraventricular hemorrhage. The osseous structures are unremarkable. Stable mucosal thickening of the maxillary sinuses. | Expected evolution of left frontal intraparenchymal hemorrhage and multifocal subarachnoid hemorrhages. |
Generate impression based on findings. | 30 years old Female. Reason: mastoiditis? intracranial spread? History: right ear pain, mastoid ttp, dm The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. There are patchy opacification in the ethmoid air cells bilaterally and debris within the nasal passages. Small amount of opacification is also present in several right mastoid air cells without overlying soft tissue thickening. The inferior most left mastoid air cells are incompletely imaged. | Minimal nonspecific opacification of the ethmoidal air cells and right mastoid air cells without overlying soft tissue thickening. Please correlate clinically. |