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Generate impression based on medical findings. | Cerebral infarction, unspecified [I63.9] / Other amnesia [R41.3], Reason for Study: ^Reason: right subcortical stroke, memory difficulties History: as above. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is encephalomalacia on the right basal ganglia with the susceptibility artifacts indicating prior hemorrhagic infarct.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Right basal ganglia chronic hemorrhagic infarction with encephalomalacia.No acute ischemic or hemorrhagic lesion on this scan. |
Generate impression based on medical findings. | 52-year-old man with history of excruciating back pain and bilateral sciatica. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L5 on S1; otherwise the alignment is within normal limits. Bone marrow signal is slightly heterogeneous but benign. The L5/S1 disc is desiccated. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: There is a minimal disc bulge. There is also mild prominence of the dorsal epidural fat and minimal narrowing of the spinal canal. Otherwise no significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: There is a mild disc bulge with mild right and minimal left neural foraminal stenosis. There is moderate facet arthropathy. No spinal canal stenosis.L5-S1: There is a mild disc bulge with small central protrusion. There is mild right neural foraminal stenosis and mild to moderate left neural foraminal stenosis. No spinal canal stenosis.Paraspinous soft tissues are within normal limits. | 1.Mild multilevel degenerative disease of the lumbar spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. There is mild right L4-5 and L5-S1 and mild to moderate left L5-S1 neural foraminal stenosis. Additional details as above.2. Moderate facet arthropathy at L4-5 which may also be contributing to patient's low back pain. |
Generate impression based on medical findings. | 2 years, Male, strep pneumonia meningitis. Previous seen areas of nonsuppression of CSF in the cerebral hemispheres on the FLAIR sequences have resolved. Subtle foci of T2/FLAIR hyperintensity are again seen within the bilateral cerebellar hemispheres, which are slightly decreased in prominence on the right and slightly increased on the left. There is subtle associated diffusion hyperintensity. No abnormal parenchymal or meningeal enhancement is appreciated. No intracranial mass or mass effect. No findings to suggest cerebral abscess or evidence of empyema. Ventricles are normal in size without evidence of hydrocephalus. No evidence of acute ischemia or hemorrhage.There is symmetric enhancement of the bilateral cavernous sinuses without evidence of cavernous sinus thrombosis. Pituitary gland appears unremarkable for patient's age. Bilateral orbits appear grossly unremarkable. Interval marked improvement in previously seen opacification of the bilateral maxillary sinuses and ethmoid sinuses is noted. Previously seen opacification of the left mastoid air cells is much improved with mild residual opacification. | 1. No evidence of cavernous sinus thrombosis. No evidence of intraparenchymal abscess or empyema. 2. Previously seen nonsuppression of CSF on the FLAIR sequence related to meningitis is no longer appreciated and is suggestive of overall improvement of meningitis. There are however subtle foci of FLAIR hyperintensity in the bilateral cerebellar hemispheres, which are slightly decreased on the right and slightly increased on the left since 1/1/2016; these findings are likely related to parenchymal involvement of infection.3. Interval improvement in previously seen paranasal sinus opacification as well as improved aeration of the left mastoid air cells. |
Generate impression based on medical findings. | 66-year-old male with rising PSA after prostatectomy. PSA 0.21 PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted. Asymmetric soft tissue along the left aspect of the cystourethral anastomosis with corresponding mild early asymmetric enhancement (series 1501, image 42). LYMPH NODES: Prominent bilateral inguinal lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Asymmetric soft tissue demonstrating early enhancement along the left aspect of the cystourethral anastomosis is equivocal for a focus of residual/recurrent disease. |
Generate impression based on medical findings. | Reason: back pain, sp fall, evaluate for disc problem History: pain. 31 year old patient with lower back pain. She does have a left breast marker. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left perimedian disk extrusion present with the disk material extending slightly behind the adjacent endplates. There is a some encroachment of the nerve roots of the left lateral recess resulting. There is mild loss of disk space height and disk desiccation at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge and disk desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There is a left paramedian disk protrusion present at L4-5 which encroaches the nerve roots of the left lateral recess increta mild degree of spinal stenosis. |
Generate impression based on medical findings. | 39-year-old male with seizure status post a partial suprasellar mass resection. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. Right frontoparietal craniectomy with overlying skin staples and surgical drain with adjacent frontal and left temporal pneumocephalus consistent with postsurgical procedure. A small amount of hemorrhage is present in the subarachnoid space and overlying the left cerebellar hemisphere. This examination is nondiagnostic for evaluation of the pituitary sella; for evaluation of residual disease, MRI of the pituitary may be considered.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Postsurgical changes as described above without acute abnormality.2. For evaluation of residual disease MRI of the pituitary may be considered. |
Generate impression based on medical findings. | 59 year old male with a history of heart failure with preserved ejection fraction, hypertension, coronary artery disease, atrial arrhythmias, and COPD who was recently discharged after decompensated heart failure. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is asymmetric severe left ventricular hypertrophy (basal to mid anteroseptal wall 17mm and posterior wall 7 mm). There is no LVOT gradient or flow acceleration noted. There is a significant amount of late gadolinium enhancement which involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is mildly elevated (1120 ms). The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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. No systolic anterior motion of the mitral leaflets. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size and systolic function (LVEF 64%). There is asymmetric severe left ventricular hypertrophy which is worst in the basal anteroseptum. There is also a significant amount of late gadolinium enhancement which nearly circumferentially involves much of the basal to mid left ventricular endocardial surface. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The morphological features of the left ventricle are suggestive of hypertrophic cardiomyopathy; however, the late gadolinium enhancement pattern is fairly suggestive of the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 54%).3. Moderate biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 77-year-old male with left-sided weakness, poor balance and dysarthria Multiple areas of vasogenic edema and some with internal areas of high density are believed to represent multiple metastatic lesions some with hemorrhagic component. Further correlation with an MRI or a postinfusion CT is recommended. There appears to be a large mass within the corpus callosum with bilateral extension. Images through posterior fossa are unremarkable. | 1.Findings findings concerning for multiple metastatic lesions some with hemorrhagic components.2.Follow-up with an MRI with infusion is recommended. |
Generate impression based on medical findings. | 51 year old female status post left mastectomy in August of 2014 for invasive ductal carcinoma. Patient received radiation, chemotherapy. Status post left mastectomy and left axillary lymph node dissection.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.There is a benign lymph node at right axillary tail.No abnormal enhancement is seen in right breast or left mastectomy bed. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Gait abnormality. Evaluate for radiculitis. Alignment is notable for 3 mm of anterior subluxation of L4 relative to L5 as a result of facet degenerative disease. This is associated with mild height and T2 signal loss at L4-L5 disc. Alignment is otherwise anatomic and the other discs are preserved in height and T2 signal. Vertebral bodies are preserved in height. Foci of fat-signal are present in L2, L4 and S1 bodies. Otherwise, marrow signal heterogeneity is associated with complete suppression on the fat suppressed sequences and therefore most likely of no significance. The spinal canal is moderately to severely narrowed at L4-L5 level. It is preserved at the other levels. Only on the sagittal STIR images, there is a small focus of increased signal in the posterior aspect of the spinal cord at T11-T12 intervertebral level. This is not covered on the axial images and is not conspicuous on the other sagittal sequences and therefore may very likely be artifactual. Otherwise, the conus medullaris has normal morphology and signal. The tip of the conus medullaris is at the L1-L2 level.T12-L1: There is no central or foraminal stenosis.L1-L2, L2-L3 and L3-L4: Disc bulges are minimal. There is no central or foraminal stenosis.L4-L5: Anterior subluxation is associated with uncovering of the disc. There is also facet hypertrophic change and ligamenta flava buckling. Together, these result in moderate to severe central spinal narrowing. The subarticular recesses are also narrowed and there is mild right and left foraminal narrowing.L5-S1: There is mild facet hypertrophic change but no central or foraminal narrowing. Small renal lesions are not completely assessed though likely cysts. | 1.Moderate to severe narrowing of the central and lateral spinal canal at L4-L5 is caused by spondylolisthesis/disc uncovering and posterior element hypertrophy/thickening as described above. Moderate right and mild left foraminal narrowing.2.Spondylosis at the other levels is minimal.3.A focus of apparent signal abnormality in the lower spinal cord seen only on the sagittal STIR sequence is likely artifactual. |
Generate impression based on medical findings. | MS, follow-up progression. History of paresthesias. There are several punctate and curvilinear T2/flair hyperintensities demonstrated in the periventricular and subcortical white matter which are unchanged in size, appearance, and location compared to the prior MRI. A stable punctate T2/flair hyperintensity is noted within the left superior pons. No new lesions are identified. There is no evidence of intracranial hemorrhage or mass. The pituitary gland appear unremarkable. 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. | No significant interval change in size and number of scattered T2/FLAIR hyperintensities seen in the subcortical and periventricular distribution, compatible with history of demyelinating disease. |
Generate impression based on medical findings. | Knee pain and effusion Tendons and ligaments: The anterior cruciate ligament and the posterior cruciate ligaments are intact.The medial collateral ligament is intact. The lateral collateral ligament, the biceps femoris tendon, the popliteus tendon and the iliotibial band are intact. The quadriceps tendon and the patellar tendon are intact.Menisci: There is maceration of the medial meniscus body and posterior horn. There is mild anterior extrusion of the anterior horn of the medial meniscus. There is an obliquely oriented tear of the posterior horn of the lateral meniscus.Joints:There is extensive cartilage loss of the medial femoral condyle with a small amount of reactive marrow edema along the posterior aspect. Similar although less severe cartilage loss is also identified in the lateral compartment. Again noted are apparent erosions of the medial cortex of the femur.The patellofemoral articulation is intact and without evidence of subluxation and articular cartilage defect.Joint effusion and soft tissues: There is a trace amount of joint fluid with thickened enhancing synovium. Additionally, a small focus of signal void is seen in the anterior joint space which demonstrates some associated artifact. A mild amount of subcutaneous edema is present.Osseous structures: No focal marrow replacing lesions are identified. There is no fracture. | 1. Diffuse synovitis with apparent erosions of the medial joint space. Additionally, there is extensive cartilage loss particularly of the medial compartment with a mild amount of reactive marrow change in the posterior aspect of the medial femoral condyle. These findings are again nonspecific and may be inflammatory in nature however the possibility of infection cannot be excluded.2. Maceration of the posterior horn of the medial meniscus with oblique tear of the posterior horn of the lateral meniscus.3. Small focus of signal abnormality within the joint may represent either a small focus of gas or small metallic artifact possibly from instrumentation of the knee such as scope or aspiration |
Generate impression based on medical findings. | Clinical question: Dizziness; evaluate for structural lesions. Signs and symptoms: Dizziness. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates scattered foci of FLAIR hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia, bilateral thalami (R>L) and bilateral paramedian pons. Findings are nonspecific and demonstrate no evidence of susceptibility signal changes. A few of the lesions demonstrate perpendicular access to the ventricular wall in their orientation. In this age group this appearance is often result of microvascular ischemic changes however less likely possibility of demyelinating disease considering and also be consideredThere is no detectable signal abnormality of the cortex or the cerebellum/vermis. This signal void in major intracranial arterial branches are identified. Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Findings highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild to moderate degree both in supra and infratentorial brain parenchyma. Remote possibility of demyelinating disease cannot be entirely excluded.3.Unremarkable nonenhanced brain MRI otherwise for patient's stated age of 68. |
Generate impression based on medical findings. | There are nonspecific foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are favored to represent chronic small vessel ischemic disease. A focus of peripherally increased T2-weighted signal in the left anterior parietal white matter is favored to represent a chronic lacunar infarct. Foci of increased T2 weighted signal in the globi pallidi may be related to prior toxic metabolic or ischemic injury. No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no abnormal enhancement within the brain. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. The visualized paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable. | 1. No evidence of intracranial metastases.2. Additional chronic findings, including mild chronic small vessel ischemic disease, lacunar infarct in the left anterior parietal white matter and areas of T2 hyperintensity in the globi pallidi, which may be related to remote toxic metabolic or ischemic injury. |
Generate impression based on medical findings. | HTN, preDM and new right CN 4 palsy, worsening. MRI: There are a few scattered T2 hyperintensities in the cerebral white matter bilaterally. The brainstem and cerebellum appear unremarkable. There is no evidence of intracranial hemorrhage or acute infarction. There is no midline shift or mass effect. There is mucosal thickening of the maxillary sinuses, left greater than right, with an fluid in the left maxillary sinus. The orbits, cavernous sinuses, and skull are unremarkable. MRV: The major dural venous sinuses are patent and symmetric, without evidence for dural venous sinus thrombosis. | 1. No discernible cranial nerve abnormality.2. A few scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic microvascular ischemic disease.3. No evidence of venous sinus thrombosis.4. Findings suggestive of acute left maxillary sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Possible TIA. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse patchy cerebral white matter T2 hyperintensity. 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. | Mild diffuse patchy cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | Male 17 years old Reason: History of PSC, MRCP to evaluate for worsening disease and biliary sludge involving the pancreatic neck as seen on outside ultrasound. History: History of PSC with elevated LFTs, abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: There is marked dilatation of the common hepatic duct, with beaded appearance extending into the left and right hepatic ducts as well, increased from prior exam. Abrupt transition of dilatation, with no discrete mass or stone identified. Favor stricture as etiology. Gallbladder is distended, new from prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Normal parenchymal appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval development of marked intrahepatic biliary ductal dilatation and gallbladder distention, with abrupt transition in common hepatic duct. No mass or stone identified, favor stricture as etiology. |
Generate impression based on medical findings. | 80-year-old male presents with insidious cognitive impairment. There appears to be diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal amount of periventricular cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild mucosal thickening in the paranasal sinuses. The skull, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. | 1. Apparent diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. This may indicate the possibility of Alzheimer dementia. A PET scan may be useful for further evaluation.2. Minimal amount of periventricular cerebral white matter T2 hyperintensity is nonspecific, but may reflect chronic small vessel ischemic changes.3. Mild mucosal thickening in the paranasal sinuses.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Status post liver donor transplant 2/08 for PSC, elevated AP 483 and CA 19-9 112. Evaluate for biliary dilatation, assess hepatic vessel patency, evaluate for evidence of cholangiocarcinoma. ABDOMEN:LUNG BASES: Left lung base nodule. Prominent right cardiophrenic lymph node, unchanged.LIVER, BILIARY TRACT: Postsurgical findings of liver transplant with hepaticojejunostomy. Geographic mass-like areas of hypoenhancing T2 hypointensity and T1 hyperintensity in the posterior right hepatic lobe and caudate lobe, significantly increased in size dating back from 2/2010. These may represent perfusion abnormalities; tumor is felt to be unlikely as vessels course through these areas without attenuation or mass effect and there is no associated diffusion restriction. No signal loss on opposed phase images in these areas to suggest fat.No definite suspicious hepatic mass is identified. Hepatic arteries, portal vein, hepatic veins are patent. Diminutive left portal vein, unchanged.Mild intrahepatic biliary ductal dilatation with scattered foci of narrowing, not significantly changed.SPLEEN: Splenomegaly with prominence of the splenic vein, unchanged. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent porta hepatis lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace abdominal ascites. | 1.Stable mild intrahepatic biliary ductal dilatation with scattered areas of narrowing. Patent hepatic vasculature.2.Geographic areas of signal abnormality involving the right posterior hepatic lobe and caudate lobes progressively increased in size from 2010, possibly representing perfusion abnormalities. 3.No definite suspicious hepatic mass is identified.4.Left lung base nodule, for which CT chest is recommended for further evaluation. |
Generate impression based on medical findings. | Redemonstrated are remote post-operative findings related to a left parieto-occipital craniotomy for tumor resection. There is unchanged T2/FLAIR hyperintensity surrounding the resection cavity as well as unchanged bilateral periventricular and subcortical T2/FLAIR hyperintensity, left greater than right. There is no suspicious enhancement. There is a thin rim of T1 shortening and susceptibility artifact along the periphery of the surgical cavity, consistent with blood degradation products and/or mineralization. There is an unchanged punctate focus of susceptibility effect within the left frontal white matter, consistent with hemosiderin deposition from chronic microhemorrhage. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, including mild ex vacuo dilatation of the left ventricular atrium. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | Compared to 1/22/2015 and 7/9/2014, there are stable post-operative findings related to a remote left parieto-occipital craniotomy for tumor resection with surrounding T2/FLAIR hyperintensity consistent with posttreatment change. No evidence of tumor progression. |
Generate impression based on medical findings. | Reason: evaluate for meniscal tear, ligament tear, etc. Had a fall about 6 weeks ago with subsequent persistent swelling History: right knee pain MENISCI: There is complex, multidirectional tearing of the medial meniscus involving the body and posterior horn, with a prominently oblique component, which contacts the superior and inferior articular surfaces, and has progressed from the prior study in 2013. Additionally, there is a complex, multidirectional tear of the lateral meniscus with lateral extrusion and redundancy of the fragmented meniscus into the posterior intercondylar notch. There is a posterior lateral parameniscal cyst. Overall, the tearing is likely degenerative, and has progressed from the prior study.ARTICULAR CARTILAGE AND BONE: Again seen is severe tricompartmental osteoarthritis including near total chondral loss in the weightbearing aspects of the joint, particularly in the lateral tibiofemoral compartment, slightly progressed from the prior study in 2013. There is diffuse grade 3 chondral loss in the patellofemoral compartment. There are exuberant tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. The posterior corner structures appear to be intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Complex, multidirectional degenerative type tearing/maceration of the medial and lateral menisci, which has progressed from the prior study in 2013.2.Tricompartmental osteoarthritis with exuberant osteophyte formation and multifocal complete chondral loss.3.Moderate joint effusion. |
Generate impression based on medical findings. | Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3 t scanner ccm protocol, qsm/permiability History: s/p resection from 7/21 Evidence of left frontotemporal craniotomy with susceptibility lesions on the left mesial temporal lobe indicate postoperative status.There is underlying dural enhancement and thickening at the level of craniotomy which is again postoperative changes.There is no evidence of acute hemorrhagic or ischemic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Left mesial temporal lobe cavernous malformation resection status, no unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on medical findings. | Characterize liver lesion seen on outside hospital CT. ABDOMEN:LIVER, BILIARY TRACT: Please note that the outside hospital CT from July is not available for comparison. There are several scattered T1- weighted hypointense lesions within the liver parenchyma the majority of which measure less than 1 cm with minimal thin-walled peripheral enhancement. The largest is a segment 8 lesion measuring 1.2 x 0.8 cm. This corresponds to the subtle hypoattenuating lesion seen on the CT dated 11/22/2014 where it measured 2.9 x 1.9 cm. The additional hypoattenuating lesion seen on CT have corresponding lesions on the MRI which are also significantly decreased in size.No new suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few left renal cyst. No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Interval improvement in previously seen partially imaged pericolonic inflammatory changes.BONES, SOFT TISSUES: Very small fat-containing umbilical hernia.OTHER: No significant abnormality noted. | 1. Please note that the outside hospital CT referred to in the order is not available for comparison. However, given this limitation the largest lesion measures 1.2 cm and is significantly decreased in size from the 11/2014 CT study. Additional subcentimeter thin peripherally rim-enhancing hypointense lesions demonstrate interval decrease in size and are compatible with treated residua of previously seen large abscesses. No suspicious liver lesion is identified.2. Interval improvement in previously partially imaged pericolonic inflammatory changes. |
Generate impression based on medical findings. | Reason: Eval for TIA/stroke like symptoms History: transient paresthesias, dyscoordination, numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a small T2 and flair signal hyperintensity present along the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the ethmoid air cells. 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 and the proximal anterior, middle and posterior cerebral arteries.The right vertebral artery demonstrates normal antegrade flow beyond the origin of the right posterior inferior cerebellar artery. The left vertebral artery is diminutive distally. The basilar artery appears to be occluded or near occluded beginning at the vertebrobasilar junction. The posterior communicating arteries appear to be the main supply to the posterior cerebral arteries and the P1 segments.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.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The left common artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing of the proximal right internal carotid artery with approximately 20% focal narrowing approximately 15 mm from the origin of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries. | 1.Findings are compatible with occlusion or near occlusion of the distal right vertebral artery intracranially as well as the basilar artery with reconstitution of posterior circulation flow via collaterals from the anterior circulation as well as the posterior inferior cerebellar arteries.2.There is no evidence for acute ischemic infarction appreciated.3.Findings suggest an old lacunar infarct in the right pons |
Generate impression based on medical findings. | History of left cavernous sinus aneurysm. The examination demonstrates expansion of the left cavernous sinus. In comparison with a prior brain MRI, it remains stable. The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial hemorrhage, edema, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in volume and symmetric.Visualized paranasal sinuses mastoid air cells are normally pneumatized. The bony density of the calvarium and skull base is radiographically normal.CTA shows a gigantic aneurysm in the anterior aspect of the left internal carotid artery, which is mostly within the cavernous sinus with little expansion into the supraclinoid segment. It measures 14.4 x 19.2 mm on the sagittal view and 19.9 x 12.0 mm on the coronal view. In addition, little ectasia of the right internal carotid artery is noted. The right internal carotid, vertebral, basilar and their intracranial major branches are patent with no evidence of aneurysm or significant stenosis. | Grossly stable left cavernous sinus fusiform aneurysm as detailed above. |
Generate impression based on medical findings. | Clinical question: Spinal cord? Signs and symptoms: Neck pain. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwiseC5 -- C6 demonstrate mild disk disease and loss of disk height and mild bilateral facet degenerative changes. There is resultant mild to moderate left neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height and minimal facet disease. There is a broad-based disk -- osteophyte complex on the left with resultant effacement of the left subarachnoid space without detectable mass effect on the cord. There is mild central spinal stenosis and significant left neural foraminal compromise.C7 -- T1 demonstrate mild degenerative changes and unremarkable otherwise.Normal signal intensity of the cervical and upper most visualized thoracic cord. | 1.C6 -- C7 demonstrate degenerative changes, broad-based disk osteophyte complex on the left with resultant mild central spinal stenosis and significant left neural foraminal compromise.2.Degenerative changes at C5 -- C6 with resultant mild to moderate left neural foraminal compromise.3.Mild degenerative changes at other levels without spinal stenosis or neural foraminal compromise. |
Generate impression based on medical findings. | History of small cell lung cancer, with known brain metastases and seizure. There is an irregular peripherally-enhancing mass in the left anterior temporal pole that measures up to nearly 30 mm. There is extensive T2 hyperintensity and mild swelling throughout the left amygdala and hippocampus, with scattered punctate foci of faint enhancement. There is an enhancing nodule in the right fusiform gyrus that measures 8 mm in diameter, with surrounding confluent T2 hyperintensity. In addition, there is an enhancing lesion in the left occipital lobe that measures 6 mm in width, with surrounding confluent T2 hyperintensity. There is no evidence of acute intracranial hemorrhage or infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left anterior maxillary alveolus cystic defect. | Multiple brain metastases with associated vasogenic edema, the largest of which is located in the left anterior temporal pole. Diffuse swelling involving the amygdala and hippocampus with patchy foci of enhancement may be related to seizure activity associated with the metastatic disease. |
Generate impression based on medical findings. | Female 21 years old Reason: Assess for small bowel abnormality History: abd pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No focal inflammation, stricturing or obstruction. The terminal ileum is normal. Contrast has reached the ascending colon.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: Colon is not distended. No focal area of stricturing obstruction or inflammation is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic fluid, likely physiologic. | 1.No focal small bowel or colonic inflammatory change, stricture or obstruction. |
Generate impression based on medical findings. | There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few unchanged patchy foci of T2 hyperintensity within the left frontal and bilateral parietal white matter. The previously noted signal adjacent the right stylomastoid foramen appears symmetric on today's exam. The previously noted signal abnormality within the ventral pons is not well appreciated on today's exam. 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 skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the right maxillary sinus. | 1.No evidence for acute ischemia, hemorrhage, or mass.2.A few unchanged patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific. There are no lesions particularly suggestive of demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 58-year-old male with history of chronic osteomyelitis and medication noncompliance presents with altered mental status and elevated white blood cell count, evaluate for progression of chronic osteomyelitis. Again seen is ulceration of the soft tissues posterior and inferior to the calcaneus. The margin of the posterior calcaneus is less distinct on the current study compared to the prior compatible with stated history of osteomyelitis which was confirmed on MRI study dated 9/10/2015. Additionally, there has been development of a new pathologic fracture through the superior aspect of the posterior calcaneal tuberosity with approximately 1 cm anterosuperior displacement of the retracted fracture fragment. There is thickening of the adjacent Achilles tendon. The bones appear demineralized suggestive of osteopenia. Arterial calcifications are noted in the soft tissues. | Soft tissue ulceration with osteomyelitis at the calcaneus and a new pathologic fracture through the superior aspect of the posterior calcaneal tuberosity.The above findings were communicated via telephone to Mark Belkin, MD at 09:13 AM on 11/03/2015. |
Generate impression based on medical findings. | Right wrist pain. Injection in midcarpal region to assess for lunotriquetral ligament tear. LIGAMENTS: Following midcarpal injection of contrast, contrast remained within the midcarpal joint and does not communicate with the radiocarpal joint. The intrinsic ligaments of the wrist are intact, including the scapholunate and lunotriquetral ligaments.On the T2 weighted images, there is a small amount of fluid in the radiocarpal joint and distal radioulnar joint which is within normal limits. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons are intact. BONES: Bone marrow signal is within normal limits.ADDITIONAL | No evidence of disruption of the intrinsic ligaments of the wrist. |
Generate impression based on medical findings. | 63 year old female with breast cancer and brain METs presents after having a focal seizure in her right arm. There is no evidence of intracranial hemorrhage. Exam is limited for metastatic disease due to lack of post contrast enhancement. Focal area of well-defined hypodensity in the left posterior parietal region along the high convexity is consistent with vasogenic edema. There is mild effacement of the sulci within this region and may be further evaluated with MRI with contrast as clinically indicated. No acute cortical ischemia is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses cells are normally pneumatized.The left mastoid air cells appear opacified. The internal auditory canals are patent bilaterally. | Left posterior parietal region of vasogenic edema may be further evaluated with contrast enhanced MRI as clinically indicated. |
Generate impression based on medical findings. | 55-year-old female patient with lateral joint line pain and popping. Evaluate for lateral meniscus tear. MENISCI: There is a complex tear, including horizontal and vertical components, as well as free edge blunting of the posterior horn of the lateral meniscus. The medial meniscus intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness chondral fissure in the medial patellar facet. There is a 4 mm full-thickness chondral defect in the anterior portion of the medial femoral condyle. There is approximately 1.3 cm of full thickness chondral loss in the weight bearing surface of the lateral tibial plateau and partial-thickness fraying of the weightbearing portion of the lateral femoral condyle.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament complex, medial collateral ligament, and patellar retinacula are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL | 1.Complex tear of the posterior horn of the lateral meniscus.2.Tricompartmental chondromalacia, worst in the lateral compartment. |
Generate impression based on medical findings. | 56-year-old female with degenerative menisci and IT band infection syndrome. MENISCI: Intrasubstance signal within the posterior horn of the medial meniscus compatible with intrasubstance degeneration. No definite tear. Apparent increased signal intensity within the root of the posterior horn of the lateral meniscus likely represents pulsation artifact. No definite tear.ARTICULAR CARTILAGE AND BONE: There is superficial delamination of the articular cartilage of the lateral facet of the patella. Focal blistering of the articular cartilage of the medial facet likely degenerative in etiology. Articular cartilage of the medial and lateral tibiofemoral compartments appears normal for age Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL | 1.Findings compatible with mild IT band friction syndrome.2.Degeneration of the articular cartilage of the patella.3.Mild meniscal degeneration. |
Generate impression based on medical findings. | Aphasia. There is a cluster of punctate foci of restricted diffusion and high T2 signal involving the left inferior frontal gyrus, Heschl gyrus, and superior temporal gyrus. There are otherwise scattered punctate foci of cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts. | Punctate acute posterior left peri-Sylvian sulcus infarcts, without evidence of hemorrhagic transformation. |
Generate impression based on medical findings. | Reason: eval for chronic tenosynovitis History: swelling/pain at wrist LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No evidence of tenosynovitis of the flexor tendons. Extensor tendons are involved in the diffuse swelling of the soft tissue, which limits evaluation of tenosynovitis.BONES: No significant abnormality noted.ADDITIONAL | 1.Diffuse soft tissue swelling and inflammatory changes.2.No evidence of tenosynovitis of the flexor tendons.Extensor tendons are involved in the diffuse swelling of the soft tissue, which limits evaluation of tenosynovitis. |
Generate impression based on medical findings. | Cerebral infarction, unspecified [I63.9] / Hemiplegia, unspecified affecting unspecified side [G81.90] / Diplopia [H53.2], Reason for Study: ^Reason: Hx of metastatic melanoma s/p premlozumab treatment with right hemiparesis, diplopia , R/o PRES, brain me Brain MRI:There are multiple restricted diffusion lesions involving left side lower midbrain-upper pons posterior aspect, left middle cerebellar peduncle and left superior cerebellar hemisphere indicating acute ischemic infarction without evidence of hemorrhagic transformation. There are also focal lacunar infarcts on the left basal ganglia posterior aspect and the right parietal lobe. Underlying brain shows multifocal patchy high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel disease.No evidence of metastasis.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate the left superior cerebellar artery is not visualized. This could be related to hypoplastic left SCA, however, could also represent focal occlusion. Bilateral distal ICAs, right distal vertebral artery, left PCA P2-P3 junction appear to be narrowed in luminal diameter indicating intracranial atherosclerosis.There is no evidence of intracranial arterial aneurysm. Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. Acute ischemic infarct involving left lower midbrain, upper pons, left middle cerebellar peduncle and part of left superior cerebellar hemisphere without evidence of hemorrhage transformation.2. Multiple lacunar infarcts with the nonspecific small vessel ischemic disease on underlying brain.3. Nonvisualization of left superior cerebellar artery. Underlying intracranial arterial system shows atherosclerotic changes. No intracranial aneurysm was seen. 4. No evidence of significant luminal stenosis on extracranial arterial system. |
Generate impression based on medical findings. | Low back pain with radiation into left thigh, also history of metastatic breast cancer, possible spinal stenosis, on tamoxifen. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is mild heterogeneity of the bone marrow which is nonspecific. Endplate marrow signal changes are noted at L4-L5 and L5-S1 which are on a degenerative basis. No suspicious focal lesions are appreciated. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge with mild right foraminal disk protrusion. Minimal narrowing of the inferior aspect of the right neural foramen. Otherwise, no significant spinal canal or left neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disk desiccation with loss of height with mild diffuse disk bulge. There is also ligamentum flavum thickening and mild facet arthropathy which result in minimal narrowing of the spinal canal. There is mild to moderate left neural foraminal narrowing. No right neural foraminal stenosis.L5-S1: There is disk desiccation with loss of height and mild bulge. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. There is mild multilevel facet arthropathy. Paraspinous soft tissues are within normal limits. Small bilateral renal cysts. | 1. No compression fractures or suspicious lesions within the lumbar spine to suggest metastatic disease. Postcontrast study would be more sensitive for small lesions and can be considered if clinically indicated.2. Mild multilevel degenerative changes as detailed above. There is minimal narrowing of the spinal canal at L4-L5, otherwise no significant spinal canal stenosis at any level.3. There is mild to moderate left neural foraminal stenosis at L4-L5 related to disk bulge and facet arthropathy. There is contact of the exiting left L4 nerve root. |
Generate impression based on medical findings. | Diagnosis: Hemangioma of intracranial structuresDiagnosis Edits: Clinical question: 3T Scanner, QSM/Permeability, CCM Protocol, please evaluate for changesSigns and Symptoms: loss of bowel control, new dizziness and trouble speakingComments: 3T Scanner, QSM/Permeability, CCM Protocol, please evaluate for changes | There is redemonstration of a hemorrhagic lesion centered in the left pons but also involving the left middle cerebellar peduncle which is not changed substantially in dimensions. It currently measures 25 x 45 mm and previously measured the same. When compared to the 9/14/2015 exam signal characteristics within the lesion have a changed slightly especially along the left pontine cystic lesion which previously had a more heterogeneous signal in the size and more cystic signal. A hemorrhagic lesion within the right cerebral peduncle and another one in the left upper posterior midbrain are also stable.A high signal intensity lesion on T2 imaging in the left medulla remains stable.There is a developmental venous anomaly redemonstrated in the left cerebellar hemisphere inferiorly.The patient is status post suboccipital craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus as well as minor opacities in the left ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is redemonstration of multiple cerebral cavernous malformations in the brainstem and cerebellum associated with a left cerebellar developmental venous anomaly. Although the dimensions are relatively stable the associated blood products continue to evolve.2.Status post posterior fossa surgery. |
Generate impression based on medical findings. | Chiari malformation, headaches. The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pituitary gland is unchanged, measuring up to 10 mm in height, which is within normal limits. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening. | The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly. |
Generate impression based on medical findings. | Left ear pain, swelling, and drainage. Previous abnormal CT: otorrhea and otalgia. There is a fluid collection in the inferior external auditory canal and auricle that measures up to 28 mm, with extensive enhancement of the surrounding subcutaneous tissues and posterior aspect of the left glenoid fossa and parotid gland. The left inner ear structures and mastoid air cells are intact. The right temporal bone region is unremarkable. There are inflammatory mucosal changes in the left maxillary and ethmoid sinuses. The imaged intracranial structures and orbits are unremarkable. | 1. Left inferior external auditory canal and auricle abscess, with extension of the inflammatory process to the left glenoid fossa and parotid gland. 2. Findings suggestive of sinusitis. |
Generate impression based on medical findings. | Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: 69 year old with short-term memory loss, likely dementia, considering Alzheimer disease and vascular etiology. Please comment on hippocampus. History: memory loss. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Bilateral amygdala and bilateral parahippocampal gyri appear to be symmetrically small in size. There is no evidence of increased signal intensity of bilateral hippocampus on FLAIR or T2 images though this is not a dedicated temporal lobe MR scan. There is no evidence of preferential fronto-parietal lobar atrophy. Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.The ventricular system appears to be slightly enlarged but unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Bilateral symmetric atrophic changes of both amygdala and parahippocampal gyri as described above, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Non specific small vessel ischemic disease. |
Generate impression based on medical findings. | Low back pain, leg numbness, hip weakness. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Minimal L2 on L3 retrolisthesis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Sagittal images demonstrate an epidural collection measuring at least 12 mm in the AP dimension and at least 4 cm in the craniocaudal dimension and extending outside of the field-of-view. This lesion is not well evaluated, but there appears to be effacement of the dorsal thecal sac. This collection demonstrates predominantly fluid density with possible low T2 signal inferiorly.Multilevel degenerative changes are seen, as described below:L1-L2: There is dorsal annular fissure with small left paracentral protrusion. No significant spinal canal or neural foraminal stenosis at this level.L2-L3: There is loss of disc height, associated endplate marrow signal changes, and mild diffuse disc bulge. There is no significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. Minimal left neural foraminal narrowing. No spinal canal or right neural foraminal stenosis.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.There is mild facet arthropathy in the lumbar spine, relatively worse at L4-L5 and L5-S1. Small perineural cysts are incidentally seen at the S2 level. Paraspinous soft tissues are within normal limits. | 1. Mild degenerative changes in the lumbar spine as detailed above without significant spinal canal or neural foraminal stenosis at any level.2. There is an epidural collection in the lower thoracic spine which is seen on the sagittal images and not included on the axial lumbar spine images. There appears to be at least mild narrowing of the thecal sac posteriorly. Recommend dedicated thoracic spine MRI for better evaluation.Findings were communicated to Dr. Roitberg at 1230 pm on 6/16/2015. |
Generate impression based on medical findings. | Aphasia [R47.01], Reason for Study: ^Reason: eval for stenosis History: aphasia Brain MRIMultifocal restricted diffusion lesions on the left hemisphere including left frontal lobe superior and middle frontal gyri, left insular cortex, and left frontal operculum indicating acute ischemic infarction. There is no evidence of hemorrhagic conversion. Underlying brain shows patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of arterial luminal stenosis, no arterial aneurysm on bilateral ICAs, MCAs, ACAs and vertebrobasilar system.Neck MRAMotion artifacts degraded examination quality.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate no evidence of significant (more than 50%) of luminal narrowing of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins appear to be normal but tortuous proximal bilateral vertebral arteries. There is no evidence of luminal stenosis in the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. Multifocal left MCA territorial acute ischemic strokes without evidence of hemorrhagic conversion as described above.2. No evidence of significant arterial luminal stenosis on both intracranial and extracranial craniocervical arterial system. |
Generate impression based on medical findings. | High risk for breast cancer screening, strong family history of breast and ovarian cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | History of left cerebellopontine angle meningioma resection: dizziness. There are postoperative findings related to retrosigmoid craniotomy for resection of a left cerebellopontine angle mass. There is a residual enhancing dural-based mass along the posterior aspect of the left petrous apex with underlying hyperostosis extension into the left internal auditory canal that measures up to 7 mm in thickness. There is minimal mass-effect upon the left pons. There is unchanged patchy T2 hyperintensity, enhancement, and susceptibility effect within the central pons, which may represent a telangiectasia. There are unchanged mildly The supratentorial structures are otherwise appears unremarkable and there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. | Postoperative findings related to retrosigmoid craniotomy for resection of a left cerebellopontine angle mass with a residual enhancing dural-based mass along the posterior aspect of the left petrous apex with underlying hyperostosis extension into the left internal auditory canal that measures up to 7 mm in thickness, which is compatible with residual meningioma. |
Generate impression based on medical findings. | Diagnosis: Non-Hodgkin lymphoma, unspecified, unspecified siteDiagnosis Edits: Clinical question: PCNSL s/p ASCT, re-evalSigns and Symptoms: NHL The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially.The patient is status post suboccipital craniotomy.A small focus of encephalomalacia is present in the right middle frontal gyrus. This is unchanged since the prior exam.There is encephalomalacia present along the right cerebellar hemisphere which is unchanged since prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Small foci of encephalomalacia in the right middle frontal gyrus and right cerebellar hemisphere are redemonstrated and unchanged.2.There is no evidence for recurrent lymphoma. |
Generate impression based on medical findings. | Left shoulder pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa of doubtful significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear of the superior labrum with paralabral cyst formation along the posterior superior aspect of the glenoid. The glenohumeral joint alignment is within normal limits. The articular cartilage appears intact. There is no effusion.BICEPS TENDON: There may be mild tendinosis of the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus.ADDITIONAL | Superior labral tear with paralabral cyst formation. |
Generate impression based on medical findings. | 17 years Female (DOB:7/2/1998)Reason: structural abnormalities History: migraines with visual changes, losing visionPROVIDER/ATTENDING NAME: PATRICIA OGDEN MICHAEL H. KOHRMAN MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 right A1 segment appears to be small.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses and some minor mucosal thickening in the ethmoid air cells and maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits: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.There is no evidence for mass lesion in the midbrain or other lesion within the brain parenchyma to explain the patient's migraines.2.No mass lesion or other abnormalities identified within the orbits.3.There is opacification of the frontal sinuses bilaterally associated with a small amount of opacification of anterior ethmoid air cells. This nonspecific. It's most likely inflammatory in nature. A point of obstruction is not clearly defined on this exam. |
Generate impression based on medical findings. | Outside imaging concerning for hepatocellular carcinoma. History of alcoholic cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with micronodular contour and reticular T2-weighted fibrotic changes. Moderate perihepatic ascites.In segment 7 of the liver there is a 3.6 x 2.9 cm (series 13/59) intrinsically T1 hyperintense lesion demonstrating postcontrast enhancement which is less than the background liver and no definite washout.Additional 1.3 cm lesion in the right hepatic dome (series 13/73) demonstrates similar imaging characteristics. Additional T2-weighted hypointense subcentimeter nodules are noted in the liver.No intra or extrahepatic biliary ductal dilatation.Partially distended gallbladder with numerous gallstones. Nonspecific minimal pericholecystic fluid.The vessels appear patent.SPLEEN: Splenomegaly measuring 16.5 cm in the craniocaudal dimension with numerous siderotic micronodules.PANCREAS: 1.6 x 1.6 pancreatic body cystic lesion demonstrates no postcontrast enhancement but has mild internal complexity. No definite communication with the main pancreatic duct which is normal in caliber. Normal variant ductal anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is significantly distended to the level of the second portion of the duodenum without a discrete mass lesion evident, of unclear etiology. Small volume ascites.BONES, SOFT TISSUES: Recannulated periumbilical vein. Bilateral gynecomastia.OTHER: No significant abnormality noted. | 1. Cirrhotic liver with extensive fibrosis and nodularity. 2. 3.6 cm segment VII lesion does not meet imaging criteria for hepatocellular carcinoma at this time and may represent a giant regenerative nodule or dysplastic nodule. Additional 1.3 cm right hepatic dome lesion with similar imaging characteristics. Continued surveillance imaging is recommended.3. Small volume ascites, splenomegaly and collateral vessel formation compatible with portal hypertension.4. 1.6 cm pancreatic body cystic neoplasm with mild internal complexity but no postcontrast enhancement. Follow up is suggested. |
Generate impression based on medical findings. | 69-year-old male with family history of HCC and liver lesion seen on outside hospital imaging. ABDOMEN:LIVER, BILIARY TRACT: Small right hepatic lobe cysts. No suspicious hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.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. | No significant abnormality. |
Generate impression based on medical findings. | Diagnosis: Headache Hydrocephalus, unspecified Presence of cerebrospinal fluid drainage deviceClinical question: new weakness, h/o spina bifida s/p VP shuntsSigns and Symptoms: new weakness The patient is status post ventriculostomy tubes one coursing through the right temporal lobe into the trigone of the right lateral ventricle other one coursing through the left occipital lobe into the body of the left lateral ventricle with tip anteriorly adjacent to the frontal horn. There is a linear signal change present within the right frontal lobe which is a compatible with prior ventriculostomy tract is unchanged since the prior exam. There is a port adjacent to the left occipital catheter associated with tubing.There are periventricular T2 and FLAIR signal hyperintensities present as well as signal hyperintensities in the corpus callosum on T2 and FLAIR MRI which are stable compared to the previous exam.On susceptibility imaging imaging there is a punctate signal hyperintensity in the left centrum semiovale. Translation and is of little clinical significance. Some foci of signal hypointensity are also present along the right frontal lobe ventriculostomy tube tract.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 demonstrates mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. | 1.The MRI of the brain is stable compared to the 10/23/2014 MRI brain exam. There is redemonstration of status post ventriculostomy tube placement as well as signal changes brain parenchyma which are most likely related to ventriculostomy tube tracts. |
Generate impression based on medical findings. | Female, 61 years old, with low back and leg pain. Alignment is anatomic. Vertebral body height and morphology are preserved. No concerning marrow replacement or evidence of marrow edema is seen. Fatty degenerative endplate signal is demonstrated at L4-5, similar to the prior examination.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk asymmetric to the left. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.L5-S1: Marked facet hypertrophy with ligamentum flavum thickening. Bulging disk with perhaps a small superimposed left paracentral protrusion. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. | Multilevel degenerative disk findings and posterior element hypertrophy, most severely affecting the L4-5 level where there is a moderate spinal canal stenosis and mild bilateral foraminal narrowing. No significant interval change is seen and there are no new abnormalities. |
Generate impression based on medical findings. | Recent recurrent small bowel obstruction. Evaluate for extent of Crohn's disease. 6/13/2014 biopsy showed mildly active chronic enteritis of the ileum. 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: The small bowel is adequately distended with oral contrast.There are long segments of fixed narrowing, indicating strictures, involving the small bowel in the right hemiabdomen including the terminal ileum and distal small bowel with associated fibrofatty perforation, mild circumferential wall thickening, restricted diffusion and postcontrast enhancement. These are not completely contiguous compatible with at least 3 skip lesions. There is moderate prestenotic/upstream small bowel dilatation, however these are not flow limiting strictures as there is oral contrast in the right colon. The lesion of the terminal ileum involves approximately 9 cm. More proximally there is a lesion measuring approximately 15 cm.There is mild angulation of the small bowel in the right lower quadrant towards the mesentery suggesting non-obstructive adhesive inflammatory changes.Also note is made of a pedunculated polypoid lesion in the distal small bowel measuring 1 cm (series 15/28), compatible with an inflammatory polyp.No free fluid or loculated fluid collection. No specific findings of sinus tract or fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Multifocal skips lesions of acute inflammatory changes of the distal small bowel superimposed on moderate length nonflow-limiting chronic strictures. There is upstream/prestenotic dilatation of the small bowel, consistent with partial obstruction (fluid seen distally in colon). The total length of disease involvement is at least 24 cm.At least one presumed inflammatory polyp in the distal small bowel, measuring up to 1 cm. |
Generate impression based on medical findings. | 24-year-old female with seizure, prior abnormal MRI and CT, evaluate for HIV encephalopathy, PML, or other. Several sequences are motion degraded. Given this caveat:Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. For example the confluent nature of the centrum semiovale has significantly improved, and hyperintense abnormality within the basal ganglia remains significantly improved when compared to the older MRI of 10/11/2015. The previously noted more conspicuous rounded hypodense foci on the most recent CT correlates with a small focus of residual T2 hypointensity that has remained in a prior region of confluent abnormality. However, T2 hyperintensity has progressed within bilateral subinsular white matter. Additionally, T2 hyperintensity within the cerebellum is less conspicuous, however more confluent.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses without superimposed fluid levels. Mastoid air cells remain clear. | Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. Given the asymmetry, PML is considered most likely. CMV infection can also present involving the white matter with asymmetry. Primary HIV encephalopathy most often represents in a symmetric faction and thus is considered less likely. |
Generate impression based on medical findings. | History of Chiari malformation status post decompression. Interval follow-up exam. Evaluate CSF flow. Brain:Postoperative changes from suboccipital craniectomy. There is an unchanged pointed appearance of the cerebellar tonsils which extend down to the inferior margin of C1. CSF flow imaging through the foramen magnum shows biphasic flow ventrally. This is questionably decreased from prior, however this is suspected to be predominantly due to technical factors in the CSF flow scan as there is a stable appearance of the CSF spaces at the level of the foramen magnum. CSF flow dorsally through the foramen magnum remains decreased.Stable prominence of the supratentorial ventricular system. No abnormal T1, T2, or diffusion weighted signal in the brain. No extra-axial fluid collection. Myelination appears appropriate for age. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:The vertebral body and intervertebral disc heights are maintained. There is straightening of the cervical lordosis likely related to positioning. Alignment is otherwise maintained. Stable partially visualized epidural lipomatosis in the thoracic spine. The cord signal and morphology is within normal limits. | 1. Postoperative changes from suboccipital craniectomy. CSF flow sequences show questionably decreased flow ventrally through the foramen magnum when compared to prior, however this is suspected to be predominantly due to technical factors in the CSF flow scan as there is a stable appearance of the CSF spaces at the foramen magnum. CSF flow dorsally through the foramen magnum remains decreased.2. Stable prominence of the supratentorial ventricular system. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Tension-type headache, unspecified, not intractable [G44.209], Reason for Study: ^Reason: Assess response to radiation and chemotherapy. Pt experiencing muscle contraction sensation along left skull History: Previously seen left frontal extra dural enhancing lesion appears to be slightly thinner than prior (4.2mm, 6.3mm in maximum thickness previously).Overlying sclerotic left frontal skull metastatic lesion does not show any interval change.There is no evidence of new abnormal enhancement on the scan.There is no evidence of acute ischemic or hemorrhagic lesion.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. Interval decrease in thickness of left frontal lobe extra dural enhancing lesion since prior scan.2. Stable left frontal skull sclerotic metastatic lesion since prior scan. |
Generate impression based on medical findings. | Reason: Right shoulder dislocations over the past 2 months, history of multiple myeloma tx'd at outside hospital, now with acromial mass and lesion in proximal humerus and scapula, evaluate for cause of instability History: above ROTATOR CUFF: There is a high-grade partial-thickness tear of the bursal surface fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity without significant retraction, measuring approximately 15 mm in the AP dimension. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is interstitial tearing of the subscapularis at the level of the myotendinous junction. The teres minor muscle and tendon appear intact. There are intramuscular cysts within the muscle belly of the subscapularis.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal intensity within the superior, anterior, and inferior labrum suggesting degeneration/degenerative tearing. No fluid-filled tear is evident on this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL | 1. Findings consistent with the stated history of multiple myeloma as described above.2. Avascular necrosis of the humeral head.3. High-grade partial-thickness tearing of the supraspinatus as well as additional interstitial tearing of the rotator cuff without significant retraction.4. Glenoid labral degeneration/degenerative tearing. |
Generate impression based on medical findings. | Provided history of tuberous sclerosis and renal angiomyolipomas. ABDOMEN: Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology.LIVER, BILIARY TRACT: Findings suggesting iron deposition. Numerous punctate probable hepatic cysts may reflect poly-cystic liver disease versus biliary hamartomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. No pancreatic cysts.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are markedly enlarged and the parenchyma is entirely replaced by innumerable well-defined simple and minimally complex (fluid-fluid levels and T2-weighted hypointensity) presumed cysts. Lack of intravenous contrast limits evaluation for a solid or cystic renal neoplasm. None of the lesions demonstrate significant macroscopic fat to suggest an angiomyolipoma. A lesion in the right superior pole measures 9.6 x 4.2 cm (series 4/31) and demonstrates restricted diffusion; may reflect a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings compatible with polycystic kidney disease. No discrete fat-containing lesion is identified to suggest an angiomyolipoma. Lack of intravenous contrast limits evaluation for a solid or cystic renal neoplasm. 2.Indeterminate right superior pole measures 9.6 x 4.2 cm (series 4/31) may reflect a large hemorrhagic cyst versus solid mass.3.Multiple punctate hepatic cysts may be related to polycystic liver disease or biliary hamartomas.4.Findings of iron deposition of the liver may reflect prior blood transfusions. |
Generate impression based on medical findings. | Male; 66 years old. Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.7 x 3.2 cm.Peripheral Zone: Scattered T1 hyperintensity due to hemorrhage. Multifocal prostate cancer with dominant lesion in the right posteromedial mid to apical peripheral zone with low T2 signal and restricted diffusion, measuring up to 1 x 1.8 cm (series 903/204). A smaller focus of prostate cancer is seen in the left posteromedial mid gland (series 903/204).Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Multifocal prostate cancer with dominant lesion in the left mid to apical peripheral zone. No evidence of extracapsular extension. |
Generate impression based on medical findings. | 50-year-old female with ulnar-sided wrist pain A marker was placed along the ulnar aspect of the wrist. There is thickening and abnormal signal intensity of the extensor carpi ulnaris tendon as it courses along the distal ulna and ulnar aspect of the wrist indicating moderate to severe tendinosis. There is increased signal intensity within the tendon extending to the surface indicating partial thickness tearing. Enhancement of the tendon sheath indicates tenosynovitis. In addition, there is inflammation in the soft tissues surrounding the tendon sheath.Multiple slips of the abductor pollicis longus may reflect a normal variant. A small cleft is present within the extensor carpi radialis just proximal to its insertion which may represent partial thickness tearing, but this may not be of any current clinical significance. The visualized musculature is within normal limits. A lobulated small collection of fluid signal intensity with peripheral enhancement volar to the radioscaphoid articulation, along the distal margin of the radioscaphocapitate ligament, likely represents a ganglion or synovial cyst. The scapholunate and lunotriquetral ligaments are intact. There is mild increased signal intensity and enhancement along the medial fibers of the articular disc of the TFCC at the ulnar styloid; this may be due to mild inflammation or degenerative changes, but we see no discrete tear. Mild synovial enhancement is seen within the carpus suggesting a mild synovitis. A small lobulated focus of abnormal signal intensity within the capitate may represent a degenerative cyst, chronic erosion or ganglion. | Tenosynovitis, tendinosis and partial tearing of the extensor carpi ulnaris with other findings as described above. |
Generate impression based on medical findings. | 70-year-old woman with history of diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is age-related pancreatic atrophy but the pancreatic duct appears normal. There is no focal pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is a small hiatal hernia. There is no evidence of bowel wall thickening, abnormal enhancement, or obstruction.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted. | No abnormality to explain the patient's symptoms. |
Generate impression based on medical findings. | Diagnosis: Malignant neoplasm of brain, unspecified site Other postprocedural status(V45.89)Clinical question: 11-year-old male with history of cerebellar juvenile pilocytic astrocytoma, follow-up evaluationSigns and Symptoms: 6 month follow up for changes The patient is status post posterior fossa surgery. A surgical defect is present along the medial aspect of the left cerebellar hemisphere which is stable compared to the previous exam and associated with minor FLAIR/T2 signal hyperintensity and SWI hypointensity at the surgical margins. No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest recurrence.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | The patient is status post suboccipital craniotomy for tumor removal. The examination is stable when compared to the previous exam. There is no convincing evidence for local recurrence. |
Generate impression based on medical findings. | 22-year-old female with altered mental status Redemonstrated is confluent bihemispheric periventricular white matter and centrum semiovale low attenuation indicating nonspecific small vessel ischemic disease, not significantly changed. The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses are clear. Redemonstrated is partial opacification of a dependent left mastoid air cell. Note is again made of vascular calcifications. | 1.Redemonstrated is confluent bihemispheric periventricular white matter and centrum semiovale low attenuation indicating nonspecific small vessel ischemic disease, not significantly changed. Please note CT is insensitive for the detection of acute nonhemorrhagic ischemia and MRI can be considered for further evaluation if deemed clinically beneficial.2.No acute hemorrhage. |
Generate impression based on medical findings. | 80 years, Male, Reason: pt with a history of met renal cell cancer, please assess for disease progression History: met RCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.Reference segment 6 lesion measures 1.0 x 0.6 cm (14/49), previously 0.9 x 0.6 cm.Reference segment two lesion measures 1.7 x 1.5 cm (14/68), previously 1.9 x 1.3 cm.Posterior segment 6 lesion measures 2.4 x 2.1 cm (14/50), previously 3.0 x 2.6 cm.Segment 5 hemangioma an adjacent cyst are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion within the pancreatic duct is unchanged in size measuring 0.3 x 0.8 cm (8/27), previously 1.9 x 1.3 cm.ADRENAL GLANDS: Right adrenal gland is absent. Left adrenal nodularity is stable.KIDNEYS, URETERS: Status post right nephrectomy. Complex cystic lesion in the left upper pole containing calcification is unchanged. Additional renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted. | 1.Stable reference hepatic lesions. No new lesions identified.2.Stable nonspecific pancreatic cyst. |
Generate impression based on medical findings. | 32-year-old female with newly diagnosed extensive left breast carcinoma presents for MRI for staging and surgical planning. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.At the approximate 4 o'clock position of the left breast, posterior depth, there is enhancing, spiculated mass which contains susceptibility artifact from a biopsy clip measuring 1.5 x 1.4 x 1.6 cm with 3 immediately adjacent satellite lesions for total measurement of 2.1 x 2.7 x 1.8 cm. This area corresponds to the patient's known malignancy. Approximately 2.7 cm superior to the aforementioned mass, at the 1 o'clock position of the left breast, there is a second spiculated, enhancing mass which contains susceptibility artifact from a biopsy clip measuring 1.2 x 0.7 x 1.3 cm, corresponding to the patient's known malignancy. Approximately 1 cm anterolateral to the second mass, is a third enhancing mass measuring 0.4 x 0.4 x 0.7 cm. Total area of enhancement in the left breast is 2.5 cm AP x 3.1 cm transverse x 5.6 cm CC.At the approximate 11 o'clock position of the right breast, anterior depth, there is a 2.1-cm hematoma which corresponds to the site of prior benign biopsy. Within the upper outer quadrant of the right breast, mid depth, there is a masslike area of enhancement with washout kinetics measuring 1.4 x 0.7 x 1.0 cm.No abnormal lymph nodes are identified in either axillary region. | 1. Multiple enhancing masses within the outer left breast. Total area of enhancement is 2.5 x 3.1 x 5.6 cm. Two of these masses contain susceptibility artifact from biopsy clips, and are compatible the patient's known malignancy.2. Area of masslike enhancement within the upper outer right breast measuring up to 1.4 cm. MR guided ultrasound is recommended for further characterization.3. Hematoma measuring 2.1 cm at the approximate 11 o'clock position of the right breast, corresponding to site of prior benign biopsy.Findings conveyed to Dr. Chhablani at the time of dictation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 92 year-old male with altered mental status, found down. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are mildly enlarged secondary to diffuse volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. No acute intracranial abnormalities.2. Multifocal regions of patchy hypoattenuation compatible with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. |
Generate impression based on medical findings. | 42-year-old man history of HIV status post kidney transplant with midfoot pain, along the metatarsal area. Rule out fracture. There is an oblique nondisplaced fracture line seen at the base of the third metatarsal, consistent with a stress fracture. There is moderate associated edema extending into the mid third metatarsal.Degenerative cysts are noted in the medial aspect of the first metatarsal head. Physiologic fluid is noted at the first MTP joint. Soft tissues are unremarkable. | Nondisplaced stress fracture base of the third metatarsal. |
Generate impression based on medical findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits, with the conus terminating at the L1-2 level.L1-2: Unremarkable. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L2-3: Unremarkable. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. Mild interval progression of findings.L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild right neural foraminal narrowing. Mild interval progression of findings. | Mild scattered degenerative changes as detailed above, with mild right neural foraminal narrowing at L5-S1. |
Generate impression based on medical findings. | Preoperative planning: glioblastoma. There are prior postoperative findings related to biopsy of a rim-enhancing mass centered in the right temporal stem and posterior right insula that measures up to approximately 5 cm, with multiple adjacent smaller peripherally-enhancing nodules and extensive surrounding edema involving right thalamus, right middle cerebral peduncle, right basal ganglia, and right parietal lobe. There are areas of T2 hyperintensity in the right parietal lobe white matter without corresponding enhancement. There is effacement of the temporal horn of the right lateral ventricle and most of the third ventricle, but prominence of the left lateral ventricle. There is 10 mm of midline shift to the left. There is no evidence of acute infarct. The major cerebral flow voids are intact. There is prominence of the bilateral optic nerve discs and optic nerve sheath cerebrospinal fluid, which is suggestive of raise intracranial pressure. There are retention cysts in the left maxillary sinuses. There are skin fiducial markers. | Preoperative planning MRI demonstrates a dominant necrotic mass centered in the right temporal stem and posterior right insula, with multiple satellite lesions, compatible with high grade glial neoplasm. The mass effect is associated with 10 mm of midline shift to the left and obstructive hydrocephalus. |
Generate impression based on medical findings. | Male; 48 years old. Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size: 3.8 x 4 x 3.3 cm. Peripheral Zone: No focal lesions suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of prostate cancer. |
Generate impression based on medical findings. | Diagnosis: Seroma versus abscess in a patient with prior history of multiple cranial infections at the craniotomy site. MRI shows a fluid collection at the anterior aspect of the craniotomy site. Please aspirate and culture.Clinical question: s/p craniotomy on 6/4 now with MRI evidence of fluid collection; evaluate fluid collection Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity which was aspirated subsequently. The patient is status post left craniectomy with bone graft placement and myocutaneous free flap placement. There is encephalomalacia along the left frontal lobe and left parietal lobe. | Left craniotomy site collection aspiration under CT guidance. Two mL clear straw colored fluid was aspirated from the fluid collection. |
Generate impression based on medical findings. | Female; 45 years old. Reason: progression of disk herniation History: paresthesias and weakness in L5 dermatome/myotome Grade 1 retrolisthesis of L5 on S1 is again noted, unchanged in extent. Fatty degenerative endplate changes at L4 and L5 are stable. The conus is normal in signal and morphology and terminates at an appropriate level.L1/2: No evidence of neuroforaminal or central canal stenosis, unchanged.L2/3: No evidence of neuroforaminal or central canal stenosis, unchanged.L3/4: Mild ligamentum flavum and facet hypertrophy. No evidence of neuroforaminal or central canal stenosis. These findings are unchanged.L4/5: The disc demonstrates moderately reduced T2 signal with mild loss of disk height. Superimposed on the previously demonstrated moderate disc bulge with slight extrusion upwards is a new right paracentral disc protrusion causing marked right lateral recess stenosis. Mild facet joint hypertrophy and minimal bilateral neural foraminal narrowing is unchanged.L5/S1: The disc demonstrates moderately reduced T2 signal. There is progressive thickening of ventral epidural fat resulting in thecal sac narrowing, but the nerve roots are not crowded. There is a mild disk bulge minimally effacing the ventral CSF space without significant central canal stenosis. Mild facet joint hypertrophy. Mild right greater than left neuroforaminal narrowing. Mild thickening of the ligamentum flavum. These findings are unchanged. | At L4/5 there is a new right paracentral disc protrusion causing marked right lateral recess stenosis. Degenerative changes elsewhere are stable in appearance and described in detail above. |
Generate impression based on medical findings. | Gait instability, enlarged ventricles, concern for NPH. There is prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci. In fact, bilateral parietal lobe sulci are prominent. There is moderate cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. There are also punctate foci of T2 hyperintensity in the bilateral thalami. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. Prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci may represent normal pressure hydrocephalus superimposed on cerebral volume loss. 2. Cerebral white matter T2 hyperintensity, mainly in a periventricular distribution, is nonspecific, but may represent chronic small vessel ischemic disease, and lesions in the bilateral thalami may represent chronic infarcts. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | Reason: ? Cuff tear; ? Subscap tear History: pain ROTATOR CUFF: The supraspinatus tendon appears thinned, suggesting chronic attritional tearing. There is also a focus of linear high signal intensity separating the tendon from its insertion on the greater tuberosity indicating an insertional tear. While this insertional tear appears to involve the majority of the thickness of the tendon, it is only seen on one image and measures approximately 3 mm in the AP dimension and it spares the bursal surface fibers. We see no retraction or evidence of a full-thickness rotator cuff tear. Additionally, there is perhaps mild interstitial tearing of the supraspinatus tendon more proximally. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is focal increased signal intensity along the undersurface fibers of the subscapularis proximal to its insertion suggesting mild fraying with a tiny defect along the anterolateral margin overlying the humeral head, but we see no full-thickness tear. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint appears normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Given the limitations of a non-arthrogram study, the labrum appears normal for age. We see no fluid-filled articular cartilage defects.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL | 1. Thinning of the supraspinatus tendon suggesting chronic attritional tearing as well as a partial-thickness insertional tear as described above.2. Focal undersurface fraying of the subscapularis, but we see no discrete tear. |
Generate impression based on medical findings. | 57 years, Female, post brain biopsy. History of breast cancer and AML. Again seen are postsurgical changes of biopsy of left occipital intraparenchymal hemorrhagic lesion via burr hole. There has been evolution of the signal features of the blood products as well as slight decrease in size of the lesion, which measures approximately 2.2 x 2.8 x 2.3 cm, previously 3.2 x 3.2 x 3.1 cm. Surrounding vasogenic edema has resolved. There is intrinsic T1 hyperintensity related to late subacute hematoma without definite enhancement.No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the right ventral pons likely representing a chronic microhemorrhage. No new intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a 9 x 7 mm small pineal cyst which remains unchanged. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and/or posttreatment-related changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. No destructive lesions within the calvarium. | 1. Interval evolution of left occipital intraparenchymal hematoma with decrease in size and resolution of surrounding edema. There is no convincing evidence of metastatic disease in the brain; however, given the hemorrhagic nature of the lesion which may potentially obscure enhancement, consider an additional follow-up study. 2. Punctate focus of chronic microhemorrhage in the right pons. |
Generate impression based on medical findings. | Male, 18 months old, with complex febrile seizures. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The medial temporal structures are symmetric and unremarkable. The pituitary region is within normal limits for age. Brainstem and cerebellar vermis are normally formed and unremarkable. The cerebral hemispheres are normally formed and the cerebellar tonsils terminate above the level of the foramen magnum. Corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for age.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Patchy opacification is seen through the paranasal sinuses and in the right mastoid air cells. | Unremarkable evaluation of the brain with no specific findings to account for the patient's seizures. |
Generate impression based on medical findings. | Reason: r/o stroke History: aphasia MRI of the brainarea of diffusion traction is present which involves the posterior aspect of the insular cortex, adjacent left superior temporal gyrus, adjacent left some central lobular and adjacent left supramarginal gyrus. There are additional punctate foci of diffusion restriction in the left postcentral gyrus and inferior parietal lobule.There is signal loss on susceptibility weighted imaging within the left medullary draining veins.On susceptibility imaging there are foci of signal loss present in the basal ganglia and in the right frontal subcortical white matter indicative of prior microhemorrhages. The there are T2 signal hyperintensities in the basal ganglia at these foci of basal ganglia microhemorrhage.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There are subdural effusions present in the posterior fossa and supratentorial brain probably related to atrophy.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 right internal carotid artery, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left internal card artery is occluded and reconstituted via the left posterior communicating artery.There is occlusion of the left middle cerebral artery at the distal M1 segment involving a divisional branch each which includes the left posterior parietal artery. There is antegrade flow in the some of the superior division branches as well as some of the inferior division branches. It is suspected this represents a partial occlusion of inferior division trunk with complete occlusion of the posterior parietal artery.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 medium sized. The vertebral arteries are asymmetric with the right larger than left. Extracranially the left vertebral artery appears to be occluded.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The left common artery originates from the innominate artery.There is high-grade stenosis present at the proximal right vertebral arteryThere is 60% stenosis present along the proximal left subclavian artery.Complete occlusion of the origin of the left internal carotid artery.Complete occlusion at the origin of the left vertebral arteryOn the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. | 1.Occlusion of the left internal card artery at its origin without distal reconstitution of the communicating segment via the left posterior communicating artery.2.Occlusion at the inferior division of the left middle cerebral artery with complete occlusion of branches centered around the left posterior parietal artery.3.Occlusion of the left vertebral artery proximally with distal reconstitution via the vertebrobasilar junction.4.Acute infarction in in the left middle cerebral artery territory centered around the left posterior parietal artery territory.5.There is high-grade stenosis present at the proximal right vertebral artery6.There is 60% stenosis present along the proximal left subclavian artery.7.The findings are suggestive of hypoxia to the left hemisphere.8.Old lacunar infarcts in the basal ganglia are likely associated with prior hemorrhage. |
Generate impression based on medical findings. | Female, 35 years old, with fatigue, gait disorder, and previous abnormal MRI. Redemonstrated are numerous small foci of T2 hyperintensity and T1 hypointensity, ranging in size from punctate up to about 5 mm, identified within the bilateral deep and subcortical cerebral white matter. There is also a larger curvilinear focus of T2 hyperintensity involving the cortex and subcortical white matter of the right frontal operculum. Of note, no lesions are seen within the corpus callosum and there are no infratentorial lesions. These lesions are unchanged and there are no definite new lesions. Postcontrast images demonstrate no evidence of pathologic parenchymal or extra-axial enhancement. Brain morphology is otherwise unremarkable. No mass-effect or parenchymal edema is detected. No abnormal fluid collections are seen. The ventricles are normal in size and morphology. | Stable appearing scattered small foci of signal abnormality are identified in the bilateral cerebral white matter with one larger lesion also involving the cortex of the right frontal operculum. None of the lesions demonstrates contrast enhancement. The corpus callosum and posterior fossa are spared. There are no definite new lesions. |
Generate impression based on medical findings. | Clinical question: Neck pain. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:The alignment of vertebral is anatomical.The signal intensity which column is unremarkable other than subtle changes in the degenerative disease.The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild disk desiccation and minimal uncovertebral hypertrophic changes. Findings results in mild bilateral neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate mild disk desiccation and loss of disk height, mild bilateral uncovertebral hypertrophic changes. Small left lateral shallow disk protrusion is present with resultant very subtle flattening deformity of the cord without detectable signal abnormality. There is moderate (right greater than left) neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate mild disk desiccation and mild facet and ligamentum flavum hypertrophy. No spinal stenosis however mild right neural foramina compromise is suspected.C7 -- T1 demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise. | 1.C5 -- C6 demonstrate mild degenerative changes and a left lateral shallow disk protrusion with resultant sulcal flattening deformity of the cord however without central spinal stenosis. Moderate (right greater than left) neural foraminal compromise at this level is also present.2.Mild degenerative changes at other levels however without central spinal stenosis as detailed.3.Normal signal intensity of cervical and upper most visualized thoracic cord |
Generate impression based on medical findings. | H/o AML. S/p intrathecal methotrexate. There is a redemonstration of bilateral hemispheric subcortical and white matter edema. In comparison with prior brain MRI, the extent of the edema has been grossly unchanged. A right frontal Omaya catheter is in place with its tip in the left lateral ventricle. Air is present in bilateral frontal horns. There is no intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection. The ventricles are normal in volume and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Grossly stable subcortical and white matter edema likely represent drug related change in light of clinical history provided. |
Generate impression based on medical findings. | 61-year-old female with metastatic colon cancer to liver. ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy. Multiple T2 hyperintense cystic lesions scattered toward the liver are not significantly changed when compared to the prior exam. There is no new focal lesion. There is trace perihepatic fluid. There is mild restricted diffusion along the liver capsule and abdominal wall peritoneum with corresponding postcontrast enhancement without definite nodule or mass.SPLEEN: There is linear focus of restricted diffusion along the peritoneum adjacent to the spleen with corresponding postcontrast enhancement.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: High T2 signal, enhancing lesion within the L1 vertebral body is unchanged. | 1.Linear foci of restricted diffusion along the liver capsule and along the abdominal wall peritoneum, particularly adjacent to the spleen, with corresponding postcontrast enhancement is suspicious for carcinomatosis.2.Status post left lobectomy and unchanged T2 hyperintense cysts. No new liver lesions. |
Generate impression based on medical findings. | Back pain. There is no significant spinal canal or neural foramen stenosis in the lumbar spine. There is straightening of the lumbar vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions. The paravertebral soft tissues are unremarkable. | No evidence of spinal stenosis. |
Generate impression based on medical findings. | Ms. Tennant is a 37-year-old female with biopsy-proven DCIS and ADH of the left breast. She presents today for MR evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. There is a moderate amount of background parenchymal enhancement noted bilaterally, which limits the sensitivity of MRI.In the left upper outer breast, susceptibility artifact from biopsy marker clip is identified, at site of biopsy-proven DCIS. Seen immediately inferior to the biopsy clip artifact is linear nonmass enhancement, measuring approximately 2.2 cm in AP dimension. Note that the MR detected area of linear enhancement (2.2 cm-AP dimension) measures less than the mammographically detected area of calcifications (4.0 cm-AP dimension). There is no abnormal enhancement seen at the site of biopsy-proven ADH in the left lateral breast.No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. | (1) Moderate amount of background parenchymal enhancement, which limits the sensitivity of MRI.(2) 2.2 cm linear nonmass enhancement corresponding to the site of biopsy-proven DCIS in the left breast. Note that the MR detected area of enhancement (2.2 cm-AP dimension) measures less than the mammographically detected area of calcifications (4.0 cm-AP dimension).(3) No abnormal MR enhancement at the site of biopsy-proven ADH in the left breast.(4) No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Esophageal cancer. Evaluate for brain mets prior to starting new treatment. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. | No evidence of intracranial metastases. |
Generate impression based on medical findings. | 52-year-old female with history of DCIS status post left mastectomy and reconstruction. History of right mastopexy. Family history of breast cancer in mother. There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.There are postsurgical changes of left mastectomy and reconstruction. There are additional postoperative changes of right mastopexy.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Reason: further evaluate pancreatic changes noted on recent CT History: abdominal pain, anorexia ABDOMEN: Suboptimal examination due to motion artifact of several sequences. LIVER, BILIARY TRACT: The liver is enlarged measuring 23 cm in craniocaudal dimension, which may be due to a normal variant Riedel lobe. No focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation. No gallstones. SPLEEN: No significant abnormality noted.PANCREAS: Fullness and mild restricted diffusion of the pancreatic head with marked fatty atrophy of the body and tail. There is diffuse decreased enhancement of the pancreatic head relative to the remainder of the pancreas, raising the question of parenchymal necrosis. No discrete abnormal fluid collection. No pancreatic mass identified. No pancreatic ductal dilatation. Peripancreatic and perigastric enlarged lymph nodes are unchanged and likely reactive.The SMV-portal vein junction is narrowed, although patent. No vascular complication. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of the stomach. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Fullness of the pancreatic head with associated likely reactive lymphadenopathy compatible with history of pancreatitis. Diffuse decreased enhancement of the pancreatic head raises the question of parenchymal necrosis. Recommend short term follow-up to resolution. |
Generate impression based on medical findings. | Reason: evaluate for intracranial abnormalities History: pre-syncope Brain parenchyma appears within normal limits. There are no masses, mass effect or herniation. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are unremarkable. | MRI of the brain is within normal limits. Specifically, no evidence of intracranial mass, mass effect or acute infarct..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. Neck: There are post-treatment findings in the right nasopharynx with mild right asymmetric pharyngeal mucosal space thickening without measurable residual mass, although assessment is limited by the lack of intravenous contrast. There is also diffuse mucosal enhancement that is suggestive of mucositis. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unchanged. There is unchanged enhancement within the right mandibular ramus. There is mild anterolisthesis of C3 on C4 and C4 on C5, as well as cervical spondylosis with at least moderate spinal canal stenosis at C5 and C6 and retrolisthesis of C6 on C7. There are several cervical neural foramina subcentimeter perineural cysts. There are degenerative changes in the right temporomandibular joint with an associated trace effusion.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is persistent fluid signal within the bilateral mastoid air cells. There are maxillary sinus retention cysts and scattered paranasal sinus mucosal thickening. There is radiation-associated fatty marrow signal in the skull base and upper cervical spine. | 1. Post-treatment findings in the right nasopharynx without measurable residual mass.2. No evidence of intracranial tumor.3. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.4. Unchanged nonspecific enhancement within the right mandibular ramus. |
Generate impression based on medical findings. | Please evaluate for malformations, hydrocephalus, or tumors: speech delay, macrocephaly, 5 cafe-au-lait spots one large (12x15cm). Brain: The lateral ventricles and third ventricle are diffusely prominent. The cerebral aqueduct and fourth ventricles are intact. There is a left medial middle cranial fossa arachnoid cyst that measures 15 mm in width. There is a mega cisternal magna. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There is a normal degree of myelination. There is no abnormal intracranial enhancement. Orbits: The globes and ocular adnexa are intact. No intraorbital enhancement or mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The optic nerves are grossly unremarkable. | 1. Prominence of the triventricular system and a left middle cranial fossa arachnoid cyst. Otherwise, no stigmata of neurofibromatosis type 1, intracranial tumors, or hemorrhage. 2. Unremarkable orbits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits. The hippocampi are symmetric and normal in appearance. The degree of myelination is appropriate for age. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a 16 mm enhancing lesion within the right cheek soft tissues with questionable foci of susceptibility effect. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. | 1.MRI of the brain is unremarkable. MRA of the head is also unremarkable. 2.Right cheek lesion may represent a hemangioma or possibly a venous malformation and can be correlated with clinical features. |
Generate impression based on medical findings. | Headache [R51] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: Evaluate for brain lesions or normal pressure hydrocephalus History: Recurrent bilateral leg weakness and headache. No evidence of acute ischemic or hemorrhagic lesion.About 8mm x 10mm sized pineal cyst, unchanged in its size and MR characteristics since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no other 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 mastoid air cells are clear.Mucosal thickening on the right maxillary sinus and sphenoid sinus. | Unchanged pineal gland cyst in terms of size and MR characteristics.Otherwise no remarkable finding. |
Generate impression based on medical findings. | Diagnosis: Disturbance of skin sensationClinical question: thoracic cord compression?Signs and Symptoms: R>L LE numbness and pain The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.Schmorl's nodes are present at the inferior endplate of T7, T9, T10 and T11 and superior endplate of T12 andT11. There are small discrete effusions present at T7-8 and T8-9 as well as T11-12.The patient is status post anterior spine fusion at C5-6 and C7-T1 and posterior element fusion with instrumentation at C5-6. | There are mild degenerative changes present in the thoracic spine without significant compromise to spinal canal or exiting nerve roots. |
Generate impression based on medical findings. | 39-year-old female with a personal history of new diagnosis of DCIS in her left breast presents for MRI breast staging. She does has a family history of breast cancer and prostate cancer in her father. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:Susceptibility artifact from the biopsy clip is identified in the right breast, approximately 9:00 position, posterior depth, located medial to the biopsy cavity, as noted on post biopsy mammograms. Mild patchy enhancement around the biopsy clip and along the biopsy trajectory likely represents the postprocedure inflammatory change. Extending anteriorly from the biopsy clip are multiple enhancing foci scattered in the upper outer right breast. The total AP extent of the enhancing foci measures approximately 6 cm. The location of these foci correlates with the calcifications in the right upper outer breast on the mammogram. No additional suspicious enhancement is identified elsewhere in the right breast.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region. | Multiple enhancing foci in the RIGHT upper outer breast extending anteriorly from the biopsy-proven DCIS correlate with the mammographic calcifications. Given the MRI and mammographic correlation, stereotactic biopsy of an anterior cluster of calcification is suggested to evaluate the extent of the disease.No MRI evidence for malignancy in the LEFT breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | History of chronic pancreatitis and IPMN status post distal pancreatectomy and splenectomy. Evaluate for recurrence. 11/25/2009 Pathology demonstrated side-branch IPMN and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 17 cm in craniocaudal dimension. No focal suspicious lesion. No vascular abnormality.Lobular dilatation of the common bile duct is not significantly changed in caliber or morphology without a filling defect, stricture or mass lesion. Minimal central intrahepatic ductal dilatation, unchanged.Normally distended gallbladder.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from distal pancreatectomy. The main pancreatic duct is mildly irregularly prominent up to 4 mm, slightly improved from prior. There is mild side branch ectasia and several punctate subcentimeter T2 hyperintensities in the parenchyma without definitive communication with the main pancreatic duct.No suspicious postcontrast enhancement. The pancreatic parenchyma has diminished intrinsic T1-weighted signal intensity but demonstrates homogeneous postcontrast enhancement. No specific findings of acute pancreatitis.ADRENAL GLANDS: Stable small left lipid rich adrenal adenoma.KIDNEYS, URETERS: At least partially duplicated collecting system on the right. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large perineural cyst/Tarlov cysts in the partially imaged sacrum, unchanged dating back to 2013.OTHER: No significant abnormality noted. | 1. Interval mild decrease in residual pancreatic ductal irregular dilatation without a focal lesion evident, likely stigmata of chronic pancreatitis.2. Stable punctate cystic pancreatic parenchymal foci without definitive communication with the main pancreatic duct may represent small side branch IPMNs vs other tiny cystic lesions. No suspicious imaging characteristics. |
Generate impression based on medical findings. | Yearly surveillance of AVM and meningioma, right side finger and toe numbness, occasional vision "unsteadiness" lasting 1-2seconds. MRI: There is an unchanged extra-axial left parafalcine enhancing mass measuring up to 28 mm, with mass effect upon the superior sagittal sinus and underlying brain parenchyma, but no associated edema. There is mild high T2 signal in the parenchyma surrounding the right central sulcus arteriovenous malformation. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.MRA: There is an unchanged nidus related to an arteriovenous malformation in the right central sulcus, measuring up to 30 mm. There is no evidence of significant steno-occlusive lesions or aneurysms. | 1. Unchanged left parafalcine meningioma.2. No significant interval change in the right central sulcus arteriovenous malformation. |
Generate impression based on medical findings. | Acute onset of dizziness, unsteadiness and difficulty with word finding. Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate findings consistent with small vessel disease of indeterminate age. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Considering provided clinical data an MRI examination is recommended. | Small vessel disease of indeterminate age. |
Generate impression based on medical findings. | Reason: Pt w/ desmoid fibromatosis of the right lower abdomen s/p excisional biopsy in October - please eval for recurrence History: Desmoid fibromatosis s/p excision on 10/19/2016 PELVIS:UTERUS, ADNEXA: Multiple intramural and subserosal fibroids are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen subcutaneous soft tissue nodule in the right pannus appears removed. Marker is noted overlying this region. There is mildly enhancing linear soft tissue nodularity at this region, given recent surgery favor enhancing scar tissue.OTHER: No significant abnormality noted. | Interval removal of subcutaneous nodule in the right pannus. There is mildly enhancing linear soft tissue nodularity at this region. Given recent surgery favor enhancing scar tissue, but follow-up may be helpful. |
Generate impression based on medical findings. | Foot weakness. Evaluation of the left lumbosacral plexus is requested. There is diffuse heterogeneity of the bone marrow signal which is nonspecific and may be related to marrow reconversion. No discrete destructive osseous lesion is demonstrated.There is no abnormal T2 signal or enhancement involving the lumbosacral nerve roots or the lumbosacral plexus more peripherally in the pelvis. No abnormal signal or enlargement of the sciatic nerves is present. No masses to suggest extrinsic compression. Aortoiliac ectasia again noted. Small disc bulges at L4-L5 and L5-S1 with minimal left neural foraminal narrowing again seen, without clear evidence of impingement. | 1. No abnormal signal or evidence of extrinsic compression involving the lumbosacral plexus.2. Diffuse heterogeneity of the bone marrow signal is nonspecific and may represent marrow reconversion. No discrete destructive osseous lesion is appreciated. |
Generate impression based on medical findings. | Diagnosis: Other specified disorders of muscleClinical question: history of old stroke, possible new strokeSigns and Symptoms: as above MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the left thalamus and ponsThere are small foci of susceptibility effect in signal loss present in the basal ganglia thalami and pons. The largest one is located in the right thalamus and can be identified on T2-weighted imaging root measures approximately 5 x 7 mm axial dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. 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 small.. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. | 1.There are multiple microhemorrhages present in the basal ganglia, thalami and brainstem was pattern is suggestive of hypertensive microhemorrhages. 2.There is a 1cm old hemorrhagic focus in the right thalamus. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm. |