instruction
stringclasses 1
value | input
stringlengths 15
6.12k
| output
stringlengths 3
2.67k
|
|---|---|---|
Generate impression based on medical findings. | Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. There are no significant degenerative changes and there are no stenoses. | Negative contrast-enhanced MRI of the cervical and thoracic spine. Specifically, there are no MRI findings to explain the patient's symptoms. |
Generate impression based on medical findings. | 47 year old female enrolled in high risk breast cancer research screening protocol. She has a family history of breast cancer in her mother at the age of 60, and sister at the age of 46. History of bilateral mastopexy in April 2008. She has had a benign biopsy of the right breast by MRI guidance in March of 2007 at 12 o'clock with unsuccessful clip placement. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Minimal postsurgical changes are present in both breasts. Scattered foci of enhancement are present throughout both breasts, unchanged from prior examination. An area asymmetric parenchymal tissue within the upper outer right breast is unchanged from multiple prior examinations. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Pt with gait/balance issues; ? Possible parkinsonism, PSP The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate subcortical white matter lesions present which are right on T2 and FLAIR MRI and not associated with diffusion restriction or contrast enhancement nor susceptibility effect.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 left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No abnormal mass lesions are appreciated intracranially that would explain the patient's symptoms.2.There are several subcortical white matter punctate-sized lesions which are probably of little clinical significance and not unusual in this age group |
Generate impression based on medical findings. | Clinical question: Blunt trauma. Signs and symptoms: Loss of consciousness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal limits. Very small focus of low-attenuation in the periventricular white matter is believed to represent a small was ischemic disease as was noted on prior MRI examcalvarium is intact. No evidence of hemorrhage or swelling of the scalp is detected.Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Visualized paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable. | With the exception of minimal small vessel ischemic disease of indeterminate age this study is within normal limits. |
Generate impression based on medical findings. | Reason: ro meniscal/ligament injury History: continued pain, swelling since fall in May MENISCI: The posterior horn of the medial meniscus is abnormally small, highly suspicious for a tear. However no fragment is identified within the joint.ARTICULAR CARTILAGE AND BONE: The trochlear groove is abnormally shallow, consistent with trochlear dysplasia.There is bone marrow edema involving the lateral femoral condyle. The articular cartilage is within normal limits.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1.Shallow trochlear groove consistent with trochlear dysplasia.2.Abnormally small posterior horn of the medial meniscus, likely secondary to meniscal tear.3.Bone marrow edema involving the lateral femoral condyle.4.Moderate joint effusion. |
Generate impression based on medical findings. | 21 years Male (DOB:11/11/1994)Reason: eval for aneurysm; History: ha with lifting and vision and hearing loss for 2-3 years.PROVIDER/ATTENDING NAME: HOLLY JOAN BENJAMIN HOLLY JOAN BENJAMIN 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 a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is no evidence for intracranial mass lesion2.Please note that CT angiogram and MR angiogram or more sensitive in detecting aneurysms than MRI of the brain with and without contrast. |
Generate impression based on medical findings. | Female, 10 years old, status post cardiac arrest. The choroid plexus within the right lateral ventricular atrium is enlarged relative to the left. The morphology of this tissue is frond-like without any notable cysts. The tissue demonstrates susceptibility effect which may reflect calcification or blood product.The lateral ventricles are not enlarged. The fourth ventricle is slightly prominent which may reflect mild vermian hypoplasia. No evidence of parenchymal edema is seen. No restricted diffusion is evident to suggest acute ischemia. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The mesial temporal structures are unremarkable. | 1.No evidence of ischemic injury or any other acute intracranial abnormality.2.Asymmetric enlargement of the choroid plexus within the right lateral ventricular atrium is seen. This could represent a choroid plexus papilloma, less likely normal variant hypertrophy. No evidence of lateral ventricular enlargement is seen to suggest CSF overproduction. Further evaluation with postcontrast imaging should be considered. |
Generate impression based on medical findings. | Male 78 years old with neuroendocrine tumor of the head of the pancreas. Evaluate for liver metastases. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There are at least 4 mildly T2 hyperintense lesions the largest in segment 6 of the liver measuring 2.3 x 1.8 cm. Previously the lesion measured 1.2 x 1.1 cm. The other lesions have also grown in size.SPLEEN: No significant abnormality noted.PANCREAS: There is a large T2 hyperintense mass involving the pancreatic body. The mass measures 6.2 x 6.6 cm previously, 6.1 x 6.1 cm. The tail is atrophic. Pancreatic duct in the head of the pancreas is normal. Common bile duct is normal in caliber. There are subtle T2 hyperintense foci within the pancreatic head which may represent small branch type IPMN's.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left pleural effusion and ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/8/2016 14:43:00)PANCREATIC BODY MASS: 6.2 x 6.6 cm (Image 34, Series 16); 6.1 x 6.1 cm on prior (7/29/2016) (Image 65, Series 19).SEGMENT 6 LESION: 2.3 x 1.8 cm (Image 17, Series 11); 1.2 x 1.1 cm on prior (7/29/2016) (Image 73, Series 19). | 1.Findings of a 6.6 cm pancreatic body mass which is slightly increased in size from prior.2.Increase in the size of the liver lesions.3.Given the lack of intravenous contrast the liver lesions or pancreatic lesion cannot be fully characterized however, given the pancreatic mass shows size increase and increase in the size of the liver lesions these are most compatible with metastatic disease. |
Generate impression based on medical findings. | Cardiac arrest, cause unspecified [I46.9] / Unspecified coma [R40.20], Reason for Study: ^Reason: prognostication after cardiac arrest History: absence of mental status There are multifocal symmetric diffusion restriction lesions on bilateral occipital lobe, parietal lobes and frontal lobes. There is also focal diffusion restriction on the left basal ganglia.There is focal susceptibility artifact on the left inferior medial aspect of temporal lobe (series 901, image 92). There is no associated surrounding edema. The differential diagnosis include focal hemorrhage, parenchymal calcification or an artifact.The ventricles, sulci and cisterns are symmetric and unremarkable.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. | Symmetric acute ischemic infarctions involving bilateral frontal, parietal and occipital lobes which is consistent with global hypoxic injury. |
Generate impression based on medical findings. | 60 year old male patient with back pain. Evaluate for nerve compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. The conus medullaris is normal in position. There is mild prominence of the dorsal epidural fat.There is spondylolysis of L5 with grade 1-2 spondylolisthesis of L5 on S1. There is trace retrolisthesis of L1 on L2 and L2 on L3. There are anterior osteophytes throughout the lumbar spine with disc dessication at all levels, which is most severe at L5/S1. There is mild endplate irregularity of lower lumbar spine with a small focus of enhancement within the superior endplate of L3 which is likely degenerative in etiology. Furthermore, there is enhancement within the epidural space at L5/S1 as well as the facet joints, likely on a degenerative basis. Additional multilevel degenerative changes are as described below:L1-L2: Mild posterior disc bulge without significant spinal canal or neural foraminal stenosis. L2-L3: Minimal posterior disc bulge without significant spinal canal stenosis. Ligamentum flavum thickening and facet hypertrophy contribute to minimal right neural foraminal stenosis.L3-L4: Minimal posterior disc bulge eccentric to the right, ligamentum flavum thickening, and facet hypertrophy without significant spinal canal and minimal right neural foraminal stenosis.L4-L5: Mild posterior disc bulge, ligamentum flavum thickening, and moderate facet hypertrophy contribute to mild spinal canal stenosis, particularly involving the lateral aspect of the thecal sac, moderate to severe left neural foraminal stenosis, and mild to moderate right neural foraminal stenosis. L5-S1: Grade 1-2 spondylolisthesis of L5 on S1 with disc uncovering, ligamentum flavum thickening, and moderate facet arthropathy cause severe left and mild to moderate right neural foraminal stenosis. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits. | Multilevel degenerative changes of the lumbar spine, worst at the L4-L5 and L5-S1 levels. There is grade 1-2 spondylolisthesis of L5 on S1 with bilateral pars defects of L5. There is significant neural foraminal stenosis at L4-L5 and L5-S1, worse on the left than the right. Please see additional details above. |
Generate impression based on medical findings. | The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a T1 hyperintense lesion within the T4 vertebra, which likely represents a fat-containing hemangioma. The vertebral bone marrow signal is otherwise unremarkable. There is no pathologic enhancement. There is mild facet arthropathy of the lower thoracic spine. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is partially imaged left lower cervical and upper mediastinal lymphadenopathy, which encases the left common carotid artery. There is also partially imaged pretracheal lymphadenopathy. Incidentally noted is a right chest port. | 1.No evidence of metastatic disease within the thoracic spine.2.Partially imaged left lower cervical and upper mediastinal lymphadenopathy encasing the left common carotid artery and pretracheal lymphadenopathy are better evaluated on CT neck soft tissue of 4/2/2015. |
Generate impression based on medical findings. | 17 year-old female with knee pain for 3 to 4 years. MENISCI: No significant abnormality noted. The menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No abnormal thinning or defects of the articular cartilage. No abnormal bone marrow signal. No evidence of osteochondritis dissecans within the patella or elsewhere as clinically questioned.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are normal in appearance.EXTENSOR MECHANISM: The extensor mechanism is intact. No visible abnormal patella plica.ADDITIONAL | Normal examination. |
Generate impression based on medical findings. | Dysarthria and vomiting. Evaluate for posterior circulation stroke. Brain MRI: There is an area of diffusion restriction and increased T2 signal in the right cerebellar hemisphere that measures up to 16 mm. There is also a punctate focus of diffusion restriction in the superior right postcentral gyrus. There are a few tiny scattered T2 hyperintense foci in the cerebral white matter that most probably reflect mild chronic microvascular ischemia. There is no evidence of intracranial mass lesions or hemorrhage. There is no midline shift or ventricular dilatation. The orbits and paranasal sinuses are unremarkable. The skull and scalp soft tissues are also grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. The right internal carotid artery has a retropharyngeal course. | 1. Foci of diffusion restriction in the right cerebellar hemisphere and right postcentral gyrus are compatible with acute infarcts. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Male, 62 years old, with brain metastases status post stereotactic radiosurgery. Evaluate for progression. A small hemosiderin stained resection cavity is again seen involving the left precuneus. No pathologic enhancement or new signal abnormality is detected in this vicinity. A 2 to 3 mm focus of enhancement within the left putamen with associated susceptibility effect is unchanged. No new enhancing lesions are seen. Scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres show no significant interval change. Diffuse prominence of the perivascular spaces is seen. No abnormal extra axial collections are detected. The ventricles are stable in size and morphology. | 1.Stable postoperative findings in the left parietal lobe with no evidence of tumor recurrence.2.Stable focus of enhancement within the left putamen.3.No new intracranial lesions are seen. |
Generate impression based on medical findings. | Female, 56 years old, with back pain status post lumbar instrument fusion, status post epidural hematoma evacuation. Evaluate for hematoma. Evidence of posterior instrumented fusion is again seen with pedicle screws on the right at L4-S1, and on the left at L5 and S1. Interbody devices have also been placed at L4-5 and L5-S1. Evidence of laminectomy/facetectomy is also seen on the right at L4-5 and on the left at L5-S1.Since the prior examination, the previously seen large fluid collection within the superficial soft tissues of the lumbar region has resolved. A fluid collection which was evident more deeply within the right L4-5 operative bed, extending to the epidural space, has also significantly improved with only a small amount of residual fluid or edema present. Previous encroachment upon the thecal sac has improved as well.Marrow signal abnormality compatible with edema is seen involving nearly the entirety of the L4 and L5 vertebral bodies, a finding which has progressed from the prior examination. There may be some edema in the prevertebral soft tissues, but this is equivocal. No definite evidence of any new epidural or paraspinal fluid collection is seen. Edema persists within the right psoas musculature.Straightening of the cervical lordosis is again seen. Vertebral body heights are largely preserved with the exception of postoperative change at L4 and L5. No other areas of marrow signal abnormality are seen.At L3-4, facet arthropathy, ligamentum flavum thickening, and a disc bulge with central annular fissure contribute to mild spinal canal narrowing. The foramina are not significantly compromised.At L5-S1, posterior element hypertrophy and bulging disc material resulting in a moderate narrowing of the spinal canal, but improved from the prior examination. Moderate right and mild left foraminal narrowing is seen.At L5-S1, posterior element hypertrophy and disc bulging asymmetric to the left lateral recess is seen. No significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed. | 1.Since the prior examination, the previously demonstrated subcutaneous and epidural fluid collections within the operative region have resolved or nearly completely resolved. No findings are seen to suggest new or progressive bleeding. The thecal sac remains narrowed at the L4-5 level though this is improved relative to the prior study.2.Progressive edema is seen within the L4 and L5 vertebral bodies when compared to the prior examination. There may be mild edema within the prevertebral soft tissues but this is equivocal. No new fluid collections are seen. In the absence of leukocytosis or an abnormal ESR, these findings may simply represent edema reactive to surgical instrumentation. Infection is considered less likely but cannot be eliminated as a possibility based on imaging. At least one follow-up MRI can be considered if the patient's symptoms do not improve. |
Generate impression based on medical findings. | Female, 56 years old. Chronic right knee pain. Outside MRI study suspicious for pigmented villonodular synovitis. Three weightbearing views of the right knee demonstrate a large joint effusion. There is mild joint space narrowing along the patellofemoral compartment with patellofemoral osteophyte formation. | Large joint effusion with mild osteoarthritis of the right knee. |
Generate impression based on medical findings. | Major depressive disorder, recurrent, moderate [F33.1], Reason for Study: ^Reason: vascular dementia History: htn and cognitive impairment No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/flair high signal intensity lesions on subcortical white matter and periventricular white matter are nonspecific but may indicate small vessel ischemic disease.The ventricles, sulci and cisterns are 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.No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease. |
Generate impression based on medical findings. | 67-year-old male with history of prostate cancer status post robotic prostatectomy now with rising PSA. PELVIS:PROSTATE:Prostate: Status post prostatectomy. No nodules or masses in the prostatectomy bed.BLADDER: Small left posterior bladder diverticulum.LYMPH NODES: 4mm bilateral pelvic nodes just superificial to the perirectal fascia. 6 mm right external iliac node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post prostatectomy with no suspicious nodules, masses, or foci of enhancement. Tiny bilateral pelvic nodes are nonspecific. 6 mm right external iliac node is not enlarged by size criteria, however its location is suspicious and this should be followed. |
Generate impression based on medical findings. | There are postoperative findings related to right frontotemporal approach for resection of a right parasellar meningioma. There is mild residual dural thickening and enhancement along the right anteromedial portion of the middle cranial fossa, lateral aspect of the cavernous sinus, and right posterior clivus that measures up to approximately 3 mm in thickness. There is a small amount of residual confluent T2 hyperintensity in the anterior right temporal lobe adjacent to the resection bed, which may represent encephalomalacia or gliosis. 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. | Postoperative findings related to resection of a right parasellar meningioma with what may represent a small amount of residual tumor versus residual reactive dural thickening in the resection bed. |
Generate impression based on medical findings. | MRI: There is a linear focus of restricted diffusion implant hyperintensity in the left hemipons medially consistent with acute infarct. There is other mild nonspecific periventricular and subcortical T2 signal abnormality. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, and in the right frontal operculum. These may represent foci of chronic microhemorrhage.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid in the nasal cavity with mild frontal, moderate ethmoid and right sphenoid sinus mucosal thickening. Sagittal T1 weighted images are not available.MRA: Mild motion artifact degrades axial image quality. Within this limitation, no focal high-grade stenosis is identified in the intracranial circulation. There is a 4 x 4 mm saccular aneurysm arising at the branch point of the right M1 segment directed laterally, which may actually originate from the proximal right M2 segment. The neck of the aneurysm is not well visualized. The right vertebral artery is slightly larger compared to the left, with development to diminutive left V4 segment post-PICA. There is moderate narrowing of the distal left V4 segment. Both vertebral arteries join to form the basilar artery. | 1.Acute medial left hemipontine nonhemorrhagic infarct. Other nonspecific foci of white matter FLAIR hyperintensity likely which likely represents chronic small vessel ischemic changes.2.No flow limiting intracranial stenosis, with moderate narrowing of the distal left V4 segment.3.4 x 4 mm saccular aneurysm arising from the right M1 segment branching point, likely originating from the proximal inferior M2 segment. CTA of the head recommended for further evaluation, as the neck is not well visualized on this MR exam.Findings were communicated with the emergency department by the radiology resident on call at the time of preliminary interpretation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 49-year-old woman with multiple vascular and risk factors with acute mental status changes and slurring of speech. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. The ventricles and basal cisterns are normal in size and configuration. Subtle asymmetry to the sulci is likely related to patient positioning. However subtle abnormalities cannot be ruled out and an MRI may be considered if an acute infarct is suspected.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | No acute abnormality noted. However, subtle findings cannot be ruled out and an MRI may be considered if acute infarct is suspected as clinically indicated. |
Generate impression based on medical findings. | There is unchanged mild retrolisthesis of L5 on S1 measuring approximately 5 mm. The vertebral body heights are well-maintained. There is disc desiccation of L3-L4, L4-L5 and L5-S1, which is unchanged. There is mild loss of disc height at L3-L4 and L4-L5 and moderate loss of disc height at L5-S1, which are unchanged. 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-L2 level. T1 hyperintensity is again present within the filum terminale, which demonstrates signal loss on fat suppression and STIR technique on the 7/21/2014 exam.T12/L1: Bilateral facet degeneration, but no significant disc bulge, spinal canal or foraminal stenosis.L1/2: Bilateral facet degeneration, but no significant disc bulge, spinal canal or foraminal stenosis.L2/3: Bilateral facet degeneration, but no significant disc bulge, spinal canal or foraminal stenosis.L3/4: Mild disc bulge, bilateral facet degeneration and ligamentum flavum thickening, but no significant spinal canal or foraminal stenosis.L4/5: Diffuse disc bulge, bilateral facet degeneration and ligamentum flavum thickening, contributing to mild spinal canal stenosis.L5/S1:Diffuse disc bulge with superimposed left paracentral disc extrusion with inferior migration measuring 7 mm, progressed since prior study, bilateral facet degeneration and ligamentum flavum thickening, contributing to mild to moderate central canal stenosis and effacement of the left lateral recess, and mild right and moderate left foraminal stenosis. | 1. Degenerative changes of the lower lumbar spine with new left paracentral disc extrusion at L5/S1 with resulting effacement of the left lateral recess and mild to moderate central spinal canal stenosis. There is mild right and moderate left L5/S1 foraminal stenosis. There may be impingement of the traversing left S1 and exiting left L5 nerve roots at this level. Mild spinal canal stenosis at L4/L5.2. Fatty filum terminale with conus terminating normally at L1-2.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 55-year-old female with pain. Evaluate for AVN. MENISCI: The medial meniscus appears intact. The anterior horn of the lateral meniscus is markedly truncated consistent with a radial tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration of the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is fluid between the superficial and deep fibers of the MCL which may represent an MCL bursitis.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Tear of the anterior horn of the lateral meniscus. No evidence of avascular necrosis.2. Near full-thickness articular cartilage degeneration as described above.3. Findings consistent with a MCL bursitis.4. Small-to-moderate size joint effusion.5. Nonspecific subcutaneous edema about the knee. |
Generate impression based on medical findings. | Diagnosed with meningitis following presenting with headache and vomiting. Gait is drifting toward the right side. Assess for focal brain abnormality. There are subtle scattered punctate foci of cortical diffusion restriction, some of which correlate with T2/FLAIR hyperintensity. For example, a focus involving the left hippocampus is seen on axial diffusion image #191, FLAIR images #17. Punctate foci in the paramedian frontal lobes are seen on diffusion image #182. There is no large territorial diffusion restriction or intracranial hemorrhage. There is no abnormal parenchymal or leptomeningeal contrast enhancement. There is no abnormal extra-axial fluid collection. The ventricles and other CSF-containing spaces are normal in size. There is no midline shift or brain herniation. Major intracranial vascular flow voids are preserved, reflecting gross patency.There is no gross orbital abnormality. There is no destructive skull lesion. The mastoid air cells are clear. Very minimal ethmoid sinus mucosal thickening is nonspecific. | 1.There is no evidence of intracranial abscess or empyema.2.Subtle, scattered cortical punctate foci of diffusion restriction, some of which demonstrate T2 FLAIR hyperintensity may relate to the known infection. Embolic disease and seizure-related foci are additional possibilities but atypical. |
Generate impression based on medical findings. | Developmental delay, porencephaly, 4 month history of progressive hearing loss, gait decline, change in speech, and multifocal pains, intracranial bleeding, new-onset seizure like episodes and 50pound weight loss. Brain: There are bifrontal porencephalic cysts and deficiency of much of the septum pellucidum. There is layering intermediate T1 and low T2 signal hemorrhage in the occipital horns of the bilateral lateral ventricles. There is extensive supratentorial and infratentorial superificial siderosis. There are bilateral cerebral convexity subdural fluid collections, measuring 16 mm on the left and 6 mm on the right, with compression of the underlying brain. The ventricular system is unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the right globe. There is a left maxillary retention cyst and mild right maxillary sinus mucosal thickening.Lumbar Spine: There is diffuse T2 hypointensity along the surface of the imaged spinal cord. There is also a small amount of high T1 and low T2 signal material within the inferior spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. | 1. Bifrontal porencephalic cysts.2. Layering acute hemorrhage in the occipital horns of the bilateral lateral ventricles and subacute hemorrhage in the inferior spinal canal. 3. Bilateral cerebral convexity subdural effusions, left larger than right.4. Extensive superficial siderosis involving the intracranial contents and imaged potions of the spinal cord. |
Generate impression based on medical findings. | 39 year-old female with multiple sclerosis diagnosed in 2005. MRI BRAIN: There is a new left pontine lesion with low T1 signal and a newly apparent patchy T2 hyperintense lesion in the right middle cerebellar hemisphere. Otherwise, there has been no significant interval change of the T2 hyperintense cerebral white matter and small medial left cerebellar hemisphere lesions, which are predominantly distributed in the periventricular regions. Many of the lesions demonstrate T1 hypointensity, but there is no evidence of associated enhancement. The ventricles are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. There is mild persistent scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unchanged. MRI CERVICAL SPINE: There is redemonstration of scattered high T2 signal lesions in multiple portions of the cervical and thoracic spinal cord. No enhancing lesions are identified. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is mild disc desiccation signal throughout the cervical spine and mild disc height loss at C5-6. The vertebral bone marrow is unremarkable. A posterior disc osteophyte complex with central disc protrusion is demonstrated at C5-C6 with mild flattening of the ventral spinal cord. There is no significant neural foraminal stenosis is evident. | 1. Newly apparent infratentorial demyelinating lesions. The supratentorial demyelinating lesions otherwise appear to be similar as on the prior exam, accounting for differences in technique. 2. The demyelinating lesions in the cervical and thoracic spinal cord do not appear significantly changed, given differences in technique.3. Interval central disc protrusion at C5-C6 that mildly indents the spinal cord. |
Generate impression based on medical findings. | Reason: 71 yo M hx of recurrent acute pancreatitis, OSH imaging shows calcifications in the pancreatic tail, and pseudocyst near the head of the pancreas. MRI/MRCP to assess pancreatic parenchyma, rule out small tumor, also eval pancreatic duct and emptying History: recurrent acute pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 9 mm cystic lesion within the pancreatic body with additional cystic lesions, most prominent in the pancreatic head and tail. These most likely represent dilated side branches from chronic pancreatitis. The main pancreatic duct within the head, neck and body is nondilated.There is abrupt dilatation of the main pancreatic duct involving the distal 5 cm of the tail suggesting a focal stricture or obstructing lesion. Within the associated pancreatic tail, there is atrophy with low T1 signal and diffusion restriction, which may be associated with chronic obstruction and pancreatitis.There is overall loss of lobulations throughout the pancreas with a bulbous appearing uncinate.An appropriate response is present following secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right chest wall lipoma measuring 0.3 cm (8/4).OTHER: No significant abnormality noted. | 1.Focal stricturing of the main pancreatic duct within the pancreatic tail with associated ductal dilatation and findings suggestive of chronic pancreatitis. An obstructing lesion or stone is not visualized, however a lesion cannot be excluded at the site of obstruction. Recommend three-month follow-up MRCP if an endoscopic ultrasound is not planned.2.Loss of pancreatic lobulations and a bulbous appearing uncinate may be related to resolving pancreatitis or an autoimmune pancreatitis. |
Generate impression based on medical findings. | The risks (including, but not limited to, those of bleeding, infection, allergic reaction, inability to access the joint, and failure of medication to relieve pain) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge.Under fluoroscopic guidance, 22 gauge needle was advanced into the joint in the mid carpal compartment. Next, 7 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Both ulnar deviation and radial deviation spot images were obtained without apparent extravasation of contrast into the radiocarpal compartment.Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information. Exposure time: 1:35 minutes | Successful fluoroscopically guided injection of contrast into the midcarpal compartment of the right wrist. Please refer to the subsequent MRI report for further information. |
Generate impression based on medical findings. | Reason: breast cancer with brain met; RT planning for SRS History: RT planning; no neuro symptoms The previously seen superior left cerebellar punctate enhancing nodule has decreased in size, now measuring 3 x 3 mm on 401/75, as compared to previous 5 x 6 mm. There is associated punctate susceptibility now, with mild T2 hyperintensity.There are a few areas of ill-defined enhancement within the calvarium bilaterally, slightly more conspicuous. The areas along the vertex are more rounded in configuration (401/155 and 160). One rounded lesion along the left parietal bone (403/71) is not definitely seen on the prior exam. Review of outside bone scan seems to suggest some areas of corresponding focal uptake in the calvarium.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological parenchymal enhancement. No extra-axial fluid collection is identified. | 1. Interval decreased size of single left superior cerebellar enhancing nodule, now only measuring 3 mm.2. Multiple areas of ill-defined calvarial enhancement, appearing more rounded near the vertex, suspicious for osseous metastatic disease especially given recent bone scan correlation. These appear minimally progressed since prior. |
Generate impression based on medical findings. | 4 4 year-old male with history of intraventricular hemorrhage with hydrocephalus, status post shunt placement, ex-28 week premature gestation, experiencing new seizure As before, several sequences are degraded secondary to artifact induced by the patient's ventricular shunt reservoir. Given this caveat:Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. There has been no interval change in size of the dysmorphic lateral ventricles when compared to the most recent CT. The third and the fourth ventricles remain unchanged in size. Left hemispheric dysmorphism is unchanged.A previously demonstrated prominent left extra-axial fluid space redemonstrates mid intensity on T1, hyperintensity on T2, with diffuse enhancement. This extends to also involve the tentorium and falx, as well as to a lesser extent the right hemispheric dura. Overlying this is a second area of crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing, lower intensity on T1and T2 when compared to the overlying process, yet appearing hyperintense on T1 and T2 compared to CSF. These sizes, morphologies, and characteristics are stable.Hemosiderin staining along the epididymal surface of the lateral ventricles is unchanged. Redemonstrated is residua from germinal matrix hemorrhage. There is no midline shift or basal cistern effacement. Myelination within the uninvolved brain appears mature. Redemonstrated is thinning of the corpus callosum and volume loss in the white matter.Major intracranial flow voids appear present. Previously demonstrated complete opacification of the paranasal sinuses has nearly resolved. Mastoid air cells and middle ear cavities are clear. Orbital contents are unremarkable. | 1.Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. 2.There has been no interval change in size of the dysmorphic lateral ventricles when compared to the most recent CT.3.Stable multiple intracranial abnormalities as described in detail above. |
Generate impression based on medical findings. | Personal history of left breast skin sparing mastectomy in 2011 for DCIS. Family history of breast cancer in paternal grandmother, paternal great aunt, and paternal cousins. Patient is status post left mastectomy with reconstruction. There is mild parenchymal enhancement and a heterogeneous amount of fibroglandular tissue in the right breast.No abnormal enhancement is seen in the right breast or the reconstructed left breast. Scattered enhancing foci in the right breast are similar to prior studies dating back multiple years. A few high T2 signal cysts are present on the right as well. No abnormal axillary 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. | Study limited due to due to the artifacts from the orthopedic fusion hardware.Posterior fusion screws are seen at L3, L4, L5, and S1. The conus medullaris ends at the level of L1-L2. The spinal canal at the L1-2 and L2-3 levels is vaguely appreciated without significant stenosis. Elsewhere, the spinal canal is not well assessed.The level of T12-L1 demonstrates no disc bulge with no spinal or neural foraminal compromise.The level of L1-L2 demonstrates minimal disc bulging with no foraminal or spinal compromise.The lower level of the disks could not be assessed due to artifact from the fusion hardware.Note is made that of the orthopedic screws appear intact. | Limited study due to artifacts from the orthopedic hardware. The spinal canal at L1-L2 and L2-L3 is vaguely discerned with no significant stenosis. Elsewhere, the spinal canal is not well assessed. |
Generate impression based on medical findings. | Low back pain, occasional radicular symptoms down right lower extremity. Pain down right posterior buttock Numbering is performed similar to prior MRI report from 2004 with postoperative changes of spinal fusion from L4 to S1. As numbered, hypoplastic ribs are noted associated with the L1 vertebral body, better seen on recent CT.There is solid osseous fusion involving the posterior elements from L4 through S1 as well as fusion at the L4-L5 and L5-S1 interbody levels.There is mild retrolisthesis of L2 on L3 and L3 on L4 similar to prior. There has been progression of disc height loss at the L3-L4 level compared to 2004 compatible with adjacent segment disease. Disc height loss and endplate changes at the L2-L3 level have also progressed. There is marrow edema involving the endplates from L2 to L4. Vacuum phenomena is evident at the L1-L2, L2-L3, and L3-L4 levels. Bone marrow signal is benign without suspicious osseous lesions evident. Vertebral body heights are maintained. The conus medullaris is normal in position.Individual levels further described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is minimal narrowing of the spinal canal and minimal narrowing of the neural foramina. L2-L3: There is disc bulge and prominent ligamentum flavum thickening and facet arthropathy. There is moderate spinal canal stenosis as well as severe right neural foraminal stenosis. There is mild left neural foraminal stenosis. These findings have significantly progressed since prior 2004 MRI.L3-L4: There is retrolisthesis with endplate osteophyte and advanced bilateral facet arthropathy which contributes to moderate narrowing of the lateral aspect the spinal canal grossly similar to prior. There is up to moderate narrowing of the bilateral neural foramina similar to prior.L4-L5: No spinal canal stenosis. There is mild right and minimal left neural foraminal narrowing. L5-S1: No spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. | 1. Postsurgical changes of spinal fusion from L4 to S1 are again seen with intact hardware and evidence of solid osseous fusion better seen on recent CT from 12/18/2015.2. Advanced degenerative changes are seen above the level of the fusion at the L2-L3 and L3-L4 levels with moderate spinal canal stenosis, particularly progressed at the L2-L3 level when compared to remote MRI study from 9/9/2004. There is severe right L2-L3 neural foraminal stenosis and to a lesser degree at additional levels, as detailed above.3. Please note comment about numbering in the findings section above. |
Generate impression based on medical findings. | Diagnosis: Sickle-cell disease without crisisDiagnosis Edits: Clinical question: sickle cell ds Signs and Symptoms: eval for moya moya/stenosis MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial cerebrovascular occlusion. The anterior communicating artery is identified. The posterior communicating arteries are asymmetric. The right posterior communicating artery is almost is large in diameter as the right P1 segment the left posterior communicating artery is small. The right posterior communicating artery is larger than the left posterior communicating artery. The vertebral arteries are similar in size.Low marrow signal is a nonspecific finding but expected in a patient with sickle cell disease. | 1.No evidence for cerebrovascular occlusive disease. There is no evidence for moyamoya.2.No evidence for cerebral infarction. |
Generate impression based on medical findings. | Acinic cell carcinoma that originated in the right parotid gland, with extension to the skull base, status post treatment and osteonecrosis. There are postsurgical findings related to prior right lateral temporal bone resection and parotidectomy. There is unchanged patchy heterogeneous enhancement involving the right basiocciput, petrous ridge, condylar and squamous portions of the occipital bone, and the right lateral mass of C1, with a small soft tissue component in the upper carotid space, all appearing similar to prior examinations. Intracranially, no new or suspicious lesions are seen. There are a few unchanged punctate foci of enhancement within the right lateral cerebellum, immediately adjacent to the abnormal skull base, with surrounding T2 hyperintensity. Supratentorially, there are several scattered foci of nonspecific T2 hyperintensity, which appear unchanged. Otherwise, there are no new enhancing intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles remain normal in size and morphology. There is a small left maxillary sinus retention cyst. | Findings related to right lateral temporal bone resection and parotidectomy without significant change in the treated right skull base and right craniocervical junction tumor, as well as the abnormality along the inferior right cerebellar hemisphere. |
Generate impression based on medical findings. | Chiari decompression with worsening headache and difficulty swallowing. Brain: There are postoperative findings related to Chiari decompression surgery. There is persistent tenting of the posteroinferior cerebellum to the overlying dura associated with intervening hypointense bands. There is also blunted cerebrospinal fluid flow across the posterior aspect of the neo-foramen magnum. Otherwise, there is intact cerebrospinal fluid flow across the anterior neo-foramen magnum and the inferior cerebellum extends to the level of tip of the dens, which is unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are slightly smaller in size. There is no midline shift. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is unchanged, with paucity of the usual cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. | 1. Postoperative findings related to Chiari decompression surgery with persistent evidence of adhesion formation along the posteroinferior cerebellum.2. No evidence of syringohydromyelia in the cervical spinal cord. |
Generate impression based on medical findings. | Hip by car on 4/25/2016 status post 2 knee surgeries for patellar tendon rupture. The tear appears swollen with tenderness over the MCL and positive laxity. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Bony contusion of the lateral femoral condyle.LIGAMENTS: The ACL and TCL are intact. The LCL complex and MCL appear within normal limits. EXTENSOR MECHANISM: Postoperative findings from patellar tendon rupture including orthopedic fixation devices and thickening of the patellar tendon.ADDITIONAL | Postoperative findings related to patellar tendon reinsertion. The MCL appears within normal limits. There is a large joint effusion. |
Generate impression based on medical findings. | Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination. | 1.Unremarkable CT of breath.2.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam. |
Generate impression based on medical findings. | Left renal mass seen on CT. ABDOMEN:LIVER, BILIARY TRACT: Mildly nodular liver contour. No suspicious liver lesion. Patent vasculature. Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal superior pole 5.7 x 5 5 cm cyst (series 4/12). Anteriorly there is a small mural nodule which does not demonstrate enhancement (series 4/12).In the anterior cortex of the right kidney interpolar region is a stable 2.9 x 1.9 cm angiomyolipoma (series 1000/37).Immediately inferior is a 3.1 x 2.4 cm intrinsically T1 hyperintense (series 10/43) nonenhancing lesion compatible with a hemorrhagic/proteinaceous cyst.In the left kidney interpolar region posterior cortex there is a 1.3 cm T2 hypointense lesion. The lesion demonstrates mild postcontrast enhancement. There is also signal loss on the T2-weighted fat-suppressed images (series 4/19). The lesion does demonstrate some signal loss on out of phase imaging suggesting intra-voxel fat (series 1002/49). 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.Indeterminate 1.3 cm left renal interpolar region lesion is stable in size. We favor that this represents an angiomyolipoma. Possibility of Renal cell carcinoma cannot be excluded. However, continued imaging follow-up is recommended.2.Stable right renal angiomyolipoma measuring 2.9 cm.3.Simple and minimally complex right renal cysts.4.No suspicious liver lesion. |
Generate impression based on medical findings. | 37-year-old female with fever and back pain. Evaluate for discitis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. No evidence of discitis-osteomyelitis or epidural or paraspinous collections to suggest abscess. Diffuse low T1 marrow hypointensity is seen which is nonspecific. Scattered foci of T1 and T2 hyperintensities are nonspecific and compatible with foci of fat or small hemangiomas. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Minimal degenerative changes are seen in the lumbar spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is a minimal disc bulge, minimal facet hypertrophy and minimal ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L5-S1: There is a minimal disc bulge, minimal facet hypertrophy and minimal ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina. | 1.No evidence of discitis-osteomyelitis or epidural or paraspinous collections to suggest abscess. 2.Diffuse low T1 marrow hypointensity which is nonspecific but can be seen with marrow reconversion related to chronic illnesses, chronic anemias, as well as marrow proliferative disorders3.Minimal degenerative changes without significant spinal canal or neural foraminal stenosis. |
Generate impression based on medical findings. | Hemangioma of intracranial structures [228.02], Reason for Study: ^Reason: 3T Scanner, CCM Protocol History: Abnormality noted on prior MRI; CCM vs. AVM, please evaluate and compare with priori images Brain MRIRe-demonstration of right cingulate gyrus anterior aspect signal void just above the level of caudate head. The lesion does not show associated edema, nor high signal intensity on T1 weighted image.On Gad enhanced image, there is prominent vascular structure extending from the lesion to the adjacent cortex.There is another linear enhancing structure on the left frontal lobe middle frontal gyrus. These two white matter linear enhancing structure are likely representing developmental venous anomaly (DVA).And the signal void lesion on the right cingulate gyrus likely represent cavernous malformation. The size and MR characteristics of the lesion do not show any interval change since prior exam.There is prominent enhancement on the right side angular gyrus which could represent prominent vein of Labbe or associated small DVA.There focal signal void on the left frontal lobe medial orbital gyrus (series 1202, image 14/28), however, this lesion was not seen on the original gradient echo images, thus the reconstructed images likely represent volume averaging artifact. The ventricles, sulci and cisterns are symmetric and unremarkable. 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 normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. | 1. Right cingulate gyrus cavernous malformation with associated developmental venous anomaly. Another developmental venous anomaly on the left frontal lobe and possible DVA on the right angular gyrus. No change since prior exam.2. Normal brain MRA. |
Generate impression based on medical findings. | Nasopharyngeal cancer, status post treatment, now with dysarthria, neck spasm, and left shoulder weakness. Brain: In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous, on the order of 50, new intraparenchymal foci of infratentorial and supratentorial susceptibility effect. There is no evidence of acute infarct. 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 orbits are grossly unremarkable. The calvarium is intact. Neck: There are secretions in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant upper cervical lymphadenopathy. The salivary glands appear unchanged. The major cervical flow voids are grossly intact. There is a posterior small disc osteophyte complex at C5-6. | 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous new intraparenchymal foci of infratentorial and supratentorial susceptibility effect, which could represent microhemorrhages, perhaps related to treatment effects, versus less likely atypical metastases. |
Generate impression based on medical findings. | 77-year-old female with right facial droop and expressive aphasia status post code stroke, tPA given for presumed ischemic stroke. There are areas of restricted diffusion involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum. There is no intracranial hemorrhage, focal mass effect, midline shift, herniation, or extra-axial fluid collection.There is additional moderate periventricular and subcortical white matter hypoattenuation which is nonspecific. Additional small areas of probable prior infarct include the left occipital region and right thalamus.The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1.Acute infarct involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum.2.No evidence of intracranial hemorrhage or mass effect.3.Moderate chronic likely small vessel ischemic disease. |
Generate impression based on medical findings. | History of renal cell carcinoma liver metastases. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.The reference segment 6 lesion measures approximately 8 x 7 mm (series 11/47), compared to 9 x 6 mm previously.The reference segment 2 lesion measures 2.3 x 1.5 cm (series 11/69), compared to 1.9 x 1.5 cm previously.Reference peripheral segment 6 lesion measures 3.5 x 2.1 cm (series 3/11), compared to 3.4 x 2.3 cm previously. The additional peripherally enhancing lesions in the liver are not significantly changed in size.Segment 5 hemangioma and adjacent cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Stable nonenhancing cystic lesion in the pancreatic head measuring approximately 1.4 x 0.8 cm (series 11/224).ADRENAL GLANDS: Status post right adrenalectomy. The left adrenal gland is stable in appearance with mild nodular thickening.KIDNEYS, URETERS: Postsurgical changes from right nephrectomy. Complex cystic lesion in the left upper pole with calcification is unchanged. Additional renal cysts are noted and are unchanged without suspicious features.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted. | 1.No significant interval change in the metastatic liver lesions. 2.Stable nonspecific pancreatic cystic lesion without suspicious imaging characteristics, likely a branch-type IPMN. |
Generate impression based on medical findings. | Follow-up hemangioma. History of P53 syndrome. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Segment 7 lobular T2 hyperintense lesion measuring 4.8 x 4.4 cm demonstrates peripheral nodular discontinuous enhancement which progressively fills in, compatible with a hemangioma.Numerous small and large gallstones within an elongated gallbladder without evidence of cholecystitis.No intrahepatic biliary duct dilatation, additional suspicious liver lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild bilateral left greater than right adrenal thickening without a discrete nodule.KIDNEYS, URETERS: Right renal superior pole simple appearing cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses. Diastases of the rectus abdominis muscles with broad base fat-containing hernia without evidence of complication.OTHER: No significant abnormality noted. | 1.The right hepatic lobe lesion currently measures 4.8 x 4.4 cm compared to 3.6 x 3.4 cm in 2013 and remains compatible with a hepatic hemangioma.2.Bilateral hyperplastic adrenal glands, unchanged.3.Hepatic steatosis. |
Generate impression based on medical findings. | 63-year-old male with worsening gait There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are T2 hyperintense foci within the brainstem, periventricular and subcortical white matter, some of which have a radiating appearance, not significantly changed. However, there is a new focus within the anteromedial right thalamus which demonstrates susceptibility artifact suggesting interval, yet remote in appearance, microhemorrhage. There is stable mild volume loss and prominence of the cerebellar folia. The corpus callosum appears to be focally thinned in certain areas, unchanged in extent. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. As before, there are maxillary retention cysts, opacification of the right sphenoid sinus and mucosal thickening within a posterior ethmoid air cell, stable. There is new opacification within a pneumatized air cell located just anterior to the right glenoid fossa. | 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Redemonstrated is T2 brainstem, periventricular and subcortical hyperintensity, stable in appearance. The morphology is suggestive of a demyelinating disease, but other etiologies such as vascular disease and prior inflammation are not excluded.3.There is a new focus within the anteromedial right thalamus which demonstrates susceptibility artifact suggesting interval, yet remote in appearance, microhemorrhage. |
Generate impression based on medical findings. | Reason: Eval for MPFL tear History: Patellar instability MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema along the anterolateral aspect of the lateral femoral condyle likely from recent patellar dislocation. The superior aspect of the femoral trochlea appears shallow indicating femoral trochlear dysplasia, but the articular cartilage of the patellofemoral articulation appears intact. The articular cartilage of the medial and lateral compartments appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is mild increased signal intensity within the posterior fibers of the superficial band of the MCL which may represent a mild sprain, but we see no tear.EXTENSOR MECHANISM: The patellar tendon appears intact. The quadriceps tendon appears intact. There is thickening and abnormal signal intensity of the medial retinaculum indicating tearing. The MPFL is not well visualized as a discrete structure in this patient and is likely torn. Of note, the retinacular structures appear abnormal and likely torn at both the patellar and femoral attachments. There is also edema superficial to the vastus medialis muscle.ADDITIONAL | Findings indicating prior transient lateral dislocation of the patella including bone marrow edema along the anterolateral aspect of the lateral femoral condyle as well as tearing of the medial retinaculum and MPFL as described above. |
Generate impression based on medical findings. | Multiple sclerosis with left lower extremity weakness and diplopia. Brain: There are unchanged extensive supratentorial and infratentorial high T2 signal cerebral white matter lesions without definite associated enhancement. Many of there demonstrate low T1 signal. There are multiple punctate foci of susceptibility effect in the bilateral deep grey matter, brainstem, cerebellum that likely represent chronic microhemorrhage. There is no evidence of intracranial mass or acute infarct. The major intracranial flow voids are grossly intact. There is a left maxillary sinus retention cyst. The extracranial structures are otherwise unremarkable. | 1. No significant interval change in the extensive supratentorial and infratentorial demyelinating lesions and no evidence of acute infarction.2. Multiple punctate foci of susceptibility effect in the bilateral deep grey matter, brainstem, cerebellum that likely represent chronic hypertensive microhemorrhage. |
Generate impression based on medical findings. | Vertigo. Brain: There are multiple scattered cerebral white-matter lesions that are most pronounced in the frontoparietal lobes. None of the lesions shows abnormal contrast enhancement. Compared to the previous examinations, there is no new or growing lesion. The lesions are more visually more conspicuous on today's examination but this may relate to technical factors.There continues to be no corpus callosal lesion. The corpus callosal volume is preserved. A small right dorsal pontine lesion is present. There is no significant involvement of the posterior fossa, otherwise.The small medial left middle cranial fossa arachnoid cyst is unchanged. Mild expansion of the ventricles and to lesser extend the sulci has not changed since the previous examination and probably reflects loss.The mastoid cells and the paranasal sinuses are clear. There is no gross orbital abnormality.Internal Carotid Canal:Internal artery canals are symmetric and normal. There is no abnormal signal or enhancement along the cisternal and canalicular segments of the seventh/eighth cranial nerve complexes. The inner ear structures are symmetric and show no abnormal contrast enhancement. The mastoid air cells are clear as well as the middle ear cavities. There is no destructive petrous lesion.Cervical Spine:Alignment is anatomic. The vertebral bodies are preserved in height and marrow signal. The intervertebral discs are also unremarkable. There is no central spinal canal or foraminal stenosis.The cervical spinal cord shows normal morphology and signal. There is no abnormal spinal cord or leptomeningeal contrast enhancement.There is a partially imaged 2 cm left thyroid lobe nodule. This was present on the previous neck ultrasound examination of January 21, 2013. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1.Brain: Numerous cerebral white-matter lesions without contrast enhancement are not significantly changed since the August 2015 MRI. The lesions do not show typical or specific features of multiple sclerosis, but an atypical demyelinating process may still be considered. Other etiologies including postinfectious and inflammatory phenomena would also be in the differential.2.IAC-CPA: No significant abnormality along the seventh/eighth cranial nerves or in the inner ear structures. There is a punctate T2-hyperintensity in the dorsal pons which has not changed since the previous examination. Otherwise, the brainstem is normal.3.Cervical spine: Normal. A left thyroid nodule is only partly visualized. |
Generate impression based on medical findings. | 44-year-old female with osteomyelitis presents with fever and discharge. Evaluate for osteomyelitis extension. Again seen is T1 and T2 prolongation involving the left ischium consistent with the history of osteomyelitis, appearing increased when compared to the prior study. There is soft tissue irregularity/ulceration along the posterior aspect of the left hemipelvis which extends to the level of the left inferior pubic ramus overlying the aforementioned area of bone marrow signal abnormality. There is extensive increased signal abnormality on fluid sensitive sequences in the surrounding soft tissue, consistent with inflammatory changes, which extend to the level of the posterolateral aspect of the anus and a enterocutaneous fistula cannot be completely excluded. No focal fluid collection is identified to suggest abscess formation. There is linear increased signal abnormality traversing the left inferior pubic ramus suspicious for a nondisplaced stress fracture. There is mild periosteal reaction in the surrounding area. There is nonspecific subcutaneous edema type signal abnormality involving the left mons pubis, left perineum, left anterolateral thigh and right lateral thigh. There is diffuse fatty atrophy of the musculature of the hips. Again seen are changes consistent with bilateral hip dysplasia with deformity of both femoral heads and the acetabuli. There is a nonspecific lobulated focus of fluid signal intensity along the anterior aspect of the sacrum which may represent inflammatory or postsurgical change, appearing similar to the prior studies. Again seen is a posterior myelomeningocele. Foley catheter in place. | Slight interval increase in findings consistent with acute on chronic osteomyelitis involving the left ischium. Probable nondisplaced stress fracture of the left inferior pubic ramus. No drainable fluid collection is identified. Other findings as described above. |
Generate impression based on medical findings. | Renal cell carcinoma status post right partial nephrectomy. 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: Postsurgical changes from right partial nephrectomy. There is surrounding fat necrosis and fascial thickening. There is no evidence of local recurrence. No regional lymphadenopathy.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 evidence of locoregional recurrence or metastatic disease in the upper abdomen. |
Generate impression based on medical findings. | Left hip pain. Evaluate for occult fracture, metastasis, AVN. There is no evidence of an occult fracture. Subchondral foci of decreased T1 signal along the bilateral superior femoral heads without associated increased T2 signal likely represent bone islands. Bone marrow signal is otherwise within normal limits without abnormal enhancement. A 20 x 9 mm ovoid lesion within the left gluteus medius muscle follows fat on all sequences and is compatible with an intramuscular lipoma. | 1. No evidence of avascular necrosis, fracture, or metastases. 2. Left gluteus medius intramuscular lipoma. |
Generate impression based on medical findings. | 31-year-old male. Clinical question to be answered: Intracranial hemorrhage. Signs and symptoms: Acute cysts left ear. Changes consistent with patient's history of pituitary adenoma with enlarged sella are again identified with no interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. This examination remains a stable since prior study. Exclude residual pituitary tumor an MRI examination with infusion is the appropriate study.Mastoid air cells and middle ear cavities are unremarkable. Limited view of paranasal sinuses are unremarkable. | No areas of interval change since prior examination from 6 -- 28 -- 2009. |
Generate impression based on medical findings. | Female, 36 years old, with history of C6-7 disc replacement and worsening left upper extremity pain. Artifact from surgical instrumentation at C6-7 obscures the adjacent vertebral bodies and spinal canal.Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of edema, replacement or pathologic enhancement is seen. The visualized portions of the cervical spinal cord show normal signal characteristics and are likewise free of pathologic enhancement. No epidural collections are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal disc bulge. No spinal canal or foraminal stenosis. No interval changes. C5-6: The spinal canal is partially obscured by artifact, more so than on the prior exam. No definite foraminal narrowing is seen. C6-7: The spinal canal and parts of the neural foramina are obscured by artifact. The lateralmost aspects of the neural foramina are patent. C7-T1: Minimal central disc protrusion. No spinal canal or foraminal stenosis. | Within the limitations of artifact related to the patient's orthopedic instrumentation, no definite new findings are seen to account for the patient's symptoms. |
Generate impression based on medical findings. | 82-year-old female patient with nausea, anorexia, failure to thrive. Question of cholangitis, hepatic parenchymal infection following findings seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of patchy areas of peripheral T2 hyperintensity with diffusion abnormality within the anterior right and left hepatic lobes, similar to the most recent CT and subtly present on prior MRI; this likely represent cholangitis. No fluid collection or abscess is identified. The hepatic vasculature is patent. There is intra- and extrahepatic biliary ductal dilatation. While pneumobilia limits evaluation of the biliary system, there does appear to be a focus of signal void within fluid in the non-dependent portion of the common bile duct at the level of the ampulla (image 33, series 6). This is suspected to represent a stone, possibly measuring up to 4 mm. SPLEEN: There is an accessory splenule.PANCREAS: The main pancreatic duct is non-dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral renal cysts, some of which are complicated. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | 1.Within limitations of pneumobilia affecting assessment of the biliary system, suspected stone within the common bile duct at the level of the ampulla. 2.Intra- and extrahepatic biliary ductal dilatation with peripheral regions of signal abnormality within the liver favored to represent cholangitis given patient's clinical course.Findings communicated via telephone to J. Abimansour at 1646 hrs on 9/8/2016. |
Generate impression based on medical findings. | Male, 49 years old, history of metastatic lung cancer to the brain status post radiation and multiple chemotherapy regimens, now status post two cycles of Alectinib. Innumerable T2 hyperintense, enhancing lesions are redemonstrated both supra- and infratentorially, most of which demonstrate some degree of hemosiderin staining. Since the prior examination, a majority of these lesions show a several-mm interval decrease in size both on post contrast and T2 weighted images. Some of the smaller lesions which were evident on the prior examination are no longer distinctly seen. No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system is stable in size and morphology. | A majority of the known innumerable brain metastases demonstrate an interval decrease in size on the order of several millimeters. Some of the smaller lesions which were evident on the prior examination are no longer clearly seen. |
Generate impression based on medical findings. | Female, 21 years old, with headache for one month, nausea and vomiting, and history of HIV with low CD4 count (88). Assess for tumor or mass. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.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. Mucosal thickening is seen in the sphenoid sinuses. Bone marrow signal characteristics are within normal limits. | No specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | Female, 75 years old, with left sixth nerve palsy and known cavernous sinus mass. Additional patient history includes multiple myeloma. There is a 3.1 x 2 7 x 2.5 cm well-defined, homogeneously enhancing lobulated mass with intermediate T1 and T2 signal centered on the left petroclival ligament. The lesion extends into the sella, left cavernous sinus and Meckel's cave, left middle cranial fossa and left prepontine cistern. A normal pituitary gland is not identified separately, though the pituitary stalk deviates slightly to the right as it enters this mass . There is enlargement of the sella turcica with infiltrative changes to the left aspect of the tuberculum sella and anterior superior aspect of the clivus. The mass completely encases a majority of the cavernous segment and part of the distal petrous segment of the left internal carotid artery, which are mildly narrowed. There is mild mass effect on the left aspect of the pons. The left cranial nerve VI is not well seen at the level of the exiting right cranial nerve VI. The mass also likely impinges encases the cisternal trigeminal nerve. The fourth ventricle is patent. There is no evidence of mass effect on the optic chiasm or other cranial nerves. Mild mass effect is present in the medial aspect of the left inferior anterior temporal lobe. No additional enhancing lesions are identified. The internal auditory canal structures appear normal. No abnormal fluid signal is demonstrated in the middle ear cavities, mastoid air cells or external auditory canals. Generalized cerebral volume loss is noted in the visualized portion of the brain. There is no evidence of hydrocephalus. No diffusion restriction is evident in the brain parenchyma.Asymmetric low T1 signal is noted in the region of the left parietal bone, best seen on coronal precontrast T1 imaging (series 12 image 29). Elsewhere, the marrow spaces peppered with numerous tiny abnormal foci of low signal. | 1. Enhancing mass centered on the left petroclival ligament invading the skull base, left cavernous sinus and Meckel's cave, left middle cranial fossa, and left prepontine cistern. The location and imaging characteristics are fairly typical of a meningioma. Given the patient's history, the possibility of a myelomatous deposit or plasmacytoma would have to be considered as well. A pituitary macroadenoma would also be in the differential diagnosis, though this is probably less likely. 2. Replacement of fatty marrow in the left parietal bone is seen along with innumerable small foci of marrow signal abnormality. Findings would be compatible with patient's diagnosis of multiple myeloma. |
Generate impression based on medical findings. | There is no evidence of intracranial hemorrhage or acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with moderate chronic small vessel ischemic disease. 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 left parotid gland and adjacent soft tissues are slightly smaller than the right of uncertain clinical significance. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are possible mild appearing degenerative changes of both temporomandibular joints. | 1.No evidence of left mastoid abnormality, although, this exam is not designed to evaluate this region. 2.No evidence of intracranial hemorrhage or acute infarct.3.Moderate supratentorial and infratentorial presumed chronic small vessel ischemic disease.4.The left parotid gland and adjacent soft tissues are slightly smaller than the right of uncertain clinical significance.5.Possible mild appearing degenerative changes of both temporomandibular joints that is not well assessed on this exam. |
Generate impression based on medical findings. | 46-year-old female with increased ICP and history of SAH status post right craniotomy with PCOM aneurysm clipping. Increased ICP? Postoperative changes status post right frontal craniotomy for clipping of an aneurysm is again noted without interval changes. Right-sided ventricular catheter with no interval change in its course and position with its tip located in the frontal horn of the right lateral ventricle. Small amount of hemorrhage is again noted in the dependent portion of the occipital horn of the right lateral ventricle, unchanged.Ventricular system and basal cisterns appear unchanged. No evidence of acute hemorrhage, edema or mass effect.Multiple prior studies were reviewed and demonstrate persistent low positioned cerebellar tonsils with crowding of the foramen magnum, raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered. | 1. Stable postoperative changes.2. Persistently low positioned cerebellar tonsils with crowding of the foramen magnum are noted raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered. |
Generate impression based on medical findings. | 17-year-old female patient with pain and swelling of the left knee. Evaluate for meniscal tear. MENISCI: There is no evidence of meniscal injury.ARTICULAR CARTILAGE AND BONE: No focal articular defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, medial collateral abdomen complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | No acute abnormalities in the left knee. |
Generate impression based on medical findings. | 56-year-old male with history AV malformation, seizure disorder who presents with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Vascular calcifications are noted. The region of encephalomalacia within the posterior temporal occipital region with high density clip/coils presumably from the prior AVM repair. No evidence of hemorrhage. Multiple patchy low low attenuation is nonspecific and likely represents small vessel disease, age determinate. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Chronic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered. |
Generate impression based on medical findings. | 84-year-old male with history of Crohn's disease, status post ileocecectomy. History of recurrent bowel obstructions. History of small bowel resection. Now with severe diarrhea and weight loss. 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: Multiple loops of distended small bowel, no significant dilatation seen to suggest SBO. No focal wall thickening, fistulous connection, or drainable fluid collection. No ascites. The presumed neoterminal ileum (given reported history of ileocecectomy) is unremarkable (axial series 16 image 25).BONES, SOFT TISSUES: Small T2 hyperintense focus which demonstrates loss of signal on fat saturated sequence is most compatible with a benign osseous hemangioma (coronal series 7 image 19).OTHER: No significant abnormality noted. | No evidence for bowel obstruction or active inflammatory bowel disease. |
Generate impression based on medical findings. | 45 year old woman with advanced heart failure, referred for evaluation of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 164 ml/m2 (normal range: 65+/-11), the LVEDV is 260 ml (normal range 109+/-23), the LV end systolic volume index is 127 ml/m2 (normal range 18+/-5), the LVESV is 202 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 153 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 107 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere are moderate bilateral pleural effusions with lung atelectasis vs infection . In the right lung, there is either a mass or infiltrate and the pleural effusion are complex appearing with evidence of septations. This 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable. Image quality is somewhat limited by patient have difficulty with breath-holds.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%.3. Severe biatrial enlargement4. Severe mitral and tricuspid regurgitation.5. Right lung mass vs infiltrate associated with significant, complex appearing pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 36 years, Female, Reason: 36yo female with possible small bowel inflammation on outside CT and bloating. Evaluate for small bowel Crohn's disease History: bloating. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter right hepatic cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening, abnormal enhancement or diffusion restriction. No evidence of obstruction. No fistulas or abscesses.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis is likely physiologic. | No evidence of small bowel inflammation or sequela of chronic inflammation. |
Generate impression based on medical findings. | Clinical question: please do dr Javed MS protocol and compare to prior MRI on 3 T. Signs and Symptoms: fatigue and headaches. Pre and post enhanced brain MRI:Mild to moderate supratentorial and minute infratentorial findings of chronic demyelinating disease are again identified and without convincing evidence of any appreciable interval change since prior exam. Lesions extensively involving the periventricular white matter and the corpus callosum and minimally of the subcortical white matter of cerebral hemispheres.There is mild prominence of cortical sulci for patient's stated age of 24 similar to prior exam and concerning for underlying parenchymal volume loss.Similar to prior exam there is a single small focus of FLAIR hyperintensity/demyelinating plaque in the dorsal aspect of cervical cord at C2-C3 disc level.There is no detectable abnormal enhancement of the above detailed lesions. There is revisualization of a tiny developmental venous anomaly in the paramedian left frontal lobe.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns. | 1.Stable chronic findings of demyelinating disease primarily in the supratentorial white matter and corpus callosum and minutely in the posterior fossa.2.Stable mild prominence of cerebral cortical sulci for patient's stated age. |
Generate impression based on medical findings. | Ms. Duran is a 46 year old female with a personal history of left breast lumpectomy in 2011 for IDC and DCIS. Patient received radiation, chemotherapy, and hormonal therapy. There is posterior bilateral benign MR guided biopsies in 2010 (left breast-fibrotic breast tissue, right breast-papilloma). Family history of breast cancer in her maternal aunt. She has no current breast related complaints. Three standard views of both breasts and a left laterally exaggerated CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.A linear marker is placed on the scar overlying the left breast. There are stable post-lumpectomy changes present in the left breast, including architectural distortion, increased density, and surgical clips. Bilateral clips from benign MRI biopsies are present. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on medical findings. | Anaplastic astrocytoma, WHO grade III, treated with TMZ and radiation therapy. There are post-treatment findings unchanged cystic cavities in the left parietal lobe. However, there is interval increase in size and number of the enhancing lesions with susceptibility effect in the treatment bed region. For example, an enhancing lesion in the left periatrial white matter measures 10 x 18 mm, previously 8 x 14 mm. There appears to be increased blood volume associated with at least some of the lesions, although a few are too small to characterize on perfusion imaging. There is persistent surrounding confluent white matter T2 hyperintensity. There is an unchanged lesion with susceptibility effect and central T1 hyperintensity in the inferior pons, with an associated developmental venous anomaly, but no surrounding T2 hyperintensity. There is diffuse surrounding confluent T2 hyperintensity in the white matter, without associated mass effect. There is no midline shift or herniation. The orbits are unremarkable. There are bilateral maxillary sinus retention cysts. | 1. Post-treatment findings in the left parietal region with interval increase in size and number of lesions in the treatment bed region, which may represent tumor progression.2. Subcentimeter pontine cavernous malformation with associated developmental venous anomaly, but no evidence of surrounding edema. |
Generate impression based on medical findings. | NF1 and optic glioma. BRAIN: There is an unchanged patchy area of T2 hyperintensity within left cerebellar hemisphere. There are also unchanged areas of T2 hyperintensity in bilateral parietal periventricular white matter, hypothalamus, and posterior right putamen. There is no associated abnormal enhancement. The pons and corpus callosum are unchanged. The optic chiasm is not enlarged. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The cerebral flow voids appear to be grossly intact. There are inflammatory changed within the left sphenoid sinus.ORBITS: There is unchanged enlargement of the intraorbital and perhaps the intracanalicular portions of the left optic nerve up to approximately 3 mm in width, with mild T2 hyperintensity and negligible enhancement. The right optic nerve appears to be normal. In addition, the globes, extraocular muscles, lacrimal glands, retrobulbar fat, and preseptal soft tissues are normal bilaterally. | 1. Unchanged intracranial stigmata of neurofibromatosis type 1.2. No significant interval change in the small left optic nerve glioma. |
Generate impression based on medical findings. | 62-year-old male with mildly elevated creatinine of 1.6. Evaluate for renal abnormalities. This examination is limited by absence of oral and intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal pelvic calcifications are nonobstructive. Bilateral renal cysts. In the left midpole region dorsally there is a 1.4-cm partially exophytic solid lesion. This may be more fully evaluated with dedicated contrast enhanced CT or MRI examination. The lesion is best seen at axial image 36 of series 3 adjacent to a large benign simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the lower lumbar spine and pelvis.OTHER: No significant abnormality noted | No acute abnormality to explain the elevation in creatinine. Suspicious left midpole lesion may be an occult renal mass, so contrast enhanced dedicated kidney MRI or CT exam is recommended for further evaluation. |
Generate impression based on medical findings. | Multiple sclerosis [G35], Reason for Study: ^Reason: MS; f/u progression History: leg weakness There are multifocal bihemispheric periventricular and deep white matter high signal intensity lesions on FLAIR imaging.The extent and number of high signal intensity lesions appear to be increased in number and size since prior scan. In addition, there are multiple new lesions involving left cerebellar hemisphere, lateral aspect of left side Pons, mid to lower pons, left middle cerebellar peduncle and pontomedullary junction.The ventricles, sulci and cisterns are symmetric and unremarkable. 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 progression of supratentorial white matter lesions since prior scan.2. New development of posterior fossa white matter lesions as described above since prior scan. |
Generate impression based on medical findings. | The cerebellar tonsils are unchanged in appearance and terminate 5 mm below the craniocervical junction, but maintain a rounded configuration. There is biphasic CSF flow at the craniocervical junction and normal CSF space at this level. There is no syringohydromyelia. There is straightening of the cervical spine alignment in the sagittal plane and mild apex leftward thoracolumbar curvature that appears centered at L3; these findings were not apparent previously. There is an unchanged 5 mm pineal cyst. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus medullaris terminating at L1. The paravertebral soft tissues are unremarkable. | 1. The cerebellar tonsils extend 5 mm inferior to the foramen magnum, but display rounded morphologies and the CSF flow across the foramen magnum appears to be intact. 2. Straightening of the cervical spine alignment in the sagittal plane and mild apex leftward thoracolumbar curvature that appears centered at L3.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Right pain following injury MENISCI: The lateral medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of both the lateral and medial compartments. There is no focal full-thickness articular cartilage defect. A small partial-thickness defect of the medial patellar facet is noted. There is mild diffuse thinning of the articular cartilage of the femoral trochlea but no discrete full-thickness defect appreciated.LIGAMENTS: The ACL is torn. The PCL is intact. The medial and lateral collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Ruptured ACL with associated marrow contusions of the lateral femoral condyle and tibial plateau.2. Moderate joint effusion.3. Mild diffuse thinning of the articular cartilage of the knee without discrete full-thickness defect. |
Generate impression based on medical findings. | Left shoulder pain ROTATOR CUFF: There is small near full-thickness to full-thickness tear of the distal fibers of the supraspinatus upon its insertion upon the greater tuberosity. This is superimposed upon diffuse tendinopathy. The remaining rotator cuff tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A trace amount of fluid is noted in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a non-arthrographic exam, there is no evidence of gross labral detachment. A small amount of fluid is noted within the subcoracoid recess with a possible small loose body.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | 1. Small near full-thickness to full-thickness tear of the distal insertional fibers of the supraspinatus tendon. The remaining rotator cuff tendons are intact.2. Osteoarthritis of the acromioclavicular joint with possible small loose body in the subcoracoid recess. |
Generate impression based on medical findings. | Clinical question: Patient with dysphagia and a positive is esophagogram. Nonenhanced cervical MRI:There is generalized uniform smaller caliber of the spinal canal which is believed to represent a congenital anatomical variation.There is normal anatomic alignment the vertebral, however with near complete straightening of the cervical lordosis.The signal intensity of vertebral column is unremarkable other than changes related to degenerative disease. Foramen magnum is unremarkable.C2 -- C3 is unremarkable. C3 -- C4 demonstrate mild degenerative disease and mild bilateral neural foraminal and central spinal stenosis. C4 -- C5 demonstrate mild degenerative disease with mild left uncovertebral hypertrophic changes resulting in mild to moderate left neural foraminal compromise and no central spinal stenosis. C5 -- C6 demonstrate mild asymmetric right-sided uncovertebral hypertrophy resulting in mild to moderate right neural foraminal compromise and unremarkable lines.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.Uppermost visualized thoracic spine and thoracic cord is unremarkable. There is no detectable abnormality in the visualized prevertebral soft tissues. | 1.Generalized uniform smaller caliber of the cervical spinal canal represent a congenital anatomical variation.2.Mild degenerative changes of cervical spine with resultant mild central spinal stenosis at C3 -- C4 and questionably at C4 -- C5.3.Multi-level neural foraminal compromise as detailed per level above.4.No detectable abnormality in the limited view of prevertebral soft tissues. |
Generate impression based on medical findings. | 28 year old male with a history of non-ischemic cardiomyopathy s/p heart transplant in 4/2016, hypertension, history of pericarditis now with chest pain. Referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 140 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 28 g/m2 (normal range 85+/-15), and the LV mass is 66 g (normal range 164+/-36). There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal (1000-1050 ms). The ECV fraction is also within normal limits. The global relative enhancement ratio is mildly elevated (4.8).Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. There is no CMR evidence of constriction based on myocardial tagging and absence of interventricular septal variation with respiration. Extracardiac FindingsThere are sternotomy wires present consistent with previous surgery. This 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 55%) without any late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and normal in systolic function (RVEF 50%).3. There is evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. No evidence of pericardial constriction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Malignant neoplasm of unspecified site of right female breast [C50.911] / Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes [C77.3] / Malignant neoplasm of unspecified site of right female breast [C50.911], Multiple bone marrow replacing lesions involving T4, T6 and T7 vertebrae are again seen and show interval increase of extent of involvement.At the level of T4, the right pedicle and right side transverse process show enhancement and T2 high and T1 low signal intensity indicating metastatic lesion, progressed since prior scan.The vertebral body lesions involving both T6 and T7 also appear to be increased in extent of inhomogenous enhancement, however, there is no paravertebral soft tissue mass formation.There is no evidence of spinal canal stenosis or neuroforaminal stenosis.There is no other bone marrow replacing lesion seen. There is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. | 1. Interval increase of size of T4, T6 and T7 bone marrow replacing lesions since prior scan which are consistent with metastatic lesions.2. No evidence of spinal stenosis or neuroforaminal stenosis.3. Spinal cord signal intensity is normal. |
Generate impression based on medical findings. | 27 years, Female, Reason: 27 F p/w epigastric pain, hyperbilirubinemia and elevated liver enzymes. RUQ u/s showed mildly dilated bile duct without stone. History: as above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Intrahepatic biliary ductal dilatation with dilated common bile duct to 8 mm. There is a stone in the distal common bile duct measuring 4 mm. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct.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. | Distal common bile duct stone causing mild intrahepatic and extrahepatic biliary ductal dilatation. |
Generate impression based on medical findings. | 56-year-old male with elevated PSA who presents for evaluation of the prostate gland. Patient with biopsy in August 20, 2011 which showed benign prostatic tissue. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.0 x 3.9 cmPeripheral Zone: There are multiple lesions in the peripheral zone which demonstrate T2 hypointensity with corresponding low ADC signal; these lesions are stable compared to the previous examination. For example, the left lateral peripheral zone lesion from approximately 1 to 3:00 position is unchanged and measures 1.3 x 0.5 cm (series 801, image 13).Central Gland: There is a lesion in the right transitional zone which demonstrates T2 hypointensity with corresponding low ADC signal and early enhancement with washout; this lesion is slightly increased in size compared to the previous examination and measures 1.5 x 1.5 cm (series 801, image 10).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. | 1.Right transitional zone lesion is slightly increased in size compared to the previous examination with signal characteristics as above. This may represent stromal benign prostatic hypertrophy but prostatic adenocarcinoma cannot be excluded.2.Multiple stable peripheral zone lesions with abnormal signal suspicious for prostate carcinoma. |
Generate impression based on medical findings. | 53 year-old female with known left breast cancer, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, the known cancer is again visualized at central - 3 o'clock position, measuring 29 x 32 x 21 mm (AP x LR x CC, previous measurement: 29 x 39 x 34 mm). There is susceptibility artifact from two biopsy marker clips superior to the mass. The medially located clip is approximately 10 mm superior to the anterior portion of the mass.No other abnormal enhancement in present in the left breast.In the left axilla, no abnormally enlarged lymph nodes are identified (previously, there were two abnormally enlarged lymph nodes). A susceptibility artifact from a marker clip is present in the left axilla.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.A Port-A-Cath is present within the medial superior right chest wall. | 1. Mild reduction in size of the known left breast carcinoma 2. Marked reduction in size of left abnormally enlarged lymph nodes.3. No MR evidence for malignancy in right breast or right axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Left lower quadrant pain, thought to be from ovarian cyst but cyst now resolved and still with persistent pain 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: Left renal T2 hyperintense focus, likely a cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic follicles seen in both ovaries, including dominant follicle on right side measuring up to 1.8 cm. Minimal fat stranding near junction of sigmoid colon and left ovary, nonspecific. Intrauterine device present. Visualized junctional zone normal in size, no evidence of adenomyosis. Nabothian cyst formation. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered sigmoid colon diverticula without definite evidence of acute diverticulitis. BONES, SOFT TISSUES: Visualized bone marrow signal within normal limits. OTHER: Small pelvic free fluid, likely physiologic. | 1. Physiologic ovarian follicles. 2. Sigmoid colon diverticulosis. |
Generate impression based on medical findings. | Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesias There is a mild degree of periventricular and subcortical white matter FLAIR and T2 signal hyperintensity is present. They have not changed since prior exam.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. | Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. Patient with clinical history there are known to be related to demyelinating disorder. Compared to the prior exam the have not changed. |
Generate impression based on medical findings. | Clinical question: history of metastatic melanoma with multiple brain metastases s/p SRS to L occipital lesion; surveillance exam. Signs and Symptoms: brain mets. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.A right frontal cingulate virus enhancing metastatic lesion measuring at 7.2 x 9.3, 9.9 times mm demonstrates subtle interval increase in size since prior study measurements of 5.4 x 8.4 x 5.9 mm no appreciable surrounding vasogenic edema and with stable nonenhancing cystic-appearing component.A right superior occipital 2.2 mm enhancing metastatic lesion demonstrates subtle interval increase since prior study measurement of approximately 1.7 mm.A left posterior temporal-occipital metastatic lesion measuring at 3.2 x 4 mm demonstrate also subtle interval increased size since prior study measurement of approximately 3.1 x 3.1 mm. There is no surrounding edema or mass effect. No additional new foci of parenchymal or leptomeningeal enhancement since prior exam.Stable cortical sulci, ventricular system and CSF spaces for patient's stated age.A tiny right posterior frontal developmental venous anomaly is again identified and without change since multiple prior exams.A small cyst with very thin rim of enhancement in the pineal cistern remains identical to multiple prior studies.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series. | 1.No acute intracranial process and negative diffusion weighted series.2.Very minimal interval increased size of multiple supratentorial metastatic lesions as detailed/measurement above. No evidence of new metastatic lesions.3.Stable tiny right posterior frontal developmental venous anomaly and a small cyst of the pineal region.4.Unremarkable calvarium, orbits, mastoid air cells and middle ear cavities.5.Stable mild bilateral (right greater than left chronic maxillary sinus disease and unremarkable other paranasal sinuses. |
Generate impression based on medical findings. | Postcontrast images are limited by patient motion. There is minimal grade 1 retrolisthesis of C4 on C5 and C5 on C6 measuring 1-2 mm, degenerative in etiology. The cervical spine is otherwise in normal alignment, with straightening of the normal cervical lordosis. There is moderate disc narrowing at C5-C6 and C6-C7 with mild disc narrowing at C4-C5. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C2-C3, there is left-sided ligamentum flavum thickening.At C3-C4, there is mild right greater than left uncovertebral hypertrophy. There is minimal left-sided ligamentum flavum thickening. There is minimal right foraminal narrowing.At C4-C5, there is uncovering of the disc with a diffuse posterior osteophyte disk complex with superimposed right paramedian central disc protrusion. There is moderate bilateral foraminal narrowing and overall moderate central spinal canal stenosis. There is an indentation of the right ventral cord. There is trace left ligamentum flavum thickening.At C5-C6, there is a mild posterior osteophyte disk complex superimposed central/right paracentral disc protrusion as well as uncovering of the disc. There is mild right uncovertebral hypertrophy and moderate right foraminal narrowing and mild-moderate central spinal canal stenosis. There is deformity of the right ventral cord. There is trace left ligamentum flavum thickening.At C6-C7, there is a mild disc bulge with bilateral uncovertebral hypertrophy. There is mild-moderate central spinal stenosis.At C7-T1, there is no significant disk pathology or stenosis.THORACIC SPINE | 1. No MR evidence of demyelinating disease within the spinal cord.2. Mild scattered spondylotic changes including minimal degenerative subluxations as detailed above. Mild deformity of the ventral cord at C4-C5 and C5-C6.3. Mild chronic anterior wedging of the T12 vertebral body with associated Schmorl's node. |
Generate impression based on medical findings. | 63-year-old woman with history of recurrent rectal cancer status post subtotal vaginectomy. PELVIS:UTERUS, ADNEXA: Patient is status post subtotal vaginectomy. There is circumferential, nodular thickening of the remaining vagina (901/29) with enhancement. Bilateral ovaries are seen.BLADDER: There is a Foley catheter within the bladder. There is diffuse, circumferential wall thickening of the bladder, nonspecific; however at the level of the base, heterogeneously enhancing soft tissue signal suspicious for neoplastic extension.LYMPH NODES: Multiple nodules within the presacral space and along the peritoneal reflections described below.BOWEL, MESENTERY: Patient is status post proctocolectomy with right lower quadrant abdomen ostomy. Within the presacral space, there is now confluent, near circumferential soft tissue thickening along the peritoneal reflections which enhances avidly. This enhancing soft tissue abuts the obturator internus musculature bilaterally (1101/265). Additionally, there are nodular soft tissue deposits in the presacral space (601/20) with at least one nodular focus seen abutting the right obturator internus muscle as well. For reference, a presacral nodule measures 11 x 8 mm. The majority of these lesions are solid, however there is a mixed cystic/solid deposit immediately anterior to the sacrum (901/46), newly appearing from earlier exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Vaginal wall thickening and nodular, irregular enhancing soft tissue in the surgical cavity suspicious for locally advanced recurrent disease with possible involvement of bladder (specifically base), please refer to details above. |
Generate impression based on medical findings. | 36 years, Female, Reason: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive History: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left-sided corpus luteum and normal appearing bilateral follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (14/91).OTHER: Small amount of free fluid in the pelvis is likely physiologic. | Enhancing lesion in the left rectus abdominis muscle is nonspecific but has the typical location and appearance of a desmoid and would be amenable to percutaneous biopsy. |
Generate impression based on medical findings. | Assess for cause for increased confusion in patient with dementia and left retro-bulbar mass. There is no evidence of intracranial hemorrhage or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease of indeterminant age. Prominence of the ventricles and sulci indicate corticomedullary volume loss. No specific findings to indicate acute ischemia. However if there is concern for an acute stroke, an MRI may be helpful for further evaluation.Limited views of the orbit shows an ill-defined soft tissue within the left orbit posterior to the globe with proptosis and deformation of the left globe is again noted. When accounting for differences in technique the size of this mass and enhancement appears decreased when compared to the prior MRI exam.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Small vessel ischemic disease of indeterminate age. No findings to indicate acute ischemia. However, if there is concern for an acute stroke an MRI is recommended for further evaluation.2. Ill-defined left orbital soft tissue mass with proptosis and deformation of the left globe. Suggestion of interval decrease in size when compared to the prior MRI exam performed 3/12/08. |
Generate impression based on medical findings. | 30-year-old female with syncope and question of seizure and right lower extremity hyperreflexia. Evaluate for MS or other central lesion. Artifact limits evaluation on diffusion-weighted images. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. The cerebellar tonsils are minimally low-lying, but display rounded morphologies. The pituitary gland is mildly flattened, which is nonspecific. There are no areas of abnormal signal or abnormal intracranial enhancement. There is no diffusion abnormality or susceptibility artifact. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses and mastoid air cells are unremarkable. The orbits are unremarkable. | 1. No evidence of potential seizure foci or demyelinating lesions.2. The cerebellar tonsils are minimally low-lying, but display rounded morphologies. 3. The pituitary gland is mildly flattened, which is nonspecific. |
Generate impression based on medical findings. | 30-year-old female with optic neuritis, evaluate for demyelinating lesions. 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 and scalp soft tissues are grossly unremarkable. Mild mucosal thickening of the bilateral maxillary sinuses.The optic nerves demonstrate no abnormal enhancement or increased T2 signal to suggest optic neuritis. There is ectasia of the optic nerve sheaths bilaterally as well as optic nerve sheath dilatation. In addition, there is questionable mild flattening of the left posterior globe and a slitlike appearance of the frontal horns of the lateral ventricles. The retro-orbital fat appears normal. No intraconal or extraconal lesions are identified. | 1.Normal MR brain without findings to suggest multiple sclerosis.2.Findings supportive of radiographic intracranial hypertension (a.k.a. pseudotumor cerebri) in the correct clinical setting.3.No evidence of optic neuritis. |
Generate impression based on medical findings. | Cerebral cysts [348.0], Reason for Study: ^Reason: history of arachnoid cyst. Please eval for recurrence. No evidence of acute ischemic or hemorrhagic lesion on the scan.Redemonstration of suboccipital craniectomy and C1 laminectomy status.The retro cerebellar arachnoid cyst is again shown. The maximum diameter of the arachnoid cyst is 30.4mm (AP) x 78.1mm (Craniocaudal) x 42.5mm (Right to left) which does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no abnormal/unusual enhancement.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Post decompressive suboccipital craniectomy and C1 laminectomy status.2. No change of retro cerebellar subarachnoid cyst in terms of size and MR signal intensity since prior scan.3. No acute ischemic or hemorrhagic lesion. No abnormal enhancement. |
Generate impression based on medical findings. | Male, 35 years old, with neck pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Unremarkable. C5-6: Mild left foraminal narrowing secondary to uncovertebral and facet hypertrophy. C6-7: Central and left paracentral disc extrusion which effaces the ventral thecal sac but causes no cord impingement and only mild narrowing of the spinal canal. No significant foraminal narrowing. C7-T1: Unremarkable. | 1.A central and left paracentral disc extrusion is seen at C6-7 which causes effacement of the ventral thecal sac but no significant cord impingement.2.Mild foraminal narrowing is demonstrated on the left at C5-6 due to uncovertebral and facet hypertrophy. |
Generate impression based on medical findings. | Brain MRI:The ventricles and sulci are normal in size. Incidental note is made of a cava septum pellucidum. The cerebellar tonsils are in normal position. 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 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. There is no abnormal enhancement within the brain. Incidental note is made of a subcentimeter cutaneous focus overlying the anterior right parietal bone, most likely representing a sebaceous cyst.Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses. | Negative MRI of the brain and cervical spine including gadolinium enhancement. Specifically, there are no findings to explain the patient's left hand weakness. |
Generate impression based on medical findings. | 47-year-old male with renal cell cancer, status post left partial nephrectomy. Evaluate disease status. Rule out metastasis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter left lateral hepatic segment anterior hypodensity in is too small to characterize. This was not definitely seen on the CT scan examination from 11/2010, but the prior examination includes only a single delayed post-contrast phase. The significance is uncertain. Dedicated hepatic CT or MRI examination maybe helpful for further evaluation, if clinical indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status-post left upper pole partial nephrectomy with postoperative changes. No local recurrence. No hydronephrosis or perinephric collections. The left exophytic midpole cyst is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Subcentimeter hepatic hypodensity can be further characterized with dedicated CT or MRI examination, if clinically indicated.Status post left superior pole partial nephrectomy, with postoperative changes. No local evidence of recurrence or metastasis. |
Generate impression based on medical findings. | Reason: Carpal abutment rule out TFCC tear History: ulnar sided pain LIGAMENTS: No contrast traverses the scapholunate or lunotriquetral ligaments to suggest a tear. No intra-articular gadolinium is identified within the mid carpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: There is disruption of the ulnar styloid attachment of the triangular fibrocartilage complex. There is a subcentimeter focus of fluid signal intensity which fills with gadolinium which presumably represents ganglion formation. There is heterogeneity of the foveal attachment indicating mild degeneration. No intra-articular gadolinium is identified within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: There is a small amount of increased signal abnormality within the dorsal aspect of the lunate which is nonspecific, but could be related to ulnar abutment syndrome. Otherwise no bone marrow signal abnormality is identified.ADDITIONAL | Disruption of the ulnar styloid attachment of the triangular fibrocartilage complex as described above. Tiny subchondral cyst within the lunate is nonspecific, but could be related to ulnar abutment syndrome. |
Generate impression based on medical findings. | 77 year old male with history of biliary stricture and evidence of chronic pancreatitis on EUS. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour. There is mild extrahepatic biliary duct dilatation with the common bile duct measuring 12 mm in diameter, appearing similar to the prior study. There is associated narrowing at the level of the head of the pancreas. No significant intrahepatic biliary ductal dilatation. No focal parenchymal lesions. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is marked atrophy of the pancreas. A small volume of residual tissue demonstrating signal characteristics of normal pancreas remains in the pancreatic head, unchanged. The main pancreatic duct is markedly dilated measuring 12 mm in diameter, previously 10 mm. The main pancreatic duct is again noted to smoothly taper just proximal to its junction with the common bile duct. No mass lesion is evident. In response to secretin administration, there is normal opacification of the entire duodenum up to the ligament of Treitz, however, there appears to an overall blunted response to secretin augmentation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L2 vertebral body.OTHER: No significant abnormality noted. | Persistent findings consistent with chronic pancreatitis. There is main pancreatic duct and common bile duct dilation with associated narrowing at the level of the pancreatic head, most consistent with benign stricturing which may be a sequela of chronic pancreatitis. There are no focal pancreatic mass lesions identified. |
Generate impression based on medical findings. | 19-year-old female with left foot pain for 5 weeks. Markers were placed along the dorsum of the foot.There is a intra-articular fracture through the plantar corner of the base of the second metatarsal with mild displacement. There is edema in the fracture fragment and the adjacent bone. There is also edema within the base of the fourth metatarsal with a thin linear band of low signal intensity representing a nonarticular transverse fracture of the metatarsal. There is further edema within the third metatarsal, but we see no discrete fracture line. There is minimal edema within the tuberosity of the fifth metatarsal, but we see no fracture. The middle and lateral cuneiform bones also show edema, but no evidence of fracture line.Although the Lisfranc ligament is not optimally visualized, a band of low signal intensity extends from the medial cuneiform to the base of the second metatarsal just distal to the fracture line. This is favored to represent the main portion of the Lisfranc ligament, which appears intact.The visualized tendons appear intact. The study was not protocoled for detailed evaluation of the ankle ligaments, but they also appear intact. | 1. Fractures of the bases of the second and fourth metatarsals.2. There is also edema within the third metatarsal, middle cuneiform, lateral cuneiform, and tuberosity of the fifth metatarsal bones, but we see no discrete fracture lines in these bones.Findings were relayed to Dr. Sandoval at the time of dictation. |
Generate impression based on medical findings. | Diagnosis: Ataxia, unspecifiedClinical question: h/o cerebellar ataxiaSigns and Symptoms: preop planning for DBS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the T2 images. A high signal focus on T2 imaging is present in the ponsNo abnormal 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 left 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 vertebral artery is very small and may be partially occluded.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.This is a limited exam for the purpose of DBS planning.3.Findings raise the question of stenosis at the right vertebral artery.4.A high signal focus on T2 imaging is present in the pons. This is nonspecific. |
Generate impression based on medical findings. | Reason: L knee pain History: Left knee pain Due to the patient's body habitus, the high definition knee coil could not be utilized. An alternative coil was used instead resulting in slightly suboptimal image quality.MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness degeneration of the articular cartilage of the medial facet of the patella and superficial degeneration of the articular cartilage of the lateral facet of the patella. There is also mild focal degeneration of the articular cartilage of the femoral trochlea, centrally. The tibiofemoral cartilage appears relatively preserved. There is slight lateral translation of the patella relative to the center of the femoral trochlea, but the tibial tubercle trochlear groove distance is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | Patellofemoral cartilage degeneration and small joint effusion. |
Generate impression based on medical findings. | 86 years Male (DOB:6/18/1930)Reason: new occipital left headache History: as abovePROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is a focus of signal loss present within a sulcus in the right temporal lobe. On T2 imaging the lesion measures approximately 4 x 5 mm axial dimensions.Periventricular punctateNo abnormal 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 some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.There is a small hemorrhagic lesion present within a right temporal lobe sulcus. One possibility is that this represents a cerebral cavernous malformation. Hemorrhagic lesions from other sources can also produce such a lesion. If the patient has known primary tumor this could represent a hemorrhagic metastasis.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | Neurofibromatosis, arm mass Within the medial soft tissues of the arm is a well-circumscribed mass measuring 4.3 x 4.6 x 7.3 cm in the greatest transverse, AP, and craniocaudal dimensions. The mass is predominantly hyperintense to skeletal muscle on T2-weighted sequences (although contains some areas of heterogeneous low signal intensity) and isointense to skeletal muscle on T1 sequences. The mass does not appear to invade the surrounding fat planes and is and otherwise does not demonstrate aggressive features. Following contrast administration, there is solid but heterogeneous enhancement. This mass was evident on the comparison examination from 2011 and has increased from that exam when it measured approximately 3.9 x 4.3 x 6.5 cm.A second similar appearing mass is identified just posterior to the humerus at the same level. This mass measures approximately 1.7 x 1.6 x 3.2 cm in the greatest transverse, AP, and craniocaudal dimensions. Following contrast administration, there is solid central enhancement. This mass was evident on the comparison examination from 2011 and has increased from that exam when it measured 1.3 x 1.2 x 2.5 cm.A third smaller mass is seen within the anterior soft tissues and is further detailed on the dedicated MRI of the left elbow.The underlying marrow signal of the humerus is normal. | Multiple soft tissue masses consistent with peripheral nerve sheath tumors. These have increased in size from a comparison exam of the left humerus dated 4/20/2011. |