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Generate impression based on medical findings. | 33-year-old female with metastases. 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: There is no evidence of obstruction. There is abnormal enhancement and corresponding restricted diffusion involving a medium length segment of colon which is persistently decompressed. The terminal ileum is aperistaltic and dilated with fecalization present. There is no discrete narrowing or abnormal enhancement of the ileocecal valve. Underlying incompetence is not excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Abnormal enhancement and corresponding restricted diffusion of a persistently decompressed sigmoid and descending colon may reflect acute on chronic inflammation.2.Aperistaltic and dilated terminal ileum with fecalization present. There is no discrete narrowing or abnormal enhancement of the ileocecal valve. Underlying incompetence is not excluded.3.Gastric distention with debris is present without obvious active disease to explain this finding. |
Generate impression based on medical findings. | 45 years Female (DOB: 2/18/1971)Reason: please evaluate progression of disease and compare to imaging brought in from. History: progressive LE weakness with T4 sensory level. MRI spine shows T-spine T2 non-enhancing lesionsPROVIDER NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI brain: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.On susceptibility weighted imaging there is a hypointense focus present in the left inferior parietal lobule subcortical white matter. This is not readily identified on any of the other pulse sequences. There is no associated contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a T2 hyperintense lesion present in the right hemicord at the T2 vertebral body level C1 vertebral body level length. Another T2 hyperintense lesion is present in the left hemicord at the T2 and T3 vertebral body levels. Additional T2 hyperintense lesions are present at T3-4 on the left side extending one vertebral body length and at the T5-6 level in the left hemicord staining under 1 vertebral body level length. There is no associated contrast enhancement with these lesions.There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is a transitional vertebra present with sacralization of L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are cystic lesions present in the pelvis. A multicystic lesion in the right hemipelvis is suspected to represent an ovary. There is a larger cyst associated with this measuring 34 x 20 mm axial dimensions | 1.There are multiple lesions present in the upper thoracic spinal cord. Etiology is uncertain. They appear to involve gray matter. Demyelinating disorder could have this appearance. Alternatively, myelitis may have a similar appearance.2.A microhemorrhage in the left inferior parietal lobule in isolation is of unknown clinical significance.3.There is a cystic lesion present in the pelvis which is not completely imaged on this exam. One possibility this represents an ovarian cyst. If clinically appropriate additional imaging of the pelvis may be of further benefit.4.An alphanumeric page and email were sent to Dr Kamson. |
Generate impression based on medical findings. | Headache, ataxia, slurred speech. Brain: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. There are multiple small thoracic Schmorl nodes. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow appears unremarkable. There is prominent anterior epidural fat in the sacral spinal canal. There is otherwise no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | No evidence of intracranial or spine tumors or abnormal enhancement on this abbreviated post-contrast study. Please refer to the recent non-contrast brain and spine MRI for additional details. |
Generate impression based on medical findings. | Female, 53 years old, with history of brain mass/skull lesion. Evaluate for change. A heterogeneously enhancing, expansile mass is redemonstrated centered on the calvarium, just to the left of midline at the cranial vertex. The lesion measures 48 mm AP, 58 mm TV, and 32 mm CC showing no significant change from the prior examination.The lesion displaces both the inner and outer tables of the skull. It indents the underlying left parietal lobe, along with the cortical veins and the superior sagittal sinus which nevertheless appear patent. No evidence of parenchymal invasion or parenchymal edema is seen. No other enhancing calvarial lesions are detected . Minimal scattered small foci of T2 hyperintensity are seen within the cerebral white matter, a stable and nonspecific finding. No evidence of significant parenchymal edema or restricted diffusion is seen. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology. | 1.No significant change in the size or appearance of a large, expansile mass centered on the calvarium at the cranial vertex.2.As before, the lesion indents the underlying brain parenchyma, but there is no evidence of brain invasion or parenchymal edema.3.No other concerning osseous lesions are seen. Evaluation of the brain parenchyma is unremarkable. |
Generate impression based on medical findings. | Disturbance of skin sensation, sarcoidosis, history of neurosarcoid, new left No evidence of acute ischemic or hemorrhagic lesion on this scan.Subtle enhancement of the slightly thickened optic chiasm, optic tract especially left and hypothalamus was again demonstrated, no change since prior scan.Otherwise no abnormal enhancement.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 mastoid air cells are clear.Bilateral maxillary sinus opacifications. | No evidence of acute ischemic or hemorrhagic lesion.No change of subtle enhancement of optic chiasm, left optic tract and hypothalamus since prior exam. |
Generate impression based on medical findings. | Female 59 years old Reason: thyroid nodule seen on routine CT for GIST History: none RIGHT LOBE MEASUREMENTS: 6.0 x 2.1 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 1.5 cmISTHMUS MEASUREMENTS: 0.22 cmRIGHT LOBE: Within the right lobe there is a heterogeneous thyroid nodule with internal cystic and solid components measuring 2.1 x 1.3 x 1.6 cm. There is some internal vascularity. No calcifications, no ringdown, and no pseudocapsule is present.LEFT LOBE: Within the left thyroid lobe there is a small hypoechoic nodule measuring 1.3 x 1.1 x 0.9 cm. The remainder of the left thyroid lobe is normal in appearance.ISTHMUS: There is a nodular focus measuring 1.4 x 1.4 x 1.4 cm. The remainder of isthmus is normal in appearance.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign appearing lymph nodes are present.OTHER: No significant abnormality noted. | Dominant mixed solid and cystic nodule in the right thyroid lobe. Small left thyroid and isthmus nodules. |
Generate impression based on medical findings. | Reason: PSC, eval for strictures History: PSC ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhosis with areas of T2 hyperintensity compatible with fibrosis. No suspicious arterially enhancing lesions. Similar appearance of beaded intrahepatic bile ducts likely secondary to multifocal strictures. Trace progression of the stricturing of the common bile duct (series 7 image 59, 60, and 63) without significant change in bowel duct caliber. No dominant stricture.No new dominant stricture.SPLEEN: Splenomegaly measuring 14.3 cm with extensive splenorenal shunt.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Similar-appearing retroperitoneal and porta hepatis lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized right lower quadrant anterior abdominal wall hernia/ostomy.OTHER: Small pericardial cyst or a cardiophrenic lymph node. | 1.Cirrhotic morphology of the liver and multifocal biliary strictures. There may be slight interval progession of common bile duct stricturing without significant change in bile duct caliber. Intrahepatic stricturing appears similar to prior study. 2.No dominant stricture or suspicious mass. |
Generate impression based on medical findings. | Tuberous sclerosis with SEGAs: worsened headache. There are stigmata of tuberous sclerosis complex, including multiple "cortical tubers" and subependymal nodules. In particular, there is no significant interval change in size of the nodule in the left foramen of Monro region, which measures up to 16 mm or the nodule in the right foramen of Monro region, which measures up to 14 mm. The ventricles are unchanged in size and configuration. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. | Unchanged stigmata of tuberous sclerosis complex, including the bilateral subependymal giant astrocytomas. |
Generate impression based on medical findings. | ORBITS: The globes, lenses, extraocular muscles, optic nerves, optic chiasm, and intraconal space are symmetric and normal. The orbital soft tissues are normal. There is no abnormal enhancement.The imaged intracranial contents are unremarkable, without evidence of mass, mass effect, hemorrhage, or acute infarct. There is minimal mucosal thickening of the bilateral maxillary sinuses and nasal cavity. There is mild leftward nasal septum deviation. NECK: The minimal diffuse mucosal thickening in the nasopharynx, oropharynx, and hypopharynx is unchanged. The effacement of the mucosal contours of the posterior nasopharynx are similar to prior. Asymmetry in the left oropharynx is noted and appears similar to prior. There is no enhancing mass identified. The salivary and thyroid glands appear within normal limits. There are small scattered lymph nodes, which are not enlarged by size criteria. Again noted is a left paracentral disc protrusion at C4-5, which effaces the left ventral spinal cord and contributes to mild to moderate spinal canal narrowing. There is T1 shortening of the skull base and upper cervical vertebrae, compatible with prior radiation therapy. | 1. No MR evidence for local tumor recurrence or cervical lymphadenopathy.2. Unremarkable MRI of the orbits. |
Generate impression based on medical findings. | 25-year-old female with history of AML status post embolization. Limited exam; only wide field of view survey images obtained.Multiple bilateral renal lesions are incompletely evaluated. Gravid uterus. | Limited exam as above. Bilateral renal lesions are incompletely evaluated. Recommend patient returns to complete exam when clinically appropriate. |
Generate impression based on medical findings. | 57 years, Female, Reason: H/o HCV; CT scan on admit showing 1.6 cm indeterminate lesion; stable from previous imaging in 11/2014; evaluate for HCC versus other etiology History: as above. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 1.6-cm lesion in the left hepatic lobe is hyperintense on T2 weighted images with concentric enhancement which fills in on delayed phases. No washout.SPLEEN: Small splenule's. Subcentimeter splenic lesion which is hyperintense on T2, likely a lymphangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cysts.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.Enhancing left hepatic lobe lesion. There is a lack of nodular enhancement and an atypical hemangioma is considered most likely. 12-month follow-up is recommended. |
Generate impression based on medical findings. | History of multiple myeloma, now with pain with flexion and extension of spine. Thoracic spine: Diffuse osteopenia likely secondary to multifocal tumor involvement seen on MRI from 5/12/2016. Multilevel degenerative disease. Superior endplate compression deformity of T11 vertebral body with approximately 10% height loss. This study was seen on prior study is likely chronic. No acute fractures or malalignment.Ribs: No acute fractures. Left central venous catheter terminates near midline. | No acute abnormalities. Redemonstration of degenerative changes and mild compression deformity of T11 vertebral body. |
Generate impression based on medical findings. | Known brain lesion and history of neurofibromatosis type 1. There is an infiltrative T2 hyperintense, non-enhancing, mildly expansile lesion centered within the pons with extension into the medial left cerebellum and medulla. There is diffuse leptomeningeal enhancement within the posterior fossa, particularly within along the brainstem. There is also a non-enhancing, rounded, subcentimeter, T2 hyperintense, subcortical lesion in the lateral left occipital lobe. There are also punctate non-enhancing T2 hyperintense foci in the white matter of the bilateral parietal lobes. There is coaptation of the right lateral ventricle frontal horn. Otherwise, the lateral and third ventricles are borderline prominent. There is no evidence of acute infarction or hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are several punctate enhancing nodules in the scalp. | 1. An infiltrative lesion within the pons with extension into the medial left cerebellum and medulla and regional leptomeningeal enhancement may represent a neoplasm, such as a low-grade glioma in the setting of neurofibromatosis versus less likely an infectious or inflammatory process. 2. A subcentimeter subcortical lesion in the lateral left occipital lobe and small white matter lesions in the bilateral parietal lobes may also represent manifestations of neurofibromatosis.3. Several punctate enhancing nodules in the scalp may represent neurofibromas. Discussed with Dr. Awad at 9:30 AM on 1/20/16. |
Generate impression based on medical findings. | History of dilated pancreatic duct on MRCP, stricture, acute pancreatitis and cystic lesions in the pancreas. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous T2 hyperintensity of the peripheral posterior hepatic segment is unchanged. Stable 7 mm hepatic lobe cyst. No suspicious liver lesion.The liver is otherwise normal in morphology, size and signal intensity.Stable minimal intrahepatic biliary ductal irregularity.The portal vein is replaced by numerous collateral vessels in the hepatic hilum, unchanged.SPLEEN: The splenic vein is not well opacified and is suspected to be thrombosed. The spleen is normal in size. There are small gastroepiploic collateral vessels.PANCREAS: The pancreatic body/tail lobular cystic lesion measures 1.4 x 1.2 cm (series 3/19), not significantly changed from the prior where it measured 1.5 x 0.9 cm. It has internal thin enhancing septations. No mural nodularity or soft tissue enhancement. It does not definitively communicate with the main pancreatic duct which is normal in caliber.Approximately 7 mm pancreatic tail intermediate T2-weighted signal and low T1 weighted signal intensity lesion without enhancement.The pancreas demonstrates normal intrinsic T1-weighted signal. No evidence of acute inflammation. Demonstrated again is a stricture of the pancreatic tail with mild obstructive dilatation. Following secretin administration there is an adequate exocrine response with fluid extending to the level of the ligament of Treitz.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild atherosclerotic disease of the abdominal aorta without aneurysmal dilatation.OTHER: No significant abnormality noted. | 1.1.4 x 1.2 cm pancreatic body/tail lobular cystic lesion with internal thin enhancing septations but no mural nodularity or other suspicious features. Stable nonspecific 7 mm cystic lesion in the pancreatic tail.2.Stable pancreatic duct stricture at the level of the pancreatic tail. 3.The portal vein is replaced by numerous small collateral vessels, unchanged. Suspected splenic vein thrombosis. |
Generate impression based on medical findings. | Confusion. There is mild scattered cerebral white matter T2 hyperintensity. There is a small area of susceptibility effect and faint enhancement in the right caudate nucleus, which may represent a telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. | Nonspecific mild scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease and/or perivesicular spaces. No evidence of intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | Reason: possible right lateral meniscal tear vs other internal derangement History: instability MENISCI: There is undulation of the free edge of the body of the medial meniscus likely representing meniscal flounce. There is no fluid-filled or unstable tear. There is minimal globular intrasubstance degeneration within the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is heterogeneous bone marrow which likely represents residual islands of red marrow. There is a focus of low signal intensity within the proximal fibula likely representing a benign bone island.LIGAMENTS: The cruciate and collateral ligaments appear intact. There are lobulated foci of fluid signal intensity along the posterior aspect of the PCL which may reflect mucoid degeneration or ganglion formation.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Mild intrasubstance degeneration of the medial meniscus without evidence of a meniscal tear.2. Tiny Baker's cyst. |
Generate impression based on medical findings. | 41-year-old female with paresthesias and previous abnormal brain MRI, evaluate for progression 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 FLAIR and T2 images, unchanged over the interval. There are no new lesions, and there are no posterior fossa lesions.The patient is status post suboccipital craniotomy for Chiari I, unchanged in appearanceMild gyral asymmetry between the parietal lobes is stable and may simply represent a developmental asymmetry.There is a redemonstration of a small focus of susceptibility effect in the right centrum semi-ovale associated with central T2 and flair signal hyperintensity, unchanged in appearance, and consistent with a developmental venous anomaly which may be associated with a small cavernous malformationNo 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. | 1.Stable periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are not specific and could be vascular related, related to demyelination, trauma, vasculitis, or sarcoid. However, they have not changed significantly when compared to the previous exam.2.Stable postsurgical changes from prior suboccipital craniotomy for Chiari decompression. |
Generate impression based on medical findings. | Cervical spine:The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology, unchanged. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils, unchanged in extent.Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.C4/5: Unremarkable and unchangedC5/6: Unremarkable and unchangedC6/7: Unremarkable and unchangedC7/T1: Unremarkable and unchangedThoracic 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.T1/2 demonstrates no significant disc bulge or cord encroachment, unchanged.T2/3 demonstrates no significant disc bulge or cord encroachment, unchanged. T3/4 demonstrates no significant disc bulge or cord encroachment, unchanged. T4/5 demonstrates no significant disc bulge or cord encroachment, unchanged. T5/6 demonstrates no significant disc bulge or cord encroachment, unchanged.T6/7 demonstrates no significant disc bulge or cord encroachment, unchanged. T7/8 demonstrates no significant disc bulge or cord encroachment, unchanged. T8/9 demonstrates no significant disc bulge or cord encroachment, unchanged. T9/10 demonstrates no significant disc bulge or cord encroachment. There is right ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged. T10/11 demonstrates no significant disc bulge or cord encroachment. Bilateral ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged.T11/12 demonstrates no significant disc bulge or cord encroachment. Slight ligamentum flavum thickening and facet hypertrophy without significant resulting stenosis, unchanged.T12/L1 demonstrates no significant disc bulge or cord encroachment, unchanged. | 1.The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology providing MRI evidence of Chiari I formation. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils. These findings are stable in appearance.2.There are no MRI findings of syrinx.3.C3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.4.Mild degenerative changes of the lower thoracic spine without significant resulting stenosis are stable in appearance. |
Generate impression based on medical findings. | 87 years Female (DOB:10/1/1929)Reason: stroke History: fallPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY MRI of the brainThere is a focus of diffusion restriction present along the posterior aspect of the left paracentral lobule with a larger diffusion weighted abnormality associated with it. Other foci of signal hyperintensity and diffusion-weighted imaging left frontal lobe and right parietal lobe are associated with T2 shine through.There are multiple periventricular and subcortical white matter areas of confluent T2 and FLAIR signal hyperintensity associated with small foci of encephalomalacia in the right inferior parietal lobule, right postcentral gyrus left cuneus, right lingual gyrus , the left inferior frontal gyrus and the right orbital gyrus. The one in the right orbital gyrus, right postcentral gyrus and left inferior parietal lobule present on the prior exam the rest of developed since thenNo 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 aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right vertebral artery is larger than the left vertebral artery. There is extracranial origin of the left posterior inferior cerebellar artery present. | 1.Findings suggest a subacute focus of infarction along the posterior aspect of the left paracentral lobule. 2.Multiple foci of encephalomalacia are scattered in both hemispheres of the brain which are suspicious for prior foci of infarction. Many of these are new since December 20123.There are extensive white matter signal changes throughout much of the brain which are nonspecific. It's possible that these are vascular related. These have significantly progressed since the prior exam from December 20124.No evidence for cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm. |
Generate impression based on medical findings. | 39-year-old female with right-sided weakness and facial droop. Evaluate for acute infarct. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are several foci of T2/FLAIR hyperintensity within the supratentorial periventricular and subcortical white matter. These include few foci along the bilateral corpus callosal bodies as well as a juxtacortical lesion along the right parietal lobe. There is no significant change in the interval. No new lesions are appreciated.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.MRI C-Spine:Again demonstrated is abnormal T2/STIR hyperintense cord signal involving the right posterolateral aspect of the spinal cord at the C3-4 level as well as a second smaller lesion again involving the right lateral aspect of the cord at the C5 level. The C3-C4 lesion appears slightly larger with increased cranial extension. There also appears to be enhancement involving the superior aspect of this lesion.There are otherwise no new lesions or abnormal enhancement elsewhere in the cervical cord.The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There are mild degenerative changes are relatively more prominently involving the C5-6 level where there is a small disc osteophyte but there is no significant spinal canal or neural foraminal stenosis at any level. The bone marrow signal is within normal limits. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits. | 1. No significant change in several scattered supratentorial T2/FLAIR hyperintense lesions including two small foci along the corpus callosum and a right parietal juxtacortical lesion which are suggestive of demyelinating disease. No new lesions in the brain or abnormal enhancement to suggest active demyelination in the brain.2. There is increase in cranial extent of T2 signal abnormality associated with a previously seen C3-C4 lesion. There is also associated enhancement, findings which are suspicious for active demyelination adjacent to a chronic demyelinating plaque. Smaller right C5 lesion also again seen. Dr. Ali discussed findings with Dr. Burns at 1005 hours on 12/12/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Metastatic carcinoma of the lung status post craniotomy, adjuvant SRS, and most recently carbo/taxol. There are postoperative findings related to right suboccipital craniotomy with persistent subcentimeter nodular and linear areas of enhancement along the margins of the resection cavity, which overall appear to have slightly diminished. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a new nodular areas of enhancement in the right posterior upper neck paraspinal soft tissues that measure up to 19 mm. There is a left maxillary sinus retention cyst. | 1. Postoperative findings related to right suboccipital craniotomy with persistent areas of enhancement along the margins of the right cerebellar hemisphere resection cavity that may represent treatment effects, although small amounts of residual tumor cannot be entirely excluded.2. New nodular areas of enhancement in the right posterior upper neck paraspinal soft tissues that measure up to 19 mm may represent tumor deposits versus treatment effects, such as organizing hematomas. |
Generate impression based on medical findings. | Reason: right thigh mass? Lipoma? History: right mobile thigh mass, mostly painless Patient motion artifact limits multiple sequences. A skin marker overlies the lateral aspect of the right thigh presumably corresponding to the patient's palpable area of concern. There is a lobulated mass situated within the proximal thigh within the vastus lateralis muscle which demonstrates predominantly fat signal intensity with some internal septations, measuring 5.0 x 2.0 x 6.5 cm. No dominant nodular nonadipose elements are identified. No bone marrow signal abnormality is seen. Metallic susceptibility artifact from the patient's right total hip arthroplasty limits evaluation of the right hip. There is a small right-sided hydrocele. The remaining soft tissues of the right thigh are unremarkable. | Adipocytic tumor of the vastus lateralis likely representing a lipoma or less likely an atypical lipomatous tumor. |
Generate impression based on medical findings. | Reason: underlying lesion of SAH History: SAH. There is increased T1 signal in the right cerebellum corresponding to subacute hemorrhage seen on the prior exams. This is associated with mild increased T2 signal. Hemorrhage is seen along the posterior aspect of the right cerebellum extending into the cisterna magna as well as within the right ambient cistern. Fluid in the occipital horns of the lateral ventricles also likely represents subacute hemorrhage and is similar to the prior exam. No abnormal signal is seen within the left frontal lobe to correspond with finding on prior CTs. Susceptibility along the tentorium bilaterally is likely the result of hemorrhage.There is no evidence of mass, however due to the lack of postcontrast sequences, an underlying lesion in the right cerebellum at the site of hemorrhage cannot be excluded. Prominent ventricles and sulci suggest mild atrophy. Scattered punctate subcortical and periventricular T2 hyperintensities without diffusion restriction are nonspecific but likely represent mild small vessel ischemic disease. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Dysplastic maxillary sinuses with mucosal thickening | 1.Limited exam, which was terminated prior to pre and postcontrast T1 and MRA sequences due to patient claustrophobia.2.Overall stable right cerebellar hemorrhagic contusion and subarachnoid hemorrhage. Due to lack of postcontrast and MRA sequences, and underlying mass or vascular anomaly in the right cerebellum cannot be excluded.3.Mild chronic small vessel ischemic disease and atrophy. |
Generate impression based on medical findings. | Clinical question: Evaluate for postop hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT: Examination demonstrates a surgical cavity in the right frontal lobe containing fluid and air density as well as very minimal blood product. It measures approximately 35 x 36 -mm in size.There is a small focus of high density measuring approximately 4 x 4.5-mm in size suspected of a small acute hematoma immediately lateral to the surgical cavity in the right frontal lobe.Extensive residual surrounding vasogenic edema and very minimal subarachnoid hemorrhage is present. A small residual vasogenic edema in the left frontal lobe is also present and unchanged since prior brain MRI from 5 -- 3 -- 13. The overall mass effect of this finding and resultant midline shift to the left immediately adjacent to the tumor remains fairly similar to preoperative study. Stable normal size of the supratentorial ventricular system and unchanged since prior study.Expected postoperative changes of right frontal craniotomy. | 1.Surgical cavity at the site of previously known right frontal lobe tumor with fluid/air and very minimal blood content.2.Minimal subarachnoid hemorrhage in the vicinity of surgical cavity and an approximately 4 x 4.5-mm accurate hematoma lateral to the surgical cavity.3.Postop changes and residual vasogenic edema extensively in the right frontal and minimally in the left frontal and associated mass effect remains similar to prior study. |
Generate impression based on medical findings. | 60-year-old male with coronary artery disease, coronary artery bypass graft ('98, redo '03), also with PCI, and angina. Referred for cardiac MRI to assess for any region of new ischemia for possible intervention. Left Ventricle (Resting Condition)The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%. The LVEDV is 206 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 99 ml (normal range 47+/-19) and the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9). The LV mass is 59 g (normal range 164+/-36) and the LV mass index is 26 g/m2 (normal range 85+/-15). There is (1) thinning and akinesis of the basal to mid inferior and inferolateral walls. There is additionally (2) a small focal area of akinesis and myocardial thinning involving the mid anterolateral wall. Myocardial ScarThere is a nontransmural myocardial infarction involving the basal anterior and anterolateral segments. There is a transmural myocardial infarction involving the mid anterolateral segment. There is a transmural myocardial infarct involving the basal inferior and inferolateral segments. There is a nontransmural myocardial infarction involving the mid inferior and inferolateral segments. Dobutamine ResponseDuring low dose dobutamine infusion and peak dose dobutamine infusion, the overall left ventricular systolic function increases in a stepwise fashion. There is a partial increase in contractility noted in the basal to mid inferior and inferolateral walls at low dose dobutamine; however, at peak dose dobutamine, the contractility decreases back down to baseline levels. The small focal area of akinesis involving the mid anterolateral wall does not improve at any stages of dobutamine. The remainder of the myocardium augments appropriately at peak stress. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 148 ml (normal range 142+/-31), RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVESV is 70 ml (normal range 54+/-17), and the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. Right hemidiaphragm is elevated. 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 basal to mid inferior and inferolateral segments have evidence of partial ischemia and viability. The remainder of the myocardium is not ischemic. The basal anterior and anterolateral segments have a non-transmural myocardial infarction and are likely viable. The mid anterolateral segment has a transmural myocardial infarction and is not likely viable. 2.Normal left ventricular size with low normal systolic function. LVEF 52%.3.Normal right ventricular size and systolic function. RVEF 53%.4.Elevated right hemidiaphragm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | History of meningioma, status post resection. There are stable postoperative findings related to right parietal craniotomy. There is unchanged encephalomalacia in the right parietal lobe along the margins of the resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appaer grossly unchanged. | Stable post-treatment findings without evidence of tumor recurrence. |
Generate impression based on medical findings. | Migraine without aura, not intractable, without status migrainosus [G43.009], Reason for Study: ^Reason: Migraine, increased on frequency, severity, over 2 months. ? Etiology History: Migraine, increased on frequency, severity, over 2 months. No evidence of acute ischemic or hemorrhagic lesion on the scan. No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Normal brain MRI. |
Generate impression based on medical findings. | 15-year-old female with knee pain during sports MENISCI: Increased signal intensity extending to the articular surface of the posterior horn and body of the medial meniscus indicates an undersurface longitudinal meniscal tear. No other meniscal tears are identified.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. Increased T2 signal along the posterior tibial condyles extending into the metaphysis indicates a bone contusion.LIGAMENTS: There is disruption of the midportion of the ACL indicating a tear. The PCL is intact. The MCL and lateral collateral complex is intact.EXTENSOR MECHANISM: Extensor mechanism is intact. Mildly increased T2 signal within the medial retinaculum indicating sprain. Medial retinaculum appears intact. The lateral retinaculum is intact.ADDITIONAL | 1.Complete ACL tear.2.Undersurface longitudinal tear of the posterior horn and body of the medial meniscus.3.Mild medial retinaculum sprain.4.Small joint effusion. |
Generate impression based on medical findings. | Unspecified sensorineural hearing lossClinical question: assess for hearing lossSigns and Symptoms: hearing loss No abnormal mass lesions are identified in the cerebellopontine angle cisternsImages of both right and left internal auditory canals images normal neural bundles with at least 4 neural bundle seen on the sagittal oblique views. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally. There is no evidence of abnormal enhancement.Incidental note is made of mucous retention cysts in the left maxillary sinus.Incidental note is made of several cystic lesions in the parotid glands which are not entirely included on this exam. The ones included on post gadolinium imaging demonstrate no contrast enhancement. | 1.There is no evidence for internal auditory canal or cerebellopontine angle cistern mass or abnormality appreciated.2.There are cystic lesions present in the parotid glands bilaterally. These are only partially imaged on this exam. |
Generate impression based on medical findings. | There is a 6 mm solitary, focal, ovoid T2 hyperintensity within the mid right temporal lobe without associated mass effect, restricted diffusion, or susceptibility abnormality (best seen series 801, image 16/25). This was not present on the 2009 brain MRI.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. 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 a 6 mm solitary, focal, ovoid T2 hyperintensity within the mid right temporal lobe without associated mass effect, restricted diffusion, or susceptibility abnormality. This was not present on the 2009 brain MRI. This is nonspecific in appearance, and given its solitary nature is of uncertain etiology or significance and would be an unusual appearance of neuroblastoma metastasis. Recommendations are made to repeat MRI, with contrast, in 3 months to assess for stability. |
Generate impression based on medical findings. | 51 years Male (DOB:8/22/1964)Reason: eval for cord compression, History: hx of compression, recent cervical surgery, past hx of lumbar spinal hematomaPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES The patient is status post cervical spine surgery with multilevel laminectomies at C4, C5 and C6. There is signal hyperintensity on T2 imaging within the cervical spinal cord at the C4 level. This was present on the 1/28/2016 exam. There are signal changes within the soft tissues behind the thecal sac at the surgical site.There are degenerative changes present in the lower lumbar spine without spinal stenosis.The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. | 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3.There is cord signal change present at the C4 vertebral body level. This is not adequately evaluated on this exam. It was present on the preoperative exam from 1/28/2016.4.There are degenerative changes present in the lower lumbar spine. Please refer to MRI from 1/28/2016 for further comments |
Generate impression based on medical findings. | Forgetfulness PTC refractory to I131. Increasing pulmonary mets and expansile lesion of C7. The vertebral column alignment is within normal limits. There is an expansile enhancing lesion within the anterior C7 vertebral body, without retropulsion or significant loss of vertebral body height. There is multilevel cervical and lumbar degenerative spondylosis with generally mild spinal canal stenosis, but up to moderate left L5-S1 neural foraminal stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is anatomic, aside from slight retrolisthesis of L5 on S1. The paravertebral soft tissues are unremarkable. However, there are multiple pulmonary nodules. | 1. Metastatic lesion within the anterior C7 vertebral body without retropulsion. 2. Multiple pulmonary metastases. Please refer to the separate chest CT report for additional details.3. Multilevel cervical and lumbar degenerative spondylosis with generally mild spinal canal stenosis, but up to moderate left L5-S1 neural foraminal stenosis. |
Generate impression based on medical findings. | History of prostate cancer. 5/10/2015 biopsy showed 3+3 left lateral base disease. PELVIS:PROSTATE:Prostate Size: 4.3 x 5.6 x 5.9 cmPeripheral Zone: In the left mid gland there is a 8 x 8 mm focus of restricted diffusion (series 500/284) with associated T2-weighted hypointensity (series 1 601/13) and early arterial enhancement (series 1 701/1 853) suspicious for prostatic adenocarcinoma.In the left base there is a 1.1 x 0.9 cm focus of T2-weighted hyperintensity (series 1 601/19) and restricted diffusion (series 504/384) which may represent an additional site of prostatic adenocarcinoma versus asymmetric central zone.Central Gland: In the apex anteriorly there is a 1.7 x 1.0 cm focus of restricted diffusion (series 504/204 with subtle ill-defined decreased T2 weighted hypointensity. Benign prostatic hyperplasia. Median lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic 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. 8 x 8 mm focus in the left mid gland is suspicious for prostatic adenocarcinoma and is amenable to MRI/ultrasound fusion biopsy. 2. Additional 1.1 cm focus in the left base and 1.7 cm anterior apex focus may represent additional sites of prostatic adenocarcinoma and are amenable to MRI/ultrasound fusion sampling.3. No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy. |
Generate impression based on medical findings. | Right medullary thyroid now with rising calcitonin, possible left level 4/5 nodes. There are postoperative findings related to total thyroidectomy without evidence of measurable locoregional tumor or abnormal lymph nodes in the neck. The major salivary glands are unremarkable. There is atherosclerotic plaque at the bilateral carotid bifurcations and left vertebral artery origin. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable. | Postoperative findings related to total thyroidectomy without convincing evidence of measurable locoregional tumor recurrence or lymph node metastases in the neck. |
Generate impression based on medical findings. | 73-year-old man with history of pancreatic cysts seen on outside imaging. ABDOMEN:LIVER, BILIARY TRACT: Liver appears normal without focal hepatic lesion. Patient is status post cholecystectomy and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen appears normal.PANCREAS: Numerous tiny cystic lesions are seen within the pancreatic head and tail. Of these, the largest is a round 10 x 8 mm T2 hyperintense lesion which appears to communicate with the pancreatic duct in the neck of the pancreas (5/59). This lesion is hypointense on T1 weighted images, however the postcontrast images are degraded by motion artifact and enhancement cannot be adequately evaluated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the right kidney (8/16) there is a 13 mm, round T2 hypointense lesion arising exophytically from the lower pole. Field-of-view does not extend to cover this lesion on postcontrast images. Multiple bilateral T2 hyperintense renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Indeterminate 10 mm cystic lesion in the neck of the pancreas communicating with the duct, likely a sidebranch IPMN. Enhancement of this lesion cannot be determined due to motion artifact.2.Indeterminate right renal inferior pole lesion which was not evaluated on the postcontrast portion of this study. Characterization of this lesion is recommended on subsequent enhanced imaging, otherwise one-year follow-up is recommended. |
Generate impression based on medical findings. | 45-year-old female with a mass removed but still has pain with a neuroma was removed. Again seen is a lobulated focus of fluid signal intensity along the anterior aspect of the proximal fibula which enhances on postcontrast sequences measuring 7 x 5 x 9 mm (series 17; image 30) corresponding to the findings seen on prior MRI knee examination dated 7/5/2013 which is not definitively changed when compared to the prior study. There is linear decreased signal abnormality along the lateral aspect of the knee with foci of signal void presumably representing postsurgical change and scarring. There is a vitamin E marker is situated along the lateral aspect of the knee presumably corresponds to the patient's surgical scar. No bone marrow signal abnormalities identified in the underlying area. The imaged musculature is normal in appearance. Although this examination was not protocoled for detailed evaluation of the knee, there is full-thickness articular cartilage degeneration along the medial facet of the patella with underlying degenerative subchondral signal abnormality. There is nonspecific subcutaneous edema along the anterior aspect of the patellar tendon. | No significant interval change in the subcentimeter enhancing lobulated focus of fluid signal intensity along the proximal fibula which is nonspecific but may represent a neuroma or perhaps an atypical ganglion. Other findings as described above. |
Generate impression based on medical findings. | Headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. | Mild nonspecific cerebral white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease, but no evidence of intracranial mass lesions. |
Generate impression based on medical findings. | 72 years Female (DOB:9/17/1943)Reason: rule out structural lesion including MS History: gait problem, blurry vision, weaknessPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI GABRIELLA L BORRELLI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense foci are present in the brainstem. There are enlarged perivascular spaces in the basal ganglia.There is a punctate focus of signal loss in the right centrum semiovale on susceptibility weighted imaging. In isolation this is of microhemorrhages are known clinical significance.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 right vertebral artery flow-void is very small.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 lesions of a moderate degree and a few punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. Although not particularly characteristic of demyelination based on the morphology and pattern of demyelination cannot be excluded based on this exam. These lesions are nonspecific and demyelinating disorder is in the differential diagnosis.. |
Generate impression based on medical findings. | Thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.7 x 2.1 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple nodules on the right with the largest measuring 1.5 x 1.1 x 1.3 cm at the equator. Nodules are heterogeneous and mostly iso to hypoechoic. LEFT LOBE: Multiple nodules on the left with the largest measuring 1.6 x 1.5 x 1.3 cm located at the upper pole. Similar to the nodules on the right these are mostly heterogeneous and isoechoic to hypoechoic with respect to the remainder the gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral small level 3 lymph nodes measuring up to 1.3 cmOTHER: Attention was directed to the and left parotid tail nodule described on recent MRI for possible biopsy. This nodule represents a benign-appearing lymph node with a fatty hilum measuring 0.8 x 0.3 x 0.4 cm. Given small size and benign appearance, biopsy was deferred. The rationale for this was discussed at length with the patient at the time of the exam who agreed with the plan. | Multiple thyroid nodules bilaterally. The nodule described on recent MR appears to be a benign-appearing subcentimeter lymph node; given appearance and small size, biopsy was deferred. This was discussed with both the patient as well as the clinical service (pager 6467) at the time of the exam. |
Generate impression based on medical findings. | 28-year-old female status post left nephrectomy and left adrenalectomy in 2013 for a renal spindle cell sarcoma. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No recurrent lesion is identified in the surgical bed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Gradient echo artifacts likely related to a left lateral laparotomy incision.OTHER: No significant abnormality noted. | 1.No evidence for a recurrent lesion in the left nephrectomy bed. No evidence for metastatic disease. |
Generate impression based on medical findings. | History of left breast cancer, status post surgery and radiation. Complains of headaches. Rule out metastases. CT of brain without and with infusion:A well demarcated low-density in the left basal ganglia remains stable since prior study. Prior MRI examination from 10 -- 3 -- 2006 is also reviewed which demonstrates the same finding which is believed to represent a lacunar infarct.No evidence of any additional foci of abnormal density of brain parenchyma is detected. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Post infusion images demonstrate no evidence of any abnormal enhancement the brain parenchyma or the leptomeninges and in particular no evidence of metastatic lesion is detected.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are also within normal limits.120 cc of Omnipaque 350 was utilized for the above study. | Normal pre-and post infusion CT examination of brain and calvarium. |
Generate impression based on medical findings. | There is 4 mm of anterolisthesis of L3 upon L4. The vertebral body heights are well maintained. There are diffuse T1 and T2 hyperintense foci within the vertebral bodies likely hemangiomas or focal fat. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is disc space narrowing and desiccation affecting L2/3 and L3/4. Additional findings by level.L1/2: Disc bulge with mild left neural foramen stenosis, but no significant spinal canal stenosis.L2/3: Disc bulge, ligamentum flavum thickening, and facet hypertrophy result in severe spinal canal stenosis and mild, left greater than right, neural foramen narrowing.L3/4: Disc bulge, ligamentum flavum thickening, and facet hypertrophy result in severe spinal canal stenosis and minimal neural foramen narrowing.L4/5: Ligamentum flavum thickening and facet hypertrophy result in mild spinal canal stenosis and neural foramen narrowing.L5/S1: Facet hypertrophy, but no significant central spinal canal stenosis or neural foramen narrowing. | Multilevel degenerative spondylosis, which is most pronounced at L2/3 and L3/4, where there is severe spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | History of prostate cancer. 12/21/2015 Right apex lateral 3+4 2mm 10%. PELVIS:PROSTATE:Prostate Size: 3.5 x 5.9 x 5.1 cmPeripheral Zone: Poorly defined T2-weighted hypointense lesion in the right lateral mid-gland/apex (series 901/14) with associated restricted diffusion measuring 8 x 6 mm (series 1004/224). This is contiguous with a 1.4 x 1.1 cm focus of T2-weighted hypointensity and mild restricted diffusion extending towards the base without associated enhancement.Wedge-shaped T2-weighted foci in the right and left apex para-medially are well encapsulated without definite restricted diffusion or post-contrast enhancement.Central Gland: BPHSeminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right lateral mid gland/apex lesion abuts the prostatic boundary without definite extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific 5 mm left pelvic wall lymph node. No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 8 mm right mid-gland/apex lesion and 1.4 cm right base lesion are suspicious for prostatic adenocarcinoma. Non-specific T2 weighted hypointense foci in the apex without restricted diffusion or abnormal enhancement.The right base lesion abuts the prostatic margin without definite extraprostatic extension. No enlarged pelvic lymphadenopathy. |
Generate impression based on medical findings. | Patellar dislocation and instability Note that the exam is limited by motion artifact.MENISCI: There is mild intrasubstance signal within the anterior horn of the lateral meniscus and mild attenuation of the posterior horn of the medial meniscus but there is no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited by motion. There appears to be mild diffuse thinning of the articular cartilage of the patella superiorly but no focal fluid-filled tear is identified. There is mild subjective thinning of the articular cartilage of the lateral tibial plateau but again no fluid-filled defect is appreciated. There is poorly defined signal abnormality within the intercondylar eminence of the tibia which is likely degenerative in nature. Patchy foci of residual red marrow are seen in the distal femur.LIGAMENTS: The cruciate and collateral ligaments are intact. There is thickening and irregularity of the MPFL particularly at its attachment on the patella suggesting chronic tearing.EXTENSOR MECHANISM: There is increased signal intensity of the quadriceps tendon indicating tendinosis. The patellar tendon is intact. There is approximately 2 cm of lateral subluxation of the patella relative to the center of the femoral trochlea. There is no femoral trochlear dysplasia or patella alta. The TT to TG distance is elevated measuring 2.6 cm.ADDITIONAL | Lateral subluxation of the patella with increased TT to TG distance and chronic MPFL tearing. Additional findings are described above. |
Generate impression based on medical findings. | Ms. Trivunovic is a 72 year old female with recent biopsy-proven malignancy of the left upper outer breast. She presents for MR evaluation. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, posterior depth, there is an irregular, peripherally enhancing mass identified measuring 3.6 x 4.0 x 3.8 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this necrotic mass, compatible with biopsy-proven malignancy. Extending anteromedially from this index malignancy is an area of nonmass enhancement. Total span of abnormal enhancement (index malignancy + nonmass enhancement) measures approximately 6.2 cm in the oblique AP dimension.There is no additional abnormal enhancement seen in the left breast.RIGHT BREAST:There is no abnormal enhancement seen in the right breast.AXILLA:A biopsy marker clip is seen within a left axillary lymph node, which was proven to be a benign lymph node. No abnormal axillary lymph nodes are identified in the right axillary region.OTHERS:Note is made of a small hiatal hernia and subcentimeter hepatic cyst. | (1) Biopsy-proven malignancy + additional nonmass enhancement extending anteromedially from the index malignancy measures approximately 6.2 cm in maximal dimension in the left breast. Clip is in appropriate position.(2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | There is no evidence of acute infarction, intracranial hemorrhage, or mass, although the exam is degraded by patient motion. There are unchanged scattered T2 hyperintense foci in the cerebral white matter. There is a punctate focus of encephalomalacia in the inferior left cerebellar hemisphere. There is also unchanged high T2 signal in the left anterior temporal lobe with focal dilatation of the adjacent left anterior temporal horn and mild volume loss including the left hippocampus. There is otherwise mild diffuse cerebral volume loss. There is no midline shift. The major cerebral flow voids are preserved. There is a small retention cyst in the left maxillary sinus. | 1. No evidence of acute infarction, intracranial hemorrhage, or mass, although the exam is degraded by patient motion.2. Mild probable chronic small vessel cerebral white matter ischemic disease and a punctate left cerebellar infarct, which appear to be unchanged.3. Unchanged encephalomalacia in the anterior and medial left temporal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Left arm numbness. No evidence of acute ischemic or hemorrhagic lesion on the scan.Bilateral asymmetric high signal intensities on basal ganglia specifically globus pallidi on FLAIR images are seen. There is another lesion on the right side of cerebral peduncle which extends caudally to the level of upper pons. Interestingly, there is no imaging evidence of mass effects from these lesions except the left globus pallidus lesion.Those lesions do not show any restricted diffusion or susceptibility artifacts on gradient echo images.These findings are non specific thus the list of potential diagnosis could be very long.The differential diagnosis of these lesions include; demyelinating disease, inflammatory disease such as Neuro-Behcet disease, chronic toxic lesion such as carbon monoxide or methanol, metabolic lesions such as chronic liver disease or diabetes related non ketonic hyperglycemia or post infectious lesion such as post acute demyelinating encephalomyelopathy. Gadolinium enhanced MRI with clinical correlation might be helpful to narrow down the differential diagnosis.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.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. Non specific bilateral globus pallidi as well as right cerebral peduncle, mid brain and upper pontine high signal intensity lesions on FLAIR images as described above. Gad enhanced MR images with clinical correlation are recommended. 2. Normal brain MRA. |
Generate impression based on medical findings. | 37 years Male (DOB:9/16/1979)Reason: stroke protocol History: as abovePROVIDER/ATTENDING NAME: TERESITA M HOGAN TERESITA M HOGAN There is a large volume of diffusion restriction involving the all the right basal ganglia, the entire right insular cortex, almost all the right frontal lobe and small portions of the right parietal and temporal lobe. | 1.Large acute ischemic cerebral infarction involving ACA and MCA territories as described above. Endovascular intervention is not indicated here.2.Findings were discussed with Dr Ardelt at the time the exam was obtained. |
Generate impression based on medical findings. | History of a type I aortic dissection status post repair. CHEST:LUNGS AND PLEURA: Basilar pulmonary opacities which are nonspecific but may reflect atelectasis.MEDIASTINUM AND HILA: Postsurgical changes from a type A aortic dissection repair. The dissection flap extends into the left subclavian, proximal left common carotid and right brachiocephalic arteries, appearing grossly similar to the prior study, although the great vessels are not well visualized due to technical factors.The aortic root measures 4.8 cm in AP dimension (series 1101, image 134), not significantly changed.The ascending aorta measures approximately 3.1 cm in AP dimension (series 1101, image 145), not significantly changed.The descending aorta measures 4.4 cm in AP dimension (series 1101, image 145), not significantly changed.The abdominal aorta measures 3.5 cm in AP dimension (series 1101, image 65), not significantly changed.Focal ulcerations within mural plaque within the false lumen appears similar to prior examinations.The celiac, superior mesenteric and right renal arteries appear to arise from the true lumen. The left renal and inferior mesenteric arteries appear to arise from the false lumen. The dissection flap extends to the iliac bifurcation beyond the inferior margin of the images.CHEST WALL: Sternotomy changes.ABDOMEN:LIVER, BILIARY TRACT: Probable subcentimeter hepatic cysts. No focal suspicious liver lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged and are without evidence of enhancement.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. See above for discussion of the aorta.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change in type A aortic dissection status post repair. However, the components of the dissection within the great vessels are not well evaluated on this examination, and dedicated imaging of the neck (such as with a CTA) can be considered if clinically warranted. |
Generate impression based on medical findings. | Female, 42 years old, with right-sided hand weakness after motor vehicle accident. T2 hyperintense foci are seen within the neural foramina along the right C8 and T1 nerve roots (see image 16 and 17, series 8; and image 30 and 36, series 5). The other neural foramina are free of similar findings. There may be mild increased STIR signal more distally along the right brachial plexus, though this is equivocal given some motion artifact. The finding cannot be confirmed on axial T2 images due to inadequate fat suppression.Otherwise, no specific abnormalities of the brachial plexus are seen. Postcontrast images are within normal limits. The spinal cord remains at midline within the thecal sac. There is no evidence of any abnormal intraspinal fluid. Bone marrow signal characteristics are also within normal limits. | T2 hyperintense foci are demonstrated along the right C8 and T1 nerve roots. Without consideration of patient history, these would be attributed to normal variant perineural root sleeve cysts. However, given the right-sided symptomatology, and absence of similar findings elsewhere in the visualized spine, the possibility of mild injury to the nerve root sleeves is raised. If the distribution of the weakness correlates with C8 and T1 supply, then this possibility would become more likely. |
Generate impression based on medical findings. | History of bladder cancer status post partial cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Postsurgical changes of a partial cystectomy without evidence of recurrent or residual disease.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen right inguinal region fluid collection is no longer evident.OTHER: No significant abnormality noted. | No evidence of recurrent, residual or metastatic disease. |
Generate impression based on medical findings. | 57-year-old female with right knee pain and possible meniscal injury. MENISCI: Fragmentation and increased T2 signal within the posterior horn of the medial meniscus is compatible with a complex tear that demonstrates both horizontal and vertical components. Increased T2 signal is also noted along the inferior aspect of the anterior horn of the lateral meniscus, suspicious for a vertical undersurface tear.ARTICULAR CARTILAGE AND BONE: Within the patellofemoral compartment, there is complete loss of articular cartilage along the medial facet as well as generalized thinning of articular cartilage along the lateral facet. Mild thinning of articular cartilage along the medial femoral condyle is also noted.Bone marrow edema is identified in the medial femoral condyle and medial tibial plateau, consistent with recent injury.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Complex tear of the posterior horn of the medial meniscus with adjacent bone marrow edema.2.Findings suspicious for vertical undersurface tear of the anterior horn of the lateral meniscus.3.Complete loss of articular cartilage along the medial facet of the patella. |
Generate impression based on medical findings. | Cirrhosis. HCC status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder. The hepatic vasculature is patent.The segment 6 ablation cavity measures approximately 3.7 x 2.9 cm containing heterogeneous proteinaceous/hemorrhagic products.The right hepatic dome lesion measures approximately 2 x 1.6 cm containing heterogeneous proteinaceous/hemorrhagic products. Adjacent peripheral wedge-shaped increased T2-weighted signal intensity is likely posttreatment related, unchanged.No areas of suspicious focal enhancement.The vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left superior lumbar fat-containing hernia.OTHER: No significant abnormality noted. | Post ablation changes of segment 6 and the right hepatic dome without evidence of marginal recurrent or residual disease.Cirrhotic liver without new suspicious lesion. |
Generate impression based on medical findings. | Reason: sp seizures, r/o intracranial pathologies History: seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. On the flair and T2 MR imaging there is signal hyperintensity present along the cortex at the level of the pre-cuneus and cuneus bilaterally as well as to a lesser degree in the frontal lobes bilaterally at the junction of superior and middle frontal gyri and along the right posterior temporal lobe. There is no associated diffusion restriction.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. | 1.Lesions in the cuneus, precuneus and frontal lobes bilaterally are suggestive of posterior reversible encephalopathy syndrome. |
Generate impression based on medical findings. | 41-year-old female with question of posterior myelitis on radiograph There is a collection measuring 2.5 x 1.9 x 4.6 cm (TR x CC x AP) (series 801, image 36 and series 601, image 15) abutting the plantar surface of the second metatarsal with destruction of the cortex and distal second metatarsal. The collection has a T1 hyperintense rim with predominantly T2 hyperintensity centrally. The lesion abuts the third metatarsal with destruction of the medial cortex. There is high T2 signal within the second and third metatarsals. Amputation of the second digit at the MTP joint.Significant soft tissue swelling particularly over the dorsum of the foot.Small subchondral cysts are noted in the calcaneus. Cysts and T2 hyperintensity and T1 hypointensity in the navicular. Moderate degenerative changes involving the tarsometatarsal joints. | 1.Mixed intensity collection with partial lysis of the second and third metatarsals and surrounding inflammation/edema compatible of an abscess with small component of hemorrhage.2.Status post amputation of the second digit at the MTP joint. |
Generate impression based on medical findings. | History of kidney transplant with radicular pain down his leg status post physical therapy for several weeks but with persistent pain, evaluate. There is a grade 1 retrolisthesis of L5 on S1. Otherwise, the alignment is anatomic. At L1-L2, there is no significant spinal canal or neural foraminal stenosis. At L2-L3, there is thickening of the ligamentum flavum with facet joint hypertrophy resulting in mild right neural foraminal stenosis. At L3-L4, there is left greater than right thickening of the ligamentum flavum and hypertrophy facet joints, resulting in moderate to severe left neural foraminal narrowing and mild right neural foraminal narrowing. At L4-L5, there is protrusion of the disc into the right neural foramina along with ligamentum flavum thickening and facet joint hypertrophy, resulting in moderate to severe right neural foraminal stenosis. At L5-S1, there is a disc bulge with no significant spinal canal stenosis. However, facet joint hypertrophy and ligamentum flavum thickening result in moderate to severe right and mild left neural foraminal stenosis. There is a subcentimeter hemangioma in the S1 vertebral body. The vertebral body heights are preserved. The imaged portions of the spinal cord are unremarkable. The native kidneys are atrophic and there is a partially imaged, but large complex lesion in the right renal fossa. There is a transplanted kidney in the right iliac fossa. | 1. Multilevel degenerative lumbar spondylosis, with particularly pronounced right L4-5 and L5-S1 neural foraminal narrowing and left L3-4 neural foraminal narrowing.2. Renal transplantation and bilateral renal atrophy with a partially imaged, but large complex lesions in the right renal fossa, which may represent a neoplasm. Dedicated renal imaging may be useful for further evaluation.Discussed with Dr. Jay Koyner at 11:50 AM. |
Generate impression based on medical findings. | 66 year old woman with AML, LV dysfunction and NSVT, referred for stress CMR for further evaluation of underlying etiology of cardiomyopathy. MEDICATIONS: amiodarone, coreg, lasix, losartan, crestor, aldactone First Pass PerfusionDuring hyperemia, there is a possible small perfusion defect in the mid inferolateral wall with a corresponding perfusion defect score of 6% (2/32).Viability/ Myocardial ScarThere is a small line of mid myocardial late gadolinium enhancement in the basal septum ("mid wall stripe"). This pattern is often seen in non-ischemic dilated cardiomyopathies. The presence could also suggest an underlying fibrosing, infiltrative, or inflammatory process. In addition, there is a second small area of late gadolinium enhancement in the mid inferolateral wall, the significance of which is uncertain. The remaining myocardium is viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 136 ml/m2 (normal range: 65+/-11), the LVEDV is 243 ml (normal range 109+/-23), the LV end systolic volume index is 86 ml/m2 (normal range 18+/-5), the LVESV is 154 ml (normal range 31+/-10), the LV mass index is 60 g/m2, and the LV mass is 108 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. The leaflet tips appear thickened. There is at least moderate 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. There is a small perfusion defect in the mid inferolateral wall with a corresponding perfusion defect score of 6% (2/32).2. There is a small line of mid myocardial late gadolinium enhancement in the basal septum ("mid wall stripe"). This pattern is often seen in non-ischemic dilated cardiomyopathies. The presence could also suggest an underlying fibrosing, infiltrative, or inflammatory process. In addition, there is a second small area of late gadolinium enhancement in the mid inferolateral wall, the significance of which is uncertain. The remaining myocardium is viable3. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Unspecified esotropia [H50.00], Reason for Study: ^Reason: L ptosis, L esotropia History: above Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening of bilateral ethmoid sinuses.Brain MRA3D 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. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA |
Generate impression based on medical findings. | History of right hepatic lobe lesion incidentally seen on breast MRI which has gradually increased in size since 2009. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. Within segment 5, there is a lobulated sharply marginated structure (series 4, image 10) measuring 16 x 22 mm. The structure demonstrates high T2 signal, does not enhance, and is compatible with a benign cyst. This cyst has increased in size from 2009 when it measured up to approximately 13 mm in greatest dimension. There are a few scattered additional subcentimeter cysts. No suspicious focal hepatic lesions are identified.No biliary ductal dilatation. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without focal lesions. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few subcentimeter simple cysts are present within the left kidney. No suspicious renal lesions are identified.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. | Benign simple cyst in the right lobe of the liver. |
Generate impression based on medical findings. | Reason: concern for DDD, osteoarthritic changes of spine History: pain shooting down LEFT leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. L5 is presumed to be a transitional vertebra with sacralization of L5.There is redemonstration of a perineural cysts in the sacral canal. One measures 12 x 16 mm axial dimensions at the S2 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild/moderate degree bilateral facet hypertrophy at this level which has not changed since the prior exam. There is one or 2 mm anterior subluxation of L4 on L5 present which is also unchanged. There is disk desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, diffuse disk bulge and facet and ligamentum flavum hypertrophy present at this level with mild triangulation of the thecal sac appeared this has not change substantially when compared to the previous exam.At L2-3 there is diffuse disk bulge present associated with ligamentum flavum hypertrophy and some mild facet hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.Sclerotic foci in the right iliac bone and another one in the left bone are stable. | 1.Please note that there is a transitional vertebra present. L5 is sacralized. 2.There is redemonstration of multilevel degenerative changes in the lumbar spine were sent L4-5 and L3-4 but without significant compromise of spinal canal or exiting nerve roots.3.There are perineural cysts in the sacral spinal canal present. These are stable when compared to the previous exam. |
Generate impression based on medical findings. | Clinical question: Evaluate for evidence of herniated disc or spinal stenosis at L2-L3 area. Signs and symptoms: Radicular pain L2-L3 dermatomes and bilateral hip flexor weakness. Nonenhanced lumbar MRI:Examination demonstrates severe levoscoliosis of lumbar spine centered at L2 level. There is also significant dextroscoliosis of lower thoracic spine.The visualized lower thoracic spine from T9 inferiorly demonstrate mild degenerative changes however without evidence of spinal canal compromise or stenosis. The signal intensity and caliber of thoracic cord and conus remains within normal.T12-L1 demonstrate no spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild degenerative changes without central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate asymmetric right-sided hypertrophic changes of posterior elements with subtle mass effect and deviation of the thecal sac to the left however without spinal stenosis or neural foraminal compromise.L3-L4 demonstrates asymmetric right-sided facet hypertrophic changes resulting in mild right neural foraminal compromise and no central spinal stenosis.L4-L5 demonstrate no spinal stenosis or neural foraminal compromise mild to moderate asymmetric right-sided facet and ligamentum flavum hypertrophy however is present.L5-S1 demonstrate no spinal stenosis or neural foraminal compromise.Unremarkable images through the sacral spine. | 1.Severe levoscoliosis of lumbar spine and dextroscoliosis of thoracic spine is noted.2.There is no evidence of spinal stenosis at any level.3.There is no significant neural foraminal compromise at any level.4.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina and unremarkable paraspinal soft tissues.5.Mild to moderate asymmetric hypertrophic changes of posterior elements correlating with the scoliosis as detailed above. |
Generate impression based on medical findings. | History of HCC status post intra-operative ablation. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic dome ablation cavity measures 5.4 x 4.3 cm. There is intrinsic intermediate and high T1-weighted signal intensity internally suggestive of proteinaceous/blood products. Within the ablation cavity there is a curvilinear region of intrinsic T1-hyperintensity which does not completely null on subtraction imaging, likely due to mis-registration. No evidence of internal enhancement or marginal recurrent and/or residual disease.In the right hepatic dome there is a 7-mm T2-weighted hypointense, T1-weighted hyperintense subcentimeter focus (series 501/35), without associated arterial enhancement. No suspicious arterial enhancing lesion.Numerous punctate siderotic nodules.Cholelithiasis without cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval RFA ablation of the left hepatic dome lesion without evidence of residual or recurrent disease.2. 7-mm right hepatic dome lesion may represent a dysplastic nodule; attention to this lesion on follow-up surveillance imaging is recommended. |
Generate impression based on medical findings. | 10-year-old female with history of neurofibromatosis type I with large left sacral mass extending into the left leg.EXAMINATION: MRI pelvis and left femur without contrast 10/24/16 Extensive and multifocal T2 hyperintense masses throughout the lumbar spine, predominantly left paraspinal musculature, left lower quadrant, and extending into the left lower extremity, to the level of the mid thigh. These lesions are compatible with plexiform neurofibromata. The masses are relatively confluent, extending superiorly, out of the field of view, to the level of the superior kidneys, (seen on same day MRI lumbar spine). The greatest transverse diameter (in the left lower quadrant) measures greater than 13 cm and greatest AP dimension, also measures 13 cm. The neurofibromata cause significant mass effect in the pelvis, resulting in rightward deviation of the urinary bladder, rectum, as well as the aorta and iliac vasculature. Tumor also surrounds and splays the left internal and external iliac vessels, but flow voids remain patent.There is extensive involvement of the musculature with intramuscular neurofibromas in the left gluteal muscles, paraspinal musculature, psoas, obturator, as well as the majority of the musculature of the left thigh, with relative sparing of the vastus lateralis.Similar to that seen on prior radiographs, the osseous structures in the left pelvis and left femur are markedly abnormal, with heterogeneous marrow signal, thickened cortex, and multifocal areas of thinning.Additionally, there is extensive T2 signal abnormality involving the subcutaneous tissues of the vulva, buttocks, and lower back, compatible with cutaneous neurofibromata. Multiple cutaneous neurofibromata are also present in the posterior and lateral left thigh.Smaller neurofibromata can be seen more distally in the left thigh, which are separate from the confluent masses more proximally.There is extensive dural ectasia of the distal spinal canal with dextroscoliosis of the lumbar spine. Multiple neural foramina in the lower lumbar spine are widened secondary to tumor involvement of the exiting nerve roots.There is asymmetric bladder wall thickening along the anterior/right aspect of the bladder, measuring up to 1 cm in thickness, which may be related to chronic mass effect/obstruction by the massive plexiform neurofibromata.There is a small amount of free fluid in the pelvis, which is likely physiologic. | 1.Extensive plexiform neurofibromata involving the lumbar spine, left hemipelvis, and left thigh which results in extensive mass effect on the pelvic organs and vasculature.2.Multiple intramuscular neurofibromata, particularly in the left gluteal, left psoas, and muscles of the left thigh. 3.Abnormal and bizarre configuration of the bones in the left hemipelvis, which likely reflects a combination of intrinsic bone abnormality as well as mass effect from adjacent and surrounding tumor.4.Extensive sheetlike cutaneous neurofibromata of the lower back, buttocks, vulva, and posterior left thigh. 5.Asymmetric wall thickening along the anterior/right aspect of the bladder, which suggests chronic mass effect/obstruction from adjacent tumor.6.Please refer to same-day MRI of the lumbar spine regarding additional findings including dural ectasia and multifocal neural foraminal widening. |
Generate impression based on medical findings. | 52-year-old female with a history of metastatic breast cancer status post whole brain radiation. The enhancing medial right cerebellar lesion measures 3 x 3 mm (series 11, 46), previously 5 x 4 mm. There are two enhancing lesions in the left cerebellar hemisphere. The more superior lesion measures 2 x 2 mm (series 11, image 42), previously 4 x 4 mm and the more inferior lesion is no longer discretely measurable due to faint, indistinct enhancement (series 11, image 27). The enhancing lesion in the white matter adjacent to the lateral right thalamus measures 8 x 5 mm (series 11, image 7), which is unchanged in size, although the surrounding T2 signal abnormality has decreased. No new enhancing lesions are identified. There is patchy T1 hyperintensity in the bilateral globi pallidi. There is no evidence of intracranial hemorrhage or acute infarct. 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. There are no focal skull lesions. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1.Interval decrease in size of metastatic lesions in the left and right cerebellum.2.Unchanged size of a lesion in the deep white matter adjacent to the right thalamus, but with a decrease in surrounding edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Brain MRI:There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. A punctate focus of FLAIR signal in the left frontal white matter adjacent to the insula is unchanged and non-specific. There is no other significant parenchymal lesion or abnormal enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified. | 1. No specific intracranial findings to account for the patient's symptoms. 2. Normal MRA of the brain. |
Generate impression based on medical findings. | Known ulcerative colitis with new onset pruritus and elevated alkaline phosphatase. Evaluate for PSC versus other etiology of cholestasis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and signal intensity without a focal lesion. Distended gallbladder without cholelithiasis. No choledocholithiasis. There is mild irregularity of the biliary system which is not adequately evaluated without MRCP images.There is suggestion of mild fatty infiltration.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. | Normal liver morphology without a suspicious lesion.There is mild irregularity of the biliary tree which is not adequately evaluated without MRCP images. The patient is being called back for dedicated MRCP images without intravenous contrast. |
Generate impression based on medical findings. | There is no acute infarct, mass effect, or cerebral edema. There a few punctate T2 hyperintensities in the right frontal subcortical white matter which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | No acute intracranial abnormality. |
Generate impression based on medical findings. | Female, 13 years old. Uterine anomaly vs. uterine agenesis and vaginal agenesis. Abd pain, abnml USEXAMINATION: MRI pelvis without and with IV contrast 07/27/2016 PELVIS:UTERUS, ADNEXA: The uterus is small measuring 1.4 x 2.1 x 2.4 cm. The normal uterine layers are not identified. An even smaller focus of soft tissue to the left of the uterus is of uncertain etiology. There appears to be a cervix and suggestion of a vagina, but the vagina cannot be traced to the perineum or urethra. The ovaries are normal, with multiple follicles of varying sizes.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid. The kidneys are normal in appearance. | 1.Very small, dysmorphic uterus.2.There appears to be cervix and suggestion of a vagina, but the vagina cannot be traced to the perineum or urethra. 3.The ovaries are normal. |
Generate impression based on medical findings. | Female, 95 years old, with one episode of aphasia, history of meningioma. Assess for changes. A plaque-like extra-axial enhancing lesion is redemonstrated predominantly along the right aspect of the clivus where it measures up to 9 mm in thickness and shows no significant interval growth or expansion. As before, a dural tail associated with this lesion extends to the right internal auditory canal. Superiorly, there is a small contiguous nodular component of the lesion which projects into the suprasellar cistern, also appearing similar to the prior exam. Effacement of the right prepontine cistern and slight flatten of the ventral pons are unchanged. No new intracranial enhancing lesions are seen. Patchy foci of T2 hyperintensity are seen in the periventricular and subcortical white matter of the bilateral cerebral hemispheres and left basal ganglia without significant interval change. No restricted diffusion is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricles and sulci are mildly and proportionately prominent compatible with volume loss. | 1.Stable presumed meningioma along the right aspect of the clivus.2.No change in the appearance of chronic microvascular ischemic disease.3.No new or acute intracranial findings. |
Generate impression based on medical findings. | Pituitary adenoma status post TSH in 11/2013: surveillance. There has been interval evolution postoperative findings related to transphenoidal surgery. There is a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width. The infundibulum remains deviated slightly to the left. The optic apparatus is intact. There is an unchanged probable Thornwaldt cyst in the nasopharynx. There is a subcentimeter left maxillary sinus retention cyst. | Interval evolution postoperative findings related to transphenoidal surgery with a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width, which may represent recurrent tumor. |
Generate impression based on medical findings. | 56-year-old female with pain. ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus indicating mild to moderate tendinosis. There is also more focal increased signal intensity within the distal fibers of the tendon, at its insertion, indicating a small insertional tear that appears to involve the majority of the tendon thickness including the bursal surface, but spares the articular surface fibers at their insertion. There is minimal tendon retraction. Slightly more proximally, the articular surface fibers of the tendon are indistinct, suggesting fraying or focal degenerative tearing. The supraspinatus muscle appears intact. There is minimal interstitial tearing along the myotendinous junction of the infraspinatus. There is mild tendinosis of the infraspinatus tendon. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. There is minimal tendinosis of the subscapularis distally, but no tear is evident. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial/subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No joint effusion is evident. There is minimal increased signal intensity within the superior labrum which may reflect degeneration, but we see no fluid-filled labral tear, given the limitations of a non arthrogram study.BICEPS TENDON: Give the limitations of a non arthrogram study, the tendon of the long head of the biceps appears normal. | 1. Tendinosis and partial-thickness tearing of the supraspinatus involving both the bursal and undersurface fibers as described above. Other rotator cuff findings as described above.2. Mild osteoarthritis of the acromioclavicular joint and other findings as described above. |
Generate impression based on medical findings. | Clinical question: Evaluate for discitis; E faecalis bacteremia with high CRP> 200. Signs and symptoms: Low back pain, severe pain in right groin radiating to buttocks. Pre and post enhancement lumbar MRI:Examination demonstrates abnormal increased T2 signal intensity of the disc space at L3-L4 level. There is also very extensive marrow signal changes of adjacent L3 and L4 vertebral bodies consistent with edema. There is significant enhancement of vertebral bodies of L3 and L4 however without detectable enhancement of the disc space. Findings are highly suggestive of discitis-osteomyelitis. Examination in addition demonstrate mild thickening and enhancement of epidural space without distinct cavity/abscess formation within the spinal canal. There is however extraosseous spread of infection into the bilateral psoas muscles with evidence of loculated cavity formation/abscess on the left extending from the disc level to beyond the field of exam in the pelvis on the left. A smaller localized right anterior lateral psoas abscess is also noted.Significant posterior ligamentum flavum hypertrophy at this level and degenerative changes anteriorly results in significant central spinal stenosis at this level.L3-L4 demonstrate moderate to advanced disc disease and extensive hypertrophic changes of posterior elements with resultant significant central spinal stenosis and mild to moderate right neural foraminal compromise.L4-L5 demonstrate advanced degenerative disc disease with significant loss of disc height and broad-based bulging disc which in combination with hypertrophic changes of posterior elements results in significant central spinal stenosis and mild to moderate bilateral neural foraminal compromise. There is also subtle T2 increase signal intensity of disc space at this level however without enhancement of the disc or adjacent endplates.L5-S1 demonstrate mild disc disease and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.Examination at T12-L1 and L1-L2 levels are unremarkable.On sagittal and axial T1 weighted images there is evidence of fatty signal intensity of L5 and terminale extending from L3-L4 disc level inferiorly and consistent with fatty filum. There is however normal termination of the cord at L1-L2 disc level. Visualized lower thoracic cord and conus demonstrate no signal abnormality or abnormal enhancement. | 1.Signal abnormality of L3-L4 disc and with diffuse marrow signal abnormality and enhancement of adjacent vertebral bodies consistent with discitis-osteomyelitis. There is mild epidural thickening and enhancement without abscesses/cavity formation. There is bilateral paraspinal extension of inflammation/infection and with evidence of loculated psoas abscess formation on the left which extends from L4 inferiorly beyond the field of exam in the left pelvis. Smaller right-sided psoas abscess at the level of infection is also noted.. Extensive degenerative changes at this level also results in significant central spinal stenosis.2.Extensive degenerative changes at L2-L3 and L4-L5 levels results in significant central spinal stenosis.3.Neural foraminal compromise as detailed per level above.4.There is fatty filum terminale however with normal termination of the cord at L1-L2 level.5.No detectable abnormal signal or enhancement of the cord or the cauda equina. |
Generate impression based on medical findings. | 53-year-old with history of ALH of the left breast There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Three metallic artifacts are again seen within left breast; upper inner quadrant, 3 o'clock position, and lower outer quadrant. 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. | Male, 53 years old, with chronic low back pain, right leg pain, left leg weakness. Spinal alignment is anatomic. Vertebral body heights are preserved. A lumbosacral transitional morphology is evident at L5.Fatty degenerative endplate signal abnormality is seen at L2-3 and to a lesser extent at L3-4, similar to prior study. Both disc levels demonstrate degeneration with endplate irregularity and progressive loss of disc height at L3-4. Small Schmorl's nodes are evident T12-L1. The visualized distal spinal cord and conus are within normal limits.The spinal canal remains congenitally slender. Prominent dorsal epidural fat is seen. Multilevel superimposed degenerative findings are as follows:T12-L1: Mild facet hypertrophy. Mild disc bulge. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. No significant interval changes. L1-2: Progressive facet hypertrophy and ligamentum flavum thickening. Minimally progressive disc bulging. Moderate generalized spinal canal narrowing with crowding of the cauda equina, slightly worse than prior. Mild bilateral foraminal narrowing, unchanged. L2-3: Facet hypertrophy and ligamentum flavum thickening, slightly progressed. Loss of disc height and disc bulging with osteophytic ridging. Moderately severe spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No significant interval changes. L3-4: Marked facet arthropathy and ligamentum flavum thickening, slightly progressed from prior. Progressive loss of disc height with bulging and osteophytic ridging. Severe spinal canal stenosis with exclusion of CSF and crowding/impingement of the cauda equina, not definitely changed. Severe bilateral foraminal narrowing, slightly progressed on the left. L4-5: Marked facet arthropathy and ligamentum flavum thickening, slightly progressed. Disc bulging, similar to prior. Severe spinal canal stenosis with exclusion of CSF and crowding/impingement of the cauda equina, similar to prior. Severe bilateral foraminal narrowing, unchanged. L5-S1: Facet arthropathy, slightly progressed. Disc bulging asymmetric to the left with effacement of the left lateral recess. Mild spinal canal stenosis, progressed. Severe bilateral foraminal narrowing, progressed on the left. | Multilevel degeneration of the disks and posterior elements is redemonstrated with mild progression at most levels when compared to the prior examination. In particular, there is a severe degree of spinal canal stenosis at L3-4 and L4-5 with crowding/impingement of the cauda equina. |
Generate impression based on medical findings. | Slurred speech and left arm weakness. Rule out acute stroke. The examination is limited by patient motion, which is most pronounced on the post contrast images.There is no acute infarct or intracranial hemorrhage, accounting for cortical mineral deposition in the chronic infarcts. The encephalomalacia and gliosis from the chronic right posterior cerebral artery infarct, involving the right occipital, temporal and parietal lobes, has not changed. The smaller infarct involving the inferior right cerebellum is also unchanged. Patchy and confluent cerebral white-matter T2 hyperintense lesions also remain unchanged. Also, the focal T1-hypointense, T2-hyperintense signal in the upper right pons is unchanged. The ventricles as well as the other CSF-containing spaces remain enlarged moderately, reflecting underlying brain volume loss which is most prominent in the anterior and medial temporal lobes. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved, accounting for diminutive right posterior cerebral artery, which probably reflects the chronic nature of its territorial infarct. Accounting for limitation caused by motion, there is no abnormal gross intracranial contrast enhancement.There is mild mucosal thickening in the ethmoid sinuses. The mastoid air cells are clear. There is no gross orbital abnormality. There is no destructive lesion of the mildly thickened skull. | 1.Examination is limited by patient motion, especially on postcontrast imaging.2.No acute infarct or intracranial hemorrhage. No definite brain metastasis.3.Unchanged chronic right posterior cerebral artery and small right cerebellar and right pontine infarcts as well as moderate diffuse cerebral white-matter changes of chronic microvascular ischemia. 4.Brain volume loss remains most prominent in the anterior and medial temporal lobes. |
Generate impression based on medical findings. | 71-year-old male with history of lung cancer and lower back pain, evaluate for spinal stenosis Alignment is anatomic. There is degenerative disk disease, increased at L2-L3 and L3-L4 where there is vacuum disk phenomena. There are new endplate degenerative changes along the superior endplates of L4 and L3 and inferior endplate of L2. T1 and T2 hypointense rounded structure in the posterior aspect of L4 with mild STIR hyperintensity is unchanged and while nonspecific, may represent an atypical hemangioma. There is otherwise diffuse heterogeneous signal of the marrow. Multiple Schmorl's nodes and mild endplate depressions are unchanged. Signal within the distal cord and conus is normal, terminating at T12-L1.T10-T11: Diffuse disk bulge seen only on sagittal views is unchanged. No gross neuroforaminal or central canal narrowing.T11-T12: Central disk extrusion extending caudally 14 mm is unchanged. Mild spinal stenosis is unchanged. No neural foraminal stenosis, however there is narrowing at the left lateral recessT12-L1: Mild diffuse disk bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild to moderate spinal stenosis. Narrowing at the lateral recess ease bilaterally.L1-L2: Mild diffuse disk bulge. Ligamentum flavum thickening and facet arthropathy. Mild effacement of the ventral thecal sac, unchanged. No neural foraminal stenosis.L2-L3: Moderate diffuse disk bulge and thickening of the ligamentum flavum is unchanged. Moderate bilateral neuroforaminal narrowing, right greater than left, slightly worse on the left. Moderate to severe spinal stenosis is unchanged. Prominent epidural fat.L3-L4: Broad-based disk bulge with a right paracentral disk extrusion extending cranially 8 mm appears similar to the prior exam. Ligamentum flavum thickening and facet arthropathy. Severe spinal stenosis is unchanged. Severe right and mild left neural foramina stenosis is unchanged.L4-L5: Mild diffuse disk bulge, ligamentum flavum thickening and facet arthropathy. Moderate left and mild right neural foraminal stenosis is unchanged. Mild narrowing of the left lateral recess.L5-S1: Diffuse disk bulge and facet arthropathy without spinal or neuroforaminal stenosis.There is a right adrenal nodule consistent with adenoma, grossly unchanged. There are probable tiny right renal T2 hyperintense cysts. Atrophy of the right psoas muscle. | 1.Multilevel degenerative disk disease, increased at L2-L3 and L3-L4.2.Severe central spinal canal stenosis at L2-L3 and L3-L4 is unchanged.3.Prominent disk extrusions at T11-T12 and L3-L4 are unchanged.4.Multilevel neural foraminal narrowing, slightly worse at L2-L3 where it is moderate in degree. |
Generate impression based on medical findings. | For numbering purposes, a total of 5 lumbar type vertebral bodies are identified. Alignment is anatomic. There are no fractures or subluxations. Vertebral body heights and intervertebral disc spaces are preserved. There is bone marrow signal heterogeneity and scattered foci of T1 hyperintensity in the lumbar vertebral bodies, suggestive of fat or hemangiomas. There are additional areas of low T1 and low T2 signal such as in the anterior L2 vertebral body, inferior midportion of the L3 vertebral body, and inferior aspect of the L4 vertebral body. No associated STIR hyperintensity or enhancement is seen. There is no definite evidence of osseous metastatic disease, however possibility of these lesions representing sclerotic, possibly metastatic lesions is not entirely excluded. There is no evidence of epidural tumor or compression fracture. The conus is normal in signal and morphology and terminates at T12-L1 level. No abnormal enhancement of the cauda equina is identified. Multiple subcentimeter cystic-appearing structures are noted in bilateral kidneys.T12/L1: No evidence of neural foraminal or spinal canal stenosis.L1/2: No evidence of neural foraminal or spinal canal stenosis.L2/3: There is mild disc bulge and facet joint arthropathy, with no significant spinal canal or neural foraminal stenosis.L3/4: There is a disc bulge with moderate facet joint arthropathy, with partial effacement of the lateral recesses and mild bilateral neural foraminal stenoses. No significant central spinal canal stenosis. There is mild enhancement associated with facet arthropathy at this level, likely related to degenerative changes.L4/5: There is a disc bulge with left posterior annular fissure and mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis is identified. Mild facet joint arthropathy noted at this level.L5/S1:No significant spinal canal or neural foraminal stenosis. Bilateral facet arthropathy. | 1.No definite evidence of metastatic disease in the lumbar spine. However there are several small nonspecific foci of low T1 and T2 in the lumbar spine vertebral body, as described above. These are nonspecific, however the possibility that these may represent sclerotic metastatic disease is not entirely excluded. Consider bone scan or follow-up MRI as clinically appropriate.2.No evidence of significant spinal canal stenosis.3.Scattered neural foraminal stenoses, as described above. |
Generate impression based on medical findings. | 35 years Male (DOB:12/23/1980)Reason: assess for structural abnormality History: twitching of left handPROVIDER/ATTENDING NAME: ADIL JAVED ROBERT T KAVITT 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. Incidental noted is made of a 5 mm pineal region cystic type lesion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | There are no MRI findings which can explain the patient's hand twitching. There is no intracranial mass lesion appreciated. |
Generate impression based on medical findings. | Kaposi's sarcoma treated with CRT, colostomy, and IVC filter, now with severe sepsis improving, but persistently altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia. There is diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There is a fluid level in the right sphenoid sinus. There is right scleral buckling. | 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes may represent Alzheimer disease. 3. A fluid level in the right sphenoid sinus may represent acute sinusitis. |
Generate impression based on medical findings. | 35-year-old female with history of erosive sinusitis and Wegener's. Saddle nose.IMAGE ACQUISITIONS: Non-infused CT of the sinuses. Extensive bone destruction including the fovea ethmoidalis, ethmoid air cells, and medial wall and floor of the left orbit is again demonstrated, but not significantly changed in comparison with the previous exam. Thinning of the right lamina propecia also again noted. Complete opacification of the frontal, sphenoid and maxillary sinuses. Opacification of the remnant right maxillary sinus and right frontal sinus is slightly increased. Soft tissue extension to the orbit was noted previously and is again seen, with extension of granulation tissue and mass effect on the extraocular muscles. It does extend to the level of the inferior orbital foramen, although foramen has not changed in appearance since the previous exam to suggest further erosion. Extension through the fovea ethmoidalis as noted with a slight bulge superiorly could be evaluated with brain MRI clinically warranted. | Stable extensive erosive sinus disease. Extension into the left orbit and into the fovea ethmoidalis are stable findings. |
Generate impression based on medical findings. | There are postoperative findings related to right retrosigmoid craniotomy for resection of an internal auditory canal and cerebellopontine angle mass. There is subjacent unchanged CSF signal intensity extra-axial fluid collection resulting in mild mass effect on the right cerebellar hemisphere as well as the right CN V and VII and VIII. There is a rounded focus of enhancing tissue within the right internal auditory canal that measures approximately 6 x 5 mm, previously 7 x 6 mm. There is also a rind of enhancing tissue along the resection margins in the right cerebellopontine angle that appears slightly thicker anteriorly (3 mm vs. 2 mm on the prior exam) although resolved medially and posteriorly.There is persistent ventriculomegaly that is improved from the prior exam. There is no evidence of acute infarct. There are a few unchanged scattered patchy foci of T2 intensity within the supratentorial white matter are most compatible with mild chronic small vessel ischemic disease. There are no areas of abnormal parenchymal signal. There is no midline shift or herniation. The major cerebral flow voids are intact, although, there are unchanged findings of a right middle cerebral artery bifurcation aneurysm and a left M1 segment aneurysm that are not well assessed on this exam. | 1.Postoperative findings related to partial resection of a right vestibular schwannoma with residual intracanalicular and cisternal enhancing presumed tumor that is not significantly changed. 2.Persistent but improved ventriculomegaly.3.Bilateral middle cerebral artery aneurysms that are not well assessed on this exam. |
Generate impression based on medical findings. | Rule out multinodular goiter RIGHT LOBE MEASUREMENTS: 7.9 x 2.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 7.1 x 2.1 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | No thyroid nodules or other evidence of multinodular goiter. |
Generate impression based on medical findings. | 46-year-old with paresthesias. Evaluate for demyelinating disease. There is a single punctate focus of increased T2 signal in the right temporal lobe subcortical white matter. The remaining brain parenchyma is unremarkable.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. | 1. Single punctate focus of increased T2/FLAIR signal in the right temporal lobe. This is nonspecific given the small size and singularity of the lesion.2. No evidence of acute ischemic or hemorrhagic lesion |
Generate impression based on medical findings. | 68 years, Male, Reason: hx of penile mass, evaluate local extent of invasion and inguinal/pelvic lymphadenopathy History: penile mass. PELVIS: MalePROSTATE, SEMINAL VESICLES: Large lesion of the distal penis measures 6.9 x 7.7 x 5.0 cm (401/10 and 501/13). The distal corpus and urethra are not well delineated and likely replaced with tumor. The lesion extends within the subcutaneous fat of the left scrotum and abuts the left testicle (401/9 and 807/198), however no definite invasion within the testicle is evident. The base of the penis is normal appearing.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral inguinal lymphadenopathy with a right inguinal node measuring at 1.9 x 1.6 m (802/547). There are several small subcentimeter pelvic nodes. For example, a left external iliac node measures 1.5 x 0.6 cm (401/44). There is a subcentimeter node within a right fat containing inguinal hernia (401/32) which is nonspecific.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Distal penile mass. further described above, abuts and extends along the left scrotum, and underlying invasion into the scrotum is not excluded. 2.Bilateral inguinal lymphadenopathy. |
Generate impression based on medical findings. | 64-year-old female with epigastric pain radiating to the back ABDOMEN:LIVER, BILIARY TRACT: Fatty liver infiltration. Cholelithiasis with small amount of pericholecystic fluid at the gallbladder fundus. Enhancement of the gallbladder mucosa and thickening of the gallbladder wall measuring up to 5 mm. Nonspecific soft tissue infiltration at the porta hepatis with enlarged porta hepatis lymph node.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic left kidney with T2 hyperintensities compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings suspicious for acute on chronic cholecystitis with cholelithiasis as described above.2.Nonspecific soft tissue infiltration at the porta hepatis with enlarged porta hepatis lymph node. |
Generate impression based on medical findings. | 75 year old female with a history of hepatic mass. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without evidence of cirrhosis. There is a 4.8 x 4.2 cm lobulated mass in segment 2/3 of the liver with associated central scar, slight increased T2 signal abnormality and homogeneous enhancement on postcontrast sequences, which persists on the two and half hour delayed contrast enhanced sequence. These findings are most consistent with a benign FNH in a non cirrhotic liver. There is no washout on delayed postcontrast sequences.Simple cyst in the right lobe of the liver. The gallbladder is filled with numerous gallstones without evidence of acute cholecystitis. No intra hepatic biliary ductal dilation is identified. There is dilation of the common duct measuring up to 9 mm in diameter. Note is made of numerous common duct stones measuring up to 3 mm in diameter, which appear similar to the prior study performed at an outside hospital.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a 10.0 cm simple cyst in the interpolar region of the left kidney.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. | 1.4.8-cm mass in the left lobe of the liver with imaging characteristics most consistent with an benign FNH, as detailed above.2.Choledocholithiasis with slight dilation of the common bile duct.3.Innumerable gallstones without evidence of acute cholecystitis. |
Generate impression based on medical findings. | possible demyelinating disease with paresthesias. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Cervical Spine: 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 are minimal posterior disc-osteophyte complexes are C4-5 and C5-6 without no significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | 1. No evidence of demyelinating lesions in the brain or cervical spinal cord.2. No evidence of intracranial or cervical spine mass lesions. |
Generate impression based on medical findings. | 60 years, Female, with a history of syncope versus seizure. Brain parenchyma appears within normal limits for age. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Minimal nonspecific foci of T2/FLAIR hyperintensity in the supratentorial white matter. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. Incidentally seen are enlarged bilateral parietal foramina, a normal variant. | Brain parenchyma appears within normal limits. No evidence of infarct, intracranial mass, or abnormal enhancement. No findings to suggest seizure focus. |
Generate impression based on medical findings. | Female, 51 years old, with neck pain and numbness in the hand. Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are detected. No evidence of significant disc osteophyte formation, spinal canal or foraminal compromise is demonstrated. No interval changes are noted. | No specific findings are seen to account for the patient's symptoms. |
Generate impression based on medical findings. | 33-year-old female with left knee pain. Evaluate for medial meniscus tear. MENISCI: There is attenuation of the body of the medial meniscus likely representing a combination of a radial tear and additional chronic attritional tearing. The body of the medial meniscus at this location is replaced with intermediate signal intensity on image 16 of series 3 likely representing extensive focal degeneration and additional tearing. There is mild intrasubstance intermediate signal intensity within the posterior horn of the medial meniscus likely representing intrasubstance degeneration, but otherwise the anterior and posterior horns appear intact. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the weightbearing portion of the medial femoral condyle and medial tibial plateau with a linear full-thickness cartilage cleft centrally along the medial tibial plateau and degenerative low signal intensity in the underlying subchondral bone. The articular cartilage of the lateral femoral compartment appears intact. Focal low signal intensity within the articular cartilage of the lateral facet of the patella and focal high signal intensity centrally within the femoral trochlea likely represent additional sites of cartilage degeneration. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | Medial meniscus tear and osteoarthritis as described above. |
Generate impression based on medical findings. | Pituitary lesion. There is perhaps mildly heterogeneous enhancement in the pituitary gland, with apparent slightly more hypoenhancement in the right lobe. Otherwise, there is no evidence of discrete mass lesions and the pituitary gland is not enlarged or atrophic, measuring up to 6 mm in craniocaudal dimension. The pituitary stalk is situated in the midline and is not enlarged. The cavernous sinuses and optic apparatus are intact. | Possible nonspecific mildly heterogeneous enhancement in the pituitary gland, which may be related to a treated microadenoma. Otherwise, there is no evidence of discrete mass lesions and the pituitary gland is not enlarged or atrophic. |
Generate impression based on medical findings. | 69-year-old male with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensities in periventricular white matter most consistent with small vessel ischemic disease, which were present on prior MRI.The ventricles and basal cisterns are normal in size and configuration.Several small, round bony excrescences are seen arising from outer table of skull, of unclear etiology but doubtful clinical significance (sagittal series 80475, image 26). The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | No acute intracranial abnormality. |
Generate impression based on medical findings. | 69-year-old male with history of cholangiocarcinoma status post chemotherapy. Evaluate for treatment response. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a lobulated segment 7 mass which has increased T2 signal and restricted diffusion. The mass has peripheral arterial enhancement with gradual fill in delayed images compatible with a cholangiocarcinoma. This measures 4.9 x 4.5 cm, previously 4.9 x 4.1 cm. Again similar to prior there is inferior extension of the tumor into segment 5.Additional small focus of arterial enhancement previously noted in segment 6 is not identified. Scattered punctate foci of increased T2 signal without enhancement compatible with small cysts.Also similar to prior, the right hepatic vein and the posterior segment of the right portal vein are poorly visualized and likely thrombosed. The remaining hepatic veins, portal vein branches, and hepatic arteries are patent.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic but maintains normal signal. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy in the upper abdomen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged enhancement and increased T2 signal adjacent to L3 vertebral body inferior endplate irregularity is presumed degenerative in etiology.OTHER: No significant abnormality noted. | 1.No significant interval change in size of the patient's segment 7 mass. No specific evidence of disease elsewhere in the upper abdomen. |
Generate impression based on medical findings. | 72-year-old female with a right thigh mass status post radiation therapy. There is a large mass within the anterior compartment of the right thigh measuring 14.5 x 12.3 x 23.6 cm (TR x AP x CC) which results in medial displacement of the rectus femoris and vastus medialis muscles (41; series 601). The mass also displaces the femoral vessels medially, but does not definitively contact the vessels themselves. The mass is largely isointense to muscle with a few hyperintense foci likely representing subacute blood products. The mass demonstrates predominantly fluid signal intensity on T2-weighted images with low signal intensity septations. The majority of the mass does not enhance following administration of contrast although there is a peripheral rind of enhancement. There is also edema type signal intensity and enhancement of the vastus lateralis muscle belly posteriorly and distally which may reflect denervation, although we cannot entirely exclude tumor extension. The signal abnormality and enhancement within the vastus lateralis muscle contacts the femur, as does enhancing tissue arising from the posteromedial aspect of the mass, but we see no signal abnormality within the cortex or medullary cavity of the femur itself to suggest tumor invasion. There is mild edema and enhancement within the anterior musculature of the hip. There is a small knee joint effusion with enhancement suggestive of a mild synovitis which is nonspecific. | Large soft tissue mass as described above. |
Generate impression based on medical findings. | History of major concussion, changes in memory. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Incidental note is made of xanthogranulomatous cysts. There is mild supratentorial and infratentorial volume loss including the superior cerebellar vermis. No particular volume loss involving the hippocampi.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. | 1.Mild chronic small vessel ischemic changes. No intracranial hemorrhage or mass effect.2.There is mild global volume loss which appears within normal limits for age. There is mild relative increased volume loss involving the superior cerebellar vermis which is nonspecific but can be seen with chronic alcohol use. Examination is otherwise unremarkable. |
Generate impression based on medical findings. | A patient submitted outside study for review. Submitted for review are right breast mammogram 9/9/2015, ultrasound of the right breast 9/8/2015, ultrasound guided biopsy imaging 9/9/2015, right breast mammogram 9/8/2015, MRI breasts 9/4/2015, mammogram of the left breast 8/10/2015 and ultrasound of left breast 8/11/2015 performed at Center for breast care at River Forest, IL. For comparison,mammogram 9/15/2014, ultrasound of the left breast 9/15/2014 are available. Patient initially presented to outside hospital for follow-up of the multiple cysts in the left breast. Mammogram of the left breast on 8/10/2015 demonstrated interval decrease in size of the masses in the medial aspect of the left breast. In addition, there is a focal asymmetry in the far posterior left breast only seen MLO view without a definite sonographic correlate for which breast MRI was recommended. On ultrasound 8/11/2015, there is interval decrease in size of the multiple cysts with the largest cyst at 8:00 in the left breast measuring 9 mm vs 12 mm on the prior. Additionally, there is an another 9 mm indeterminate periareolar hypoechoic mass at the 2:30 o'clock of left breast. MRI was recommended to follow up with the focal asymmetry in the far posterior left breast on the mammogram and the 9 mm indeterminate hypoechoic mass at the 2:30 o'clock left breast. This most likely represents a complicated cyst. MRI BREAST 9/4/2015MR breast was performed as per outside MRI imaging protocol. The breasts are composed of dense fibroglandular tissue bilaterally. There is mild background parenchymal enhancement. A 10 x 11 x 18 mm (LR x AP X SI) mass is present in the posterior right breast, 1:00 location. This mass is abutting the pectoralis muscle without enhancement in the muscle. No additional suspicious mass or nonmass enhancement is noted in either breast. Multiple cysts are noted on the T2-weighted imaging, most prominent on the left breast. Bilateral axillary lymph nodes are unremarkable.DIAGNOSTIC MAMMOGRAM OF THE RIGHT BREAST 9/8/2015:The breast is composed of heterogeneously dense fibroglandular tissue. A small 10 mm partially visualized focal asymmetry is noted in the posterior upper inner right breast, corresponding to the MRI finding.DIAGNOSTIC ULTRASOUND OF THE RIGHT BREAST 9/8/2015:At 1:00 radian, 8 cm from the nipple, there is a 10 x 7 x 9 mm hypoechoic irregular mass, which also corresponds to the MRI and mammogram finding.ULTRASOUND GUIDED BIOPSY 9/9/2015 :Biopsy needle pierces through the hypoechoic mass at the 1:00 location of the right breast. 4 core biopsies were performed as per the provided imaging.POSTPROCEDURE MAMMOGRAM 9/9/2015:CC, ML and exaggerated CC views of the right breast demonstrated a long X shaped clip in the posterior, upper outer right breast, at the site of the biopsied mass.Pathology showed IDC grade 3 | Biopsy-proven malignancy in the posterior upper inner right breast. Biopsy clip in the appropriate location. No additional imaging evidence of malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | There are postoperative findings related to right-sided L4-L5 microdiscectomy. There is persistent enhancement and effusion with a subcentimeter synovial cyst associated with the left L4-L5 facet joint. There is also enhancement along the right aspect of the L4-L5 intervertebral disc. There is a diffuse disc bulge at L4-5, with superimposed right foraminal component and associated facet arthropathy resulting in moderate bilateral neural foraminal stenosis at L4-L5 level and posterior epidural lipomatosis with mild-to-moderate spinal canal stenosis. There is a disc bulge at L5-S1, resulting in bilateral moderate neural foraminal stenosis. The vertebral body heights are preserved. There is endplate degenerative changes and Schmorl's node in the inferior endplate of L5 vertebra. The vertebral bone marrow signal is otherwise unremarkable. There is loss of disc height at L5-S1 and mild loss of disc height at L1-L2 and L4-L5 level. There is no abnormal signal within the imaged portion of the spinal cord. There is an unchanged perineural cyst in the sacral spinal canal. | 1. Postoperative findings related to right L4-L5 microdiscectomy with residual eccentric right disc protrusion and what appears to be associated scar versus granulation tissue.2. Persistent enhancement and effusion associated with a subcentimeter synovial cyst involving the left L4-L5 facet joint may represent synovitis.3. Degenerative spondylosis at L5-S1 with bilateral moderate neural foraminal stenosis. |
Generate impression based on medical findings. | 33-year-old female with a history of removal of 3 lesions along the medial aspect of the left extremity, suspect schwannoma. A vitamin E capsule overlies the medial soft tissues of the left upper extremity, presumably representing the patient's surgical scar. No focal mass lesions are identified. No abnormal enhancement is identified on postcontrast sequences. The imaged musculature of the left upper extremity is within normal limits. The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of glenoid labrum, there is heterogeneity and increased signal intensity within the posterior labrum which may reflect degeneration, but this is equivocal. There is minimal nonspecific subcutaneous edema along the posterior aspect of the elbow/olecranon. | No focal mass lesions are identified. No evidence of residual or recurrent disease. |
Generate impression based on medical findings. | Preoperative MR examination prior to clival biopsy. There is motion limiting the T2 sequence images. Within this limitation, the lobulated high T2/low T1 signal, nonenhancing lesion which extends from the right lateral aspect of the clivus to involve the Petrus apex at the petro-clival junction is again demonstrated. This has a nonaggressive appearance on CT demonstrating a sclerotic rim and thinning of the bone which separates it from the CP angle posteriorly (difficult to assess for breakthrough given the progressed thinning ) and anteriorly where it is closely opposed to the posterior aspect of the carotid artery. There is no associated flow void and aneurysm is felt to be unlikely. This measures up to 3.2 by 1.2 x 2.2 cm (previously 2.9 x 1.4 by 2.1 cm in similar dimension). There is no associated mass effect on adjacent structures.Intracranially, there is no other visualized mass, fluid collection, hemorrhage or hydrocephalus. The midline is intact. Limited views of the orbits are unremarkable. Paranasal air sinuses, including the sphenoid, are unremarkable. | Demonstration of the nonaggressive appearing intra-osseous lesion at the right petro-clival junction which, given features such as remodeling of bone, absence of matrix and signal characteristics most likely represents a cephalocele. Differential considerations could include cholesteatoma, neurenteric cyst, or possibly cystic fibrous dysplasia. |
Generate impression based on medical findings. | Status post L3-L5 fusion, planning to extend the sacrum Five lumbar type vertebral bodies are presumed to be present. Grade 1 anterolisthesis of L5 on S1 is better seen on prior upright radiograph. Vertebral body heights and alignment are otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Postoperative changes of spinal fusion from L3 to L5 are again seen with hardware better assessed on recent CT. Left L5 pedicle fracture also better seen on same-day CT.Susceptibility artifact related to the hardware slightly limits assessment. Degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Interbody fusion. No spinal canal or neural foraminal stenosis.L4-L5: Interbody fusion. Mild disc bulge eccentric to the right with mild right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis. Small extradural fluid collection, likely postoperative, in the left laminectomy bed.L5-S1: Disc bulge and moderate bilateral facet arthropathy. There is mild to moderate bilateral neural foraminal stenosis with susceptibility artifact limiting evaluation. | 1. Postoperative changes of L3-L5 fusion. No significant spinal canal stenosis at any level. There is mild to moderate bilateral L5-S1 and mild right L4-L5 neural foraminal stenosis.2. Left L5 pedicle fracture better seen on same-day CT. There is moderate bilateral L5-S1 facet arthropathy. Grade 1 anterolisthesis at this level is appreciated on upright radiographs.3. Please see same day CT report for additional findings. |