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Generate impression based on medical findings. | 35 year old male with chronic right lower extremity wounds and lymphedema. Evaluate for osteomyelitis. Please note that due to the patient's body habitus, the soft tissues of the leg are not included in their entirety. Right tibia/fibula:There is thickening of the skin and reticulation of the subcutaneous fat compatible with the stated history of lymphedema. Within the anterior subcutaneous fat of the leg, approximately 15 cm proximal to the tibiotalar joint, is an irregular crescentic collection of fluid signal intensity, measuring approximately 5.5 x 1.5 x 4.5 cm (TR x AP x CC) with thin rim enhancement, which presumably corresponds to the fluid collection seen on ultrasound examination performed earlier today. There are small foci of internal low signal intensity which could represent calcification or gas. We see no definite communication with the overlying skin surface. Distal to this collection, the edema becomes more confluent, but we see no additional rim enhancing fluid collections. There is fatty atrophy of the musculature of the leg, particularly affecting the gastrocnemius, soleus, and peroneal musculature. There is mild edema type signal within these muscle groups as well, which may simply reflect underlying atrophy. We see no evidence to suggest intramuscular abscess formation. We see no signal abnormality within the tibia or fibula to indicate osteomyelitis.Right foot:There is reticulation of the subcutaneous fat, particularly dorsally and medially, compatible with the stated history of lymphedema. Although the edema becomes confluent, we see no fluid collection to suggest abscess formation. There is increased signal intensity within the plantar musculature of the foot which may reflect underlying atrophy. There is a small amount of fluid within the flexor hallucis longus tendon sheath, near the knot of Henry, which is nonspecific. There are small subcentimeter lobulated fluid collections adjacent to the tendon sheath with minimal if any enhancement, which may represent ganglia. We see no findings to suggest osteomyelitis. | 1. Lymphedema of the right leg and foot.2. Irregular fluid collection within the anterior subcutaneous fat of the lower leg with thin peripheral enhancement corresponding to that seen on the ultrasound examination performed earlier today which could represent an abscess, but please correlate with physical examination for wounds at this location.3. No findings to suggest osteomyelitis. |
Generate impression based on medical findings. | Female, 65 years old, with compression fracture noted on x-rays. Planning examination for kyphoplasty. Thoracic:A compression deformity of the T6 vertebral body is seen with up to 60% loss of height centrally. No significant retropulsion is detected. A compression deformity of the T12 vertebral body is also seen with up to 50% loss of height centrally and mild retropulsion into the left ventral epidural space. Both vertebrae are edematous and both demonstrate heterogeneous marrow enhancement. However, the retropulsed material at T12 does not enhance.An 8 x 5 mm enhancing extramedullary dural based mass is seen within the left ventral thecal sac at T10. This lesion exerts mild mass effect upon the spinal cord but does not produce a significant generalized stenosis. No significant abnormality of the adjacent vertebral body is seen. No other enhancing lesions are detected. The spinal cord demonstrates normal signal intensity throughout.A slight exaggeration of the thoracic kyphosis is seen. Multiple midthoracic vertebrae show mild anterior wedging and generalized reduction in height. The intervertebral discs are preserved. With the exception of the T10 and T12 levels, no other significant compromise of the spinal canal or neural foramina is detected.Pleural effusions are seen, left side greater than right. It also appears that the left upper lobe is atelectatic with a masslike process at the hilum.Lumbar:An expansile enhancing lesion is evident centered on the L3 spinous process and laminae. A round enhancing lesion is seen within the left sacrum, and a large masslike, centrally necrotic process is partially visualized in the left iliac bone. Edema and enhancement of the right L4-5 facet complex is favored to be inflammatory in nature. Vague edema and enhancement within the posterior L1 and L2 vertebral bodies is nonspecific.Vertebral body heights are generally preserved allowing for mild endplate concavity at most levels. Facet arthropathy is seen at lower lumbar levels along with mild disc bulging. No significant spinal canal stenosis is observed. The right L5-S1 neural foramen is mildly narrowed.The visualized distal spinal cord, conus and nerve roots of cauda equina are within normal limits. No definite pathologic intrathecal enhancement is seen.The left adrenal gland is thickened concerning for the presence of a mass. | 1.Enhancing osseous lesions within the posterior elements of L3, the left sacrum and the left iliac bone are highly concerning for metastatic deposits. Given this, the compression deformities at T6 and T12 are highly suspected to be pathologic in nature.2.An extramedullary intradural mass is seen within the left ventral thecal sac at T10. Given the above findings, this is concerning for an intradural metastasis, though theoretically this could also represent an incidental meningioma.3.Atelectasis of the left upper lobe and a left hilar mass are suspected. Bilateral pleural effusions are seen. In addition, the left adrenal gland is thickened. These findings should be assessed with dedicated CT imaging.4.The above findings were discussed with Dr. Kallepalli at 4:30 PM on 11/1/16. |
Generate impression based on medical findings. | Reason: evaluate for lupus cerebritis or other changes related to lupus History: new diagnosis of lupus, retinopathy on exam, hypertension. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is narrowing of the proximal right m1 segment and distal right ICA.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.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are identified and are small . The vertebral arteries are asymmetric - left smaller than right.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. | 1.Findings suggest significant narrowing at the origin of the right MCA and distal right ICA. This can be confirmed using a CTA.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits4.No evidence for intracranial mass lesion. |
Generate impression based on medical findings. | Reason: prostate cancer History: elevated PSAProstate biopsy 5/29/2014: Right mid medial prostatic adenocarcinoma, Gleason 6. PELVIS:PROSTATE:Prostate Size: 5.4 x 3.8 x 4.8 cmPeripheral Zone: Lesion in the right mid peripheral zone which is dark on ADC/T2 is suspicious for prosthetic adenocarcinoma. This lesion appears similar to the prior exam. An additional less suspicious triangular appearing lesion in the far lateral right peripheral zone is also stable.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right peripheral zone lesion consistent with biopsy-proven prostatic adenocarcinoma appears similar to the prior exam. No new lesions are evident.2.No lymphadenopathy. |
Generate impression based on medical findings. | Reason: ruleout nmo, demyelinating disorder History: vision loss, changes MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery appears be hypoplasticThe visualized portions of the paranasal sinuses demonstrates partial opacification of the ethmoid air cells, mucosal thickening in the maxillary sinuses and frontal sinuses and partial opacification of the sphenoid sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .MRA brain:Antegrade flow is present in the distal internal carotid arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The vertebral arteries were not included on this exam. There is fenestration of the anterior communicating artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. | 1.MRI of the brain and orbits is within normal limits.2.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The vertebral arteries were not included on the MRA exam.3.Inflammatory changes are present in the paranasal sinuses. |
Generate impression based on medical findings. | Shoulder weakness ROTATOR CUFF: There is branching increased signal intensity within much of the distal fibers of the infraspinatus tendon and adjacent supraspinatus tendon posteriorly that is suspected to represent a network interstitial tearing which extends to both the bursal and articular surfaces of the tendon. There is also interstitial tearing of the infraspinatus tendon more proximally along the myotendinous junction with additional mild tendinosis and bursal surface fraying affecting the distal supraspinatus tendon near the 12:00 position. There is no frank fluid-filled gap or retraction of either tendon however. The subscapularis and teres minor tendons are normal. There is mild fatty atrophy of the infraspinatus muscle along the myotendinous junction but the remaining rotator cuff musculature is intact.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint and a trace amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. There are no significant arthritic changes. There is intermediate signal intensity within the superior labrum which may reflect degenerative tearing.BICEPS TENDON: No significant abnormality noted. | Network of interstitial tearing predominantly involving the infraspinatus tendon at its insertion with extension to both the bursal and articular surfaces however there is no discrete fluid-filled gap or tendon retraction of the rotator cuff. Additional findings are described above. |
Generate impression based on medical findings. | There are is failure of fat suppression on the axial sequences related to cervical hardware limiting evaluation. Anterior cervical fusion is noted from C4 to C7. There is no abnormal signal involving the brachial plexus based on the coronal STIR sequence, which is of decent quality. No abnormal enhancement is appreciated on the coronal sequences. No masses within the lung apex or lower neck soft tissues to suggest extrinsic compression. | Technically degraded study due to cervical fusion hardware. Within this limitation, no abnormal edema or enhancement is appreciated based on the coronal sequences to suggest a brachial plexopathy. There are no masses to suggest extrinsic compression. |
Generate impression based on medical findings. | Abdominal pain and CVA tenderness. RIGHT KIDNEY: The right kidney measures 8.8 cm with minimal hydronephrosis, similar to prior MRI. No shadowing nephrolithiasis. Minimal perinephric fluid as seen on MRI.LEFT KIDNEY: The left kidney measures 9.7 cm without hydronephrosis or shadowing nephrolithiasis.URINARY BLADDER: Normally distended urinary bladder. A right ureteral jet was noted.OTHER: No significant abnormalities noted. | Minimal right sided hydronephrosis is similar to the prior MRI and may be physiologic given the patient's gravid state. No shadowing nephrolithiasis. |
Generate impression based on medical findings. | 30-year-old female with abdominal pain and vomiting. Evaluate for plexiform tumor. BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: There is increased signal abnormality within the right gluteus maximus which is nonspecific but may reflect a combination of postsurgical change and subacute denervation. There is nonspecific subcutaneous edema along the posterior aspect of the right pelvis which may reflect postsurgical change. There is a nonspecific lesion within the right gluteus maximus measuring 12 mm in greatest diameter which demonstrates increased signal abnormality and fluid sensitive sequences. An additional 15 mm lesion is identified within the subcutaneous tissue along the posterior superior aspect of the right gluteal crease. Multiple additional foci of signal abnormality are identified within the right gluteal crease and subcutaneous tissue which are incompletely characterized on this noncontrast examination but likely represent neurofibromas given the patient's history of NF1.JOINTS: There is a small amount of fluid within the joint without evidence of large effusion.ADDITIONAL | Apparent postoperative changes with lesions within the right gluteus maximus muscle and subcutaneous tissue along the posterior aspect of the right hemipelvis are incompletely characterized on this noncontrast examination but likely represent neurofibromas, given the patient's stated history of NF1. |
Generate impression based on medical findings. | 39-year-old female with new diagnosis of invasive ductal carcinoma. Evaluate for satellite lesion, identified on recent mammogram. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right Breast: Within the right breast at 10-11 o'clock, mid to posterior depth, there is a 4.8 x 2.8 x 3.2 cm (AP x ML x CC) irregular heterogenously enhancing mass with type III washout, containing clip artifact from prior biopsy. Multiple adjacent satellite lesions and non mass enhancement is identified anterior, posterior and inferior to it. The most anterior satellite lesion is located retroareolar, measures 6 x 10 x 7 mm (AP x ML x CC) and is mammography occult. This retroareolar satellite is located 4.3 cm anterior to the index lesion. The largest posterior satellite lesion is located at 9:00, posterior depth, 1.9 cm posterior inferior to the index mass, has a mammographic correlate and measures 8 x 7 x 7 mm (AP x ML x CC). The index mass with adjacent satellite lesions and non mass enhancement span 13.0 x 3.8 x 5.3 cm (AP x ML x CC) in total extent.Left Breast: No abnormal enhancement is identified in the left breast. Axillae: No abnormal lymph nodes are identified in either axillary region. | 1.Right breast multifocal cancer spanning 13 cm. Right 10:00 index mass, pathology confirmed breast cancer. Multiple satellite lesions, with the largest posterior or anterior satellites that can be further evaluated with MRI directed ultrasound, amenable for ultrasound guided biopsy. 2.No suspicious enhancement within the left breast or axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | History of ileal Crohn's 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: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild circumferential low T2-weighted signal wall thickening of approximately 3 cm of the terminal ileum (series 4/21) without associated early enhancement, restricted diffusion or proximal dilatation. During the course of the examination this region demonstrates normal dispensability. The small and large bowel is normal caliber, wall thickness and enhancement. There is no abnormal restricted diffusion. No free fluid collection. No significant fibrofatty proliferation.BONES, SOFT TISSUES: Mild thoracolumbar curvature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of active bowel inflammation. Stigmata of prior/chronic inflammatory changes of approximately 3 cm of the terminal ileum which demonstrates normal distensibility and no pre-stenotic dilatation. |
Generate impression based on medical findings. | Clinical question: Demyelination? Signs and symptoms: Lower extremity weakness. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Images through the posterior fossa demonstrate a tiny linear right median pontine foci of FLAIR hyperintensity similar to prior exam and unremarkable images otherwise.Images through the supratentorial space demonstrate stable few scattered foci of FLAIR and T2 hyperintensity in the periventricular and to a lesser degree subcortical white matter of cerebral hemispheres as was noted on prior study. These findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. This is a similar observation is prior exam. Although nonspecific considering patient's stated age of 81 the above findings likely representing chronic changes of microvascular ischemic disease. Possibility of demyelinating disease is considered significantly less likely and cannot be entirely excluded.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Signal voids of major intracranial arterial branches are identified. No abnormal parenchymal, leptomeningeal, calvarial or retroperitoneal abnormal enhancement.Pre- and post enhanced cervical MRI:The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal and without intravenous or abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant moderate right neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy with resultant significant right and moderate left neural foraminal compromise and mild central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Moderate to severe left and moderate right neural foraminal compromise and mild central spinal stenosis.C7-T1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet (left greater than right) and ligamentum flavum hypertrophy. No spinal stenosis however mild left neural foraminal compromise is detected. | 1.Pre and post enhanced brain MRI demonstrate no acute intracranial process and no evidence of any new findings since prior study. Stable scattered nonspecific FLAIR hyperintensity in the periventricular anterolisthesis in the subcortical cerebral hemispheres and punctate focus in the right paramedian pons remained identical to prior exam and without evidence of hemorrhagic change or enhancement. Findings are more suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.2.Pre and post enhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cervical and upper most visualized thoracic cord without abnormal enhancement. Multilevel degenerative changes with resultant mild central spinal stenosis at C5-C6 and C6-C7 levels as detailed. Multilevel neural foraminal compromise as detailed per level above. |
Generate impression based on medical findings. | Sacral decubitus ulcer The exam is markedly limited by extensive motion artifact, a lack of intravenous gadolinium, and the patient's body habitus.A large decubitus ulcer is seen posterior to the right gluteus maximus muscle with extension to the gluteal cleft. Abnormal signal intensity extends from the ulcer through the subcutaneous fat to the rectum. This abnormal signal intensity may reflect edema and/or scarring but we see no focal fluid collection to suggest abscess in this area.There is no abnormal marrow signal intensity of the sacrum to suggest osteomyelitis. The marrow signal intensity of the upper coccyx also appears normal on T1 sequences arguing against active osteomyelitis. More distally, the coccyx is not seen which may be secondary to chronic erosion from long-standing infection. The bone marrow of the remaining pelvis and proximal femora is unremarkable.There is severe degenerative disc disease of the lower lumbar spine with disc protrusion of L4-L5 and anterolisthesis of L4. There is diffuse subcutaneous edema with combined atrophy and edema of much of the visualized pelvic musculature which is nonspecific in nature. A Foley catheter is noted. There is osteoarthritis of the hips but there are no large hip joint effusions. | Markedly limited exam demonstrates large decubitus ulceration overlying the right gluteus maximus muscle. We see no abnormal signal intensity within the sacrum or proximal coccyx to suggest active osteomyelitis. The lower coccyx is not seen which may reflect chronic erosion from long-standing infection. |
Generate impression based on medical findings. | Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites [C85.89], Reason for Study: ^Reason: evaluate for etiology of double vision History: cocern for recurrence of orbital lymphoma Orbit MRINo evidence of recurrence mass within the orbit. There is no evidence of abnormal enhancement.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement. Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the left frontal lobe is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening are seen within the frontal sinus and ethmoid sinus. Empty sella is noted.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of left side laminectomy at the level of L34, L4-5 and L5-S1.Soft tissue fluid collections are seen from L23 to L45 which likely represent postoperative changes.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal.The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Broad-based disc protrusion central to left which abuts thecal sac. However, no significant neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation with diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. L4-L5: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis. L5-S1: Left sided total laminectomy status. Diffuse bulging of disc with left side lateral recess stenosis. | 1. No evidence of recurrence orbital tumor or abnormal enhancement within the orbit.2. No evidence of acute ischemic or hemorrhagic lesion or abnormal enhancement of the brain.3. Unchanged left frontal encephalomalacia since prior scan.4. Postoperative status, left side laminectomy from L3-4 to L5-S1.5. Degenerative changes of lumbar spine including various degree spinal canal stenosis at the level of L3-4, L4-5 and left lateral recess stenosis at L5-S1. |
Generate impression based on medical findings. | Reason: eval for meniscal tear History: knee pain 2-3 months ago with rugby injury and still with pain, joint pain, pain with walking and lateral side MENISCI: There is abnormal signal intensity and deformity of the anterior horn and body of the lateral meniscus representing a tear, with low signal intensity adjacent to the peripheral fibers of the body of the meniscus likely representing a displaced meniscal flap fragment. The posterior horn of the lateral meniscus appears intact. The medial meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is edema within the lateral tibial plateau posteriorly, representing a contusion, adjacent to subchondral low signal intensity that may represent a nondisplaced subchondral fracture. There is relatively mild edema within the lateral femoral condyle, also likely representing contusion. There appears to be superficial loss of articular cartilage along the lateral tibial plateau and lateral femoral condyle adjacent to the free edge of the posterior horn of the meniscus. The remaining articular cartilage appears normal.LIGAMENTS: The collateral and cruciate ligaments of the knee are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal.ADDITIONAL | 1.Lateral meniscal tear as described above. 2.Lateral tibial plateau bone contusion and possible nondisplaced subchondral fracture as above. 3.Other findings as above. |
Generate impression based on medical findings. | Female 66 years old Reason: Evaluation of disease in patient with cervical cancer, undergoing radiation therapy History: None PELVIS:UTERUS, ADNEXA: Again seen is a heterogeneous enhancing mass in the right aspect of the cervix, which now measures approximately 2.7 x 2.0 cm (series 401/40), previously 3.2 x 2.0 cm. The mass demonstrates subjectively less enhancement when compared to the prior examination. There has been interval placement of a cervical sleeve. Right parametrial invasion again present.Leiomyomatous uterus with degenerating fibroids again noted.BLADDER: No significant abnormality noted.LYMPH NODES: The referenced right pelvic sidewall lymph node now measures 1.3 x 0.6 cm (series 1004/14), previously 1.6 x 0.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight interval decrease in size of the cervical mass with persistent but improved parametrial invasion, but decreased subjective enhancement.2.Slight interval decrease in size of the right pelvic sidewall lymph node. |
Generate impression based on medical findings. | MCP deformity LIGAMENTS: No significant abnormality noted.TENDONS: There is buckling, increased signal, and thickening of the ulnar collateral ligament of the thumb however there is no significant increased signal within the surrounding bone or soft tissue. The radial collateral ligament is intact.The flexor pollicis longus appears normal at its insertion however more proximally it is enlarged and demonstrates increased signal throughout the remaining visualized portion into the flexor compartment. It is not well seen within the flexor compartment. Additionally, there is fluid signal surrounding the flexor pollicis longus as it courses between the flexor compartment and its insertion.BONES: There is severe osteoarthritic changes of the first metacarpal phalangeal joint. | 1. Probable partial tearing of the ulnar collateral ligament which is likely chronic in nature given the lack of edema and inflammation in the surrounding area.2. Increased signal and thickening of the flexor pollicis longus as it enters the flexor compartment suggesting intrasubstance tearing. The tendon is not well seen within the flexor compartment which is suspicious of a proximal tear and retraction of the tendon.3. Tenosynovitis of the flexor pollicis longus. |
Generate impression based on medical findings. | Left sensory stroke, likely lacunar. There is an apparent punctate area of mildly restricted diffusion and T2 hyperintensity in the posterior right thalamocapsular junction region. Otherwise, there is mild scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion, which likely represents chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the right mastoid air cells. | An apparent punctate area of mildly restricted diffusion and T2 hyperintensity in the posterior right thalamocapsular junction region likely represents an early subacute lacunar infarct. |
Generate impression based on medical findings. | Evaluate for progression of leptomeningeal carcinomatosis from breast cancer treated with WBRT. The abnormal leptomeningeal enhancement has markedly diminished and there is minimal residual T2-FLAIR hyperintensity in the left parietal sulci. There is no evidence of intraparenchymal abnormal enhancement. There is unchanged nonspecific patchy T2 hyperintensity in the periventricular white matter, particularly in the parietal regions. 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 are unchanged. | 1. Interval improvement in the leptomeningeal carcinomatosis.2. No evidence of intraparenchymal metastases. |
Generate impression based on medical findings. | Female, 41 years old, with headaches and visual changes. Numerous scattered foci of periventricular and juxtacortical T2 hyperintensity are again seen. Some of these lesions are oriented relatively perpendicular to the ventricular surface. Accounting for significant differences in technique on the prior comparison examination, no definite change in the size or number of lesions is seen. However, new enhancement is seen corresponding to a lesion along the left ventricular atrium. Some of the above-mentioned lesions are associated with mild to moderate T1 hypointensity.No significant parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is suspected. Brain parenchymal volume is preserved. The ventricular system is normal in size and morphology. | Numerous scattered white matter lesions are redemonstrated showing no significant interval change in size or number when compared to the prior examination. However, a lesion along the left ventricular atrium does appear to be newly enhancing. As before, these lesions would be compatible with a demyelinating process, with additional considerations including sequelae of migraine or vasculitis. |
Generate impression based on medical findings. | PTLD outside the CNS. There is an unchanged patchy area of T2 hyperintensity in the periventricular white matter adjacent to the left frontal horn, which measures up to 10 mm. There is also milder T2 hyperintensity diffusely in the periventricular white matter diffusely. Otherwise, there is no evidence of acute infarct or mass. There are a few subcentimeter foci of susceptibility effect in the bilateral cerebral hemispheres. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bone marrow of the skull appears to be unchanged. | 1. Unchanged nonspecific patchy area of T2 hyperintensity in the periventricular white matter adjacent to the left frontal horn. Otherwise, no convincing evidence of CNS PTLD, although assessment is limited due to the lack of intravenous contrast.2. A few subcentimeter foci of susceptibility effect in the bilateral cerebral hemispheres are nonspecific, but may represent chronic microhemorrhages. |
Generate impression based on medical findings. | 64-year-old with right upper lobe adenocarcinoma presenting with acute lumbar pain since one week. Evaluate for metastasis, radiculopathy, or other acute changes. Five lumbar type vertebral bodies are present. There is loss of normal lumbar lordosis with mild convex leftward curvature of the lumbar spine centered at the L2-L3 level. Conus is in normal position at the upper L2 level.Multilevel degenerative changes are seen with significant loss of disc space at the L2-L3, L3-L4, L4-L5, and L5-S1 levels with prominent areas of subchondral sclerosis and cyst formation as well as vacuum disc phenomena better appreciated on recent abdominal CT. Bone marrow signal is heterogeneous. There is abnormal enhancement involving the L4 and L5 vertebral bodies which is favored to be on a degenerative basis. There is somewhat more suspicious enhancement involving the L1 vertebral body with a rounded area of enhancement measuring approximately 16 mm x 14 mm in the AP and craniocaudal dimensions. No evidence of compression fractures or epidural tumor.Individual levels as below:L1-L2: Minimal disc bulge and prominence of the epidural fat. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge eccentric to the right and prominence of the epidural fat. No spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.L3-L4: There is disc bulge and prominence of the epidural fat with mild spinal canal stenosis. There is moderate right and minimal left neural foraminal stenosis.L4-L5: Disc bulge, prominence of the epidural fat, ligamentum flavum thickening, and facet arthropathy result in moderate spinal canal stenosis. There is moderate right-sided neural foraminal stenosis and severe left neural foraminal stenosis.L5-S1: Mild disc bulge and prominence of the epidural fat. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits. | 1. Multilevel degenerative changes throughout the lumbar spine. Bone marrow signal is heterogeneous with edema and enhancement involving the L4 and L5 vertebral bodies which is likely on a degenerative basis. There is a more rounded focus of enhancement involving the L1 vertebral body which is slightly suspicious and measures approximately 16 x 14 mm. Consider short-term follow-up MRI to assess for stability or bone scan for further evaluation. There is otherwise no definite evidence of metastatic osseous disease. No evidence of pathologic compression fractures or epidural tumor.2. Degenerative changes resulting in up to moderate spinal canal stenosis at the L4-L5 level. There is also moderate right and severe left neural foraminal stenosis at L4-L5. Additional levels as detailed above. |
Generate impression based on medical findings. | Spastic quadriplegic with history of cerebral palsy and TORCH infection. Evaluate for seizure focus or cerebellar lesion: horizontal nystagmus. There are extensive areas of cystic encephalomalacia within the bilateral parietal and posterior frontal lobes, with associated scattered areas of susceptibility effect, marked thinning and bulging of the body of the corpus callosum, and ex-vacuo dilatation of the lateral ventricles. There are also smaller areas of encephalomalacia and susceptibility effect in the bilateral basal ganglia. There are multiple additional scattered small foci of abnormal susceptibility throughout cerebral hemispheres bilaterally. There is diffuse prominence of the cerebellar sulci, left more than right. There is also patchy T2 hyperintensity in the left cerebellar hemisphere white matter. There is no evidence of acute infarction. There is no intracranial mass lesion or midline shift. The cranium has a microcephalic appearance and there appears to be hypertelorism. There is mild scattered paranasal sinus mucosal thickening. | 1. Areas of chronic hemorrhagic infarction in the bilateral cerebral hemispheres, particularly the frontal and parietal lobes and basal ganglia, as well as multiple scattered cerebral calcifications are compatible with the history of cerebral palsy and of TORCH infection.2. Diffuse left greater than right cerebellar volume loss and patchy signal abnormality in the left cerebellar hemisphere white matter may be related to the supratentorial infarcts with superimposed crossed cerebellar diaschises. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Brain: Evaluation of the myelination is limited due to motion. On the T1 weighted images, the myelination appears to be normal for corrected age. On the T2 weighted images, the myelination appears to be delayed, appearing similar to 9 and 11 months of age. Overall, there is decreased extent of hypointense signal in the central deep white matter as well as in expected subcortical areas at this age.There is focal prominent encephalomalacia in the left frontal lobe with ex vacuo dilatation of the lateral left lateral ventricle. The margins of the apparent encephalomalacic cleft demonstrate ill-defined T2/FLAIR hyperintensities representing gliosis. The lateral ependymal margin of the left lateral ventricle is entirely intact, and the apparent "cleft" is lined by areas of white matter.There is no pathologic midline shift. There is no abnormal enhancement. There is no evidence of acute hemorrhage or mass effect.There are no diffusion or susceptibility abnormalities.There is persistence of cavum septum pellucidum et vergae, normal variant.There is fluid in the bilateral mastoids and there is partial scattered opacification of the paranasal sinuses.MRI brain: The right A1 segment is hypoplastic. The bilateral PCOMs are not well-visualized. Otherwise, the internal carotid arteries, anterior, middle, and posterior cerebral arteries are patent. The vertebral and the basilar arteries are patent. No flow-limiting stenosis or aneurysm.MRA neck: The MRA of the neck is limited due to lack of contrast and motion. There is attenuation of flow related enhancement at the proximal petrous left ICA, likely artifactual due to tortuosity. The MRA of the neck is grossly unremarkable. The right internal carotid artery is smaller than the left, due to the hypoplastic right A1 segment.The left vertebral vertebral artery arise from the aortic arch, normal variant. | 1. There is prominent left frontal encephalomalacia with ex vacuo dilatation of the adjacent left lateral ventricle.2. Normal myelination appearance on T1-weighted images, however delayed myelination pattern on T2-weighted images, similar to between 9 and 11 months of age.3. Unremarkable MRA head.4. Limited MRA of the neck due to lack of contrast and patient motion, but is grossly unremarkable. |
Generate impression based on medical findings. | Recurrent T2N2B squamous cell carcinoma of the base of the tongue, previously treated with concurrent cisplatin/RT and now receiving chemotherapy. There is an ill-defined ulcerative lesion centered in the left tongue base with extension into the glossotonsillar sulcus that measures up to 40 mm in length and 10 mm in thickness. There is diffuse edema within the supraglottic suprahyoid soft tissues of the upper aerodigestive tract, overlying skin, as well as the left submandibular gland. There is denervation change involving the left hemitongue. There is no evidence of significant cervical lymphadenopathy based on size criteria. There are multilevel posterior cervical disc-osteophyte complexes that narrow the spinal canal. The imaged intracranial structures and orbits are unremarkable. There is minimal scattered paranasal sinus mucosal thickening. | 1. Extensive treatment effects in the upper aerodigestive tract region with an ill-defined ulcerative lesion centered in the left tongue base with extension into the glossotonsillar sulcus, which likely represents treated tumor. 2. No residual significant lymphadenopathy in the neck. |
Generate impression based on medical findings. | 90 ear old female with history of asthma, recent onset of dizziness and feeling faint, likely cardiac/asthmatic etiology. Rule out cerebellar stroke. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities within a periventricular and subcortical distribution with multiple patchy hypodensities consistent with old lacunar infarcts and small vessel disease. If there is clinical concern for acute ischemia, an MRI may be considered.Prominent sulci with proportional ventricular enlargement probably within normal limits for age.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Small vessel disease as described above. If there is clinical concern for acute ischemia, an MRI may be considered. |
Generate impression based on medical findings. | 18 day old male with history of hemorrhagic liver mass. ABDOMEN:LIVER, BILIARY TRACT: Previously seen right posterior hepatic intraparenchymal heterogeneously T2 hyperintense lesion (501/13) measures 1.5 x 2.5 x 2.1 cm, decreased in size from the previous measurement of 4.3 x 4.2 x 2.9 cm. Thin rim of peripheral enhancement about this lesion is noted, without significant internal enhancement on early or delayed images. There no significant biliary dilation or other hepatic abnormality.SPLEEN: The spleen is within normal limits.PANCREAS: No appreciable pancreatic abnormality.ADRENAL GLANDS: The adrenal glands are within normal limits.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild bibasilar pulmonary atelectasis. Mild abdominal ascites. | Interval decrease in size of the previously seen hemorrhagic right hepatic lesion as above. Continued follow-up to resolution is advised. |
Generate impression based on medical findings. | Reason: history of metastatic colon cancer with new brain metastasis s/p resection; please evaluate for radiosurgery treatment planning History: brain mass The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post left-sided posterior fossa craniotomy and left cerebellar surgery. There are multiple enhancing lesions present in the left cerebellar hemisphere and vermis. One ring enhancing lesion in the inferior aspect of the right side of the vermis measures 5 mm in diameter. One in the medial aspect of the left cerebellar hemisphere along the inferior semilunar lobule measures 7 x 6 mm. One along the lateral aspect of the inferior left semilunar lobule measures 11 x 12 mm. There is contrast enhancement present along the edge surgical planes in the left cerebral hemisphere with a nodular component measuring 5 x 7 mm axial dimensions.There is a 6-mm enhancing lesion located in the left thalamus which was also present on the prior exam, however, because it was previously evaluated using T2 imaging direct comparison is not possible.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.Status post left cerebellar surgery with the residual enhancement at the surgical site.2.There multiple small ring enhancing lesions present in the cerebellar vermis, the medial and lateral aspect of the left cerebellar hemisphere as well as in the left thalamus. Given the patient's clinical history, metastatic disease is a strong consideration. There are no prior contrast enhanced MRI of the brain studies available |
Generate impression based on medical findings. | Resection of CCM on 4/23/15. There are postoperative findings related to right frontal craniotomy. There is a cavity in the right gyrus rectus region with linear susceptibility effect along the margins and mild confluent T2 hyperintensity in the surrounding white matter. There is diffuse mild thickening and hyperenhancement of the overlying dura. There is an unchanged punctate cavernous malformation in the pontomedullary junction. There are multiple nonspecific scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or acute intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. | 1. Postoperative findings related to right frontal lobe cavernous malformation resection with mild susceptibility effect along the margins of the resection cavity, which is likely attributable to residual blood products from the surgery.2. Unchanged punctate probable cavernous malformation in the pontomedullary junction. |
Generate impression based on medical findings. | There is no restricted diffusion. There is susceptibility signal along the anterior interhemispheric fissure in the right frontal lobe; when compared with the previous head CT this susceptibility signal is suggestive of calcification.There are no T2/FLAIR abnormalities. Ventricular and the sulci are slightly prominent, age-related volume loss. There is a redemonstration of right frontal closed lip schizencephaly. There is staphyloma of the right eye globe.The septum pellucidum is not seen on this scan. The optic chiasm and bilateral optic nerves are identifiable, although appear to be a bit smaller than usual. Thus, these findings may suggest mild form of septo optic dysplasia (septo optic dysplasia plus). These findings do not show any significant interval change since prior scan performed in 2008. There is bilateral lens prostheses. | 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No acute infarct.2. No change of closed lip right frontal schizencephaly, staphyloma of the right eye globe, and mild form of septo-optic dysplasia since prior scan. |
Generate impression based on medical findings. | 43 years, Female, right frontal cavernous malformation. Three month follow-up. Compared to 9/28/2015, there is no significant change in size of heterogeneous T2 hyperintense lesion with a rim of susceptibility related to hemosiderin staining. Lesion involves the right superior frontal gyrus, with the T2 hyperintense component measuring approximately 5 to 6 cm. Including the T2 hypointensity, the lesion measures up to 10 mm in the AP dimension and unchanged. There is adjacent linear enhancement suggestive of an associated small developmental venous anomaly. No surrounding edema.Partially empty sella is incidentally noted which can be a normal variant. Remainder of the brain parenchyma appears unremarkable without evidence of recent ischemia or hemorrhage. No no new lesions. No intracranial mass effect. Ventricles and sulci appear within normal limits. Calvarium and extracranial soft tissues are unremarkable. | Again seen is a solitary, subcentimeter right frontal cavernous malformation with a small adjacent developmental venous anomaly. No findings to suggest new hemorrhage or interval enlargement. |
Generate impression based on medical findings. | Anesthesia of skin [R20.0], Reason for Study: ^Reason: evaluate for acute ischemia History: left face and arm weakness38 years Male (DOB:2/5/1978)Reason: evaluate for acute ischemia History: left face and arm weaknessPROVIDER/ATTENDING NAME: JAMES AHN No evidence of acute ischemic or hemorrhagic lesion.There is localized thickening of the falx which protrudes towards left side (series 601, image 27) which likely indicate a small falx meningioma. The size of the lesion is measured about 4.3 mm x 15 mm.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mastoid air cells are clear. The visualized portions of the orbits are intact. Mucosal thickenings are seen on bilateral maxillary sinuses | No evidence of acute ischemic or hemorrhagic lesion.Possible small falx meningioma. |
Generate impression based on medical findings. | There multiple patchy foci of decreased diffusion throughout the right frontal, parietal, and occipital lobes predominantly in a watershed distribution. This minimal susceptibility effect associated with more confluent regions in the right precentral gyrus with adjacent prominence of the sulcal vessels throughout the right frontal lobe. There is also mild leptomeningeal enhancement with apparent nodularity at the right central sulcus (or tortuous dilated vessels). In addition, there multiple punctate foci of T2 hyperintensity within the left sided supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are unremarkable. The skull is mildly thickened. | 1.Numerous foci of restricted diffusion throughout the right cerebral hemisphere are most compatible with acute/subacute infarcts. These appear predominantly in the watershed distribution. Small foci of susceptibility are also seen indicative of petechial hemorrhages. There is prominence of the pial collaterals with mild leptomeningeal enhancement and apparent nodular enhancement at the right central sulcus. This nodularity may be related to tortuous dilated collateral vessels; however, if there is possibility of underlying infection and infectious vasculopathy, suggest lumbar puncture and vascular imaging for further evaluation. 2.Additional nonspecific punctate foci of T2 hyperintensity throughout the left cerebral hemisphere.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 38-year-old female with history of bilateral breast implants and axillary pain. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Bilateral retroglandular silicone implants are intact. There is some asymmetry in their positioning, but no finding of rupture. A few radiating folds are noted. There is mild thin rim enhancement in the tissue surrounding the right implant, not concerning for malignancy, rather suggestive of mild inflammation. There are mildly prominent but largely symmetric nodes in each axilla, possibly reactive due to the implants. | No MRI evidence for malignancy. Mildly prominent axillary lymph nodes are probably reactive. Enhancement around the right implant suggestive of mild reactive/inflammatory change. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 26-year-old female with history of ulcerative colitis status post ileal pouch anal anastomosis with perianal abscess in 10/2014. Patient with burning anal pain. Evaluate the pelvis and perianal region. PELVIS:UTERUS, ADNEXA: Bilateral adnexal T2 hyperintense foci measuring up to 1.5 cm, consistent with physiologic follicles.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific bilateral subcentimeter inguinal lymph nodes.BOWEL, MESENTERY: Postoperative changes of colectomy and ileoanal anastomosis. No evidence of pelvic abscess. Small amount of pelvic fluid, likely physiologic in etiology.BONES, SOFT TISSUES: There is perineal granulation tissue with a subtle area of linear T2 signal which is nonspecific. No evidence of perineal abscess.OTHER: No significant abnormality noted. | 1.No evidence of perineal or pelvic abscess.2.Linear T2 signal in the perineal region may represent non-fluid filled tract versus granulation tissue. |
Generate impression based on medical findings. | Female, 51 years old, with sciatica, increased back pain with history of fall, works in the construction business. Thoracic:Vertebral body morphology is within normal limits. Edematous endplate degeneration is partially visualized at C7-T1. Minimal endplate edema is seen anteriorly at T11-12 with small Schmorl's nodes at this level as well. No concerning marrow replacement or evidence of significant marrow edema is seen. The spinal cord demonstrates normal signal intensity and morphology.Very small central disk protrusions are seen at T1-2 and T2-3. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:The L1 vertebral body is wedged anteriorly with about 40% loss of height. No increased STIR signal is seen within the L1 vertebral body.Remaining vertebral bodies demonstrate normal morphology and signal characteristics. A mild focal kyphotic angulation is evident centered at the L1 vertebral body, but otherwise, lumbar spine alignment is anatomic.Visualized conus and nerve roots of the cauda equina are unremarkable.T12-L1: Loss of disk height but no significant disk bulging or herniation. No spinal canal or neuroforaminal stenosis.L1-2: Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L3-4: Moderate facet hypertrophy with small facet effusions and ligamentum flavum thickening. Mild laterally bulging disk. No significant generalized spinal canal stenosis. Minimal bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with facet complex edema, particularly on the left, and perhaps a small left ligamentum flavum cyst. No significant spinal canal or neuroforaminal stenosis. L5-S1: Moderate facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. | 1. Degenerative endplate disease is partially visualized at C7-T1. Elsewhere in the thoracic spine, only minimal degenerative disease is seen with no areas of high-grade spinal canal or neuroforaminal stenosis.2. Anterior wedging of the L1 vertebral body is probably chronic given lack of marrow edema.3. Mild disk degeneration through the lumbar region is seen. Moderate posterior element hypertrophy is also present at several levels. However, no areas of high-grade spinal canal or neuroforaminal stenosis are seen. |
Generate impression based on medical findings. | CERVICAL: There is straightening of the cervical spine. The vertebral body heights are intact. There is dessication of the C2-3 through C5-6 disks with minimal height loss. The osseous marrow signal is benign.The cord signal appears somewhat increased on T1 and T2 at C4 level and below without a focal lesion; this is consistent with artifact given corresponding high T1 and T2 signal intensity in the subcutaneous tissues as well in this region.There is a congenitally narrow spinal canal with no significant disk/endplate degenerative change or significant superimposed spinal stenosis at any level.THORACIC: There is normal alignment of the thoracic spine. The vertebral body and disk heights are intact. There are few scattered T1 hyperintense lesions representing benign hemangiomas. There is a congenitally narrow spinal canal. However, there is no significant superimposed disk herniation or spinal stenosis at any level in the thoracic spine. The cord caliber and signal are unremarkable. | No evidence of cord compression or significant spinal stenosis in the cervical and thoracic spine. |
Generate impression based on medical findings. | There is slight interval decrease in size of right perirolandic enhancing lesion with susceptibility, now measuring 14 mm x 8 mm (series 10 and image 5), previously measuring 17 mm x 10 mm. The surrounding vasogenic edema is minimally diminished compared to the prior exam. Previously noted left occipital lobe lesion is no longer definitely visible. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. 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. | Slight interval decrease in size of intracranial metastasis. |
Generate impression based on medical findings. | 73-year-old female with shoulder pain. Evaluation is limited by patient motion artifact.ROTATOR CUFF: There is marked thinning of the distal supraspinatus tendon just proximal to its humeral insertion, indicating chronic attritional tearing along the articular surface and likely the bursal surface of the tendon as well, with delamination of the articular surface fibers and proximal retraction. The tendon on coronal image 11 of series 11 appears to be no more than 1 mm in thickness. More posteriorly, at the interface of the supraspinatus and infraspinatus tendons, the expected location of the tendon insertion is replaced with increased signal intensity which may indicate a full-thickness component of the tear. There is mild increased signal intensity within the remainder of the tendon likely representing a combination of degeneration and tearing. There is mild atrophy of the supraspinatus muscle. There may be mild fraying of the bursal surface fibers as well as a small interstitial tear along the myotendinous junction of the infraspinatus, but we see no full-thickness tear. There is mild fatty infiltration of the infraspinatus along the myotendinous junction. There is severe fatty infiltration of the teres minor muscle, although the tendon can be traced to its insertion on the greater tuberosity. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no joint effusion. Evaluation of the labrum is limited due to patient motion artifact and lack of fluid within the joint. The anterior inferior labrum is enlarged with increased signal intensity likely reflecting degeneration. There is branching signal abnormality within the posterior labrum likely representing degenerative tearing.BICEPS TENDON: There is focal increased signal within the tendon of the long head of the biceps, centrally, which may reflect mild degeneration. ADDITIONAL | 1. Near full-thickness to full-thickness tearing of the supraspinatus tendon as described above with relatively mild partial thickness tearing of the infraspinatus tendon.2. Severe fatty infiltration of the teres minor with intact appearing tendon.3. Acromioclavicular joint osteoarthritis and small amount of fluid within the subacromial bursa.4. Degenerative tearing of the glenoid labrum.5. Other findings as described above. |
Generate impression based on medical findings. | Male, 18 years old, with history of hemoglobin SS undergoing pre-stem cell transplant evaluation. No significant parenchymal signal abnormality is seen. There is no evidence of edema or mass effect. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology. A normal variant subcentimeter hippocampal sulcus remnant cyst is seen along the left medial temporal lobe. A subcentimeter focus of T1/T2 hyperintense signal is seen along the inner table of the left parietal bone, likely benign and of doubtful significance.On angiographic imaging, no significant intracranial vascular stenosis or occlusion is seen. The vessels of the anterior and posterior circulation demonstrate normal flow related signal. No aneurysm or vascular malformation is detected. | 1.No significant brain parenchymal abnormalities are seen.2.Unremarkable evaluation of the intracranial vasculature. |
Generate impression based on medical findings. | Left knee pain, swelling, instability. MENISCI: There is a partial thickness radial tear of the posterior horn of the medial meniscus involving the inner half of the horn. There is globular intrasubstance signal within the body of the medial meniscus indicating intrasubstance degeneration. The anterior horn of the medial meniscus appears intact. There is mild intrasubstance degeneration of the lateral meniscus but no lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild focal degeneration of the articular cartilage of the lateral facet of the patella. There is moderate degeneration of the articular cartilage of the medial facet of the trochlea with small subchondral cysts. There is a full-thickness defect of the articular cartilage of the weightbearing portion of the medial femoral condyle just above the torn posterior horn of the medial meniscus that measures just over 1 cm in AP dimension. There is mild edema-type signal within the posterior aspect of the medial tibial plateau that is likely degenerative in etiology. The articular cartilage of the lateral tibiofemoral compartment appears relatively intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL | 1.Partial thickness radial tear of the posterior horn of the medial meniscus.2.Articular cartilage degeneration and other findings as described above. |
Generate impression based on medical findings. | Diabetes insipidus with right ptosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is a punctate focus of susceptibility effect in the left posterior temporal lobe, which may represent chronic microhemorrhage. There is no abnormal intracranial enhancement. There is septum cavum pellucidum and vergae. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution is nonspecific, but may represent chronic small vessel disease. 3. Diffuse cerebral volume loss. |
Generate impression based on medical findings. | Reason: mechanical fall, concern for rotator cuff tear History: pain, limited ROM ROTATOR CUFF: Note is made of a near full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity extending from the articular surface involving greater than 50% of the tendon width. This tear extends proximally approximately 3 cm from the level of the insertion on the greater tuberosity. There is no significant retraction. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is partial thickness insertional tearing of the infraspinatus at the level of the greater tuberosity. There is no significant retraction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is anatomic. There is branching linear signal abnormality traversing the anterior inferior glenoid labrum indicating a tear which extends through the articular cartilage along the anterior inferior glenoid. There is heterogeneity and intermediate signal intensity within the superior labrum indicating a combination of degeneration and degenerative tearing. There is subchondral cyst formation within the greater tuberosity.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL | 1. High-grade near full thickness insertional tearing of the supraspinatus tendon as well as partial thickness insertional tearing of the infraspinatus.2. Acromioclavicular and glenohumeral joint osteoarthritis.3. Degeneration and degenerative tearing of the glenoid labrum as described above. 4. Moderate to large glenohumeral joint effusion. Other findings as described above. |
Generate impression based on medical findings. | 38 year old woman with non-ischemic cardiomyopathy referred for interval assessment. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 73 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 120 g (normal range 114+/-24). Abnormal septal wall motion and dyssynchrony consistent with left bundle branch block. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging. The native myocardial T1 time was mildly elevated in the interventricular septum (1,116msec) and borderline in the inferolateral wall (1,077msec).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 64%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 52 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 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%. Abnormal septal wall motion and dyssynchrony consistent with left bundle branch block. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging. The native myocardial T1 time was mildly elevated in the interventricular septum.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.3. Compared to prior cardiac MRI on 3/10/2011, the LVEF is slightly lower. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Reason: MS, f/u progression History: paresthesias Brain:Redemonstration of numerous T2 hyperintense lesions within the periventricular and to a lesser extent subcortical white matter, including within the corpus callosum. There is a single new lesion in the right posterior frontal lobe subcortical white matter (series 501 image 64 and series 801 image 47). This demonstrates mild enhancement compatible with an active lesion.There is no evidence of intracranial hemorrhage, or mass.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Again noted are multiple poorly defined long segment foci of increased T2 signal within the cervical spine. There is no associated cord expansion. The vertebral column alignment is within normal limits. The vertebral body and disc heights are preserved. The vertebral bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenoses. | 1. Numerous intracranial white matter lesions compatible with the history of multiple sclerosis. There is a single new right frontal lobe subcortical lesion which also demonstrates enhancement indicating an active lesion.2. Numerous long segment poorly defined intramedullary lesions in the cervical spine compatible with the history of MS. No significant interval change. |
Generate impression based on medical findings. | 51-year-old female with a history of neurosarcoidosis and lesions in multiple pelvic bones, Osteonecrosis of the bilateral femoral heads. Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, overall appearing more extensive compared to the prior exam. In particular, the right subtrochanteric lesion represents greater than 50% of the cross sectional area. These lesions are largely isointense (or perhaps slightly hyperintense) to skeletal muscle on T1, hyperintense on T2, and enhance following contrast administration. Osteonecrosis of the femoral heads appears similar to the prior exam. Moderate to severe degenerative disk disease is noted at L4-5. There is a small amount of fluid in the SI joints, but no enhancement to suggest inflammatory arthritis. There is no hip joint effusion or frank synovitis. Prominent retroperitoneal, iliac, and inguinal lymph nodes are again noted. The inguinal nodes appear slightly larger compared to the prior exam. Uterine fibroids and nabothian cysts are noted. | 1.Multiple bone lesions appearing more extensive overall compared to the prior exam. The differential diagnosis remains metastatic disease, multiple myeloma, and granulomas of sarcoid. 2.Stable femoral head osteonecrosis and other findings as described above.3.Slight interval enlargement of the inguinal lymph nodes. |
Generate impression based on medical findings. | 37-year-old woman personal history of BRCA2 mutation presents for screening bilateral breast MRI preparation for bilateral mastectomy. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Evaluate for extensor tendon tear. Epicondylitis pain for months. LIGAMENTS: The lateral collateral ligament, ulnar collateral and lateral ulnar collateral ligament appear intact.TENDONS: There is increased T2 signal within the common extensor tendon, consistent with a partial tear. The common flexor, biceps, triceps and brachialis tendons appear intact. ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL | Partial tear of the right common extensor tendon. |
Generate impression based on medical findings. | Melanoma Again seen are are small foci of signal void within the lateral soft tissues adjacent to the fibular head presumably representing artifact from prior surgical intervention. Scarring with minimal enhancement is seen within the soft tissues lateral to the fibular head appearing similar in extent to the prior exam. No enhancing masses are identified.There is a small joint effusion extending posteromedially into a Baker's cyst. There is mild nonspecific subcutaneous edema along the anterior aspect of the patellar tendon. There is prominence of the lateral head of the gastrocnemius which may reflect herniation through the deep fascia, but this appears similar to the prior study. Osteoarthritis affects the knee. The bone marrow signal intensity otherwise appears normal. | Surgical scarring along the fibular head without evidence of residual or recurrent disease. |
Generate impression based on medical findings. | Male, 8 years old, with frequent headaches, ataxia and tendon contractures. Evaluate for Chiari malformation, syrinx, tethered cord. A very slight levoscoliosis of the spine is seen which may be due to positioning. The sagittal alignment of the spine is otherwise unremarkable.A normal complement of normally formed vertebral bodies is seen. No segmentation anomalies are detected. Marrow signal characteristics are within normal limits.The cerebellar tonsils terminate at or above the level of the foramen magnum. The CSF space at the level of the foramen magnum is widely patent and there is robust biphasic CSF flow through this region both anteriorly and posteriorly.The visualized spinal cord demonstrates normal intensity and morphology. The conus tip terminates at the upper L2 level which is within normal limits. No evidence of any intraspinal mass or fatty infiltration of the filum terminale is seen.The intervertebral discs are well preserved throughout. No significant spinal canal or neuroforaminal stenosis is seen. | Unremarkable evaluation with no evidence of Chiari malformation, spinal cord syrinx, tethered cord, or other specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | MGUS SKULL: No focal myelomatous lesions are identified.CERVICAL SPINE: No focal myelomatous lesions are identified. There is mild degenerative disc disease at C5-C6.THORACIC SPINE: No focal myelomatous lesions are identified. LUMBAR SPINE: No focal myelomatous lesions are identified.RIBS: No focal myelomatous lesions are identified.PELVIS: No focal myelomatous lesions are identified. Mild osteoarthritis affects the hips.UPPER EXTREMITY: No focal myelomatous lesions are identified. Note is made of fusion of the proximal radius and ulna bilaterally which likely reflects congenital synostosis.LOWER EXTREMITY: There is periosteal reaction noted along the right femur which is nonspecific in nature but may relate to osteonecrosis as seen on prior MRI of 5/27/2016. Note is also made of a linear metallic density within the soft tissues of the medial thigh compatible with a broken needle which was also evident on the MRI. Periosteal reaction is also noted along the left distal femoral metaphysis with an additional underlying lucency which may also be the sequela of osteonecrosis.There is a mildly depressed fracture of the right medial tibial plateau which extends through the medial condyle. There appears to be some small adjacent callus formation but there is no definite underlying lytic lesion. These findings may be secondary to underlying osteonecrosis as well. | 1. No discrete myelomatous lesions.2. Mildly depressed fracture of the right medial tibial plateau which is further detailed above. These findings were discussed with the ordering physician, Dr. J. Godfrey, at the time of interpretation. |
Generate impression based on medical findings. | Cystic left tracheoesophageal groove lesion may represent a branchial cleft seen on CT: dysphagia, pressure sensation. There is a T2 hyperintense tubular mass adjacent to the left aspect of the cervical esophagus that extends from the level of the C6 to T1 vertebral body levels, measuring 17 AP x 18 RL x 45 SI mm. There is a crenulated pattern of enhancement within the mass, suggestive of digestive track mucosa, and central non-enhancement. In addition, following the administration of oral contrast the center of the mass also enhances, although this may potentially be due to delayed centripetal intravenous contrast enhancement. The trachea and prevertebral space appear to be intact. The mass also appears to be separated from the thyroid gland. There appears to be a mildly prominent, but subcentimeter, right tracheoesophageal groove lymph node, which is nonspecific. There are small posterior disc-osteophytes at C4-5 and C5-6 without spinal cord impingement. The imaged salivary gland are unremarkable. | A left paraesophageal mass measuring up to 45 mm may represent an esophogeal diverticulum or enteric duplication cyst with associated mucosal inflammation, although an underlying neoplastic component is a potential consideration. A vascular malformation or brachial cleft cyst with superimposed inflammation are alternative possibilities, perhaps. |
Generate impression based on medical findings. | Female, 37 years old, history of neurofibromatosis type I with back pain. Thoracic:An area of plaque-like enhancement spanning the right lateral aspect of the vertebral bodies and T10 and T11 is seen. This enhancing tissue enters the right T10-11 neural foramen but does not frankly invade the spinal canal.A small STIR hyperintense nodule along the left anterior paraspinal tissues at T1 is of uncertain significance. Likewise, a tiny STIR hyperintense nodule posterior to the left kidney at the T12 level is of uncertain significance.No other large or significant paraspinal, foraminal or intracanalicular masses are identified in the thoracic region. The visualized spinal cord is unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow signal replacement or enhancement is detected.Minimal degenerative disc disease is seen at T10-11. No significant spinal canal or neuroforaminal stenosis is identified.Lumbar:No convincing evidence of any paraspinal, foraminal or intracanalicular mass is seen. The visualized conus and cauda equina are unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow signal replacement or enhancement is detected.Mild facet arthropathy is evident most notably affecting L3-4 and L4-5. Mild degenerative disc disease is seen with loss of disc T2 signal at lower lumbar levels. No significant spinal canal or neuroforaminal stenosis is detected. | 1.Plaque-like soft tissue thickening along the right aspect of the T10 and T11 vertebral bodies, with involvement of the intervening neural foramen, is suspicious for the presence of a neurofibroma.2.Small paraspinal nodules in the thoracic region as above are of uncertain significance and could represent lymph nodes or neurofibromas.3.No definite evidence of any neurofibroma is seen in the lumbar region.4.No areas of significant spinal canal or neuroforaminal stenosis are detected. |
Generate impression based on medical findings. | Back pain There is anterior plate and screw fixation of C6-C7 with associated placement of interbody disc spacer. There is minimal levocurvature of the thoracolumbar spine with the apex noted at T8. The vertebral body heights and disc spaces are otherwise relatively well preserved.There is a positive sagittal balance of approximately 3.1 cm. There is no significant coronal imbalance. | Orthopedic fixation of the cervical spine with additional findings described above. |
Generate impression based on medical findings. | Ankle pain TENDONS: The Achilles tendon is intact although there is slight enlargement and increased signal intensity distally and a focus of near fluid signal intensity noted approximately 6 cm from its insertion.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL | 1. Mild tendinosis of the Achilles tendon with a tiny focus of increased signal intensity which may represent a small intrasubstance tear or more focal tendinosis.2. Probable ganglion at the base of the third metatarsal. |
Generate impression based on medical findings. | 41 years Female (DOB: 3/3/1975)Reason: MS History: Lhermitte'sPROVIDER NAME: ANTHONY T. REDER ANTHONY T. REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 lesions are identified in the cervical spine. There is multilevel disc desiccation present.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. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | 1.No abnormal lesions are identified within the brain parenchyma or the cervical spinal cord to suggest demyelination.2.There are mild degenerative changes present in the cervical spine |
Generate impression based on medical findings. | History of medullary thyroid cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. There is a subcentimeter hepatic cyst. Stable probable small hemangioma in the posterior hepatic segment (series 11/27).No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder with small gallstones without acute inflammation.SPLEEN: Splenic cyst. Nonspecific low T2 non-enhancing lesion, compatible with calcified granuloma as seen on CT.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal lipid-rich adenoma. KIDNEYS, URETERS: Stable left superior pole minimally complex cyst with thin internal septations but no suspicious enhancement. Additional subcentimeter probable 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. | Stable examination without specific evidence of metastatic disease. |
Generate impression based on medical findings. | There is transitional anatomy with either 11 thoracic and 5 lumbar vertebrae or 12 thoracic and 4 lumbar vertebrae. For the purposes of this exam, the last fully formed disc space will be termed L4-S1. There are postoperative findings related to suboccipital craniotomy for Chiari decompression. There is expected biphasic CSF flow anteriorly and posteriorly across the neo-foramen magnum. There is minimal retroflexion of the dens. The cerebellar tonsils lie at the level of C1. At the C1-C2 level, there is focal syringohydromyelia which measures 6 x 5 x 12 mm, previously 7 x 7 x 12 mm. There is an approximately 58 x 41 mm fluid collection within the left abdomen and pelvis, as well as smaller amount of fluid within the right abdomen that is likely related to the patient's lumboperitoneal shunt. The vertebral column alignment is unchanged, with straightening of the cervicothoracic alignment. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at T12-L1, using the chosen nomenclature for this exam. | 1.Transitional vertebral anatomy, as detailed above. Close attention and correlation during any future spine surgery is recommended. 2.Postoperative findings related to Chiari decompression surgery with patent neo-foramen magnum. 3.A focal syringohydromyelia at the C1-C2 level has minimally decreased in size. 4.Persistent intraperitoneal fluid collections may represent a pseudocyst related to the lumboperitoneal shunt. An ultrasound of this region may be useful for further evaluation. |
Generate impression based on medical findings. | Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine MRI:There is straightening the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central and moderate bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex and slight ligamentum flavum thickening. There are no significant stenoses.C7/T1: Unremarkable | 1.Negative contrast enhanced brain MRI.2.C5/6: Mild central and moderate bilateral neural foraminal stenosis. |
Generate impression based on medical findings. | Cervicalgia. There is exaggeration of the normal cervical lordosis. No focal abnormal bone marrow signal. The visualized cord demonstrates normal caliber and signal intensity. There is multilevel mild-moderate loss of disc height at C5-6 and mild loss of disc height at C6-7 and C7-T1.C2-3: No significant central canal or neural foraminal stenosis.C3-4: Mild facet hypertrophy and left uncovertebral spurring results in mild left neural foraminal narrowing but no significant central canal stenosis.C4-5: Posterior disc osteophyte complex results in minimal central canal stenosis, and uncovertebral and facet hypertrophy with mild right and severe left neural foraminal narrowing.C5-6: Posterior disc osteophyte complex, eccentric to the right and uncovertebral hypertrophy results in moderate-severe bilateral neural foraminal narrowing and mild central canal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy results in moderate bilateral neural foraminal narrowing but no significant central canal stenosis.C7-T1: Posterior disc osteophyte complex, eccentric to the right without significant central canal or neural foraminal narrowing. | Multilevel spondylosis within multilevel neural foraminal narrowing, and mild central canal stenosis at C5-6 as detailed above. |
Generate impression based on medical findings. | Female 42 years old Reason: shoulder pain and deceased ROM after fall ROTATOR CUFF: Increased T2 signal along the bursal surface of the supraspinatus tendon indicates tendinopathy, however there is no discrete tear. The remainder of the rotator cuff is intact.SUPRASPINATUS OUTLET: Type I acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Irregularity of the anterior superior labrum which appears to separate from the glenoid likely represents a portion of the middle glenohumeral ligament, a normal variant. The remainder of the glenoid labrum is intact.BICEPS TENDON: Biceps tendon is situated within the bicipital groove.ADDITIONAL | Tendinopathy of the supraspinatus tendon near its insertion. |
Generate impression based on medical findings. | 36 years Female (DOB: 6/18/1980)Reason: evaluate for new MS flair History: worsening left sided weaknessPROVIDER NAME: TAO G XIE TAO G XIE MRI brain:There is a mild to moderate degree of periventricular and subcortical white matter lesions present some which are perpendicularly oriented to the lateral ventricles. 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 lesions are identified in the cervical spine. There is reversal of the normal cervical curvature present. There is mild disc desiccation present in the mid cervical spine. There are T2 signal hyperintense ill-defined lesions present in the upper cervical spinal cord extending from the C2 level down to the C3-4 disc space level as well as some patchy T2 signal hyperintense lesions within the lateral aspects of the lower cervical spinal cord bilaterally.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. There is a disc bulge present at this level.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. | 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. The pattern is consistent with the patient's clinical history of demyelination. Contrast enhanced MRI may help distinguish acute or subacute from chronic lesions.2.Multiple patchy lesions throughout the cervical spinal cord are present without enlargement of the spinal cord. This consistent with the patient's clinical history of demyelinating disorder thyroid is nonspecific and could relate to a different entity such as transverse myelitis for example. Contrast enhanced MRI may help distinguish acute or subacute from chronic lesions. |
Generate impression based on medical findings. | 65-year-old female with cholelithiasis and LFT elevation. Concern for CBD stone. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis.The gallbladder is distended with T1 hyperintense biliary sludge and large intraluminal stones. No significant wall thickening. No pericholecystic fluid. Focal T2 hyperintense appearance of the gallbladder wall most compatible with adenomyomatosis (coronal series 4 image 32). There is mild dilatation of the common bile duct measuring 8 mm in diameter (axial series 5 image 32) with smooth tapering at the ampulla (series 11 image 43). Punctate central intraluminal hypointense signal (axial series 5 image 33) is only seen on the axial view and linear appearance, and flow related artifact is favored. No discrete intraluminal stones are identified. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal right adrenal gland. A small left left adrenal nodule with loss of signal intensity on out of phase imaging consistent with a lipid rich adenoma.KIDNEYS, URETERS: Subcentimeter right renal cyst. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Uterine fibroids (coronal series 4 images 16, 19). | 1.Mild dilatation of the common bile duct without evidence of intraluminal stones. No intrahepatic biliary ductal dilatation. Hepatic steatosis.2.Cholelithiasis without convincing evidence for acute cholecystitis.3.Finding consistent with a benign lipid rich adenoma of the left adrenal gland. |
Generate impression based on medical findings. | MS f/u progression The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion, a left thalamus lesion and a right deep cerebellar lesion which are bright on FLAIR MRI and low signal on T1 that are smaller on the current exam compared to the prior exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion and left thalamus lesion which are smaller relative to the prior exam from 8/4/14. |
Generate impression based on medical findings. | The vertebral column alignment is within normal limits although there is straightening of the normal lumbar lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable. At T11-T12 and T12-L1 there is mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L1-L2: There is a mild disc bulge asymmetric to the right as well as mild facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foramen stenosis and no significant change.L2-L3: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in unchanged mild bilateral neural foramen stenosis and no significant central canal stenosis. Findings are unchanged.L3-L4: There is a mild disc bulge with a superimposed right foraminal herniation. There is also mild facet arthropathy and ligamentum flavum thickening. This results in mild bilateral neural foramen stenosis and no significant central canal stenosis. The findings are unchanged.L4-L5: There is a moderate disc bulge as well as facet arthropathy and ligamentum flavum thickening bilaterally. This results in moderate right and mild left neural foramen stenosis and moderate spinal canal stenosis. The findings are unchanged.L5-S1: There is a mild disc bulge as well as bilateral facet arthropathy, right greater left, and ligamentum flavum thickening. Findings result in moderate bilateral neural foramen stenosis and no significant central canal stenosis. The findings are unchanged. | Unchanged mild to moderate multilevel degenerative changes with multilevel facet arthropathy and at most moderate spinal canal stenosis at L4-L5. |
Generate impression based on medical findings. | 45-year-old woman status post repair of type B aortic dissection now with increased ICP and headache. The quality of the study is suboptimal. Since the previous study, diffuse effacement of the cortical sulci has developed. There is interval decrease in size ventricular system and partial effacement of the basal cisterns. These findings are consistent with diffuse cerebral edema. There is hypoattenuation in the right MCA territory suggestive of cortical edema. Recommend MRI to assess for acute stroke.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Incidental note is made of an accessory suture in the frontal bone.A nasogastric tube is present in the right naris. | 1. Interval development of diffuse cerebral edema.2. Cortical hypoattenuation in right MCA territory. Recommend MRI to evaluate for acute stroke. |
Generate impression based on medical findings. | NF1: hands lock at times and can't grasp things. Cervical Spine: There is apparent mild thickening of multiple cervical nerve roots traversing the neural foramina. There is otherwise not mass effect upon the spinal cord or abnormal spinal cord signal. There are multiple subcentimeter T2 hyperintense nodules in the skin and subcutaneous tissues of the neck. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are partially imaged T2 hyperintense lesion in the cerebellum.Lumbar Spine: There is an unchanged fusiform lesion within the right L3-4 neural foramen with a targetoid appearance that measures up to 10 mm in width. There is also an unchanged fusiform lesion in the T12-L2 neural foramen that measures up to 8 mm in width. In addition, there appears to be enlargement of multiple sacral neural foramina. There are numerous T2 hyperintense nodules in the thoracic and lumbar paraspinous muscles, psoas muscles and subcutaneous fat. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild facet hypertrophy in the lower lumbar spine, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. | 1. Apparent mild thickening of multiple cervical nerve roots traversing the neural foramina, as well as mild enlargement of multiple sacral nerve roots, are compatible with stigmata of NF1. 2. Unchanged neurofibroma in the right L3-L4 and left T12-L1 neural foramina. 3. Numerous neurofibromas in the cervical and lumbar paraspinous muscles, subcutaneous tissues, and skin. 4. Partially imaged T2 hyperintense lesion in the cerebellum are compatible with stigmata of NF1, but are better depicted on the prior brain MRI. |
Generate impression based on medical findings. | History of tethered cord release, follow-up release. Worsening neck pain. Cervical: The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. 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 right neural foramen. There is mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a right paramedian disk protrusion associated with mild posterior ligamentous hypertrophy, endplate and uncovertebral osteophytes and effacement of CSF ventral and posterior to the spinal cord. Overall there is mild to moderate spinal stenosis at this level. Moderate right neural foraminal stenosis. No significant left neural foraminal narrowing.At C6-7 there is no significant compromise to the spinal canal. Small disc osteophyte complex, uncovertebral hypertrophy, and facet arthropathy result in moderate to severe left-sided neural foraminal stenosis. No significant right neural foraminal narrowing.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar: For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There are postsurgical changes of tethered cord release via L4-L5 level with left sided laminoplasty. Conus terminates at the L4-L5 level as before and demonstrates abnormal contour. No new cord signal abnormality, syrinx, or fluid collections within the visualized distal cord or lumbar spinal canal are appreciated. Prone images demonstrate ventral motion of the conus compatible with deep tethering.Vertebral body heights and alignment are maintained. Mild dysplasia/bifid appearance involving the L5 spinous process again seen. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with hemangioma. Mild degenerative changes are seen including mild lower lumbar facet arthropathy without significant spinal canal or neural foraminal stenosis at any level. There is minimal epidural fluid at the dorsal L4-L5 level without mass effect. There is edema involving the posterior paraspinous soft tissues also consistent with postsurgical change. | 1. Expected postsurgical changes of tethered cord release. Prone images demonstrate ventral motion of the distal cord compatible with the tethering.2. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C5-C6 level. There is also right C5-C6 and left C6-C7 neural foraminal stenosis. These findings are not significantly changed since 7/18/2015. |
Generate impression based on medical findings. | History of neuroblastoma of lumbar spine, relapse x 2 s/p chemo, transplant: weight loss, fatigue, sweats. Extreme worsening back pain, and numbness of left foot (baseline). There are postoperative findings related to laminectomies from T11-T12 to L4-L5. There is a redemonstration of an enhancing extradural mass in the right aspect of the canal from L2 to L4 with scalloping of the posterior vertebral bodies and extension through the right L2-L3 and L3-L4 neural foramina with associated compression of the respective nerve roots. The mass measures up to approximately 6 cm in length and 3 cm in width and results in moderate spinal canal stenosis. The imaged portions of the spinal cord are unremarkable. The vertebral body heights are mildly reduced at L2 through L4. There is kyphotic deformity of the lumbar spine centered at L2. There is atrophy of the right psoas muscle. There are bilateral renal cysts. | 1. Postoperative findings related to laminectomies from T11-T12 to L4-L5 and redemonstration of residual neuroblastoma in the right aspect of the canal from L2 to L4 with extension through the right L2-L3 and L3-L4 neural foramina and moderate spinal canal narrowing. 2. Kyphotic deformity of the lumbar spine centered at L2 may be related to insufficient biomechanical support related to surgical anatomic alterations.. |
Generate impression based on medical findings. | Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: evaluate for seizure. pt has EEG small sharp spikes over L \T\ R temporal areas History: she reported 3 convulsive episodes over 2015-2016 \T\ staring No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Normal brain MRI. |
Generate impression based on medical findings. | Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Lumbar spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses. | Negative MRI of the brain and lumbar spine including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms. |
Generate impression based on medical findings. | 34 weeks pregnant with 2 prior C-sections. Known placenta previa and suspicion for placenta accreta. PELVIS:UTERUS, ADNEXA: Single intrauterine pregnancy. Examination is not specifically protocoled for evaluation of fetal anatomy. No gross abnormality is identified. There is apparent paucity of amniotic fluid.Anterior low-lying uterus completely covering the internal cervical os compatible with placenta previa.The uterine wall is again noted to be markedly thinned and not well defined along the lower anterior third suspicious for placenta accreta/increta. For example on image 33 of series 4 the uterine myometrium/serosal surface is now visualized with placental signal stenting at outside the uterine contour without definite abdominal wall invasion. This is at the level of the C-section scar.No specific evidence of local soft tissue invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Suspected placenta increta at the level of the C-section scar with extension of placental signal intensity beyond the visualized uterine margin, raising the possibility of percreta of the parametrial fat without definite invasion into the abdominal wall.2.Apparent paucity of amniotic fluid. If there is clinical concern a fetal ultrasound should be considered for evaluation for oligohydramnios. |
Generate impression based on medical findings. | 61 years Female (DOB:5/25/1955)Reason: eval for stenosis or abnormality History: neck painPROVIDER/ATTENDING NAME: EDWIN RAMOS 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. There is straightening of the normal cervical curvature which could be related to muscle spasm or patient positioning.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. There is a minor disc bulge at this level which is stable relative to the prior exam.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. There is a minor disc bulge at this level which is stable relative to the prior exam.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. | There are minor degenerative changes in the cervical spine without significant compromise to spinal canal or neural foramina. |
Generate impression based on medical findings. | Clinical question: assess for mass lesions, intracranial vasculitis, spinal cord lesionSigns and Symptoms: headache, vision loss, Unqualified visual loss, left eye, normal vision right eye. Unqualified visual loss, left eye, normal vision right eye; Headache. Upper extremity hyper-reflexia, neck pain. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present.No abnormal enhancing lesions are appreciated 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. There are small uncovertebral osteophytes present at this level. There is a small central disk protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There are small uncovertebral osteophytes present at this level. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present at this level associated with disk material and mild encroachment of the right sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral recess disk protrusion at this level encroaching on the left sided exiting nerve roots. There are left sided endplate reactive changes present at this level with irregular end-plates.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRA brain:There is a 2.5 mm medially directed aneurysm along the proximal portion of the opthalmic segment of the left internal carotid artery.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.There is extracranial origin of the left PICA which is not entirely included on this exam.MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal foci of contrast enhancement are present in the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule follows CSF on all pulse sequences .There is focal atrophy of the left middle frontal gyrus.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a well circumscribed 10x7 mm focus of marrow replacement in the left parietal bone just posterior to the coronal suture and superior to the squamous temporal bone which enhances following gadolinium administration.Incidental note is made of choroid plexus xanthogranulomas.MRI orbits:There is T2 signal hyperintensity along the right optic nerve without associated contrast enhancement. This is associated with a smaller right optic nerve compared to the left optic nerve which is more obvious on the cisternal segment.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . | 1.There is a 2.5 mm left opthalmic segment aneurysm present.2.There is a small right calvarial lesion present which in isolation is non-specific. In the appropriate clinical settings it is possible that it is related to neoplasia or sarcoidosis (as was suggested in the clinical history of the chest x-ray report) for example. Please correlate with clinical history. If appropriate a follow-up with CT of the head may be helpful. Alternatively a bone scan may help evaluate for metastases in the appropriate clinical setting.3.There is a left lateral recess disk protrusion at C6-7 encroaching on the left sided exiting nerve roots.4.T2 signal hyperintensity and atrophy along the right optic nerve is a non-specific finding. One possibility is that this is related to degeneration/atrophy of the nerve or 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.Focal atrophy within a portion of the left middle frontal gyrus.7.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule likely represents an enlarged perivascular space (possibly related to remote ischemic injury).8.Although there is no evidence for vasculitis on this exam, this diagnosis cannot be excluded based on this exam alone. |
Generate impression based on medical findings. | Hysterectomy with bladder sling/mesh. Intermittent constipation. Please evaluate for herniation or mesh out of place. PELVIS:UTERUS, ADNEXA: Surgically absent. No significant abnormality is noted otherwise.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appearance of the imaged bowel loops.BONES, SOFT TISSUES: No significant abnormality noted. Please see separate MRI lumbar spine report from the same day. | No evidence of postsurgical complication or specific findings otherwise to account for the patient's symptoms. |
Generate impression based on medical findings. | Reason: hx of subcentimeter lesion in head of pancreas, recommended repeat imaging in 12 to 18 months to evaluate for size change History: hx ofsubcentimeter lesion in head of pancreas, recommended repeat imaging in 12 to 18 months to evaluate for size change ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Couple T2 subcentimeter hyperintense lesions are too small to characterize, favor cysts or hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense lesion in the head of the pancreas previously measured 0.9 x 0.7 cm. Today, this lesion measures the same (4:40) with no suspicious enhancement or component.A few other T2 hyperintense foci also likely represent side branch IPMNs, grossly stable.ADRENAL GLANDS: Left adrenal gland hyperplasia.KIDNEYS, URETERS: Small amount of perinephric fluid, likely chronic. Couple subcentimeter hypointensities best seen on postcontrast phases are too small accurately characterize but appear to have vague T2 hyperintense signal, likely small cysts. RETROPERITONEUM, LYMPH NODES: Stable infrarenal aortic aneurysm measuring up to 3 cm (15:145)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable subcentimeter lesion in the head of the pancreas favoring a side branch IPMN with no suspicious features. Other foci of T2 hyperintensities also likely represent side branch IPMNs as above.2.Hepatic steatosis.3.Stable infrarenal aortic aneurysm. |
Generate impression based on medical findings. | Male; 79 years old. Reason: ileitis demonstrated on previous CAT scan and SBFT (9/2013). Crohn's ? acute ? History: asymptomatic ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of mid to distal ileum (at least 30cm) in the right hemiabdomen demonstrate mild circumferential wall thickening and increased enhancement, compatible with active inflammation and most likely secondary to inflammatory bowel disease. The degree of inflammation is less than prior CT. There is sparing of the terminal ileum. No bowel obstruction. No free fluid. Multiple duodenal diverticula, similar to prior CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Findings compatible with active inflammation of multiple mid to distal ileal loops, most likely secondary to inflammatory bowel disease. |
Generate impression based on medical findings. | 49 years Female (DOB:3/30/1967)Reason: worsening sciatica L sided History: as abovePROVIDER/ATTENDING NAME: DEBORAH L. BURNET DEBORAH L. BURNET 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. There is mild disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet and ligamentum flavum hypertrophy at this level. There is a small left lateral disc protrusion at this level which mildly affects the left-sided exiting nerve root as it exits the neural foramen. There is some effacement of fat adjacent to this nerve rootAt 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 is a small cystic lesion in the right kidney measuring 13 x 14 mm axial dimensions. The renal pelvises are large bilaterally. | 1.There is a small left lateral disc protrusion at L4-5 which mildly affects the left-sided exiting nerve root as it exits the neural foramen.2.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots. |
Generate impression based on medical findings. | Shoulder pain ROTATOR CUFF: There is partial tearing of the superior fibers of the supraspinatus and infraspinatus tendon with minimal retraction of the tendon. This is superimposed upon moderate tendinopathy of the supraspinatus. There is a mild amount of increased signal within the subdeltoid bursa likely reflecting mild bursitis. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | Partial tears superior fibers of the supra and infraspinatus tendons with minimal retraction. There is a mild amount of associated subdeltoid bursitis and the associated muscles are normal in caliber. |
Generate impression based on medical findings. | Brain parenchyma appears within normal limits. No findings to suggest demyelinating disease. No abnormal enhancement. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles and sulci are within normal limits. Cerebellar tonsils are borderline low with preserved rounded morphology. There is a left maxillary sinus mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.CERVICAL SPINE | There is no evidence of demyelinating disease in the brain or spine or other significant abnormality to explain patient's symptoms. |
Generate impression based on medical findings. | Please evaluate for brain metastases 70-year-old femaleTechnique: 100 mL Omnipaque 350 was used and injected at two mL/sec via the right wrist using a 22-gauge needle. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There are subcortical and periventricular white matter hypodensity is present which are also identified on the MRI from 12/08. A calcific lesion is present along the faults cerebri and the right side measuring 1 cm in size and is suspected to represent a burned out meningioma.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear with the exception of a minor opacity in the left posterior ethmoid air cells unchanged since the 5/03 exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Compared to the exam of 5/29/03 there is no change in the appearance of the calvarium. | No evidence for brain metastases. |
Generate impression based on medical findings. | Reason: Re evaluate for osteomyelitis History: disseminated mycobacterial infection Direct comparison with prior study is limited due to limited field-of-view on prior study and patient refused additional images at the time. Redemonstration of distal ulnar bone marrow signal changes representing osteomyelitis measuring approximately 4.5 cm in length. This lesion appears more prominent compared to prior study indicating progression. There is also surrounding soft tissue inflammatory changes with small fluid collection in the radial aspect of the distal ulnar diaphysis measuring 6 mm x 3 mm with mild rim enhancement. | 1.Previously seen ulnar osteomyelitis is more prominent on current study indicative of progression.2.Small phlegmon adjacent to the distal ulna as above. |
Generate impression based on medical findings. | Male; 66 years old. Reason: 2.9 cm left adrenal mass identified on CTA abdomen. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 3.2 x 2.5 cm on series 9, image 14 and demonstrates heterogeneous enhancement and heterogeneous loss of signal on out-of-phase imaging, the latter of which is indicative of microscopic fat within the lesion. KIDNEYS, URETERS: Numerous bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Large abdominal aortic aneurysm measures 5.2 x 4.3 cm status post open repair, unchanged (series 9, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left adrenal lesion meets criteria for a lipid-rich adenoma as described above. 2.Unchanged abdominal aortic aneurysm. |
Generate impression based on medical findings. | Female 12 years old Reason: evaluation of iron overload History: elevated ferritin Both liver and cardiac MR was performed specifically for diagnosis of iron load.Liver T2*is of 9.7 ms on average and the heart T2*is 29.3 ms in an average. | 1. Iron load of the heart within normal limits.2. Increasing iron load of the liver. |
Generate impression based on medical findings. | 78-year-old female with bilateral renal cysts. Evaluate for interval change. Limited evaluation of the solid parenchymal organs due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Limited evaluation due to the lack of intravenous contrast. Multiple small simple renal cysts are present bilaterally. Multiple T1 hyperintense cysts are also again noted, similar in size, and compatible with hemorrhagic cysts versus proteinaceous fluid. The largest T1 hyperintense lesion measuring 2.7 x 2.4 cm is again noted in the left upper renal pole (axial series 10 image 56). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A right lower quadrant ostomy is partially visualized, and there is a stable parastomal hernia of transverse colon superiorly (series 2 image 17). No bowel obstruction.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted. | Stable bilateral renal cysts. Some are simple and others demonstrate T1 hyperintense signal compatible with hemorrhage versus proteinaceous fluid. The lack of intravenous contrast limits further evaluation. |
Generate impression based on medical findings. | Clinical question: preop for brain tumor resection. Signs and symptoms: Brain tumor. Unenhanced Stealth head CT:A standard preoperative nonenhanced stealth head CT is performed. A halo is secured to patient's head.Examination demonstrates mass in the right anterior temporal lobe with extension into the inferior right frontal lobe and right basal ganglia. Mass effect and deviation of third ventricle to the left is similar to prior MRI exam from 9 -- 6 -- 11. Ventricular system remains stable in size and unchanged. There is no detectable hemorrhage or any new foci of abnormality since prior exam. There is evidence of a small burr hole in right frontal bone likely from prior surgical approach for biopsy. | Nonenhanced stealth head CT reveals stable right temporal, frontal and basal ganglia mass and its associated mass effect. |
Generate impression based on medical findings. | There is a small cystic lesion involving the pineal gland which measures 5 x 8 x 4 mm. There is smooth enhancement involving the dependent aspect of the gland posteriorly. There is susceptibility effect which may be related to mineralization.There is a tiny left parietal developmental venous anomaly. Brain parenchyma is otherwise unremarkable without evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage. No hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable. | Small cystic lesion involving the pineal gland described above statistically likely represents a pineal cyst. No significant associated mass effect. Comparison can be made to prior imaging if made available. Brain parenchyma is otherwise within normal limits with small left parietal developmental venous anomaly again noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Small lung cancer with brain metastasis. Confusion and slurred speech. The numerous contrast-enhancing lesions which are predominantly distributed along the cortical surface have progressed since the previous examination, as well as the vasogenic edema associated with some of the lesions. The lesions are most coalescent along the left sylvian fissure, where they are also associated with increased subjacent vasogenic edema and slight mass-effect on the adjacent structures. For example, one of these lesions now measures transaxially 2.4 cm x 1.8 cm compared to 2.0 cm x 1.0 cm previously. Some of the lesions in the occipital lobes are not clearly appreciated on prior and may be new. There is no midline shift or brain herniation. The lesions are associated with mild diffusion restriction, probably reflecting their dense cellularity. The nonspecific periventricular T2/or hyperintense signal in both cerebral hemispheres remain unchanged and probably reflect a combination of microvascular ischemia and treatment effect.The orbits are grossly unremarkable. There is no destructive skull lesion. | 1.Since previous MRI of March 2016, there has been progression of intracranial metastatic disease with enlargement of numerous intraparenchymal lesions which are predominantly along the cortical surface. There is also mild increase in the associated vasogenic edema, particularly in the left insular region. There is no midline shift or herniation.2.Unchanged periventricular cerebral white-matter T2-hyperintensity probably represents chronic microvascular ischemia and treatment effect. |
Generate impression based on medical findings. | Encephalitis and encephalomyelitis, unspecified [G04.90] / Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Follow up scan re evaluated anterior temporal lobe lesion History: Seizure disorder There is no acute hemorrhagic lesion.There is no abnormal enhancement.There is focal DWI high signal intensity on the right basal ganglia (series 601, image 242) which shows suspicious diffuse restriction on ADC map but clearly showing T1/FLAIR high signal intensity. Thus, this lesion is likely represent T2 shine through instead of acute ischemic lesion.Previously demonstrated subtle increased FLAIR/T2 signal intensity on bilateral mesial temporal lobe appear to be stable, unchanged since prior scan. Left posterior inferior thalamic tissue defect indicating chronic stroke. Non specific patchy multifocal somewhat confluent bilateral periventricular white matter and centrum semiovale, unchanged since prior scan.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. No acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Unchanged subtle increase of bilateral mesial temporal lobe on FLAIR/T2 images.4. Interval development of focal T2/FLAIR high signal intensity lesion on the right basal ganglia. This is non specific but differential diagnosis includes chronic ischemic lesion or small vessel disease. |
Generate impression based on medical findings. | Metastatic NSCLC to brain status post SRS. The peripherally-enhancing left parietal lobe lesion is unchanged in size, measuring up to 4 mm in diameter. There is also an unchanged punctate focus of susceptibility effect in the right occipital lobe. There are scattered nonspecific punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is also unchanged nonspecific scattered T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an unchanged small right face skin excrescence. | Unchanged treated small left parietal lobe lesions and scattered nonspecific punctate foci of susceptibility effect in the bilateral cerebral hemispheres. |
Generate impression based on medical findings. | Reason: Evaluate for cord compression History: b/l 3/5 weakness in quads, new onset. Hx metastatic urothelial ca The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.Degenerative changes affect the cervical spine, with multilevel disc dessication and bulging, more prominent at the C4-C5, C5-C6 and C6-C7 levels, where there is mild associated neural foraminal narrowing. Degenerative changes also affect the lumbar spine, with mild subluxation at L4-L5 associated with facet arthropathy, as well as disc bulging at L5-S1. There is a mild rightward curvature of the lower thoracic and upper lumbar spine. A small hemangioma within the L1 vertebral body is noted. Bilateral lower pole renal cysts are incompletely characterized on this study. | 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.Multilevel degenerative changes affect the cervical and lumbar spine without significant compromise to the spinal canal. There is some evidence for neural foramen narrowing, however, due to the screening nature of this protocol, further details are not as evident on imaging as dedicated protocols of the spine. |
Generate impression based on medical findings. | Moyamoya disease [I67.5], Reason for Study: ^Reason: 13 y/o ho brain tumor History: none Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered FLAIR high signal intensity lesions on bilateral centrum semiovale are redemonstrated, unchanged since prior scan.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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the left MCA M1 and proximal M2 segment. The left distal MCA M2 segment is reconstituted and visualized on this MRA. The right distal ICA and proximal right MCA M1 segment show mild to moderate luminal stenosis, considering the difference of imaging technique, it is likely to be unchanged. Bilateral ACA A1 segments' luminal stenosis are again seen, unchanged. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged bilateral centrum semiovale FLAIR high signal intensity lesions since prior scan.3. Progressed obliteration of the left MCA M1 segment. 4. Stable distal right ICA, proximal right MCA M1 segment and bilateral ACA A1 segment stenosis since prior scan.5. Normal neck MRA. |
Generate impression based on medical findings. | 45 years Male (DOB:2/16/1971)Reason: GBM post crani History: GBM post craniPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Since the prior exam the patient has undergone right-sided craniotomy. There is a catheter entering the craniotomy site with tip in the larger and more laterally oriented cystic cavity of the mass lesion. Since the prior exam this tumoral cystic cavity has decreased in axial dimensions from 48 x 33 mm axial dimensions 2 38 x 12 mm axial dimensions. There is associated scalp soft tissue swelling. The left lateral ventricle is mildly dilated. There is mild subfalcine herniation present.There is no change in the appearance of the other cystic cavities within the tumor bed. One in the region of the left centrum semiovale measures 19 x 16 mm and previously measured the same. Another cystic cavity in the right thalamus measures 12 x 17 mm and has also not changed. One at the right cerebral peduncle and right internal capsule measures 14 x 12 mm and is also unchanged. The patient's right deep gray nuclei mass remains and is associated vasogenic edema which was also present on the prior exam. There are multiple punctate foci of signal hypointensity within the mass.The third ventricle is shifted towards the left by 9mm. This has decreased from 11mm.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. | Since prior exam the patient has undergone placement of a drainage catheter into a left-sided tumoral cystic cavity. The particular cystic cavity has decreased in size and there is now slightly less mass effect. There is some mild subfalcine herniation present. The rest of the tumor mass and associated vasogenic edema remain stable. |
Generate impression based on medical findings. | 17-year-old female with history of lateral knee pain status post injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is within normal limits, with no significant thinning or clefts. Abnormal high T2 signal intensity of the lateral tibial plateau suggests bone marrow edema and possible bone contusion. However, there is no linear abnormal T1 signal intensity to suggest fracture.LIGAMENTS: The cruciate and collateral ligaments are intact. Small amount of abnormal high T2 signal intensity over the distal insertion of the lateral collateral ligament may represent edema from trauma.EXTENSOR MECHANISM: The extensor mechanism is intact, without significant joint effusion.ADDITIONAL | Lateral tibial plateau bone contusion, and other findings as above. |
Generate impression based on medical findings. | Status post tumor resection. There are postoperative findings related to a right-sided craniotomy for resection of a right parietal lobe mass. There is pneumocephalus and slightly increased small fluid collection with blood products subjacent to the craniotomy site as well as within the resection cavity. There is nodular focus of T1 hyperintensity along the inferior aspect of the resection cavity may represent blood products. No definite evidence of residual tumor is appreciated at this location. There is extensive associated vasogenic edema extending anteriorly into the basal ganglia, medially into the left parietal lobe along the splenium and inferiorly into the right temporal lobe. There is partial effacement of the right lateral ventricle with a 9 mm right to left midline shift, previously measuring 7 mm. There is slight decrease in the prominence of the left lateral ventricle. There is a 5 mm enhancing nodule involving the right occipital lobe. There is a 5 mm enhancing nodule involving the posterior aspect of the left superior frontal gyrus. There is restricted diffusion compatible with infarct involving the right posterior cerebral artery territory including the right occipital lobe and extending into the posterior para hippocampal gyrus. Restricted diffusion is also noted within the right pons consistent with infarct. The capillary gyrus. | 1. Postoperative findings related to right-sided craniotomy for right parietal lobe tumor resection. No definite evidence of residual tumor within this location is appreciated. 2. There remains extensive surrounding vasogenic edema with improved right to left midline shift of 9 mm, previously 7 mm. 3. Acute infarct involving the right posterior cerebral artery territory including the right occipital lobe, right posterior aspect of the parahippocampal gyrus, and the right paramedian pons. Finding may have been the result of previously seen uncal herniation.4. 5 mm enhancing nodule in the left frontal lobe involving the posterior aspect of the superior frontal gyrus and a 5 mm enhancing nodule in the right occipital lobe involving the lingual gyrus are consistent with additional metastatic lesions.Dr. Ali discussed findings with Dr.Wallace (NSY) at 1330 hrs on 5/24/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 42 year old with strong family history of breast cancer. Family history of breast carcinoma in her sister (diagnosed at age 36), two aunts (diagnosed at age 40), and a cousin. Family history of ovarian cancer diagnosed in two aunts. BRCA mutation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Disorientation, unspecified [R41.0], Reason for Study: ^Reason: AMS; r/o structural cause History: AMS The images wasn't only available T1-weighted sagittal sequence which shows significant metallic artifacts on the right side which degraded image quality especially mandibulofacial area.Since the metal was not recognized on free imaging screening, the examination was stopped for more detailed prescreening process.Therefore this examination is nondiagnostic. | Premature termination of examination due to unexpected recognition of metallic artifacts.Non diagnostic examination |
Generate impression based on medical findings. | Multiple uterine fibroids. PELVIS:UTERUS, ADNEXA: Enlarged lobular uterus containing multiple well-defined T2 hypointense and T2 heterogeneous masses compatible with multiple leiomyomata. The uterus measures 12.2 x 9.4 cm in the sagittal plane.A right anterior fundal subserosal fibroid measures 9.6 x 5.7 cm. An anterior intramural body fibroid measures 7.9 x 6.1 cm. A dorsal intramural body fibroid measures 3.7 x 3.3 cm. Note is made of an anterior body/fundal submucosal fibroid measuring 1.6 x 1.5 cm.All the fibroids aside from the posterior/dorsal 3.7 cm fibroid demonstrate postcontrast enhancement.The endometrium/endometrial cavity is distorted by the fibroids but is normal in thickness and is homogeneously T2 weighted hyperintense in signal intensity, normal. The inner myometrium/junctional zone is well-defined and is normal in thickness.The left ovary is normal in size but contains a T2 mildly hyperintense 2.2 x 1.7 cm lesion which demonstrates peripheral thick rim enhancement and crenulated margins. The right adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple large fibroids most of which demonstrate contrast enhancement as described above.2.2.2 cm left adnexal lesion is likely a corpus luteal cyst, however 4-6 week pelvic ultrasound is recommended to confirm resolution. |
Generate impression based on medical findings. | Reason: evidence for median neuropathy, likely in forearm, recent liver transplant History: left arm numbness and tingling There is no abnormal soft tissue mass or other deformity affecting the median nerve along its course. The appearance of the carpal tunnel is normal. No soft tissue abnormalities or atrophy is evident. The osseous structures of the forearm appear within normal limits. | No abnormalities are identified to account for the patient's left arm numbness/tingling. |
Generate impression based on medical findings. | 69-year-old female with severe left hip pain. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No acute fracture or dislocation. Bone marrow signal is within normal limits without evidence of edema.SOFT TISSUES: No significant abnormality noted. ADDITIONAL | Unremarkable left hip MRI without specific findings to account for the patient's pain. |